Posts Tagged ‘BMA’

Stop feeling powerless - become a union rep

By Eleanor Draeger, deputy chair of the BMA's Junior Doctor Committee - 7th February 2012 12:41 pm

There is more to being a doctor than medicine. The really big things that affect patient care are often political. Issues like the Health and Social Care Bill and the quest to find £20 billion in efficiency savings will have a huge impact on the service patients will receive in the next few years.

There are also issues affecting our income, such as reform of the NHS pension scheme and the interminable pay freeze, both of which will have a bigger impact on junior doctors as we will still be working in the NHS when today’s consultants and GPs are long retired.

It is easy to feel powerless, especially when you are too busy to think beyond the next shift or set of exams, but it is possible for junior doctors to get their voices heard - by getting involved with the BMA. If you are the sort of person who finds yourself shouting at Andrew Lansley on Newsnight from the comfort of your armchair or explaining to your friend exactly why the Daily Mail article about young doctors being rubbish is a pile of tosh then perhaps you should consider getting more involved in medical politics.

Getting involved is easier than you think. The BMA’s junior doctor committee operates a visitor scheme that allows you to get a taste of the cut and thrust of medical politics without making a commitment to attend further meetings. It will show you how decisions are made and how the views of ordinary junior doctors can be used to solve problems ranging from banding appeals through to the government’s reforms of education and training.

If after attending your first junior doctors committee meeting you feel you have something to contribute then the next step would be to get involved with your regional junior doctors committee and stand for election to the JDC.

If you harbour serious ambitions to become a medico-political leader then you may want to consider standing for election to BMA Council. This is the main decision making body of the BMA and offers an opportunity to influence the direction of the whole association. Details of the elections can be found on the BMA website - you will have to be quick though as nominations have to be in by Friday 10 February.

The BMA often polarises opinion amongst junior doctors, but whatever your opinion, the only way to ensure your voice is heard is to get involved. So, if you are angry about the Health and Social Care Bill, apoplectic about the changes to the NHS pension scheme or frustrated at the way junior doctors are being treated in your own hospital - why not get involved with the BMA and make a difference.

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Allow consultants to work for good of wider NHS

By Mike Broad - 6th February 2012 11:53 am

The royal colleges have welcomed the GMC’s and the government’s joint letter to all NHS employers urging them to allow doctors to participate in statutory and professional agencies.

The letter, from the chief medical officers of England and the devolved countries, the NHS medical director and chairman of the GMC, urges trust boards to “look favourably” on requests for absence to undertake national work.

It cites NICE, the Committee on Human Medicines, the GMC and the royal colleges as examples of organisations that rely on the involvement of senior members of the profession for their expertise and experience.

The letter says: “The part time work they undertake alongside their clinical duties contributes a great deal to the quality of patient care, medical education and the effective running of the health service.”

Such organisations have become increasingly concerned over their operational viability with NHS trusts trying to maximise the clinical productivity of their consultants locally.

The letter continues: “We understand that in the current climate there is considerable pressure on local resources and that you will need to take account of that and ensure that contractual commitments are applied appropriately.

“However, we hope you will regard such activity by your senior clinical staff as an investment in the system and a reflection of the high standards in your organisation. The experience gained by the individual will also often be of direct benefit to the unit in which they work.”

The Royal College of Surgeons welcomed the letter. It said it relied on members giving up their time voluntarily to help ensure the quality of training and spread high standards within the profession.

It said these activities included leading practical examinations of juniors, sharing their knowledge on courses, and establishing best practice standards or assessing the value of new techniques across different forms of surgery.

Professor Norman Williams, president of the Royal College of Surgeons, said: “This letter is an important reminder of the ethos and benefits of the NHS and the role independent charities like the Royal College of Surgeons bring to helping the whole system maintain and improve our world class health system.

“Those trusts that are currently making it increasingly difficult for surgeons to participate and share their expertise at a national level should take heed.”

The BMA has also been lobbying for such work to be better recognised. Employers refusing to allow staff to work in the wider NHS were limiting the expertise available and increasing the burden on a smaller number of employers, a spokesman said.

Read the full letter.

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BMA urges peers to oppose Health Bill in Lords

By Mike Broad - 7th October 2011 11:49 am

The BMA has written a letter to all peers in the House of Lords calling for them to support the withdrawal of the Health and Social Care Bill, which will have its second reading in the house next week.

In the letter, chairman of BMA council, Dr Hamish Meldrum, says that the Bill will ‘make it harder to create the seamless, efficient care that everyone agrees is key to future sustainability’.

The BMA recognises that some significant amendments have already been made to the Bill in the light of some of its concerns, and that some of the proposals, such as giving more control to clinicians and patients, could create positive change in the health service.

However, Meldrum says ‘on balance, the BMA still believes the Bill, as it currently stands, poses an unacceptably high risk to the NHS in England’.

He also outlines concerns about the continuing lack of clarity over how the plans would be implemented, described as the ‘most radical restructuring of the NHS in a generation,’ particularly in light of the rapid rollout taking place before the legislation has been enacted.

The BMA believes the most pressing overarching concerns the Lords need to address are:

· The need for an explicit provision that the secretary of state will retain ultimate responsibility for the provision of comprehensive health services;

· Assurance that increasing patients’ choice of provider for specific elements of their care will not be given priority over the development of integrated services and fair access for all; and

· Greater scrutiny of the plans for how to tackle ‘failing’ hospitals.

In the Commons, MPs backed the Bill by 316 votes to 251 - with the majority of 65 seeing it progress to the Lords.

The BMA’s other concerns include the threat to the future capability of public health in the NHS; the unnecessary and unhelpful bureaucracy developing around clinical commissioning groups and the NHS Commissioning Board; and the proposal to abolish the cap on income foundation trusts can generate from private patients, which could worsen access to services for NHS patients.

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Union chief wins vote of support on Health Bill

By Mike Broad - 21st September 2011 2:46 pm

BMA council today agreed its next steps in the campaign to get the Health and Social Care Bill amended ahead of its second reading in the House of Lords.

A programme of lobbying, local events and further campaigning activity is planned to highlight doctors’ major concerns about the Bill and to support doctors in improving care in the best interests of patients and the public.

Council also expressed its full support for its chairman, Dr Hamish Meldrum, and fully endorsed his handling of BMA policy on the Health and Social Care Bill as agreed at the BMA’s 2011 annual representative meeting and subsequent council meeting.

Meldrum faced a revolt from grassroots members after a meeting of the union’s largest regional branch - BMA London - passed an overwhelming ‘vote of no confidence’ in his handling of the opposition to the Health Bill.

MPs backed the latest draft of the NHS reforms by 316 votes to 251 in the Commons - the government majority of 65 saw it progress to the Lords.

Dr Hamish Meldrum, chairman of BMA council said: “The clear view of BMA council is that the Health and Social Care Bill remains deeply flawed and should be withdrawn or at the very least significantly amended.

“The BMA will continue to publicly and vigorously highlight the concerns of doctors and patients, particularly to peers who have a real opportunity to protect the NHS by addressing the damage that could be done by many aspects of these reforms.”

BMA criticisms of the Bill include the removal of the cap on how much income foundation trusts can generate from private patients, which it says could lead to reduced access for NHS patients.

It also wants the Bill to reflect an intention that any increase in patients’ choice of providers should not be given a higher priority than tackling health inequalities and promoting integrated care.

The BMA is also seeking greater assurance that the health secretary will have ultimate responsibility for the provision of a comprehensive health service whilst also allowing other bodies, like the new NHS Board and clinical commissioning groups, day-to-day operational independence.

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BMA chief rocked by Health Bill ‘no confidence’ vote

Pulse - 19th September 2011 3:53 pm

BMA chair Dr Hamish Meldrum is facing an unprecedented revolt from grassroots members, after a meeting of the BMA’s largest regional branch passed an overwhelming ‘vote of no confidence’ in his handling of opposition to the Health Bill.

A motion proposing ‘a vote of censure’ in the BMA chair for his failure to promote members’ views and campaign for the withdrawal of the Bill was backed by 100 of the 110 doctors attending BMA London’s AGM.

GPs attending the meeting said that the move to formally censure Meldrum represented ‘a vote of no confidence’ in his leadership in opposing the reforms.

Read more at Pulse.

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Troubling times call for good representation

By Tom Goodfellow - 25th July 2011 10:24 am

Earlier this year I was approached by a consultant in my trust who was obviously quite concerned. He had refused to sign off a medical student who, for a number of reasons, he felt was performing significantly below standard.

The individual responded with a bullying and harassment charge against him. Now we would both be the first to admit that he is not exactly a shy retiring violet, more a ‘first fifteen’ type as it were. But I know him to be a dedicated hard working consultant, passionate about teaching and deeply committed to his patients, the students and the juniors working with him. Fortunately he had taken my advice a year or so ago and joined a union, the HCSA as it happens, and received excellent professional advice and support resulting in him being fully vindicated. However it was a difficult and stressful time for him.

On a similar vein I have been told of two SHOs a year or so ago who were so poor they were regarded as actually dangerous by the consultants they worked with. However their (mild mannered) educational supervisors refused to write anything to this effect in their e-portfolios for fear of the same hostile reaction. I am not in a position to know personally whether or not this is a common scenario but the name Harold Shipman comes to mind!

Another colleague had an identical experience with a junior several years ago. The doctor was regarded as failing, and he was asked to mentor and supervise her for a period. Despite his best attempts he did not feel able to sign her off, and was also subsequently subject to a grievance claim.

Over the last 12 months or so I have been involved with several other colleagues who suddenly found themselves completely unexpectedly in the firing line. All were sensible hard working consultants and not part of the ‘usual suspects’ brigade if you get my meaning. One, a quiet modest man, became involved in a discussion with a junior manager which became rather heated. This was completely out of character (and in my opinion he had been significantly provoked) and he returned the next day to apologise. Despite this the manager initiated a formal grievance against him. Again this proved to be a very stressful process for him.

In another case the trust received a letter from the CEO of an external NHS body making a number of very serious allegations against a senior consultant. If these had been true (which they were not) he would likely have ended up before the GMC. He was an HCSA member and was represented at the hearing by one of the officers. The trust found (I suspect with some relief) that there was no case to answer.

Another consultant was subjected to a disciplinary process because management claimed he had failed to respond to requests from managers to come in to the trust and ‘act down’, that is do a junior doctor’s work in addition to his responsibilities as the on call consultant. Again the issue was resolved, but not without a lot of stress for all concerned. Others fell foul of the job planning process and ended up in serious disagreement with their clinical directors. Fortunately all these were HCSA members and were able to get professional help and advice.

I quote the HCSA because they are the cases with which I have been personally involved. However I am sure that the BMA IROs have similar problems to deal with and that the issues are similar in trusts throughout the country.

Please do not misunderstand me: this is not an anti-management tirade (a favourite blood sport in the NHS). The behaviour of some doctors (fortunately relatively few) is quite atrocious and responsible employers have a duty to protect staff from harassment and other forms of bad behaviour, and to ensure that doctors fulfil their contractual duties to an acceptable standard.

My point is that even for the very best of us the brown stuff may suddenly hit the fan quite out of the blue. If you are not a member of a professional organisation then this is a very lonely place to be. On a weekly basis the HCSA office receives calls from highly distressed consultants who are not members of any union but who are in conflict with their employers for a variety of reasons. They wonder if they can join and get professional support. Although the officers will frequently give them informal telephone advice, they cannot legally take on a case in such circumstances. It is rather like trying to take out insurance after you have crashed the car!

All doctors need to be a member of a professional body. We are heading for very uncertain times in the NHS and many may well need the advice of experts as trusts slash and burn, trying to achieve Lansley’s £20bn savings over the next few years.

Don’t delay, join today. It is well worth the money.

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Public campaign for withdrawal of Health Bill

By Mike Broad - 21st July 2011 1:59 pm

BMA council, the union’s executive committee, has voted to “start a public campaign to call for the withdrawal of the Health and Social Care Bill”.

The council met this week and decided to continue calling for the Bill to be withdrawn, while still critically engaging with the government to achieve necessary improvements.

This follows the BMA’s annual representatives meeting where despite the chairman of council recommended that delegates accept the government’s changes, only for there to be a strong vote for continued opposition.

Council members and co-chairs of the NHS Consultants Association (and Hospital Dr bloggers) Dr Clive Peedell and Dr Jacky Davis proposed that as part of its next steps on lobbying the BMA should publicly campaign for the withdrawal of the Bill.

This will increase the pressure on ministers over the summer break who had hoped that the bill’s third reading in early September would be an easy ride.

Dr Hamish Meldrum, chairman of BMA council, said: “Whilst the BMA recognises there have been some changes following the listening pause, there is widespread feeling that the proposed legislation is hopelessly complex, and it really would be better if the Bill were withdrawn. We will continue to critically engage with government and with the parliamentary process to try to achieve this, whilst continuing to seek further amendments to the Bill.”

Meanwhile, a survey of 500 doctors by the Royal College of GPs finds that 85% have not been reassured by the government’s revisions. Almost half of GPs ‘disagreed’ or ‘strongly disagreed’ that the revised model of clinical commissioning groups would improve patient care.

The BMA voted to “reject the idea that the government’s proposed changes to the Bill will significantly reduce the risk of further marketisation and privatisation of the NHS” and “agreed that the government is misleading the public by repeatedly stating that there will be ‘no privatisation of the NHS’”.

Read the full list of motions.

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“We won’t accept an unfair assault on pensions”

By Mike Broad - 27th June 2011 2:20 pm

The government has been warned that doctors will not accept “an unwarranted and unfair assault” on their pensions by the chairman of BMA council.

Dr Hamish Meldrum told delegates at the BMA’s annual representatives meeting that the union would “consider every possible, every legitimate action that can be taken to defend doctors’ pensions”.

Chief secretary to the Treasury, Danny Alexander, recently said that many of the recommendations on pension reform made in the Hutton report earlier this year will be adopted. These include plans to link the public sector retirement age to the state pension age, which is rising to 66, and to base pensions on career average earnings rather than final salary.

Meldrum acknowledged the need for a “secure and stable” NHS pension scheme going forward, but suggested that the reforms in 2008 had already delivered this.

He called on the government to talk to the profession over the NHS pension and base their arguments on facts.

He said: “Fact, even before the imposed change from RPI to CPI and the threat of the imposed Treasury Levy, the NHS superannuation scheme was in surplus and by 2015 the scheme will have contributed over £10bn to the Treasury.”

He added that the retirement age for new entrants to the scheme has already been raised to 65; that, since 2008, there are tiered contributions with higher earners contributing 8.5% of their earnings; and, employers’ - or the taxpayer - contribution are now capped.

Meldrum said: “We want to talk and negotiate, because this the way we have successfully done business in the past. It’s also the way that usually achieves the best outcomes. But that will be made impossible if all we hear are public ultimatums and ridiculous threats such as those we heard just a few days ago from the Chief Secretary to the Treasury.”

Speaking about NHS funding, Meldrum said the NHS is in the grip of its greatest financial challenge: “The challenge of ever-increasing demand, finite resources and the most difficult financial situation the NHS - in all four nations - the biggest it has ever faced in its 63 years.

“There is a huge difference between adapt and change and slash and burn, between carefully planned reorganisations and knee-jerk closures and redundancies, between partnership working amongst health professionals, managers and patients and imposed, top-down, politically motivated diktat.”

On the Health and Social Care Bill, Meldrum acknowledged that although improved, “there is still a lot to play for, still much detail to be devilled out, still much else we want to change”.

The BMA will continue its battle against the divisive features of the healthcare market in England, said Dr Meldrum. “Doctors are not afraid of competition - in fact, they thrive on it. They want to know that they are working as well, if not better than their colleagues and they need fair, effective and evidence-based data on health outcomes to provide them with that information.

“But that is quite different from the unfettered, free market of the industrial world, because the NHS must never be like that - you only have to look across the Atlantic to see why, and why we will continue to resist all attempts to make it like that.”

Read the full speech.

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Now is the time to get tough on NHS reform

By Mike Broad - 10:55 am

The following is a letter to the profession from five members of BMA council concerning the progress of the government’s Health and Social Care Bill:

We are writing as a group of concerned members of BMA council. This week the representatives of UK doctors meet in Cardiff for the annual BMA meeting. The meeting occurs at a time when the NHS is at a crossroads. The 60-page government response to the Future Forum does nothing to reassure us about the Health and Social Care Bill and its underlying aim to impose a fully-fledged market on the NHS, which will result in increasing fragmentation and privatisation of the English NHS.

It has become very clear that on close inspection of the government’s response to the NHS Future Forum report, the key changes that the BMA and other organisations like the RCGP have asked for have not been met:

1. That the Secretary of State should retain responsibility for ensuring provision of a comprehensive health service.

A technical briefing note on the government response by the public interest lawyer Peter Roderick and Dr Evan Harris concluded that “ it appears that the new Bill will continue to propose abolition of the Secretary of State’s duty to provide health services in accordance with the Act, and of his or her duty to provide the key listed NHS services, and will not propose to give this duty to any other body”.

2. That Monitor’s primary role to promote competition should be removed.

Although the regulator, Monitor, will no longer “promote” competition “as an end in itself”, the government says that it “will maintain the existing competition rules for the NHS” and give it a “clearer statutory underpinning”. It will do this by making the Department of Health’s Co-operation and Competition Panel (CCP) a statutory body within Monitor “retaining its distinct identity”.

In addition, “the NHS Commissioning Board in consultation with Monitor will set out guidance on how choice and competition should be applied to particular services, guided by the mandate set by Ministers”. The NHSCB will also set clear expectations about offering patients choice through a “choice mandate”. Dr Evan Harris has stated that “this is simply reintroducing the marketisation of the NHS - rejected by conference - by the back door of the NHSCB.”

To make matters worse there remains lack of clarity on EU competition law, which could irreversibly open up the NHS to overseas providers competing for NHS contracts paid for by UK taxpayers.

3. Reducing the role of “Any willing/Qualified provider”

According to the government response, the revised the Bill will outlaw the government now, or in the future, from naming the NHS as preferred provider. This clearly opens up the NHS to an ‘any willing/qualified provider” rather than reducing it. In addition, the staff “right to provide” policy will enable groups of clinical staff to set up their own social enterprises or “mutuals” and sell their services back to the NHS.

These are just a few examples of the ways the government has crossed the “red lines in the sand” of the BMA and RCGP in order to stay on course with its original plans. It does not surprise us that the Lib Dem MP, Andrew George, who sits on the Health Select Committee, said: “If the Government had been listening it would have scrapped the Bill. Instead it looks as if they’ve just massaged and tweaked it a bit.”

Other examples in the government’s response, which confirm its original direction of travel include: (i) the outsourcing of the function of commissioning to private companies, exposing the system to a whole new raft of even less identifiable conflicts of interest; (ii) the extension of personal health budgets; (iii) promotion of the choice agenda (which promotes competition); (iv) no mention of a reversal in the policy of allowing the NHS CB and commissioning groups to introduce additional charges for services they decide are not part of the NHS (Clause 22, para 14s of the bill); (v) retention of all the mutually reinforcing levers of a healthcare market (patient choice, competition between a plurality of providers, payment by results, and freedom for foundation trusts).

Thus, it is clear that the NHS will be subjected to increasing market competition and private provision and commissioning of services, which will undermine the founding principles of the NHS and drive it towards a mixed system of funding. In addition, the work of Lucy Reynolds from the London School of Hygiene and Tropical Medicine published in the BMJ last week also described how the bill could allow private companies to strip NHS assets “leading to more a expensive system that will deliver worse quality of care”. We therefore totally reject the repeated claims of the Coalition leaders that their reforms will deliver greater NHS efficiency and that there will be “no NHS privatisation”.

If all of this is not bad enough then even the supporters of clinically led commissioning must be highly concerned with a return of central control in the NHS via a strengthened NHS Commissioning Board and clinical senates. Thus, even the potentially “good part” of Dr Meldrum’s “curate’s egg” has now gone rotten.

In conclusion, the simple fact is that the government’s proposed changes to the bill are mainly cosmetic in nature. There are no ’significant’ policy changes that will alter the general direction of travel of the reforms and we believe the proposals will actually create even more problems for the NHS by increasing the tiers of bureaucracy. It is at this point that we would remind Mr Clegg that “no bill is better than a bad bill”. He would also do well to listen to views of his fellow liberal Democrat colleague, Dr Evan Harris, who dismissed the choice and competition section of the NHS Future Forum report as “cliché-ridden, trite nonsense” at the Social Liberal Forum last weekend.

It is incumbent on us as doctors to ensure our patients will always have access to a health service that does not differ across the country, a health service that is there when you need it and does not require an insurance policy or self funding if you need some extra care that your personal budget won’t fund. The NHS is facing the biggest threat in its history and as its founder, Anuerin Bevan famously said: “It will last as long as there are folk left with the faith to fight for it.”

We therefore urge members of the medical profession to take up the fight for the NHS by continuing to oppose this damaging bill and call for its withdrawal. We urge them to lobby their MPs, members of the House of Lords, and BMA representatives by highlighting what this bill means for the NHS, the profession and our patients.

Yours faithfully,

Dr David Wrigley, GP, Carnforth, Lancashire

Dr Clive Peedell, consultant clinical oncologist, James Cook University Hospital, Middlesbrough

Dr Jacky Davis, consultant radiologist, Whittington Hospital

Professor Ian Banks, president of European Mens health Forum and Professor of Men’s Health, Leeds Metropolitan University

Mrs Anna Athow, consultant surgeon, North Middlesex Hospital

All members of BMA council

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“Ministers can’t claim profession’s support”

By Mike Broad - 21st March 2011 8:55 am

The BMA will continue in its approach of ‘critical engagement’ with the government following a special meeting of its representative body.

The union’s leadership said it would step up opposition to the most damaging parts of the Health and Social Care Bill. They identified the role that competition, and in particular the economic regulator Monitor, will play in planning and running health care as a key concern.

The special representatives meeting was called because grass root members feared the BMA leadership was taking a ‘softly, softly’ approach to the reforms. However, motions calling for total opposition to the Bill and a vote of no confidence in the health secretary were narrowly defeated.

Dr Clive Peedell, consultant oncologist and BMA council member, and a vocal advocate for stronger opposition by the BMA, said momentum is building against the reforms and the BMA’s annual representatives meeting in June would be an opportunity to see how far Andrew Lansley will compromise.

He said: “Although we didn’t win the total opposition motion nor the vote of no confidence in Lansley, the BMA still voted to call for Lansley to withdraw the Bill. This was a major blow to the government and has already had major political repercussions.”

Dr Hamish Meldrum, chairman of BMA council, said the BMA would demand major changes to the Bill and robustly pursue amendments following intense debate at the meeting.

He said: “Doctors attending the meeting reaffirmed the widespread concern about the plans and because of this called on the secretary of state to withdraw the Bill.

“Ministers can no longer continue to cite the often reluctant and pragmatic decision by GPs to get involved in commissioning groups as endorsement of their NHS reforms. Following the meeting the government should not be left in any doubt about the strength of feeling among the medical profession; many doctors recognise the need to change how the NHS is run but have serious concerns about scale and nature of the planned reforms which are hugely risky and, potentially, highly damaging.”

The Bill will scrap PCTs and SHAs, devolve commissioning to GP consortia and increase competition in heathcare delivery.

Peedell added: “The Bill is a blueprint for a market based healthcare system and, since competition is the lifeblood of any market system, I cannot see Lansley compromising on this. He has previously stated that competition is the main objective for his plans. This is why he needs Monitor and the NHS Commissioning Board to enforce competition. Most doctors and patients want good local care.

“This is an ideological clash that cannot be resolved. There will be more trouble ahead, without doubt.”

The special representatives meeting as it happened.

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