BMA (British Medical Association) Blog

Posts Tagged ‘Juniors’

All trainees should know their contractual rights

By Dr Ayesha Rahim, deputy chair of the BMA’s junior doctors committee - 28th July 2010 9:48 am

When I first qualified in 2003 I found the transition from medical student to junior doctor pretty challenging. Apart from getting used to the increased demands in time and energy of my clinical role, I also had to learn to juggle working full-time with my postgraduate studies and personal life.

I remember being vaguely aware of the fact that I had a contract of employment, but not really being sure of what was contained in it. One thing I do recall clearly however, was the frequent feeling of frustration when there was a mismatch between what I thought my contract said should happen, and what was actually happening in practice.

For example, I didn’t feel particularly confident in standing my ground when it came to what I was entitled to regarding the standard of my accommodation, sick-leave or correcting problems with my payslip. On top of that, I didn’t know where I’d find the time to inform myself of my contractual rights. That’s when I decided to look for guidance on my Terms and Conditions of Service, a complex document that lays out what should and shouldn’t happen regarding my working conditions.

With some assistance I’ve resolved a number of issues over the years, such as an incorrect incremental date on my payslip leading to significant back pay when corrected, and issues with monitoring and re-banding.

As junior doctors in the modern NHS, there are many demands on our time: our day-to-day clinical tasks, our out-of-hours commitments and all the associated activities of training such as appraisal and assessment. There are many provisions within our contract that can help make our working lives a little less stressful and a little more manageable.

Having this information at our fingertips in an easily accessible format can help us all focus on what we really want to do - to practise as doctors, while maintaining a healthy work-life balance. If we are well informed of our rights, we can ensure that we get fair treatment for a fair day’s work.

As it stands, there is still much confusion about many contractual issues, such as monitoring hours of work. It will come as no surprise that this is one of the most common queries we get asked about. Currently, most people “pick it up as they go along” when it comes to information about contractual rights. What I would like to see happen is for us to be equipped with this knowledge before we need it. Every final year medical student should be able to start work with a sound understanding of what their contract says, and every junior doctor should know where to get additional information about what they’re entitled to.

I feel strongly about junior doctors asserting their contractual rights and that is why, as chairman of the BMA junior doctors committee negotiating team, I’ve worked hard to put together the key entitlements of the current contract in a way which I hope is comprehensive, accessible and above all, helpful.

The JDC has put together a summary of the key entitlements of the current contract, which explains your rights in a simple and digestible way. Read more here.

Tags: Juniors, Juniors contract
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Ensuring juniors remain key to NHS success

By Dr Shree Datta, chair of the BMA's junior doctors committee - 10th May 2010 10:39 am

Dr Shree Datta addressed the BMA’s annual junior doctors conference on 8 May:

There is no doubt that this year has been another busy and productive year for the JDC, with our three largest areas of activity focussing on the EWTD, recruitment and specialty training and the junior doctors’ contract.

The EWTD has been a key challenge for UK junior doctors, with full implementation for us in August 2009. The EWTD is important health and safety legislation but despite almost 11 years for preparation, there have been tremendous concerns across the NHS about its poor implementation. We know that the greatest concerns junior doctors have about the EWTD centre around the continuity of care and quality of our training as a direct result of the haphazard approach hospitals have to dealing with the requirements of the law.

In response to these concerns, last year, we published key recommendations exploring mechanisms to maintain the quality of training. These recommendations have been taken forward in a report focussing on the impact of EWTD on training for the Secretary of State.

Next, we conducted a survey which provided a useful insight into the impact of the EWTD six months in. With over 1,500 responses, our survey was one of the most extensive and robust analyses of junior doctor working arrangements so far under the full WTD.

Those in surgical specialties in particular reported in our survey that they were more likely to have to provide emergency cover and cover for long term rota gaps. We have also heard their concerns over the quality of training promised by a 48-hour working week. In response to these concerns, we have set up a short life working party to help address the concerns specific to these trainees, with the deans and GMC and royal college input.

We found that substantial changes have been made to many rotas to make them at least appear EWTD compliant. The emphasis on training has been lost and many rotas have gained a greater anti-social component. Our survey found that four in ten junior doctors are now working on understaffed rotas. Our earlier survey back in 2008 found just three in ten respondents reported rota gaps. Things are getting worse.

In response to these concerns, we organised a conference to address the issues put forward by the EWTD on training, with solutions such as training lists and clinics, dedicated time and resources for trainers and better use of rotas put forward and informing the work of deans, NHS:MEE and others.

Shoddy and thoughtless attempts at compliance and anti-social rotas have caused many frustrations. It is clear that whilst the natural reaction may be to criticise the regulations themselves, the crux of the matter is the implementation. We have taken forward these concerns to the employers. It is essential that they engage with us to ensure not only that their rotas are New Deal and EWTD compliant but that training opportunities are maintained within that time.

One of the key issues for junior doctors relates to the information we are provided during the process of recruitment, be it for foundation or specialty training. The existing arrangements often leave junior doctors without vital information regarding our future employment. For example, where we will work and our rota. In response to our concerns, negotiations are progressing with the health departments on a Code of Practice which recruiters must follow when making appointments.

Turning to the third area of particular focus this year, it’s important to remember that the majority of queries the BMA receives are related to contractual issues which doctors encounter on a daily basis. We have heard calls for a new junior doctors contract. But, as every pundit out there predicts arctic temperatures for public sector spending, it may be some time before any negotiation on a new juniors contract would be of benefit to us.

This makes our current contract even more important, which is why we launched the successful ‘Know your contract, know your rights’ campaign. This highlighted a range of areas within our contract and aimed to make sure that juniors were fully aware of their generally underclaimed contractual rights. We brought out a huge number of resources ranging from template letters to presentations and point by point guidance on key issues such as banding and monitoring, and we want all juniors to get everything that is owed to them under our existing contract.

The election has coincided with a general consensus in the political classes that the years of generous spending on health have come to an end. The NHS is going to have to change the way it works, and that impacts on all of us, directly.

At the same time, we are seeing ongoing problems from the poor workforce planning of past decades, which will haunt us for years to come. Doctors are becoming stranded in specialties where they were tempted in at the bottom by SHO or core training posts, but where those in charge knew there were no higher training posts for them, and even after that, probably not enough consultant posts either.

So, how do you deliver tomorrow’s profession in today’s working environment?

The JDC’s priorities remain, firstly, to foster and maintain sound working conditions for junior doctors. As a trade union the BMA must first and foremost represent the interest of its members and we remain firmly committed to providing the necessary support to junior doctors experiencing problems in the work place.

Secondly, to improve the quality of post-graduate education and training.

The NHS prides itself on its highly trained staff, but the quality of doctors it produces depends on the quality of training provided. Alarmingly, our training is now under threat on many fronts. Funding cuts. Rota staffing gaps. A review of training funding that is lurching out of control. And 48 hour weeks that can feel like 40 hours have been spent on nights.

The Mid Staffs inquiry emphasised the important role of education and training in the hospital workplace and it is clear that the training of junior doctors is not an optional extra. A cavalier attitude towards our training cannot and will not be tolerated. We remain the future of the NHS and it is imperative that our concerns are addressed if we are to provide care of the highest quality to patients in the future.

Finally, the BMA looks to promote flexibility and support for junior doctors by issuing guidance and lobbying the relevant body on issues relevant to junior doctors - for example, the recent changes announced by the GMC to who will qualify for a CCT. That problem led to lobbying at the highest levels within the GMC and the royal colleges in an attempt to find a legal solution that negates the impact on junior doctors. With heavy pushing from the JDC, we are inching towards a solution that does not disadvantage us as juniors.

This year the JDC has strengthened its foundations both regionally, with more support for new regional representatives, and nationally, with better and more regular communication with the devolved nations. We have secured our foundations as the representative body for UK junior doctors by liaising and networking with all other major trainee organisations. We have strengthened our working relationship with the health departments, employers and deans. Our success and strong reputation has been built on by engaging in honest and constructive dialogue, and we will continue to hold true to what we stand for. Any new government must recognise and value the contributions of juniors to the NHS.

The year ahead promises to hold new challenges for UK junior doctors, both for training and for conditions of service. The JDC will continue to stand up for junior doctors. We will continue to take forward your concerns, and we will continue to build upon the relationships we have developed to strengthen the voice of juniors, but we need your active involvement too. Our policy must reflect the areas that doctors at the frontline wish to see the BMA campaign for - which will evolve with the needs of the profession - and the views of junior doctors remain central to the work of the JDC. We’ve heard them today and we want you to keep telling us all year what you would like to see us do next.

Because regardless of the challenges the future may hold for the NHS, it is clear that junior doctors will remain a key ingredient in a recipe for its success.

Tags: Juniors, Training
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Juniors look after up to 400 patients at night

By Mike Broad - 21st April 2010 1:19 pm

There are large variations in the provision of medical cover at night following the introduction of the Working Time Directive, with some doctors being responsible for up to 400 patients, a study finds.

The research, by the Royal College of Physicians, reveals that doctors were responsible for an average of 61 patients at night but the range was from 1 to 400.

The seniority of doctor in charge of a ward also varied considerably; 63 teams reported that, on the night the survey was carried out, the most senior medical cover was a junior doctor in their first two years of training. Consultants were involved in the direct delivery of overnight care in only 6% of teams.

Day cover on the ward ranged between two and 65 patients per junior doctor, with the highest ratio per doctor in Wales and the lowest in London. This reflects a much higher number of trainees in the capital (in 2008 there were 1,135 specialist training posts in London compared with 146 in Wales). The average number of patients per doctor also varied considerably between specialties.

Dr Andrew Goddard, director of RCP’s medical workforce unit, said: “The very low number of doctors per patient at night in some hospitals raises serious concerns for patient safety and there are also worrying reports of very junior doctors being left unsupported, which urgently require further investigation.”

The survey - sent to consultant physicians in England and Wales on a specific date in November - also raises concerns about junior doctors’ welfare. Fifty eight percent of consultants reported an increase in sickness rates of juniors working under them compared with before the introduction of WTD-compliant rotas.

The survey claims to be the first to get independent evidence of current sickness rates for junior doctors across England and Wales, and shows that they are higher than a recent survey by the NHS Information Centre suggests.

The study proposes that high sickness rates in second year trainees may reflect a loss of team working and sense of belonging in doctors a year into their training.

It also shows a vacancy rate of 8.6% among specialist trainees.

Goddard said: “The 48-hour week was brought in to improve the wellbeing of doctors, and by extension prevent mistakes in patient care. The apparent rise in sickness rates of junior doctors since the introduction of the European Working Time Directive highlights the additional stresses that are being put upon trainees by new rotas.

“Far from benefiting their welfare, the poor implementation of the directive means that juniors are missing out on crucial support and valuable training opportunities, and patient care is being spread too thinly.”

On the day of the survey, data was available on 887 hospital teams at 11am, including 4,004 junior doctors caring for 18,854 medical patients, and on 670 teams at 11pm, including 2,263 junior doctors caring for 97,561 medical patients.

Tags: Juniors, Sick leave, WTD
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Hospital doctors’ pay scales for 2010/2011

By Mike Broad - 10th April 2010 4:12 pm

Consultants did not receive a pay rise for 2010/2011. The government also froze the value of clinical excellence awards.

Foundation year doctors, house officers, senior house officers, specialty registrars, specialty doctors, associate specialists and salaried GPs in England received a 1% pay rise from 1 April 2010.

The government turned down a recommendation from the Doctors’ and Dentists’ Review Body that juniors’ pay should increase by 1.5%. Wales adopted the same pay awards to doctors, but juniors in Scotland received the 1.5% pay uplift.

In 2009/2010, all doctors received a 1.5% pay rise.

Consultant salaries 2010/2011

Threshold 1, years completed as a consultant 0, £74,504, period before eligibility for next threshold one year

Threshold 2, years completed as a consultant 1, £76,837, period before eligibility for next threshold one year

Threshold 3, years completed as a consultant 2, £79,170, period before eligibility for next threshold one year

Threshold 4, years completed as a consultant 3, £81,502, period before eligibility for next threshold one year

Threshold 5, years completed as a consultant 4, £83,829, period before eligibility for next threshold five years

Threshold 6, years completed as a consultant 9, £89,370, period before eligibility for next threshold five years

Threshold 7, years completed as a consultant 14, £94,911, period before eligibility for next threshold five years

Threshold 8, years completed as a consultant 19, £100,446

Clinical excellence awards for consultants

Level 1 £2,957

Level 2 £5,914

Level 3 £8,871

Level 4 £11,828

Level 5 £14,785

Level 6 £17,742

Level 7 £23,656

Level 8 £29,570

Bronze/Level 9 £35,484

Silver/Level 10 £46,644

Gold/Level 11 £58,305

Platinum/Level 12 £75,796

Newbies won’t know their arses from their elbows

By Bob Bury - 7th January 2010 2:29 pm

I said in my blog last time that I’d probably be acting the old curmudgeon (love that word) so this week I’m on the government’s case about its half-baked scheme to make nursing training all degree level by 2013.

Before Christmas, Hospital Dr editor Mike Broad referred in a blog to a letter I wrote on the subject to The Times. There were other letters in The Times - several from nurses - making the same point and only one opposing voice, that of the President of the RCN (as you might expect, given that the driving force for the change is the hankering of RCN apparatchiks for more professional status).

While Mike described it as an “interesting” letter, he had the temerity to disagree with its main premise that mandatory degree entry was a bad thing.

However, the week after my letter this article appeared in the same paper, confirming the fact that degree training is not appropriate for many of those who currently enter nursing, and that making it mandatory will only exacerbate the shortage of nurses in the UK.

I also know that I’m right because I recently discussed the issue with the only two people who can hold a candle to me when it comes to curmudgeonliness - my wife and daughter. Lin is a retired midwife and school nurse, and my daughter Kate is a practising midwife (yes, I share my house with two ‘madwives’ - I’m not going for the sympathy vote or anything but…).

Anyway, Kate was bemoaning the fact that trainee midwives get so little practical experience on the wards now and I was saying that it’s getting that way with medical students.

This set Lin off reminiscing about the days when we met at the Central Middlesex in the early seventies, and how there were so many medical students and junior doctors on the wards that the student nurses would often latch on to the informal teaching that was going on, or even buttonhole an SHO and ask them for a quick tutorial on something they were finding difficult to understand. And, of course, both the nurses and medical students were doing stuff as well as listening; they were acquiring the practical skills that were essential to their respective roles. Not any more, it seems.

We’ve become familiar with the concept of qualified nurses who can’t wash a patient’s dentures because they haven’t done ‘the course’, and we seem to be going down the same path with medical training. For example, as far as I can tell, today’s medical students don’t learn any anatomy - I expect they’re all too busy with their empathy workshops - and we risk producing doctors who are lovely little communicators but who don’t have anything useful to say.

It really worries me that, just when I’m likely to start needing medical attention myself, the doctors providing it will, literally, not know their arse from their elbow.

Tags: Juniors, Nursing
Posted in Bob Bury | 8 Comments »

Record numbers of junior doctor vacancies

By Francesca Robinson - 13th November 2009 9:04 am

Evidence of a worsening junior doctor recruitment crisis following the introduction of the European Working Time Directive has come to light this week.

Jobs4medical, an online recruitment service, announced that it has a record number of doctor vacancies on its site.

It is currently advertising 7,500 locum and permanent doctors’ positions, which also includes consultants and GPs.

The highest number of vacancies posted on the site for secondary care are in accident and emergency followed by paediatrics and psychiatry.

Vicky Scott, operations manager at Jobs4Medical, said: “We have seen a huge increase this year in doctors’ positions. We are getting feedback from recruiters that it’s very difficult to recruit doctors into these roles. We are finding that the movement isn’t there in the market that there was a year ago or maybe even eight months ago. It has got worse since August.”

Across Cumbria there are currently between 16 and 20 specialist junior doctor vacancies. Recruiters from the North Cumbria University Trust recently travelled to India in a bid to recruit 10 new juniors.

In an interview on Radio Cumbria junior doctor committee chair Dr Shree Datta said: “There are shortages throughout UK and we need to look at why…there are these shortages. What it means is that junior docs on the shop floor working harder than they otherwise would be. Tired doctors are not the best doctors.”

Reports are also coming in of the way that recruitment problems are beginning to impact on services. Hospital managers in Wales recently decided that adult brain surgery will be permanently centralised in Cardiff because of the nationwide shortage of junior doctors.

Dr Richard Lewis, Welsh secretary of the BMA, said the shortage of middle grade and junior doctors in Wales could be contributing to the higher number of complaints about medical staff.

Complaints about hospital services have risen by 15%. Among these two-thirds were about inpatient and outpatient care and another one in 10 about accident and emergency. More than half concerned medical staff.

“We have a shortage of junior and middle-grade doctors and that undoubtedly puts pressure on those staff who are trying to deliver a good service,” he said. “But when we have an under-doctored workforce, there will be increasing pressure on the ability of services to deliver.”

Rural and outlying areas are having the greatest struggle to fill posts. NHS managers in Scotland are currently relying on temporary cover to maintain their complement of junior doctors at Caithness General Hospital. Since August the hospital has been unable to fill three of the nine permanent posts.

A BMA spokesman commented: “Clearly the problem is getting worse. The trouble is much of the evidence is currently anecdotal. It’s an evolving picture because there is a problem with the quality of the data because, for example, there are issues with junior doctors working more hours and falsifying their hours because they want access to training.

“It is difficult to get a handle on the exact impact the EWTD is having but clearly the shortage of junior doctors is going to be putting pressure on the system particularly where there are recruitment problems already.”

Tags: Juniors, Recruitment, WTD
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Honesty needed from DH on juniors’ rota gaps

By Dr Shree Datta, chair of the BMA's junior doctors committee - 29th September 2009 2:50 pm

I was chairing my first meeting of the BMA’s junior doctors committee last week, when a copy of the Daily Telegraph was thrust under my nose. The article came as no great surprise as we had issued a press release highlighting the rota gap problem based on Department of Health figures we uncovered from 2008 recruitment. The figure was a 5% shortfall (or around 3,000 junior doctors in the UK).

What was surprising was the response from the DoH. Whilst I expected a public rebuttal, it came as a shock, as I’m sure it did to all junior doctors who read the article, to be told that: “The latest feedback from SHAs suggests the total numbers of vacancies for junior doctors in August this year was 1,055 which is only around 2% of posts.”

Given that this apparent reduction in rota gaps came at a time when most hospitals were trying desperately to prepare for the introduction the European Working Time Directive such a large drop seems almost miraculous.

Last year the DoH stated in a document on the WTD that: “Patient safety can be put at risk if critical rotas cannot be filled and in extreme circumstances, specific services may be need to be closed.” This suggests they are, or at least were, aware of the seriousness of the problem.

In the same document they acknowledged the reasons behind for the problem were Modernising Medical Careers and the changes to the immigration system. It is all there on page 9.

Yet their view is seems somewhat different now, according to their unnamed spokesman in the Daily Telegraph: “It is not true to say that as international recruitment has been stopped there will be gaps in rotas.”

They go on to dismiss our concerns about rota gaps: “The BMA are using old data…”

Has the rota gaps problem gone away? Dr Alan Axford, Hywel Dda NHS Trust’s medical director thought not when he took the unprecedented step of publicly highlighting the rota gap problems in West Wales in July. In Northern Ireland, the Erne and Tyrone County hospitals have suspended some gynaecological services due to a shortage of junior doctors and in Scotland it was recently reported that 23% paediatric trainees were on maternity leave.

The fact is that hospitals rely on junior doctors working extra unpaid hours to prop up our healthcare system. This is not a suitable or sustainable way to solve the problem. The DoH needs to stop hiding behind statistics and pretending the problem has gone away. We work on these rotas - we know it hasn’t.

Tags: Juniors, WTD
Posted in BMA | 1 Comment »

Killing season can’t be as bad as the old days

By Katherine Teale - 25th September 2009 3:33 pm

We northern provincials always get excited when we come up to London for the day: as well as gawping at the posh people and hoping to absorb some culture, I could even pop into the City to see how those bankers are enjoying my taxation.

The journey does present challenges, though. First and foremost, what on earth to wear (our northern wardrobes not being adapted for the sweltering London micro-climate). Then there’s the whole Underground experience. And lastly the trust’s decision to ban first class travel, even for managers. Great.

Not only do I have to get up in the middle of the night to get to the station with my three alternative outfits, but I have to go second class without a Virgin Trains vegetarian cooked breakfast to prepare myself for the inevitable hour going the wrong way round the Circle Line.

The official reason for my visit is to attend a course on Improving Patient Safety (because nobody’s ever thought of this before, obviously). I’m quite looking forward to it really, as the alternative is an all-day orthopaedic list.

Just to show how enthusiastic I am about the course, I’m going armed with a couple of cracking ideas of my own which should reduce our mortality rate by at least 6%. The first is not to allow patients into hospital in the first place as it’s just far too dangerous: a hypothesis which is amply supported by the harrowing ‘patient stories’ related during the course; the second, for those patients who absolutely insist on admission, is to ban trainee doctors from the wards. Even those who’ve managed to actually pass their finals are apparently a danger to the public.

I know this will come as a shock, but a significant increase in deaths during August has been identified, which coincides suspiciously with the changeover of new doctors. Of course for generations no doctor in their right mind would have dreamed of allowing any family member to be admitted until at least the end of September.

When I was a new house-officer, we were all too knackered anyway after working a million hours a week to get too worked up about a couple of extra deaths every August. When a patient took a turn for the worse, there was a well-developed system to follow: a junior (usually me) told the relatives that their loved one had “passed away”. The relatives, obligingly keeping a stiff upper lip, said something along the lines of “it’s just one of those things, doc”, before cups of tea were handed round and nothing more was heard. No Critical Incident forms were filled in, and no-one from the trust risk management unit appeared to take statements.

We just carried on, no doubt making the same mistakes.

If it’s any consolation to our new trainees, I’m pretty sure that this year’s increased mortality pales into insignificance beside previous Augusts, especially the year I started when the changeover day was a Saturday so there was nobody in the hospital who could to site a venflon for two whole days. Fortunately the Standardised Hospital Mortality Ratio hadn’t been invented, so nobody took any notice.

I suppose some things really have changed for the better.

Tags: Juniors, Patient safety
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Research suggests ‘killing season’ exists in August

BBC Health - 23rd September 2009 8:16 am

A small but statistically significant number of patients die each year when junior doctors start work in August, an Imperial College London study suggests.

Researchers looked at 300,000 patients admitted as emergencies to English hospitals between 2000 and 2008.

They compared death rates between the first week of August, when new doctors arrive, and the previous week in July.

After adjusting for various factors, they report in PLoS One that the August patients were 6% more likely to die.

The period when an influx of newly qualified doctors enter the wards has sometimes been dubbed the “killing season”, but studies to establish whether there is any truth to this have been inconclusive.

The researchers from Imperial College London stressed they were unable to draw firm conclusions about the reasons for the increase, but that it was significant, if small.

Comparisons of the raw figures showed little difference, but when factors including age, sex, socio-economic deprivation and existing medical problems were taken into account, a discrepancy began to emerge.

Time to review the policy of testing doctors for HIV

By Mike Broad - 16th July 2009 2:37 pm

New research by the Journal of Medical Ethics questions whether routine HIV testing of healthcare workers is ethical and should continue.

It reveals that juniors are being inappropriately forced into having HIV tests. Doctors involved say they were unaware that they might need an HIV test as part of their pre-employment occupational health checks until they received the letter from their prospective employer.

They were not given any information about the HIV test or told why they needed to have it - prerequisites of giving informed consent to a procedure - either in this letter or when they actually had a blood sample taken.

It may be a relatively small study - of just 24 junior doctors in four NHS hospital trusts - but the findings are worrying. It suggests that trusts are treating new juniors with a lot less respect and trust than they would a patient.

In 2007, the Department of Health issued new guidance relating to health screening for doctors working in the UK.

It stipulated that all staff should be offered tests for the serious blood-borne viruses hepatitis B and C, HIV and TB to provide reassurance to patients that the healthcare community do not harbour communicable diseases and protect patients from infection.

But the research suggests there are two challenges to its justifiable continuance: firstly, whether it is ethical to screen healthcare workers and, secondly, how the HIV test is being offered.

On the ethics of screening, there have been no cases in the UK of HIV transmission from a healthcare worker to a patient. There have been only three documented cases of transmission worldwide.

The risk of transmission from healthcare workers to patients is in the order of 1 to 42,000; the risk of transmission from a patient to a doctor is 1 in 300. There are clearly few benefits for patients from screening healthcare workers.

On the issue of how the HIV test is being offered, the research shows there’s a lack of understanding by occupational health teams on the indications of the test and little understanding of the implications of a positive result.

Juniors felt they didn’t have the opportunity to ask questions before receiving the HIV test and had concerns over confidentiality. But, most disturbingly, they felt they were forced to have the test even though in the majority of cases it was not compulsory.

The DoH guidance makes it clear that the tests are not mandatory for doctors whose work does not expose them to these viruses, nor are they a prerequisite for employment.

One doctor in the study said: “The only discussion I had with somebody about the test was to say: “We’re going to test you for HIV. Is that OK?” and then being stabbed.”

Another said: “I wonder if they’d have sacked me if it was positive. No one really explained what would happen if it were positive either. Would my bosses have been told about it?”

Only three of the doctors were actually asked about the behaviours that would have increased their risk of acquiring HIV; none felt they had been at high risk.

Few were offered any follow up counselling or discussion, which would have been provided had they been ordinary patients. And most of the doctors did not feel they had the option to refuse the test; only four did so.

It’s a significant problem because each year thousands of junior doctors will be offered an HIV test as they enter their foundation year 1 or move between NHS trusts.

“The unacceptable way in which the HIV test has been offered has far-reaching implications for healthcare professionals already employed in the NHS and future generations of junior doctors and medical students,” says the research.

Research lead Dr Lee Salkeld, ST2 GP trainee at University Hospitals Bristol Foundation Trust, explains: “This is a worrying invasion of the individual healthcare worker’s privacy.

“Would it be reasonable to start introducing depression or alcohol-dependency questionnaires in occupational health checks? The DoH policy shows little regard for the thousands of healthcare workers who have to undergo a needless, stress-inducing, HIV test.”

He also suggests that the money spent on the “unnecessary” HIV testing of healthcare workers should be better utilised.

“This policy isn’t about patient safety, it’s about public reassurance. Time and money would be much better spent educating patients about the real risk of acquiring HIV from their surgeon and improving the safety of exposure-prone procedures,” says Salkeld.

The BMA says it will take on trusts that conduct the health screening of doctors poorly. Dr Andy Thornley, chairman of the BMA Junior Doctors Committee, says: “The behaviour by trusts reported here is outrageous and is tantamount to an assault on the doctors concerned.

“It is shameful that any employer can consider putting staff through such testing without appropriate informed consent. The NHS would not treat patients in this way and so why should it be acceptable treatment for doctors. We would ask any doctors who have experienced this kind of testing for blood borne viruses to contact askBMA to highlight the offending trusts.”

The research proffers two potential solutions. Dr Salkeld says: “Scrap the policy! It’s ineffective and poorly implemented. It fails to improve patient safety. And cost-effectiveness studies performed elsewhere do not recommend the routine HIV testing of healthcare workers.”

However, if the screening policy is retained, the research concludes that: “Many of the criticisms and concerns raised by the doctors could be readily addressed by the occupational health departments of NHS trusts.”

Salkeld explains: “The overwhelming suggestion from the participants in the study was more information about the indications and implications of the test. This can either be through better occupational health practice or uniform literature provided by the DoH.”

A Department of Health spokesperson responded: “National policies on healthcare workers infected with hepatitis B, hepatitis C or HIV are kept under review to take account of changes in the evidence base. We expect that the current review will be completed in late 2009/early 2010.”

Tags: HIV tests, Juniors
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