Hospital Dr News


Consultant pay to be frozen from April, says government

By Mike Broad - 10th March 2010 5:16 pm

The pay of NHS consultants is to be frozen for 2010/2011, the Prime Minister has announced.

In a speech in the City, Gordon Brown stressed the importance of senior public sector staff showing leadership on pay restraint. Senior members of the civil service, military, judiciary and health service will all have their pay frozen from April. Brown said £3bn would be saved.

Later, health secretary Andy Burnham announced that trainees and SAS doctors’ pay will rise by 1%. He rejected a 1.5% recommendation for foundation house officers.

He said the government would take on board a recommendation that low-paid doctors receive “a special pay supplement”.

Burnham said: “These pay uplifts are a good deal for the government and the NHS. In tough times, this package targets the pay rises we can afford to make where they can do most good for patients.”

These figures contrast with MPs, who voted themselves a 1.5% increase for 2010/2011.

Dr Hamish Meldrum, chairman of BMA council, expressed his disappointment that the government overruled some of the recommendations of the independent pay review body.

He said: “Many doctors have already undergone pay freezes or sub-inflation pay rises in recent years and today’s announcement will mean a pay freeze for the most highly experienced senior doctors.

“We are particularly disappointed that the Government, in choosing to interfere with the pay review body’s recommendations, has not fully taken into account the financial pressures on junior doctors in their first years of postgraduate training - who have average debts of £22,000.

“It is interesting that the government accepted in full the salary increases recommended for MPs, yet chose to penalise dedicated and hard-working doctors who strive to lead and deliver improvements in care whilst working in exceptionally challenging circumstances.”

The pay review group said the government had argued strongly for senior staff to show leadership over pay.

It added: “We are not persuaded by this signalling argument since we have seen no evidence, in this or previous years, that the level of settlements for our small remit groups has any impact on behaviour in the wider economy. Indeed, it is hard to see how freezing pay for senior staff demonstrates leadership when more junior staff are receiving significant increases.”

Nurses are due a 2.5% pay rise in April in the last tranche of a three-year pay deal. In primary care, salaried GPs will receive a 1% uplift, while GPs in practices will also suffer a pay freeze. 

Join the debate. 

Read a blog on inflation.

See last year’s pay scales (they’re not going to change by much).

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Roll-out of e-records “should be suspended”

By Mike Broad - 11:14 am

The BMA has written to the government calling for a suspension of the programme to upload summaries of patients’ medical records in England to a national database.

In December, the Department of Health announced that the roll-out of the summary care record (SCR) would be accelerated, and doctors have raised concerns that the process is being carried out too quickly.

The SCR is a centrally stored electronic patient health summary to support emergency and unscheduled care. It consists of an initial upload of a patient’s medication and allergies from the GP record.

Anyone who does not want to have a SCR has to opt out by informing their GP or by completing a form either downloaded from the internet or requested from a national call centre. The BMA believes patients are receiving insufficient information about the choices they can make.

GPs have reported that the rushed implementation of the programme means they do not have time to support patients in making an informed choice, and that in some cases records are being created without even implied consent from patients.

The letter, to health minister Mike O’Brien, expresses concern that the roll-out of the SCR has been accelerated before sufficient independent evaluation of pilots has taken place. It calls for the Department of Health in England to urgently consider halting implementation in areas which have not yet launched public information programmes (PIP). In addition, the BMA wants future information packs sent to the public to contain an opt-out form.

The letter says: ‘The UCL independent evaluation found that the PIP had failed to inform patients of their choices, with seven out of ten patients in early adopter areas unaware of the SCR. The BMA’s acceptance of the consent-to-view model was subject to a review of the PIP.

‘We recognise that the PIP is now conducted on a regional, rather than PCT, basis but there has been no evaluation or evidence presented to the BMA that this has significantly improved awareness and that consent is therefore valid. We are also concerned that an opt-out form is not included with the patient information material and patients have to log onto a website to download a form, request a form from a call centre or inform their GP practice.’

The BMA has also issued guidance to doctors advising them that they have a crucial role to play in advising patients about their rights, and recommending that opt-out forms be made available in GP practices.

Dr Hamish Meldrum, chairman of council at the BMA, said: “The break-neck speed with which this programme is being implemented is of huge concern. Patients’ right to opt out is crucial, and it is extremely alarming that records are apparently being created without them being aware of it. If the process continues to be rushed, not only will the rights of patients be damaged, but the limited confidence of the public and the medical profession in NHS IT will be further eroded.”

A Department of Health spokesperson re-iterated that no-one has an SCR created without receiving an individual letter sent to them at the address held by their GP, at least 12 weeks beforehand.

She said: “The SCR is an important patient safety initiative widely supported by clinicians, in particular those working in out of hours and emergency settings, and by the patients they treat.

“We are surprised to have a five year timeframe criticised as a ‘break-neck pace’ when the programme had been previously criticised for its slow uptake. We absolutely support the right of any patient to opt out of having a summary care record and have provided various options to make this process straightforward.”

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More patients to be prosecuted for staff attacks

By Mike Broad - 11:07 am

Patients or family members who attack doctors will be more likely to be prosecuted in future.

Guidance issued by the Crown Prosecution Service has been broadened to include violence against “a health or social welfare professional” as a trigger for prosecution.

The code gives guidance to prosecutors on the principles to be applied when making decisions about prosecutions. Previously it gave limited specific examples of victims of offences who “served the public”, citing only nurses, police and prison officers.

Richard Hampton, head of NHS Security Management Service, said: “This effectively signals to prosecutors across England and Wales that an offence against anybody providing NHS services, including ambulance workers, is to be viewed with particular concern.

“This will in time lead to more prosecutions of offences against NHS staff and, in turn, more convictions.”

Read more about the full code.

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Safeguarding regulations damaging healthcare

By Mike Broad - 8th March 2010 12:32 pm

Operating lists and outpatient clinics for children are continuing to be cancelled across the country due to the chaotic introduction of new safeguarding regulations.

New regulations mean that consultants need to undergo a Criminal Records Bureau (CRB) check every time they work at a new hospital and are not allowed to start work until the process is completed and hard copy received by post by the employing trust.

The overzealous interpretation of the requirements by trusts, and long delays in the system, mean that NHS surgeons cannot move between many hospitals quickly enough to deal with rare cases or cover absences.

The Royal College of Surgeons (RCS) is calling for immediate roll out of passport-style arrangements that allow NHS staff who have already received an enhanced CRB check for one trust to be recognised across the health service.

The vetting and barring scheme (VBS), implemented in October 2009, sets new high standards for checking all those working with children. However, the system to deal with this additional demand does not come into full force for four years. Trusts are being overly cautious and demanding that NHS surgeons who have already received enhanced CRB checks go through the time-consuming process each and every time.

The RCS says the Department of Health is yet to offer a quick solution. As a result, highly specialised surgeons are restricted to working at one site with no flexibility to move at short notice to cover and assist colleagues with rare or emergency operations. And children must either wait or travel for treatment. 

The college says the VBS has created a range of problems, including trusts being unable to fill locum positions or having to wait up to three months for surgeons to begin work, and trainee surgeons being unable to work or receive training, particularly across central London hospitals. 

Mr John Black, president of the RCS, said: “The college has flagged up this situation with government on three separate occasions in a three month period, and we were reassured that a solution would be reached within a week.  That surgeons are still faced with this situation is simply unbelievable.”

Some trainee surgeons have had more than ten separate CRB checks in just two years.

Ms Su-Anna Boddy, Consultant Paediatric Urologist, said: “We are meant to be training expert paediatric surgeons of the future, yet training opportunities are being wasted due to the unnecessary bureaucracy of re-checking doctors who have already passed rigorous CRB checks. 

“It is imperative that we are able to utilise the best training opportunities, in the right hospitals, at the right time, and it is totally inappropriate that children be transferred to another hospital so that trainees can learn.”

A DoH spokesperson responded: “The current advice from NHS Employers is clear that a person can start work before a CRB check has been received where there is an urgent need to employ someone quickly and an appropriate risk based assessment has been carried out.

“We are committed to working with the Royal College of Surgeons, the Care Quality Commission and other interested parties in drawing up revised guidance and bringing it to the attention of NHS HR directors.”

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Justification for polyclinics shot down by figures

By Mike Broad - 5th March 2010 4:02 pm

Lord Darzi’s plans to reconfigure A&E services, shifting huge numbers of patients to polyclinics and urgent care centres across the country are based upon inaccurate estimates of patient usage, a report reveals.

Many trusts are exploring how they can deal with more patients into primary care inorder to avoid financial crisis.

In London, one of the key assertions of the strategic planning guidance issued to PCTs in the capital last year is for “60% of A&E activity to shift to polysystems”. Up to 12 A&E departments across the capital face possible downgrading to urgent care centres, with more patients being directed towards polyclinics.

However, a Department of Health-commissioned report released today shows that no more than 30% of patients attending A&E departments could be classified as needing only primary care. It may be a little as 10%.

These proportions are much lower than the levels assumed by managers and health chiefs. It followed Lord Darzi’s suggestion, in 2007, that 50% of less serious A&E cases could be dealt with by polyclinics.

The report, by the Primary Care Foundation, investigates the use of GPs and primary care professionals in A&E. It finds that the increasing number of GPs and primary care nurses working in A&E can improve the quality of patient care. However, it found little evidence for claims that this approach drives down costs or avoids inappropriate hospital admissions.

Dr David Carson, joint director of the Primary Care Foundation, said: “Patients know who their GP is and where the nearest emergency department is. So, it’s vital to get the service right.”

Dr John Lister, information director of campaign group London Health Emergency, said: “This new report shoots plans for A&E closures and hospital rationalisation in London, and in many other cities, out of the trees.

“It is clear that diverting the least serious A&E cases away from hospital A&E departments would affect less than half the number of cases that managers had assumed - and that little or no money would be saved.

“This document means that every plan to scale back A&E services to “Urgent Care Centres” or polyclinic level needs to be torn up and revised. NHS London needs to go back to the drawing board.”

Read the full report.

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“Funds to stimulate competition being wasted”

By Mike Broad - 4th March 2010 6:22 pm

NHS reforms are failing to deliver widespread benefits, research reveals.

A study by think tank Civitas suggests that efforts to establish market forces within the NHS have been compromised by continuing centralised control.

On the plus side, reforms have led to improved access for patients, reduced waiting times and improved financial management. But, it claims the benefits are not widespread with weak commissioning, low levels of innovation, and poor professional and organisational collaboration.

Report author Laura Brereton said: “While there have been improvements, they are not clearly attributable to market based reforms. The NHS appears to be in the unfortunate position of taking on the extra costs of competition without realising the benefits.”

The report says patient choice has contributed to reducing waiting times but the uptake of choice is not widespread. The Choose and Book system on which it relies is restrictive, it says, and the quality of information on providers available to patients is weak.

It claims that the threat of competition has driven efficiency in some places. Quality of care, including patient satisfaction, is often seen to be better in new entrants such as privately run ISTCs. But competition has led to confusion over the relationship between commissioners and providers and made collaboration more difficult.

Foundation trusts have performed well financially and on routine quality measures, it says. But they were the best performing hospitals before their change in status and there is little evidence to suggest they’re more innovative.

Payment by results coincided with an increase in activity and efficiency, improved financial management and a decrease in unit costs. But the report says the setting of the tariff at the ‘average cost’ encourages providers to be average. Hospitals are also incentivised to induce demand inappropriately.

Problems are also highlighted with commissioning, particularly among PCTs which are accused of lacking the necessary skills to drive performance and purchase effectively.

James Gubb, director of the health unit at Civitas, said: “While the NHS is better than it was in 2002, wavering commitment to the idea of a market has unquestionably stymied the impact it could have had.”  

Read the full report.

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Doctors risk prosecution over assisted suicide

By Mike Broad - 3rd March 2010 2:13 pm

Doctors face a greater risk of prosecution for assisting a patient’s suicide following new guidance, defence body MPS has warned.

The director of public prosecutions, Keir Starmer QC, has created six mitigating factors against an individual being prosecuted for assisting the suicide of another.

However, the MPS warned doctors to be extremely cautious when providing help or advice to patients who are considering assisted suicide.

The guidance, called Policy for prosecutors in respect of cases of encouraging or assisting suicide, includes a specific reference to the suspect acting as a doctor, nurse or other health professional as a factor in favour of prosecution.

In the interim policy, a suspect providing assistance to a victim in the course of their usual job was a factor against prosecution. This has been deleted from the final copy, which is now effective.

Dr Nick Clements, head of medical services (Leeds) at MPS, welcomed the clarification into the factors that will be taken into consideration when deciding whether to prosecute cases.

But he added: “We believe that the final policy on assisted suicide places doctors in a much more risky position than before. While we recognise that the law on assisted suicide has not changed, the factors for and against prosecution send a clear signal that the actions of health professionals will be carefully scrutinised and may well set a lower threshold for bringing prosecution against them.”

The MPS is concerned that doctors could face prosecution who were involved quite indirectly in an assisted suicide.

He said: “For instance, we have been contacted by doctors whose patients have requested medical or fitness to travel reports so that they can gain access to clinics such as Dignitas.

“The patient may not have initially made it clear to their doctor why they wish to have these reports but the doctor may harbour a suspicion. A doctor who helps a patient with these requests may leave themselves open to a criminal investigation and prosecution.”

Doctors are being advised by defence bodies to not to comply with requests for medical or travel reports if they suspect the patient may be planning an assisted suicide. The MPS is calling for greater clarity around the position of doctors. 

Read the full document.

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New rules to prevent health tourism in UK

By Mike Broad - 2nd March 2010 2:08 pm

New proposals to prevent health tourism have been launched by the Department of Health.

A key measure to restrict the access of foreign nationals to free NHS care is the requirement for all visitors to the UK to have health insurance.

People who have outstanding debts for previous NHS treatment could even be prevented from entering the country.

Health minister Mike O’Brien said: “While the NHS has a duty to any person whose life or long-term health is at immediate risk, we cannot afford to be an international health service, providing free treatment for all.

“Striking a balance between public health, migration and humanitarian principles is challenging. We are, however, determined to address these challenges and deliver high quality care to all those with a legal right to it, while protecting the NHS from those who would abuse it.”

Failed asylum seekers, who are not cooperating with the UK Border Agency, will not be entitled to free healthcare. However, those who do will remain entitled to free care prior to returning to their own country.

The DoH consultation also contains a proposal to relax the rules for UK residents who travel abroad for extended periods. UK residents are currently allowed to stay overseas for three months before they risk losing their automatic entitlement to NHS care - this would be extended to six months.

The consultation runs until 30 June.

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More support for victims of discrimination

By Francesca Robinson - 9:35 am

A new scheme designed to fill a gap in the professional services available to ethnic minority doctors facing complaints of bullying harassment and discrimination has been launched this week.

Medical Defence Shield, the brainchild of the British Association of Physicians of Indian Origin (BAPIO) will uniquely provide both medical defence protection and support for employment issues under one umbrella.

Doctors will be able to pick and mix from a package of services traditionally offered separately by trade unions and medical defence organisations.

BAPIO says they receive calls every week from doctors who say they do not get the support they need when facing unsubstantiated allegations or flawed practices during a disciplinary process.

Examples of unfair treatment include cases where severe punishment has been meted out to doctors when all that was required was a programme of training or mentoring and support.

Other evidence is the disproportionately higher numbers of ethnic minority doctors reported to the GMC over their fitness to practise. Many of them have also faced trust disciplinary procedures for fairly minor issues.

Dr Satheesh Mathew, vice chair of BAPIO, said: “It is not an exaggeration to say that the traditional institutions have been known to drag their feet when it comes to supporting international medical graduates.”

MDS is being launched in two stages. The first stage, now live, offers a competitively priced package of services providing advice and representation on: terms and conditions of service; clinical and professional issues; for criminal cases arising from professional work; on training issues; in disputes arising from non NHS work and legal representation during internal inquiries, GMC and tribunal cases. 

Packages range in price from £250 to £560 for a consultant and from £200 to £273 for a specialist trainee.

The second stage, to be launched in June, will offer full professional indemnity cover and financial compensation for patient incidents not covered by standard NHS indemnity. Geared at consultants in private practice, this service is likely to be one third cheaper than existing medical defence cover.

Claims will be dealt with by doctors with a legal background. The scheme is backed by the legal firm Linder Myers and two insurance companies, Lockton International and Amicus Legal.

BAPIO president Dr Ramesh Mehta, said: “To date the medical protection market has been monopolised by just a few institutions which have been around for over 100 years. There is a lot of bureaucracy in these organisations and they have not changed with the times.

“Medical Defence Shield is an innovative and daring concept to ensure that doctors working in the NHS receive fair and just treatment. It will be available to all doctors not just those from ethnic minorities because we have realised that all doctors need this extra support. 

“Feedback from our members shows that the existing support system lacks empathy and understanding when it comes to issues of discrimination and unfair practices.”

Read further details. 

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Patients unaware of summary care records

By Mike Broad - 1st March 2010 9:28 am

Patients don’t have enough information about electronic patient records and their roll out should be slowed down, the BMA has warned.

Following some local piloting, patients’ summary care records are set to be uploaded to a central database across England.

The summary care record (SCR) is a centrally stored electronic patient health summary to support emergency and unscheduled care. It consists of an initial upload of a patient’s medication and allergies from the GP record.

Anyone who does not want to have a SCR has to opt out by informing their GP or by completing a form either downloaded from the internet or requested from a national call centre.

Dr Grant Ingrams, chair of the GP IT Committee, said: “The care record roll-out is now happening too hastily. While we believe it has the potential to improve both the quality and safety of patient care, we are concerned at the speed because it means patients are very unlikely to be aware of what they are automatically being enrolled into.

“We don’t believe the national roll-out needs to be or should be done in a hurry. We would like to see it rolled out carefully area by area in a properly supported and evaluated fashion.”

The NHS in England has adopted a ‘consent to view’ model which means that a patient will automatically have a SCR created unless they choose to opt out. However, they should be asked explicitly, on each occasion, before their summary record is viewed, for example during out of hours care or when they go to A&E.

Five strategic health authorities recently announced they were speeding up their plans.

John May, from the BMA’s patient liaison group, said: “An independent evaluation of the regional pilots found that seven in ten patients in those areas weren’t aware of the SCR, which meant they also weren’t aware that their details would go on to a national database. There needs to be a higher profile national information campaign to ensure everyone can make an informed choice about whether or not they want to be included.

“We also think it is important that opting-out is made easier.”

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