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Contracts: share your viewsBY STEPHANIE JONES-BERRY

Doctors affected by contract nego-tiations are being urged to getinvolved to help progress formaltalks between the BMA and NHSEmployers.

The BMA has written to the relevant doctors and medical stu-dents across the UK, encouragingthem to join the debates.

In their letter to consultants inEngland and Northern Ireland,BMA UK consultants and NorthernIreland committee chairs PaulFlynn and John Woods stress: ‘It is essential that your views helpguide us through the difficult trade-offs that we face ahead.’

They tell doctors: ‘Your viewshave already had a major impact’,adding that in the build up to thenegotiations, more than 4,000 doctors made their opinions known.

They urge doctors to have theirsay in the association’s new onlinediscussion area BMA Communitiesand at special events taking placein England and Northern Ireland,promising that those who do willdirectly influence the ongoing talks.

The consultant negotiations havemainly focused on the facilitationof seven-day services and, to alesser extent, pay progression.

Other issues such as SPA (supporting professional activities)time and clinical excellence awardshave yet to be discussed in detail.

Dr Flynn says: ‘The BMA iscommitted to ensuring patientsreceive the same high quality ofcare — though not necessarily thesame range of services — acrossthe entire week.

‘Achieving common qualitystandards for all acutely ill patientsis now likely to require changesover time to working patterns,including the increased presence ofsenior clinical staff in the eveningand at the weekend, as well as thesupporting resources we need todeliver that care.’

He insists this should not meana greater workload for individuals,adding that many consultantsalready work beyond their con-tracted hours and that a healthywork-life balance was needed for

the sake of the patients.‘An essential aspect of any future

deal would be agreement of fairrates of pay for consultants whowork unsocial hours,’ he adds.

‘We are working with NHSEmployers to model the impact ofincreased consultant presence onthe consultant pay bill to feed intothe wider contract negotiations.’

The government is committed toending automatic pay progressionacross the whole public sector. The BMA is considering a numberof alternatives, but is clear theremust be fair ways of linking pay toresponsibilities and performance inany revised system.

On SPA time, NHS Employers isin agreement with the BMA on thesignificance of educational, training,

research and innovation activities.The association is also seeking to end pressure from individualemployers to reduce SPAs.

The BMA has urged the Scottishgovernment to consider applicationsto open pharmacies in rural areascarefully.

In its response to a Scottish gov-ernment consultation on pharmacyapplications, BMA Scotland sayschanges to control-of-entry arrange-ments must protect the communitiesserved by dispensing practices.

BMA Scotland supports a sug-gested ‘prejudice test’, which wouldlimit applications from pharmaciesin areas where their presence wouldhave a negative affect on servicesprovided by dispensing practices.

BMA Scottish GPs committeechair Alan McDevitt said the abilityto run dispensing services helpedremote areas retain and attract GPs.

Caution urgedover pharmacies

Saturday March 1, 2014 The voice of doctors

New BMA Scottish secretary

Jill Vickerman looks forward

to some interesting times

ahead PAGE 5

Ethics: find out about our

latest guidance on FGM and

decision-making in a military

context PAGE 2

WHAT’S INSIDE

WHAT’S ONLINE

We have a selection of

your favourite

medical mnemonics

PAGE 6

Contract events: Find an

innovative event near you

and have your say on

contract negotiations

bma.org.uk/doctorsworth

GORY YARNS: Knitted dropsof blood are appearing in public places toencourage people tobecome donors.

The ‘yarnbombing’, orguerrilla knitting, exercisehas been organised by the NHS Blood andTransplant service to appeal to young people,who make up just 15 percent of active blood donors in the UK.

The drops will appear on trees to highlight the fact that ‘blood doesn’tgrow on trees … someone,somewhere must donate it before it can be used to save lives’.� Register as a donor atwww.blood.co.uk/trees

Junior doctors leaders are concerned that thenegotiations could be used to squeeze salaries.

BMA junior doctors committee co-chairs AndrewCollier and Kitty Mohan have written to UK juniorsto assure them that, as a precondition for enteringnegotiations, it was agreed in the heads of termsdocument that the total pay available to the juniorworkforce should not decrease.

‘We have also agreed that additional fundingwill be allocated to cover any increased employercontributions into your pension,’ they add.

‘Now we have agreed how much money will beavailable, we have moved on to consider exactly

what pay will look like in the new contract.‘Banding payments can cause wild fluctuations

in salaries as juniors move from placement toplacement, so we are determined to ensure thatany new system makes it easier for juniors to plantheir finances.’

The other key issue on which views are beingsought is safe working hours. ‘Hundred-hourweeks are a thing of the past for most junior doctors, but some of you still work punishingrotas,’ write the co-chairs. ‘We are looking at waysthat juniors can have more advance notice of theirduties and the training opportunities in each post.’

� Join the conversation at communities.bma.org.uk. Lookfor the My working life section,where you will find discussionson: what should determine pay progression if not time served; the fairness of clinical excellenceawards; and seven-day services� Attend one of five eventsacross England and Northern Ireland to discuss your views with other doctors. Sign up atbma.org.uk/doctorsworth

Play your part

Protecting pay and revamping rotas for juniors

2 BMA N ews Saturday March 1, 2014


The BMA has welcomed plans todelay extended patient data sharingin light of doctors’ concerns about alack of public awareness.

NHS England last weekannounced it was postponing theextraction of data from the medicalrecords of general practice patientsfor six months.

The decision follows talksbetween the BMA and NHS England over GPs’ concerns that their patients were unaware of the implications of the care.datascheme, which was due to be

implemented in April.The BMA supports the use

of anonymised data to improvehealthcare services but fears hadbeen growing about the publicawareness levels.

Doctors said the decision to delayimplementation would benefitpatients and GPs by allowing NHSEngland more time to demonstratethe benefits of the scheme, includingsafeguards to protect anonymity andthe right to opt out entirely.

BMA GPs committee chairChaand Nagpaul said: ‘We are

pleased that the decision has beentaken to delay the roll out of extrac-tions to care.data until the autumn.

‘It was clear from GPs on theground that patients remained inadequately informed about theimplications of care.data.’

NHS England national directorfor patients and information TimKelsey said: ‘We have been told veryclearly that patients need more timeto learn about the benefits of sharinginformation and their right to objectto their information being shared.’ � See bma.org.uk/confidentiality

BMA reassured healthsafe in free-trade talksBY STEPHANIE JONES-BERRY

The BMA has been given furtherassurances that a free-trade agreement between the EU and the USA will not affect healthcarein the UK.

Talks to develop the TTIP(transatlantic trade and investmentpartnership) started last July, with a fourth round of negotiations scheduled for next month.

Letters to the BMA from the European Commission’sdirector general for trade and UKminister for trade and investmentrespond to its concerns abouthealthcare being opened up togreater market forces.

BMA lobbying has already wonassurances from key UK and EUplayers that healthcare provisionwould not be part of the talks.

BMA EU policy manager PaulLaffin said the correspondence was ‘good news’, as it reiteratedwhat the organisation has been told to date.

He said: ‘No matter what is eventually agreed for the final textof the TTIP, the European Parlia-ment can vote to reject the treaty,just as it did — overwhelmingly —with the anti-counterfeiting tradeagreement, back in 2012.’

This month, UK trade and investment minister Lord Liv-ingston wrote to BMA council

chair Mark Porter to reassure himthat the position on health servicesin the TTIP had not changed.

He emphasises it is ‘for NHScommissioners’ to take decisionsabout which providers to contractwith and the TTIP would not affectthis policy.

In a speech on the TTIP inLondon last week, European commissioner for trade Karel DeGucht said he wanted everybody tounderstand that the TTIP ‘does notendanger the NHS in any way’.

He said trade agreements wereused to create opportunities forservice companies — not publicservices such as health. � Go to bma.org.uk/europe

Concerns prompt data share delayDoctors affected by changes at theMid Staffordshire NHS FoundationTrust can debate the proposals at aspecial meeting later this month.

BMA council chair Mark Porterwill speak at the meeting organisedby the BMA’s north and mid-Staffordshire division.

The proposals suggest dissolvingMid Staffordshire with its services

taken over by the Royal Wolver-hampton Hospitals NHS Trust andthe University Hospital of NorthStaffordshire NHS Trust.

The meeting takes place at 7pmon March 20 at the North Staffs Conference Centre, Stoke-on-Trent.� Doctors can email Linda Scalesat [email protected] to find outmore and confirm their attendance.

Special meeting for dissolved trust

GPs remain opposed to any changein the law on assisted dying, a consultation has confirmed.

The RCGP (Royal College ofGPs) consulted its members to discover whether views on the issue had changed since it lastdebated the issue in 2005. More than1,700 college members responded,with 77 per cent backing the

college’s current opposition. Of the 28 RCGP bodies, such as

local branches, which responded, 20were opposed to changing the law.

Doctors believed a change wouldbe detrimental to the doctor-patientrelationship and put vulnerablegroups at risk.

The BMA is opposed tochanging the law on assisted dying.

GPs oppose assisted dying law change

A group set up to help female medical students and doctorsprogress in their careers has beenwelcomed by student leaders.

Sheffield Women in Medicineaims to inspire, nurture and supportwomen at all stages of their medicalcareers across the Sheffield area.

Founding member AlenkaBrooks, an SpR in gastroenterologyat Sheffield Teaching HospitalsNHS Foundation Trust, said therewas a national need to understandthe organisational and economicimplications of increasing numbersof women in the medical profession.

‘There remains a significantunder-representation of women in

senior leadership roles, academicpositions and some medical and surgical specialties within the NHSand university systems,’ she said.

BMA medical students com-mittee Sheffield representativeKirsty Ward said: ‘Peer support and mentoring can help womenfulfil their potential and are important for counteracting theirunder-representation at the top of the medical profession.’

The BMA launched a drive lastmonth to encourage more womeninto leadership in the organisation.� To read more about the BMA’swork go to bma.org.uk/bmawomen� See www.womeninmedicine.co.uk

Students welcome boost for women

‘Doctors have a

crucial role in

asking the right

questions to help

identify girls at

risk of FGM’

QThe government has announced measures to combat FGM (female

genital mutilation). What role do you thinkdoctors play?

AThe government said progress in tacklingthis issue would not have been possible

without frontline professionals’ commitment. Doctors have a crucial role in asking the

right questions to help identify girls at risk,and supporting those living with the resultantpsychological and physical health problems.

It is vital that doctors address this issue intheir clinical practice. I would urge them toread the BMA’s guidance (bma.org.uk/ethics).

Doctors can seek advice and support ifthey think a child is at risk of FGM from theNSPCC’s FGM helpline 0800 028 3550.

QThe BMA launched a toolkit for armedforces doctors just over a year ago. How

has this been used by doctors?

AThe toolkit was developed after a case inwhich military medical personnel were

drawn into unprofessional practice. We havehad requests for the toolkit from manydoctors and health professionals working inthe armed forces, in the UK and overseas. Ithas set an international benchmark for goodpractice. See bma.org.uk/ethics

QThe BMA has been pressing to ensurepatients are informed about the care.data

system. What other involvement has the BMAhad in these plans?

AThe Health and Social Care Act 2012creates a statutory obligation for the

Health and Social Care Information Centre torequire data from providers, including GPs.The first use of the new legal powers iscare.data, the aim of which is to useinformation to inform commissioningdecisions and improve health services.

The BMA supports use of anonymised orpseudonymised data to improve patient carebut is clear this must not undermine trust in theconfidentiality of the health service.

The BMA lobbied for improvements to theoriginal proposals and negotiated the right forpatients to object to confidential data leavingthe GP practice for care.data. Our negotiationshave resulted in commissioners having accessonly to pseudonymised or anonymised data.

QIs the committee working on any newpublications?

AAs part of the BMA’s work in upholdingand promoting health-related human

rights, we are producing a report on thehealth and human rights of children andyoung people in detention in the UK.

The report has two main aims: supportinghealthcare professionals in protecting andpromoting the health-related rights of thesechildren and young people, and highlightingaspects of the secure environment that aredetrimental to health and, to this end, makingrecommendations for change to commissioners,youth justice agencies and policy-makers. Weaim to publish the report this summer.

BMA Q&AB M A M E D I C A L E T H I C S C O M M I T T E E C H A I R T O N Y C A L L A N D

OPINION

Saturday March 1, 2014 BMA News 3


Doctors press for moresay in European policyBY GRAHAM CLEWS

Doctors should play a greater rolein developing policies that affect thehealth of all Europeans, the BMA’sEuropean election manifesto insists.

The association has set out its priorities for a healthier Europe afterMay’s European Parliament elections: MEPs should worktowards a safer, healthier Europebecause of the importance ofimproving health; doctors’ expertiseand professionalism must play agreater role in policy development;and all new EU legislative proposalsmust be evidence-based and accompanied by a full health impactassessment.

In its manifesto, the BMA outlines its support for healthcaresystems remaining the preserve ofindividual EU member states.

But it says that Europe-widepolitical decisions affect the healthof people across the continent.

BMA council chair Mark Porter

said: ‘Whatever your view on theongoing political debate over theUK’s relationship with Europe wecannot ignore the fact that the EUplays a vital role in setting publichealth policy. And while the BMAbelieves that healthcare shouldremain the primary responsibility ofeach member state, UK MEPs havea responsibility to secure a healthierEurope for their constituents.

‘Our manifesto sets out the vitalpolicy areas MEPs must engagewith over the next five years if weare to make a real difference to thehealth of all EU members.’

The BMA manifesto calls for this to be done in three key ways: championing a professional work-force, securing patients’ rights andsafety, and improving public health.

On championing a professionalworkforce, the BMA rejects anydilution of the European WorkingTime Directive on the grounds thatthis health and safety legislation isvital for patients and doctors.

The BMA would also like to seea set of EU-wide principles to ensure the fair recruitment of health professionals to protect vulnerablehealthcare systems.

On patients’ rights and safety, theBMA insists that the proposedtransatlantic trade and investmentpartnership between Europe and theUSA must not favour corporateinterests over patients’ rights.

On public health, the associationcalls for: � New measures to lower alcohol

consumption across the EU,rather than only tackling problemdrinkers

� EU recognition that the benefitsof minimum pricing for alcoholoutweigh reductions in brewers’profits

� A ‘rational debate’ about illegaldrug use and options for change

� Regulation of the use of antimicrobials.

� Read the European election manifesto at bma.org.uk/lobbying

GP locum appraisers and salariedGPs are to benefit from improvedpension arrangements followingBMA lobbying.

The changes mean that theincome GP locums earn by conducting appraisals can counttowards their pensions.

Until now, this was only the case for salaried and partner GPsappraising other doctors.

The NHSPA (NHS PensionsAuthority) last month released guidance stating that freelance

GPs can now do the same.The move followed continued

lobbying of NHS England by theGPC sessional GPs subcommittee.

GPC sessional GPs subcom-mittee chair Vicky Weeks said: ‘Thechange to locum appraisers’ pensionable income is very welcomenews for locums. The BMA has been helping to bring about this change.

‘It rectifies the nonsensical situation in which locums were discriminated against by reason

of their contractual status when all other appraisers were able topension their income.’

The NHSPA has also announcedchanges that mean all the practiceincome of salaried GPs will be pensionable.

Practice-based overtime was notpensionable for salaried GPs, whichmeant if they worked a Saturdaymorning, for example, the incomewas not pensionable.� Find out more about pensionsrights at bma.org.uk/pensions

BMA lobbying wins pensions boost for locum GPs

A crisis is a time of intense difficulty ordanger, according to the Oxford EnglishDictionary, so it seems reasonable toconclude there is one in Northern Ireland’s emergency medicine service.

A shortage of doctors has resulted inthe closure of a number of emergency

departments and restricted opening hours at others.BMA Northern Ireland has repeatedly warned of the dangers of

staff shortages and called for action. In January, the Belfast Health andSocial Care Trust declared a major incident at the Royal Victoria Hospital’s emergency department as staff struggled to cope with thenumber of people needing treatment. Patients on the night in questiondescribed chaos, with nurses reduced to tears.

It has since emerged that senior doctors at the hospital had repeatedly informed trust management that conditions in the department meant they could not always guarantee patient safety.

A report by the College of Emergency Medicine last year warned there were not enough consultants working in any of NorthernIreland’s emergency departments, including the Royal.

Early findings of a review carried out by the healthcare watchdogthe Regulation, Quality and Improvement Authority after the majorincident were even more damning. Inspectors found, at times, that notenough medics were available to treat patients properly.

About 100 staff who were interviewed raised concerns aboutstaffing levels, bullying, intolerable pressure and a dysfunctionalhealthcare system. Most recently, health bosses admitted waiting timesin the unit may have played a part in the deaths of five patients.

Certainly, the evidence of a crisis is stacking up. So, why are healthofficials so scared of using the term? They have accused the media of whipping up concern and refused to acknowledge the Royal’s emergency department is unsafe at times.

Speaking at Stormont, health, social services and public safetyminister Edwin Poots said: ‘We should stop damning our emergencydepartments because they respond very, very well to people and theyprovide excellent care to people.’

Appearing in front of the health, social services and public safetycommittee, he said Northern Ireland hospitals were ‘performingsafely’ and denied there was a crisis.

No one is saying emergency department staff are not doing a goodjob. In fact, it is clear they are working above and beyond in awfulconditions. BMA Northern Ireland has said doctors are being left frustrated that they cannot provide the level of service they would like.

It is hardly surprising that trusts cannot recruit and retain enoughdoctors to work in Northern Ireland’s emergency departments.

This is not a problem unique to Northern Ireland but it is compro-mising patient safety and creating intolerable working conditions.

Despite everything, including the possibility that waiting times in Northern Ireland’s regional trauma unit could have contributed tothe deaths of five patients, officials appear unwilling to acknowledgethe extent of the problem.Lisa Smyth

‘Patients on the night in question described

chaos, with nurses reduced to tears’

OFF THE RECORD N O R T H E R N I R E L A N D

OPINION

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BMA News is published by the British Medical Association. The views expressed in it are notnecessarily those of the BMA. It is available on subscription at £112 (UK), €151 (Eurozone),$218 (USA) per year from the subscriptions department. All rights reserved. Except as permittedunder current legislation, no part of this work may be photocopied, stored in a retrieval systemor transmitted in any form or by any means, electronic, mechanical or otherwise, without thewritten permission of the editor. Printed by Polestar (Chantry) Limited. All advertisements inBMA News are subject to the standard conditions of acceptance of advertisement ordersprinted on the rate card. A copy may be obtained from the publishers on written request.

OUT ON A LIMB: A charity is hoping to raise £5,500 by Monday to fund the delivery of 200 redundantprosthetic limbs to The Gambia.

Legs 4 Africa estimates more than 2,000 limbs are disposed of eachyear in the UK as people grow,upgrade or replace their prosthetics.

They cannot be reused in the UK but the charity is working withthe Royal Victoria Teaching Hospitalin The Gambia to recondition,customise and distribute the limbs to new owners.

The charity is keen to hear fromdoctors who work with amputeeswho can donate used limbs.

See more at legs4africa.org� Donations can be made atcrowdfunder.co.uk/legittoafrica

LEG

S 4

AFR

ICA



FRONTLINE MEDICINE

Charles Lamb is a pseudonym

I don’t know about you, but I’m a bit fed up with political dithering over minimumpricing for alcohol. It seems our leaders aren’t convinced about the harm cheap boozedoes, although half an hour spent observingany town centre on a Friday or Saturday nightwould dispel any doubt, and it would take evenless than that in any emergency department.

Maybe our leaders are concerned that fixinga price of 45p will push sensible drinkers intothe arms of the opposition so close to their elec-toral departure.

Or perhaps they’re worried about a loss oftax revenue, while ignoring the cost to theiremergency services of patching people up.

Behind our politicians, the real decision-makers are doubtless at work.

The financial equation has by now been the subject of complex mathematical modellingabout death rates, pension uptake and NHScosts, and perhaps the Whitehall fixers have calculated that it’s cheaper to let a few alcoholics die young than to keep their

livers going until retirement age. Or could it be that some policy-makers are a

little too close to the drinks industry and don’treally rate health promotion anyway, preferringthe drinks industry’s own lurid cocktail of self-regulation at the front door and ‘pile ’emhigh, sell ’em cheap’ at the back.

Somewhere in this mix there is actuallysome science, or as we now call it ‘evidencebase’. But that has been conveniently brushedaside. Our leaders may have temporarily forgotten about health and hospital crises intheir rush to stand in a flooded village for aphoto opportunity in new wellies, lookingserious, sympathetic and just a little wet.

Possibly the evidence base on climatechange hasn’t had the desired effect either. Sorather than doing something useful, we are tohave a new policy to keep lager cheap enoughfor everyone to buy with their paper-roundpocket money. Currently, one can buy lager at14p/100 mls, cider at 17p and vodka at £1.40from my local supermarket, where ‘every little

(bit of profit) helps (our share price)’. Unfortunately, this won’t change at all in

April when a minimum alcohol floor price is implemented, so it won’t be necessary to spendthe next month stockpiling, unless you weregoing to anyway.

And, reassuringly, come April the ambulances will still roll into the emergencydepartment with blood and vomit dribblingfrom under the doors. There will still be unconscious teenagers with theirclothes rearranged or missing, to bestretchered in for some R&R. Resuscita-tion and rehydration, that is.

There will still be opportunities forsome badly needed practice by theunder-utilised junior whose life in emer-gency medicine is so bereft of excitementthat one can find them sitting around the staffroom drinking coffee while watching the latestcelebrity ‘come dancing’ or ‘go swimming’contest to occupy them on a Saturday night. Charles Lamb is a consultant in emergency medicine

‘Come April,

the ambulances

will still roll into

the emergency

department with

blood and vomit

dribbling from

under their doors’

TA L E S F R O M T H E E M E R G E N C Y D E PA R T M E N T

OPINION

The BMA has issued guidance onhow having a ‘named GP’ will workfor patients aged 75 and above.

The change was agreed as part ofthe 2014/15 contract negotiationsbetween the BMA GPs committeeand NHS Employers and whichcome into effect in April.

Under the changes, all practiceswill need to ensure that each patientaged 75 and over has a named,accountable GP.

The named GP’s responsibilitieswill include ensuring the physicaland psychological needs of the patient are met and, where appropriate, working with otherhealth and social care professionalsto deliver a multidisciplinary care package.

The GPC says this role shouldnot prove particularly onerous andis in line with what many practicesare already offering.

‘This is largely a role of oversight,with the requirements being intro-duced to reassure patients over 75that they have one GP within thepractice who is responsible forensuring that this work is carried outon their behalf,’ the guidance says.

Named GPs will not have 24-hour responsibility for these patients.� Read the BMA guidance atbma.org.uk/gpcontract and look forthe FAQs section

Early registration mayharm medical educationBY GRAHAM CLEWS

Plans to register doctors on graduation could threaten patientsafety and harm UK medical education, the BMA warns.

In a submission to HEE (HealthEducation England), the BMA medical students and junior doctorscommittees say the proposals, which would include a new selection process for the foundation programme, would have no effecton tackling foundation programmeoversubscription.

Under the proposals, UK med-ical graduates would be registeredwith the GMC on graduation but would need to score well in anew selection test to be given foundation posts.

The BMA argues that the proposals are more likely to resultin an increased number of UK med-ical graduates being unable tosecure training posts because more applicants from Europe would beeligible for jobs.

The association warns that medical school curricula wouldhave to change to ensure studentsare ready for registration on graduation, meaning important ele-ments of a doctor’s education mayhave to move to post-graduation.

BMA medical students com-mittee co-chair Harrison Cartersaid: ‘These proposals don’taddress the central workforce question they were intended toaddress — oversubscription to thefoundation programme — and they

could create a number of problemsfor patient safety, standards of medical education and the UKmedical workforce.’

The HEE also suggests thatremoving the current year of pre-registration employment wouldaddress reported patient safety concerns.

However, the BMA says: ‘If thereis a patient safety concern about thepre-registration year, we do not seehow it can be resolved simply bymoving the date of registration.

‘It should be resolved by greateremphasis on appropriate supervi-sion, training and support.’� Read the submission to HEE and find out how the BMA is tackling oversubscription atbma.org.uk/news

‘Named GP’ role not too onerous

Doctors who swam the EnglishChannel have raised £26,000 for theHeart Research Fund for Wales.

There were five doctors in theeight-strong Killer Whale team (pic-tured) who completed the swim last

September. Fundraising has closed.Team captain James Wrench,

a Powys GP, said: ‘We made itdespite 3ft waves, 40mph winds and “white horses” for three quartersof the crossing.’

Swimmers show heart in channel

Doctor and journalist Ben Goldacrewill be a keynote speaker at thismonth’s annual BMA public healthmedicine conference.

He will explore the role of datain healthcare, along with NHS England chief data officer GeraintLewis. London research fellow inepidemiology Dr Goldacre has been

battling ‘bad science’ including mis-leading use of data for many years.

The conference, at BMA House,London, on March 21, will alsoexamine public health’s new rolewithin local government.� Sign up at bma.org.uk/events/2014/march/conference-of-public-health-medicine

Goldacre to speak at conference

Awareness of Wales’s new opt-outorgan donation law is on theincrease, a new survey has revealed.

In a Welsh government survey of1,000 people, 59 per cent said theywere aware of the legislationcoming into effect in December2015 when adults will be expectedto opt out of the Organ Donor Register, rather than opt in.

The survey was carried out in November last year and showedan increase of two percentage points against a similar survey

carried out in June.BMA Cymru Wales has

welcomed the increase but saidmore work needed to be done tomake sure the public were fullyaware of the changes.

BMA Welsh secretary RichardLewis said: ‘It is important that further efforts are made to increasethese figures significantly as timewill quickly pass from now until theintroduction date. The momentumof the public information campaignmust be maintained.’

Public more aware of organ opt out

Saturday March 1, 2014 BMA N ews 5


As a vote on independence looms, new BMA Scottish secretary Jill Vickerman, a former civil servant, is lookingforward to meeting her former colleagues around the negotiating table. Jennifer Trueland reports

From mathsto medicsThese are interesting times for

doctors in Scotland. Yes, there’sthe not-so-small matter of theindependence referendum in

September, and its associated debates on subjects ranging from currency to EU membership.

But for the health service, and for doctorsin particular, there remain other pressingissues such as pensions, terms andconditions and, of course, the challenge ofensuring that patients receive high qualitycare as demand rises and budgets tighten.

An exciting moment, then, for a newBMA Scottish secretary to start — and JillVickerman is relishing the chance.

Before taking up her current post inDecember, Ms Vickerman was a senior civil servant with the Scottish government,latterly as policy director of the quality unit at the health and social care directorates. Shewas involved in drawing up the Scottishgovernment’s 2020 Vision for Health andSocial Care, which has quality at its heart.

‘It was a real privilege to work on thenational strategy, and now I’m lookingforward to working with doctors to translatethat into a reality,’ she says. ‘Clinical leadersare key to making it happen.’

Joining the other teamMs Vickerman doesn’t really like the termgamekeeper-turned-poacher, but it’scertainly true that in some respects she has‘changed teams’.

Although working in partnership on someissues is in doctors’ best interests, the BMAand Scottish government don’t always seeeye to eye on everything. As the negotiatorfor doctors’ terms and conditions, obviouslythere are times when the BMA won’t agreewith what the government wants to do — on pensions, for example.

But asked how she will feel if she findsherself sitting across the table from herformer colleagues, Ms Vickerman is quickto correct the wording. ‘I might be sittingaround the table with them,’ she smiles. ‘I’veworked hard to build up good relationshipswith ex-colleagues wherever they are. I thinkthey all recognise that.

‘After all, while conversations will notalways be easy, we all have the shared goal of working for a high quality, sustainableNHS. The conversations won’t always beentirely easy, but we’re looking for the best outcome for all of us.’

Ms Vickerman, who was born inEdinburgh but went to school in Glasgow,

was encouraged to think of medicine as a career. At the time, however, the lure of numbers was too great, and she ended up studying maths and statistics atEdinburgh University.

Change of direction‘I loved maths, it was my favourite subject and I did an obscene amount of exams at school. I was always thinking about it,’ she laughs, adding thateven when attending concerts she’d be using members of the audience as subjects in probability analysis.

When she was close to graduating,however, she realised that it was the peoplebehind the statistics that really grabbed her interest. ‘I always thought I’d be anactuary, but when I was offered a job as agovernment statistician I realised that wasactually what I wanted to do. So rather than follow the big money, I went into public service.’

With a mother who was a nurse, and asister who took up dentistry, it was perhapsno great surprise that Ms Vickerman foundher niche in health, after a governmentcareer which started in transport and movedthrough education and macroeconomics.

In many of these roles she worked withthe UK Treasury and other governmentdepartments, as well as the administrationsof the other devolved nations — a part of thejob that she particularly liked.

‘I always really enjoyed that aspect of the role,’ she says. ‘It’s one of the things Imissed as health became more and moredevolved. I really think that when it comes tohealth policy you really need that [cross-UK] contact because you need to have ashared understanding of how the differentnations vary — in interpretation of data onwaiting times, for example.’

Although health is largely devolved, andis diverging further regardless of whetherScotland votes for independence, there areareas of common interest, she says. Forexample, all four nations were studying the ramifications of care failings at MidStaffordshire NHS Foundation Trust which led to a public inquiry, while the NHS in England had drawn on Scotland’sexperience of patient safety when setting upthe recent review led by Don Berwick.

Although she sees an important part of her job with the BMA as making sure theScottish voice is heard at a UK level within(and beyond) the organisation, she is alsolooking for ways in which the devolved

‘Clinical leaders are key to makingthe national strategy happen’

nations can benefit from, and contribute to, the BMA as a whole. ‘I’m lookingforward to being part of BMA UK,’ she says.

Full steam aheadAlthough the polls still suggest that Scots will not choose independence comeSeptember, it’s important to consider thepotential ramifications of the referendum, she says, at an organisational, as well as apolicy level.

‘There will be a need to think verycarefully about what that means for theBMA,’ Ms Vickerman says. ‘We’ll have tolook at the various options for the associationin the event of a yes or a no vote, becausewhatever happens in the referendum, we’renot standing still; things are changing.’

A big challenge facing the BMA inScotland, and the wider organisation, isensuring doctors’ position as professionalleaders. ‘There’s a big focus on positioning

doctors so that they are having an influenceon the planning and delivery of healthservices,’ she says.

A keen golfer — at her best her handicapwas 14, although she reckons it’s currentlynearer to 20 because she hasn’t had muchtime to play recently — Ms Vickerman alsorelaxes by taking her two border terrierswalking in the Pentland Hills near her homein Midlothian.

Embo, 10, is named after a beach near Dornoch in the far north of Scotland,and Taupo, eight, after a place in NewZealand. So why these names? ‘They’re both beautiful places, and good names fordogs,’ she says.

At the moment she is concentrating on the year ahead. ‘I think we have a window of opportunity to do some new, clear and ambitious thinking about thedirection of health and care services. It’s early days, but I’m really enjoying it.’

TON

Y M

ARSH



JOIN THE CONVERSATION

Best Memory Advice

bma.org.uk/liveandlearnblogIn the Live and Learn blog weasked for your favourite medicalmnemonics.

Blog readers commented:Cranial nerves: Only over-optimistic twerps tell a fib after going very slowly home — olfactory, optic, oculomotor,trichlear, trigeminal, abducent, facial, auditory,glossopharyngeal, vagus, spinalaccessory, hypoglossal.

Jenny Gibson

I have a way to rememberReiter’s syndrome: Can’t wee,can’t see, can’t climb a tree.

However, my all-time favouriteis the one for the layers of theScalp: SkinConnective tissue AponeurosisLoose connective tissuePeriosteum.

Eleanor

Acute Emergency Headaches:STOP DAVeS MenS: Subarachnoid haemorrhageT: Temporal arteritisO: Obstruction (Chiarimalformation, 3rd V colloid cyst)

P: PhaeochromocytomaD: Dissection (of cervical/cranialvessels)A: Apoplexy (pituitary)Ve: Vascular including Venous(stroke, ICH, CVST, vasculitis)S: Subdural and EpiduralMen: Meningitis (bacterial, viral,aseptic, fungal, malignant)

J O’Dwyer

ABCs of anaesthesia, as told tome by an anaesthetist: AirwayBreathingCrossword

D McKechnie

An easy way to remember the‘Sepsis Six’ (set of earlyinterventions to reduce mortalityin sepsis) is O2 FLUID:O2 Oxygen high flowF Fluid challenge 20-30mls/kgL Lactate measurementU Urine outputI Infection screenD Drug therapy (promptantibiotics).

Vince Perkins

Reflecting as you goIn her letter ‘Reflection notnatural’ (February 15, 2014, page 6), Fiona Toolis echoes the way many people feel aboutreflection, including me.

I work as a GP but also as atrainer and appraiser. Both rolesrequire me to ‘score’ reflection.

My message is: don’t let it getin the way of learning. If youlearn something that may change

your practice, think about howthis could change the way youwork or improve care and jot afew words down.

However, if there is no reallearning in something, it is notworth the effort of reflecting.

John Sharvill MB BS MRCGP

Deal, Kent

Europeans and alcohol

bma.org.uk/thebmablogIn the BMA blog, we stressed theimportance of the EU having aneffective alcohol strategy.·

Blog readers commented:This is an excellent (if verydepressing) piece because itdoesn’t sound to me as if we’regoing to get any positive actionout of the EU at all.

Do they still sponsor a ‘winelake’ along with the buttermountain? What is certain is thatthey will always put Frenchfarmers (and big business) aheadof the patients I see with liverdisease and psychiatric problems.

Ben Jarvis

Let’s not forget the hidden costsdue to loss of sleep for thosewhose residential streets areblighted by drunkenness.

As someone living in a‘student area’, I fear for thehealth of today’s universitystudents and despair of theinaction of the council anduniversities whose complexrelationship mirrors that betweenthe central government and thealcohol industry.

Any positive action by the EUhas to be welcomed.

Peter Bowers

Communities chatIn response to the#donateandnominate campaign:We’ve been doing this as well but calling it#needleandnominate.#donateandnominate is a muchbetter name.

I hope this spreads.Anonymous

Twitter talkOn care.data:@TheBMA better theydemonstrate they can convincepeople how important it is thaninclude an opt in form.

@Snyberwiz

@TheBMA good to see theBMA getting this right. Puts the doctors in a dodgy position.

@BenGrabham

Well done @rcgp and@TheBMA upholdingkey #nhs principles ofconfidentiality, consent and trust.

@lancsgp

CONTACT USWe want to know whatyou are thinking, so get in touch and shareyour views. Write theprize comment and you could win £50 ofRandom House books.

Email: [email protected] Write to: The Editor, BMANews, BMA House,Tavistock Square, LondonWC1H 9JP.

For letters include: Yourfull name, postal address,medical qualification andmost recent membership or fellowship of any medicalroyal college.

Twitter: @TheBMA

Facebook: /TheBMA

Communities:

communities.bma.org.uk

Blogs:

bma.org.uk/thebmablogbma.org.uk/atworkblogbma.org.uk/liveandlearnblog

All comments: Please keepthem brief and to the point.They may be edited forlength and clarity.

W O R K I N G A N D S U R V I V I N G A S A J U N I O R D O C T O R

See One, Do One is a 450-word column about life as a junior doctor. If you would like to submit an article for this column, use the contact details above.Payment is made for those published.

As a GP registrar I made more than a fewmistakes, from simple data entry errors andspelling mistakes to blunders that incurred the wrath of practice managers. There are two that stand out, and they share a theme ofpatient-centredness.

The first time I upset a practice manager was when I changed a patient’s address on

the computer system, and thenreferred them. Unfortunately for

me, the move made somethingcomplicated happen with

funding, whichexercised the

practicemanager.

Fortunatelyfor thepatient, it

was a two-week-waitreferral for a

suspected melanoma that turned out to be amelanoma. I wonder if the patient’s treatmentwould have been delayed if I had instead toldthem to register with a different practice, andseek a referral from there.

He was taken off the list, but my mistake may have saved his life.

It is the kind of ‘mistake’ I hope I would makeagain — putting patient care before the needs ofadministrative correctness. In truth, I felt smug.

The second mistake, at a different practice,was partly my fault and partly the fault of a patient.

She was a young woman who had just got ajob with a small care agency, and was in need of ahepatitis C vaccine.

‘A hepatitis C vaccine? Are you sure? I didn’tthink there was such a thing,’ I questioned her asmy mind whirred. Had I missed something in thelatest edition of the BNF or countless email alertsthat I was signed up to?

‘I think so, I’m sure it was hepatitis C,’ she

didn’t look that sure. ‘I think you mean hepatitisB, don’t you?’ I asked throwing her a lifeline. Her face brightened, ‘Yes, that must be the one!’

And in my pleasure at working out what thispatient actually wanted, I forgot to check withanyone that it was OK to give a course ofhepatitis B vaccinations to a patient for work. Thenurse who gave the course didn’t question myjudgement either.

So a few weeks later my trainer took me asideand explained that my induction hadn’t beenthorough enough; he blamed himself.

For a storm had been whipped up when the practice had billed the care agency for the vaccinations, which were after all anoccupational health service.

Perhaps naively I had again put patient care ahead of administrative correctness, except this time it wasn’t life or death but a matterof money. I’m not likely to be in a rush to repeat that mistake.Samir Dawlatly is a GP in Birmingham

‘It’s the kind

of mistake I hope

I would make

again — putting

patient

care before

administrative

correctness’

OPINIONSEE ONE, DO ONE

Saturday March 1, 2014 BMA News 7


VOICEBOX

PRIZE COMMENT

Show somewartime spirit

The letter about on-call dutiesand resultant illnesses (‘Not so sweet dreams’, February 8,2014, page 6) was interesting.

In 1949, aged 22, I was ageneral medicine andneurology house physician, one of three house physiciansat the very busy NottinghamGeneral Hospital. I spent oneweek in three on call (24 hoursa day for seven days) and didthe routine ward andoutpatients work.

There was only one medicalregistrar (resident) and we triedour best not to call him atnight. Quite outrageous ofcourse but this was normal forthat time and medicine was lesscomplicated.

The experience was greatbut looking back I realise Imust have carried out bloodtransfusions (haematemeseswere very common) andlumbar punctures half asleep.

There were no divorcesbecause we were very nearly all unmarried and I think mostof us survived.

Maybe this was due to ourwartime diet and experiences.

Melvin Ross MB FRCGP

London

FELI

X B

ENN

ETT

OPINION

On BMA council elections:The 2014 @TheBMA Councilelections have 23 per cent fewercandidates than 2012 (59 vs 77).Does this reflect apathy or poorpublicity to BMA members?

@Flattliner

@TheBMA interesting. Somedefinite ‘yes’ candidates.Pleased to see some youngleaders coming through thesystem.

@sidhuGP

Too many juniors?Heidi Phillips asks in ‘Horrible histories make for anever-ending tale’ (February 1,2014, page 7) whether thesystem needs mending.

Maybe to answer her questionwe need to think the unthinkable— perhaps there are too manyjunior doctors in hospital.

If one day someone in thegovernment were to compare theincrease in the number ofdoctors with the increase in(acknowledged an ageing)population over the last 10, 20and 30 years, the comments andanswers might be interesting.

Alan Padwell MB ChB FRCPath

Rochdale, Greater Manchester

Medical slavery is rife I would like to refer to the BMJCareers editorial ‘Subconsultantposts: watching for harm’ (BMJCareers, February 15, 2014, page 1). It concludes that: ‘…

there is a need to keep awatchful eye on the situationand to continue to raiseconcerns whenever evidenceshows that subconsultant postsare harming doctors’ careers and patient care.’

I wonder whether the BMAcould have been keeping ‘awatchful eye’ on the destructionof the careers of hundreds ofdoctors employed in associatespecialist, specialty doctor, staff grade and trust fellowpositions, who for years havebeen made to work undersimilar circumstances, despitebeing fully trained and on thespecialist register like theirconsultant colleagues.

It is time to recognise thatlawful medical slavery has beengoing on for a long time whilethe dreaded subconsultant gradedoesn’t even officially exist.

Erman Melikyan MD FRCS

Southampton

The BMA staff, associate specialists and

specialty doctors committee replies:

The BMA is opposed to the creation of

subconsultant posts and recognises the

skills and experience already provided by

doctors in the SAS grades.

This senior service must be

appropriately recognised and the SASC

will continue to lobby for this at every

opportunity.

SASC are currently working with the

GMC and NHS Employers to ensure that

SAS work is recognised both in IT systems

(such as patient coding) and through

appraisal and will also provide input to

any developments coming out of the

Shape of Training Report.

It’s all anyone is asking me at the moment: whatare you going to do after this year? Having justsurvived my F1 (foundation doctor 1) year I amfaced with a sudden, potentially career definingdecision: what do I do after my F2 year?

There are some of us who are career-focusedand born to be a cardiothoracic surgeon ordermatologist, but many who aren’t.

The junior doctor training reforms knownas MMC (Modernising Medical Careers) weremeant to structure the previously unstructuredwasteland known as the SHO (senior houseofficer) years.

The SHO grade was abolished for asupposedly streamlined and

structured approach to training,moving from the two-yearfoundation programme into run-through training that wouldtake a doctor all the way toconsultant or GP level.

But the UK Foundation

Programme’s annual report reveals not all thosewho complete the foundation programme gostraight into higher training.

In 2010, 83 per cent of F2s went directly on totraining schemes, 71 per cent in 2011, dropping to 67 per cent in 2012.

So given this information and the general lack of enthusiasm among my fellow F2s (maybe Devon is just not a very enthusiasticplace), maybe this direct route into specialtytraining is not the optimum for all aspiringconsultants or GPs?

The possibilities of trust jobs, working abroador further education offer the newly qualifiedjunior doctor a broader spectrum of workingpossibilities and possibly a more attractivelifestyle at this point in their lives.

The format of life is changing. The currentgeneration does not dream of a dog, a family anda house by the age of 25 so we need a moreflexible and accepting training scheme to adapt to these changes.

So why doesn’t the medical establishmentsupport this new wave of doctors who want to expand their experiences and education to ultimately become well-rounded andaccomplished doctors?

Is it time for the emergence of an F3 doctor,who takes the time to do locum jobs or workabroad, before entering a formalised trainingscheme?

This could become an increasingly popularoption. It seems doctors do not want to bepigeonholed prematurely and if the issue is notaddressed, the UK medical system could risklosing trainees to other countries or even otherprofessions.Paul Heron is a foundation doctor 2 in Exeter� See our guide to working abroad at bma.org.uk/developing-your-career/career-progression/working-abroadFor more about broadening your horizons atbma.org.uk/developing-your-career/career-progression/broaden-your-horizons

‘Life is changing

and we need a

more flexible

training scheme

to reflect that’

Voicebox is your 450-word forum to raise issues affecting today’s doctors. Submit articles for consideration using the details in ‘contact us’ on page 6.Payment is made for those published.

Looking after you and your career 0300 123 1233 | bma.org.uk

Making the most of

your membershipCareers

‘Highly informative and gets you thinking.’‘Interactive small group sessions.’BMA members

Book online at bma.org.uk/developingyourcareer/workshops or email [email protected]

BMA Careers Skills: Workshops

Workshops around the UK

Management essentials• Monday 31 March – Birmingham• Friday 25 April – Manchester• Thursday 1 May – Nottingham• Monday 19 May – Edinburgh• Friday 23 May – Leeds• Monday 30 June – Edinburgh

More venues being added regularly.

London dates

Management essentials• Thursday 13 March 2014• Tuesday 8 April 2014

Presenting skills • Wednesday 9 April 2014

Negotiating skills • Tuesday 18 March 2014

Don’t forget!We limit the number of attendees so that you receive focused attention from an experienced medical careers consultant and BMA members save £150 on each workshop. Not only does it count towards your continued professional development but it’s also excellent value for money.

Cost: BMA members £145 + VAT non-members £295 + VAT

What to expect at a BMJ Masterclass

BMJ Masterclasses support busy doctors like you through appraisal and revalidation via a series of face-to-face educational events.

Developed by a team of clinical editors, our one and two-day courses help general practitioners, physicians and healthcare professionals earn CPD points and keep up to date with the latest evidence, new guidelines and best practice in important clinical areas to improve patient outcomes.

Crammed with take-home messages, our practical, interactive and case-based sessions are peer reviewed and remain free from sponsorship input. We invite the top clinical experts to lead sessions to ensure you’re kept up to date by only the most trusted voices of knowledge and expertise in that subject area.

Save up to £50 off the full fee with your BMA membership discount at all BMJ Masterclasses:• before early bird deadline: £195 per day• after early bird deadline: £220 per day

Not only will you earn 6 CPD credits by attending, you will also receive:• the comprehensive course handbook and materials

to take away and refer back to• dedicated Q&A time with the leading experts in

their field• complimentary six month access to BMJ Best Practice• BLS refresher course and pre and post attendance

tests from onExamination to identify your learning gaps (GP General Update only)

• certificate of attendance, two course lunch and refreshments, and ample networking opportunities

2014 spring/summer dates

GP Courses• GP General Update LONDON

Friday 14 & Saturday 15 March

• GP General Update BIRMINGHAM Monday 12 & Tuesday 13 May Early bird deadline:

Wednesday 2 April

• GP General Update NEWCASTLE Monday 9 & Tuesday 10 June Early bird deadline:

Wednesday 30 April

• Cardiology, Diabetes and CKD

LONDON

Monday 30 June Early bird deadline:

Wednesday 21 May

Physician Courses• Haematology LONDON

Friday 2 May Early bird deadline:

Wednesday 19 March

• Physicians General Update LONDON

Friday 23 May Early bird deadline:

Wednesday 9 April

Book your place and view the full course programmes at masterclasses.bmj.com

The medical workplace is increasingly competitive and highly pressured – – we’re here to ensure you fulfil your true potential without having to spend a fortune or waste any of your valuable time. Our workshops provide the essential tools you need to build on your career successes. You can learn the top tips that can make all the difference to your career with our workshops on key topics.

Full course details and programmes can be found at masterclasses.bmj.com or follow us on Twitter @BMJMasterclass for the latest updates.

Documents

Bma News March 1