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Open letter to royal college presidents on Health Bill

The following is an open letter from the NHS Consultants Association, signed by over 180 doctors, to the royal college presidents regarding the Health and Social Care Bill:

“The Academy’s role is to promote, facilitate and where appropriate co-ordinate the work of the medical royal colleges and their faculties for the benefit of patients and healthcare.” Academy of Medical Royal Colleges statement.

Dear presidents,

We write to persuade you that the royal colleges’ current policy of cooperating with the government’s proposed NHS reforms in England as stated in the 2011 Health and Social Care Bill is not in keeping with the wishes of the majority of the medical profession and not in the best long-term interests of either patients, doctors or the Royal Colleges.

Current situation

Following the unprecedented pause in the passage of the Health and Social Care Bill to allow for a “listening exercise”, it has become clear that the government’s proposed changes to the Bill (1)  in response to the Future Forum report (2), have done little to address the concerns of the medical profession. In fact, the representative body of the BMA reinstated its policy to call for withdrawal of the bill at its Annual Representative Meeting in June.

The key issues that were highlighted by the ARM were serious concerns regarding:

i) the removal of the duty of the Secretary of State for Health to provide a comprehensive health service;

ii) the role of Monitor in the promotion of competition;

iii) the enforced nature of competition through the promotion of the choice agenda, as a higher priority than tackling fair access and health inequalities; and

iv) increasing marketisation and privatisation of the English NHS.

Professional support is lacking

In response to the government’s failure to reassure the medical profession about its proposed changes, BMA Council subsequently voted in favour of starting a public campaign to call for withdrawal of the Health and Social Care Bill. Council also agreed that the government was “misleading the public by repeatedly stating that there will be no privatisation of the NHS”.  Dr Hamish Meldrum, Chairman of the BMA said that: “there is widespread feeling that the proposed legislation is hopelessly complex, and it really would be better if the Bill were withdrawn”. (3)

The RCGP survey of over 1,000 GPs following the government response was also highly critical. Dr Clare Gerada, Chair of the RCGP stated: “GPs don’t think this bill is going to create a patient-led NHS, they don’t think it’s going to increase autonomy, they don’t think it’s going to improve patient care and they don’t think it’s going to reduce health inequalities.” (4)

An online BMJ poll of over 1000 doctors showed that 93% wanted the bill to be withdrawn, and a smaller online poll by GP magazine showed that 94% thought the bill should be scrapped. The government’s former director for heart disease and stroke, Sir Roger Boyle, also spoke out against the Bill. He pulled no punches when he stated that: “ ‘It is horrific that the NHS’s future is threatened.” (5)

Dr Evan Harris, the influential Liberal Democrat GP, dismissed the NHS Future Forum report as “cliché-ridden, trite nonsense” and held out the prospect of further revolts. (6)

Parliamentary and other support is lacking

It is not just doctors who remain concerned by the Bill. The Liberal Democrat MP and member of the Health Select Committee, Andrew George 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.” (7)

The concerns have also spread to highly influential members of the Lords. In her speech to the NHS Confederation, Baroness Williams stated that: “I would be less than candid if I failed to mention that there are still some unresolved and troubling issues to be addressed.” (8)

It is also increasingly apparent that these widespread concerns are entirely justified. Most notably, the public interest lawyer, Peter Roderick, has stated that: “The fundamental legal basis for the NHS, which was put in place in 1946, will be removed by the Government’s Health and Social Care Bill.” (9)

He goes on to state that: “A direct line of logic can now be traced in the Bill, which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided.”

This is in entirely keeping with evidence recently published in the BMJ that the reforms will inevitably lead to further NHS privatisation and NHS asset stripping in England. (10,11)

Democratic legitimacy?

Also of major concern is the lack of democratic legitimacy for this Bill. The 2010 Conservative Election Manifesto stated: “More than three years ago, David Cameron spelled out his priorities in three letters – NHS.”

This refers to the 2007 Conservative Party White Paper, NHS Autonomy and Accountability. (12)

The introduction was written by David Cameron and Lansley, which stated: “Improving the NHS is the Conservative Party’s number one priority…this requires an end to the pointless upheavals, politically-motivated cuts, increased bureaucracy and greater centralisation that have taken place under Labour.”

The document also states:

“As part of our commitment to avoid organisational upheaval, we will retain England’s ten SHAs, which will report to the NHS Board (para 4.28)”, and “PCTs will remain local commissioning bodies”.

Professor Kieran Walshe also highlighted the fact that the Coalition agreement had specifically pledged to “stop the top-down reorganisations of the NHS that have got in the way of patient care”. (13)

He estimated costs of reorganisation between £1.8billion and £3 billion. (14)

The Liberal Democrat MP, Andrew George said that Lansley had: “Torn up the agreement to resist imposing a top-down reorganisation,”  and Zack Cooper from the London School of Economics said: “The new health secretary campaigned on a pledge to eliminate top-down shake ups of the health service.  This white paper contradicts his campaign promise.” (15)

Colleges’ responsibilities

In light of the above evidence, we believe that the royal colleges should be taking a much more active role in opposing this Bill and should publicly back the BMA’s call for the Bill to be withdrawn. In fact, since the BMA represents over two thirds of all practising doctors in all branches of medicine (16), is it not incumbent upon the royal colleges to support the BMA’s position?

Unfortunately, far from backing the BMA’s call for withdrawal of the bill, the AoMRC president, Sir Neil Douglas told the bill scrutiny committee that: “…there are so many disadvantages in delaying that we have to get on with it to the best of our ability now. We will not be able to give you definitive answers on detailed questions because our members have not had a chance to respond, but we will do our best and we believe that we should be going forward at the moment.” (17)

However, surely any perceived need to avoid delay, as expressed by Sir Neil Douglas, is entirely due to the insistence by both Department of Health and the government on beginning implementation of the reforms before parliament has given its approval. This is at best undemocratic and quite possibly unconstitutional. As in athletics, jumping the gun should result in disqualification!

In addition, the president of the Royal College of Surgeons, Professor Norman Williams has recently stated that: “The college largely supports the aims of the reforms to modernise the healthcare system.” (18)

Considering the continued widespread professional opposition to the Bill, these are worrying statements that could be interpreted as showing that the colleges are out of touch with the views and concerns of the majority of grassroots doctors. The question must therefore be asked as to why the colleges, with the exception of the RCGP, have taken this position.

One explanation may be found in the government’s response to the Future Forum report (2), which secures a number of important roles for the colleges in delivering and leading the reforms. These roles include the establishment of close links with the NHS Commissioning Board (para 3.55), involvement in identifying the procedures most at risk of cherry picking (para 5.42) and prioritising work on Payment by Results (para 5.42)

Just as the government has no mandate from the electorate to push through this Bill, the royal colleges have no mandate from their members and fellows to help deliver and lead the reforms. In fact, it is unacceptable that the colleges (with the notable exception of the RCGP) have not even surveyed the opinions of their members/fellows on such an important issue.

By taking this stance, not only are the colleges failing to represent their members and fellows, we believe they also failing to safeguard their very own principles. One of the key roles of the colleges is to “promote the underlying principles of medical professionalism and leadership.” (19)

However, the last 20 years of NHS reform has seen medical professionalism and the public service ethos increasingly undermined and eroded by market based policies and ideology. This is because neoliberal market theories, such as public choice theory, reject the idea of the public service ethos and view public service professionals as self interested ‘rent seekers’ whose real purpose is to make money and legitimise monopolistic cartels. (20)

Professor Julian Le Grand (former health policy advisor to Tony Blair) noted how public choice theory had become influential under the Thatcher government from 1980’s onwards, and used the metaphorical model ofKnights, Knaves, Pawns and Queens’ to describe how this had changed attitudes towards the motivations and behaviours of public service professionals. Public servants were increasingly viewed as essentially self-interested ‘knaves’ rather than public-spirited altruists or ‘knights’, whereas service users were regarded as consumer ‘queens’ rather than passive ‘pawns’. He argued that: “Public policy should be designed so as to empower individuals: turn pawns into queens” with the ensuing logic that public services should be delivered through competition and consumer choice. (21)

This is precisely what has happened at a policy level as evidenced by the following statements by former Cabinet Minister John Denham MP: “All public services have to be based on a diversity of independent providers who compete for business in a market governed by Consumer choice. All across Whitehall, any policy option now has to be dressed up as ‘choice’, ‘diversity’, and ‘contestablity’. These are the hallmarks of the ‘new model public service’ (22) and former Prime Minister, Tony Blair in his speech to the Public Services summit in 2004 said: “It is only by transferring power to the public through choice, through personalising services, that we can create the drivers for continuous improvement in all our services.” (23)

The influence of public choice theory was a major factor in the rise of New Public Management (NPM) in the NHS (e.g the Griffiths Report, 1983), which favours narrow economic priorities and micro-management practices (e.g performance indicators, league tables, monitoring and centrally imposed targets) over professional judgment. (24)

Furthermore, relationships between medical professionals and patients depend on trust rather than contractual obligations and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend. (25)

This strikes right at the heart of the social contract, which is fundamental to medical practice and professionalism. As Professor Kenneth Arrow recently stated about markets in healthcare: “one problem we have now, is an erosion of professional standards.” (26)

It is therefore no coincidence that the American medical profession lost public support faster than any other profession during the rapid marketisation of the US healthcare system in the 1970/80s. (27)

Another reason why medical professionalism is under threat is because it actually presents an obstacle to market reforms because doctors, especially GPs as the ‘gatekeepers’, control access to the healthcare system and exert control over the market through a combination of cultural authority on patients and political influence over policy making. (28)

Doctors generally refer their patients to local services and prefer to work collaboratively to ensure the health needs of the local community are met. This form of collaboration is fundamentally anti-competitive in nature, and Professor David Marquand was therefore correct when he stated that public service professionals “are in a profound sense not just non-market, but anti-market”.

This clearly leaves Mr Lansley with a huge problem with his reform agenda because as he stated in a speech to the NHS confederation: “The first guiding principle is this: maximise competition…which is the primary objective.” (30)

He also made it clear in the same speech that the way to maximise competition is to maximise the numbers of purchasers and providers in the system. This explains the thinking behind the policies of Any Qualified Provider and patient held budgets, and also explains why GPs are being given £60 billion of the NHS budget: “The statutory formula should make clear that choice should be exercised by patients, or as close to the patient as possible, thereby maximising the number of purchasers and enhancing the prospects of competition, innovation and responsiveness to patients.” (30)

Another serious problem for Lansley is that it is now widely accepted that clinical leadership and clinical followership is crucial to successful healthcare reform (31), but this clearly requires ‘buy in’ from the profession, which relies on trust and a shared vision. However, a recent MORI poll of BMA members commissioned by the BMA clearly showed that doctors overwhelmingly think that pro-competition market reforms will be detrimental to patient care and will fragment services. (32)

Since markets also undermine medical professionalism and the doctor patient relationship, Lansley is hardly likely to gain much professional support for his reforms, which is precisely what we have been witnessing since the White Paper was published last year. In fact, New Labour’s market based reforms were also deeply unpopular and opposed by the BMA’s ‘Look After Our NHS Campaign’. (33)

The colleges should also be very concerned about the effect of market reforms on medical training and standards. The profession has already suffered the Modernising Medical Careers (MMC) debacle, which can in part be explained by the influence of market-based policies. MMC utilised a competency based tick box approach to training and it is important to note that Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money. (34)

Sir John Tooke’s report of MMC, Aspiring to Excellence, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence. A prescient editorial in the British Journal of General Practice described how the proposals for the establishment of PMETB: “…are clearly intended to enable the Secretary of State of the day to direct that standards can be lowered to meet the manpower demands of the NHS”. (36)

MMC was clearly designed to produce a ‘fit for purpose’ medical workforce in the new healthcare market. For example, the Department of Health website stated that MMC: “Focuses on the development of a flexible medical workforce…and…most importantly, will deliver a modern training scheme and career structure that will allow clinical professionals to support real patient choice.”

Conclusion

The Health and Social Care Bill builds on the market based policies of previous governments, and poses an enormous threat to the NHS, medical professionalism, the doctor patient relationship, and ultimately patient care. It will put an end to the English NHS as a publicly funded, publicly provided, publicly accountable health service, which has served us so well for over 60 years and continues to do so. (38)

These reforms are not just another episodic tinkering with the NHS, because independent expert legal opinion indicates that they will increase the likelihood of EU competition law being applied, which will effectively result in irreversible market based changes to the NHS.

So it is now more crucial than ever for the leaders of the royal colleges to join in with the chorus of opposition to the reforms to prevent the further marketisation and privatisation of the English NHS, which will be inevitable if the Bill is enacted. The Bill cannot pass without the support of the medical profession. The colleges have a rare opportunity to make a stand for the NHS, the medical profession, and patients. We therefore call upon the Academy of Medical Royal Colleges to act in the public interest by publicly calling for the withdrawal of the Health and Social Care Bill.

Finally, we would like to state that we acknowledge that the NHS is not perfect and that we favour its vigorous evolutionary development. The NHS has undergone constant change since its inception and this will clearly need to continue in order for the NHS to face up to the serious challenges of the future. However, this must involve meaningful discussion and consultation with all those who will be responsible for providing the service. It must involve full consideration of all options, not least the benefits of following the rest of the UK in abandoning the purchaser provider split and other market based policies, and pursuing a professionally led, collaborative approach to healthcare delivery based on trust, accountability, and the highest professional and ethical standards.

“Medical professionalism cannot survive in the current commercialized health care market. The continued privatisation of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the healthcare system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.” (39)

Yours sincerely,

Dr Clive Peedell MRCP FRCR

Consultant Clinical Oncologist

Co-chair of the NHSCA

Dr Jacky Davis FRCR

Consultant Radiologist

Co-chair of the NHSCA

Dr Peter Fisher FRCP

President of the NHSCA

www.nhsca.org.uk

References:

1. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127443

2. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127719.pdf

3. http://www.bma.org.uk/healthcare_policy/nhs_white_paper/latestnhsreformstatement.jsp

4.Health bill changes fail to win over GPs, RCGP survey finds’. Pulse. 21 July 2011. Available @:

http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/12436518/health-bill-changes-fail-to-win-over-gps-rcgp-survey-finds

5. ‘Sir Roger Boyle: “It’s horrific that the NHS’s future is threatened”’. The Independent. Tuesday 26th July 2011.

6.A slice of Britain: Lib Dem guerrillas plot their next move’. The Independent. 19 June 2011. Available @: http://www.independent.co.uk/news/uk/politics/a-slice-of-britain-lib-dem-guerrillas-plot-their-next-move-2299731.html

7.Taxpayers will no longer bail out failing NHS hospitals’. The Telegraph. 20 June 2011. Available @: http://www.telegraph.co.uk/journalists/martin-beckford/8587176/Taxpayers-will-no-longer-bail-out-failing-NHS-hospitals.html

8. Shirley Williams’ speech to the NHS Confederation Conference. 8 July 2011. http://www.libdems.org.uk/speeches_detail.aspx?title=Shirley_Williams%E2%80%99_speech_to_the_NHS_Confederation_Conference&pPK=fb31954a-12ee-4832-82f5-e61fa65ed5ea

9. www.dutytoprovide.net

10. Peedell C. Further privatisation is inevitable under the proposed NHS reforms. BMJ 2011; 342:d2996

11. Reynolds L. For-profit companies will strip NHS assets under proposed reforms BMJ 2011; 342:d3760

12. http://www.conservatives.com/pdf/NHSautonomyandaccountability.pdf

13. HM Government. The coalition: our programme for government. Cabinet Office, 2010. www.cabinetoffice.gov.uk/media/409088/pfg_coalition.pdf

14. Walshe K. Reorganisation of the NHS in England. Editorial. BMJ 2010; 341:c3843

15. Lansley’s GP lottery. Public Finance. 16 November 2010. Available @ http://opinion.publicfinance.co.uk/2010/07/lansleys-gp-lottery-by-zack-cooper-and-john-van-reenen

16. http://www.bma.org.uk/about_bma/index.jsp

17. Evidence to Public Bill Committee. Tuesday 28 June.      2011. [email protected]http://www.publications.parliament.uk/pa/cm201011/cmpublic/health/110628/pm/110628s01.htm

18. Personal correspondence with NHSCA, dated 17 August 2011.

19. http://www.rcplondon.ac.uk/about/mission

20. Lowe R. The Welfare State in Britain since 1945. Macmillan, Houndmills. 1993

21. Le Grand J. Knights, knaves or pawns? Human behaviour and social policy. J Soc Policy 1997;26:149–69

22. Available @: http://www.chartist.org.uk/articles/labourmove/march06denham.htm

23. Blair T. We should not shy away from radical reform. Speech to Guardian Public Services Summit, 29 January 2004.

24. Bottery M. Education, policy and ethics. Continuum. New York, 2000

25. Coates D. Reviving the Public: A New Governance and Management Model for Public Services. The Work Foundation. 2006

26. Interview with Kenneth Arrow: The Atlantic Jul 28 2009. Available @: http://www.theatlantic.com/politics/archive/2009/07/an-interview-with-kenneth-arrow-part-two/22279

27. Blendon R. “The public’s view of the future of medical care” JAMA 1988 259: 3587-3593

28. Starr P. The social transformation of American medicine. Basic Books, New York.1982

29. Marquand D. Decline of the Public. Polity Press, 2004

30. Lansley A. Extract from “The future of health and public service regulation” speech. 2005. Available @: www.andrewlansley.co.uk/newsevent.php?newseventid=21

31. Ham C. Engaging Doctors in Leadership. A review of the literature. Available @ http://www.hsmc.bham.ac.uk/work/pdfs/Engaging_Doctors_Review.pdf

32. Available @: http://www.bma.org.uk/healthcare_policy/nhs_white_paper/moripoll2011members.jsp

33. http://www.lookafterournhs.org.uk/

34. Department of Education. Working together: education and training. London: HMSO, 1986

35. Tooke J. and others. Aspiring to Excellence. Findings and final recommendations of the independent enquiry into modernising medical careers. 2008. HMSO (The Tooke Report) Available @: www.mmcinquiry.org.uk

36. Cox J. “The Medical Education Standards Board: castrating the Medical Royal Colleges? BJGP 2002. March; 179-180

37. Department of Health website. Modernising Medical Careers. Available @ http://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Browsable/DH_5835992

38. http://www.bbc.co.uk/news/10375877

39. Relman A S. Medical professionalism in a commercialized healthcare market, Cleveland Clinic Journal of Medicine. November 2008 vol. 75 Suppl 6 S33-S36

Co-signatories to the open letter to the royal college presidents:

Professor Raymond Tallis, Emeritus Professor of Geriatric Medicine University of Manchester, FRCP, F Med Sci, DLitt, LittD

Professor Trisha Greenhalgh, Professor of Primary Health Care and Director, Healthcare Innovation and Policy Unit Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry

Prof Alan Smyth, Professor of Child Health, University of Nottingham

Professor Martin McKee, Professor of European Public Health, LSHTM

Professor Francesco Pezzella, Professor of Tumour Pathology, University of Oxford, Fellow Royal College of Pathologists

Professor Simon Capewell FRCPE, FFPH, MD, DSc, Professor of Clinical Epidemiology, University of Liverpool. Dept of Public Health & Policy, Institute of Psychology, Health and Society, Liverpool

Professor Harry Keen CBE, MD FRCRP, Emeritus Professor Unit for Metabolic Medicine, Diabetes & Endocrine Clinical Unit, Guy’s and King’s College London School of Medicine

Professor Robert Elkeles FRCP Cons Physician Consultant Physician, Professor of Diabetic Medicine, Unit for Metabolic Medicine at St Mary’s Hospital, London

Professor Steve Goodacre, Professor of Emergency Medicine, Sheffield, Fellow of the College of Emergency Medicine

Professor Ian Banks, GP, European President of Men’s Health Forum

Professor Peter Fleming, Professor of Infant Health and Developmental Physiology, Consultant Paediatrician FRCP, FRCPH

Professor Anne Chamberlain, FRCP, OBE, Emeritus Prof of Rehabilitation Medicine

Professor Adam Balen MD, DSc, FRCOG, Professor of Reproductive Medicine and Surgery, Leeds Teaching Hospitals Chair of the Senior Staff Co Leeds Teaching Hospitals

Professor Finbarr C Martin MD MSc FRCP, Consultant Physician at Guys and St Thomas’ NHS Foundation Trust, Professor of Medical Gerontology, King’s College London

Professor Wendy Savage MBBCh FRCOG MSc (Public Health) Hon DSc

Professor Will Irving, Professor and Honorary Consultant in Virology, Nottingham University Hospitals NHS Trust College

Professor Imti Choonara, Professor in Child Health Academic Division of Child Health (University of Nottingham), The Medical School, Derbyshire Children’s Hospital

Professor Geoff Gill, Consultant Physician Aintree University Hospital, Liverpool

Professor Neil Pride, MD, FRCP (London), Emeritus Professor of Respiratory Medicine, Imperial College, London

Prof Allyson M Pollock, Prof of public health policy and research , Centre for Primary care and Public Health, Queen May, University of London

Professor Michel Coleman, Professor of Epidemiology and Vital Statistics, Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine

Prof Derek A Gould  FRCP FRCR Consultant Radiologist Royal Liverpool University NHS Trust

Dr Robert Scott-Jupp, National Council of the RCPCH

Dr Richard FitzGerald FRCR, Elected Member RCR Council, Consultant Radiologist Wolverhampton

Mr John Beynon FRCS FRCOG, recently retired Consultant Obstetrician and Gynaecologist. Lead O&G KSS Deanery, RCOG Council member

Dr Caroline McCowen, Retired Consultant Paediatrician, sometime Regional Advisor (Northern Region) to Royal College of Paediatrics and Child health, FRCPCH, FRCP

Dr Helen Venning, Consultant Paediatric Rheumatologist Nottingham Children’s Hospital, previous council member of RCPCH

Dr Alan Lee FRCPsych

Dr Andrea Franks MA BM BCh DCH FRCP, Consultant Dermatologist, Countess of Chester Hospital

Mr Barry Fairbrother, MD FRCS (Eng) Retired Consultant Surgeon

Dr Ian F. Pye MA MD FRCP (London), Consultant Neurologist, University Hospitals of Leicester NHS Trust

Dr Adrian Wills, Consultant Neurologist and Clinical Lead of Neurology SCE, RCP, London

Dr Dianne Campbell Lefevre MB ChB FRCP FRCPsych, Retired Consultant Psychiatrist and Consultant Psychiatrist on Psychotherapy

Dr Susan Huson, Consultant Clinical Geneticist, Genetic Medicine CMFT, Manchester, RCP London and Edinburgh

Dr Susan O’Halloran, Retired Consultant Paediatrician Royal College of Paediatrics and Child Health

Dr Kelsey M Jordan FRCP (London), Consultant Rheumatologist & Honorary Senior Lecturer , Brighton and Sussex University Hospitals

Dr Sebastian Kraemer, FRCP FRCPsych FRCPCH, Honorary Consultant, Tavistock Clinic and Consultant Child and Adolescent Psychiatrist, Whittington Hospital

Dr Rachel Tattersall, Consultant Rheumatologist, Sheffield, Member of RCP(London), Lecturer in Undergraduate Medicine, University Hospital, Coventry and Warwickshire NHS Trust and retired consultant physician

Dr Christopher Birt FRCP, FFPH, MRCP, DRCOG

Mrs Anna Athow, Consultant Surgeon FRCS

Dr John Puntis, Consultant Paediatrician, The General Infirmary at Leeds, FRCPH, FRCP

Dr A Baksi, Emeritus Consultant Physician, The Arun Baksi Diabetes Center, Isle of Wight NHS Primary Care Trust, St Mary’s Hospital, Newport, Isle of Wight

Dr Jane Flint MD FRCP (RCP London), Consultant Cardiologist

Dr Judith Williams MD FRCP FRCPCH, Consultant Paediatrician, Royal College of Paediatrics and Child Health

Dr Mark Aitken – FRCP(London) – Governor, Colchester General Hospital

Dr Pat Munday FRCOG, FRCP(Ed), Consultant Genitourinary physician

Dr Paul Revell, Consultant Haematologist, Stafford Hospital, RCP (London), RCPath and RCPCH

Dr Charlotte Abson, Consultant Clinical Oncologist, Maidstone Hospital, MRCP FRCR

Dr Richard Wenstone MBChB, FRCA, FFICM, Consultant in Intensive Care, Royal Liverpool University Hospital

Dr Trevor Turner, Consultant Psychiatrist in the East London Foundation Trust, and a FRCPysch

Dr Nicholas Hopkinson, MA FRCP PhD, Senior Lecturer and Honorary Consultant Chest Physician, National Heart and Lung Institute, Royal Brompton Hospital

Dr Cathy White, Consultant Paediatric Neurologist, RCPCH, FRCP

Dr Tim Jaspan, Consultant Neuroradiologist, University Hospital, Nottingham FRCR, FRCP

Dr Vanessa Venning DM FRCP, Consultant Dermatologist, Oxford Radcliffe Hospitals NHS Trust

Dr Marta Buszewicz, GP North London, Senior Lecturer in Primary Care, and Co-Director Central and East London CLRN

Dr Jonathan Tomlinson, GP, London

Mr Roger Hole FRCSEng, Retired Consultant Surgeon, James Cook University Hospital Middlesbrough

Dr Raymond Brown, Consultant Paediatrician, FRCP and FRCPCH

Dr Nigel Speight, Durham and a Fellow of the RCPCH

Dr David Wrigley, GP, member of BMA Council and GPC

Dr David Cundall, Locum Consultant Community Paediatrician, Leeds, RCPCH

Dr David Hawkins FRCP, Consultant Physician, Chelsea and Westminster Hospital London

Dr Katherine Teale, FRCA Consultant Anaesthetist Salford

Dr Robert Robinson FRCP, Consultant Physician, Chesterfield Royal Hospital NHS Foundation Trust

Dr Roger A Fisken, FRCP (London), Retired Consultant Physician

Miss Audrey M. Platt Consultant  (Retired) RCOG

Dr Nina Essex FRCP (Lond)

Dr Stephen Olczak, Consultant Physician RCP London, Tony Waterston, FRCPCH

Dr Tony Waterston, Fellow of RCPCH

Dr Julia Nelki, Consultant, FRCPsych

Dr Jane Dickinson, FRCP, FRCOphth, consultant ophthalmologist Royal Victoria Infirmary Newcastle

Dr Alex Scott-Samuel FFPH, Senior Clinical Lecturer in Public Health, Department of Public Health and Policy, University of Liverpool

Dr Barrie Woodcock FRCP, FRCPath

Dr Jennie Earswood, FRCPsych

Dr RS Delamont, Consultant Neurologist, RCP (London)

Dr Alison Jane Dickinson, FRCS FRCOphth, consultant ophthalmologist

Dr Brian B Scott MD FRCP (London), consultant gastroenterologist, Lincoln

Dr Norman Traub, consultant haematologist, Southend Hospital, FRCPath

Dr Gill Turner Consultant Paediatrician West Northumberland, FRCPCH

Dr Hilary Klonin, Consultant Paediatric Intensivist, FRCA

Dr Robert Boon, Consultant Paediatrician and College Tutor, Royal College of Paediatrics

Dr Frank Hargreaves, GP, Mrcgp

Dr Philip W Ind Consultant Physician, Hon Senior Lecturer NHLI at Hammersmith hospital Imperial College Healthcare Trust

Dr Deborah Colvin GP Partner, The Lawson Practice

Dr Robert Higgo, Consultant Psychiatrist, F.R.C.Psych

Dr Paul Goulden, Consultant Anaesthetist. Dewsbury (RCoA)

Dr Brian Silk

Dr Richard Grunewald Consultant Neurologist Sheffield Teaching Hospitals NHS Foundation Trust, FRCP London

Dr. J.A.( Sandy) Robertson. F.R.C.Psych

Dr Tony  Roques, FRCP, FRCPath, Retired Consulant Haematologist

Dr David Bramble, Consultant Child & Adolescent Psychiatrist, Shropshire Community Health NHS Trust,  Member of the Royal College of Psychiatrists

Dr Ron Singer, President of the Medical Practitioners’ Union-Unite,  retired GP

Dr Jacqui Ferguson, Retired Psychiatrist, FRCsych

Dr David Lewis MRCGP Vauxhall Primary Health Care, Vauxhall Health Centre

Dr Colin Godber FRCP and RCPsych

Dr Lucy Pollock, Consultant geriatrician, Musgrove Park Hospital FRCP (London)

Dr Karen Leyden, Consultant Anaesthetist at Northampton General Hospital, FRCA

Dr Alexandra Moore Consultant Psychiatrist FRCPsych

Dr Fiona Sanders, GP Partner Heron Practice, John Scott Health Centre

Dr Gerard Reissman MRCGP

Dr David B Paintin  FRCOG  Hon FFSRH Emeritus Reader in Obstetrics & Gynaecology Imperial College School of Medicine at St Mary’s

Dr Lyvia Dabydeen Consultant Paediatric Neurologist, Leicester; RCPCH

Dr Ann Capewell MB., BS., FRCPE, FRCP, Consultant Physician, Medicine for Older People

Dr Clare Donnellan Consultant Gastroenterologist RCP London

Dr AJP Lewington BSc MEd MD FRCP Consultant Renal Physician/Honorary Senior Lecturer Clinical Sub-Dean LTH St James’s University Hospital Department of Renal Medicine

Dr Damian Tolan FRCR Consultant radiologist, Leeds teaching hospitals NHS Trust

Dr Fiona Roberts, Consultant Clinical Oncologist, St James’s Hospital Leeds FRCR

Dr James M McLenachan, Consultant Cardiologist, Leeds General infirmary FRCP (Glasgow), FRCP (London)

Dr Mark Wood Consultant Paediatric Rheumatologist Leeds General Infirmary

Dr John P Watson FRCP (London) Consultant Physician in Respiratory Medicine Leeds Teaching Hospitals NHS Trust

Dr Paul Plant Consultant Chest Physician Chair of Yorkshire Cancer Network Thoracic NSSG

Dr Sheila M Clark, Consultant Dermatologist FRCP (Lond)

Dr R.L.Symonds FRCPsych (Royal College of Psychiatrists)

Mr EPL Turton Consultant breast surgeon Leeds Gen Inf RCS (Edinburgh)

Dr Patrick McHugh Consultant Anaesthetist, Leeds teaching Hospitals NHS Trust FRCA

Dr Klaus Witte MD, MRCP, FESC, FACC Senior Lecturer and Honorary Consultant Cardiologist University of Leeds and Leeds General Infirmary

Dr Jonathan Dare MB FRCP FRCPsych Emeritus Consultant Child and Adolescent Psychiatrist Maudsley Hospital

Miss Delia Parnham-Cope, consultant in Emergency Medicine

Mr Nigel Simpson MRCOG Consultant O&G, Leeds Teaching Hospitals Trust

Dr Graham Woodrow, Consultant Renal Medicine, St James’s University Hospital, Leeds and FRCP (London)

Mr John Buxton, Consultant Gynaecological Oncologist and Gynaecologist, Leeds Teaching Hospitals NHS Trust

Mr Bryan Rhodes FRCS, Consultant T&O Surgeon

Dr Agam Jung, Consultant Neurologist RCP London

Dr R G Jones, Consultant Chemical Pathologist, Leeds Teaching Hospitals NHS Trust FRCPath

Dr Philip Holland, Consultant paediatrician, Leeds Teaching Hospitals Trust, Royal College of Paediatrics and Child Health

Dr Catherine Hopkins, GP principal and member of RCGP

Dr Kevin N Franks MRCP FRCR, Consultant in Clinical Oncology, St James’s Institute of Oncology Leeds Teaching Hospitals NHS Trust

Dr John Robson GP, E London and Reader QMUL

Dr Angus Dobbie FRCP, Consultant Clinical Geneticist, Yorkshire Regional Genetics Service

Dr Tony Hale FRCP, Consultant Virologist, Leeds Teaching Hospitals

Dr Michael Snee FRCP FRCR, Consultant Clinical Oncologist, St James’s Institute of Oncology, Leeds Teaching Hospitals NHS Trust

Dr Heather Gorton, FRCA, Consultant Anaesthetist, Leeds

Dr David Thompson FRCP (Lond), Consultant Physician, St James’ Hospital, Leeds

Dr David Nugent, Consultant Gynaecological Oncologist, RCOG, St James’ Hospital, Leeds

Dr Mary Edmonson, GP Jubilee Practice, Tower Hamlets

Dr Sabah Alvi MRCP UK FRCPCH, Consultant Paediatric and Adolescent Endocrinologist, LGI

Dr Dan Agranoff PhD FRCP DTM&H, Hon Senior Lecturer in Infectious Diseases, Imperial College London, Brighton and Sussex University

Dr Saad Abdalla, FRCPath, Consultant Haematologist, Imperial College, London

Dr Murray Wheeler RCPCH, Consultant Paediatric Intensivist, Leeds General Infirmary

Dr David Alexander Russell RCS Edin Consultant Vascular Surgeon, Leeds General Infirmary

Dr Beki James FRCPath, Consultant Paediatric Haematologist, Leeds Children’s Hospital

Dr Fiona Duxbury DRCOG DCH MRCGP, Leys Health Centre, Oxford

Dr Clare Rowan Wilson FRCA, Consultant Anaesthetist, Leeds Teaching Hospitals

Dr Rajiv Chandy, Consultant Gastroenterologist, St Helens and Knowsley

Mr Vernon Long FRCOpth, Consultant Opthalmologist, St James University Hospital, Leeds

Dr Robert LC Cumming MD FRCP Ed FRCP, Retired Consultant Haematologist Glasgow

Dr Jane Sellors, FRCA, Consultant Anaesthetist, Leeds Teaching Hospitals

Dr Andrew Cummin FRCP, Consultant Physician, Charing Cross Hospital

Dr PL Zentler-Munro MA MD FRCP(Edin) Consultant Physician, Raigmore Hospital, Inverness

Dr Geoffrey Lewis, MA MD FRCA, DHMSA , Consultant Anaesthetist Emeritus University Hospitals of Leicester

Dr Georgina Gerard FRCP FRCR, Consultant Clinical Oncologist St James’s Institute of Oncology Leeds Teaching Hospitals NHS Trust

Dr Mike Bosomworth, Head of Blood Sciences, Consultant Clinical Scientist, Leeds Teaching Hospitals

Dr Anna Livingstone GP

Dr Helen Groom GP

Dr Kambeez Boomla, GP, London

Dr Roshan Agarwal MRCP PhD, Senior Lecturer/Consultant Medical Oncologist, Department of Oncology, Hammersmith Hospital, Imperial College London

Dr Catherine Pensrose MRCPCH, Consultant Paediatric Intensivist, Leeds General Infirmary

Dr Veena Zamvar, Locum Consultant Paediatrician, RCPCH, Leeds Teaching Hospitals

Dr Elizabeth Stoppard, Consultant in Rehabilitation Medicine, London

Mr Roger Franks FRCS, Consultant Cardiothoracic Surgeon, Alder Hey Children’s Hospital

Dr Bruce Duncan FRCA, Consultant Anaesthetics and ICU, St James University Hospital, Leeds

Dr George Ballard, RCP London Consultant Cardiologist, Leeds General Infirmary

Dr Catherine Harrison, Consultant in Neonatal Medicine, Transport Lead Yorkshire Neonatal Network, Leeds General Infirmary

Miss Janet Porter FRCS FCEM, Senior Lecturer in Clinical Skills and retired Accident and Emergency Consultant

Dr Duncan Johnson FRCA, Anaesthetic Consultant , Leeds General Infirmary

Dr Charles Clarke GP, London

Dr John Tomkinson Consultant Psychiatrist, Specialty Tutor in Psychotherapy, Royal College of Psychiatrists

Dr Richard Hutson, Leeds Teaching Hospitals

Dr John Main FRCP London, FRCP Edinburgh, James Cook University Hospital, Middlesbrough

Dr Jonathan Darling FRCPCH, Senior Lecturer and Honorary Consultant in Paediatrics and Child Health, Academic Unit of Paediatrics and Obstetrics and Gynaecology, Leeds Institute of Medical Education, Leeds General Infirmary

Mr Paul Harwood MB ChB, MSc (Dist) FRCS (Tr & Orth), Consultant Trauma and Orthopaedics, Leeds General Infirmary

Dr David Bareford FRCPath FRCP, Consultant Haematologist, Dept Haematology, Russells Hall Hospital

Dr Dawn Alison, Consultant in Medical Oncology and Palliative Medicine, Leeds Teaching Hospitals Trust

Dr Gerry Davies MB MRCP DTM&H PhD, Senior Lecturer in Infectious Diseases, Honorary Consultant Physician School of Clinical Sciences University of Liverpool

Dr Chris Burns-Cox

Dr Geoffrey Nunn, Consultant Neuroanaesthetist, General Infirmary at Leeds

Dr Ranjana Dwarkanath, Consultant Radiologist , COCH, Chester

Dr Clodagh M King, Consultant Dermatologist

Dr Nirmal Rajadurai, Consultant Anaesthetist, Countess of Chester Hospital

Mr Robert Dunsmuir, Consultant Orthopaedic Surgeon, Leeds General Infirmary

Dr Sabine Sommer Consultant Dermatologist, London

Dr Lynda Bobrow FRCPath, retired Histopathologist

Mr John Russell, Lead Clinician, Maxillofacial services, Leeds Teaching Hospitals

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