BACK TO HEADLINES
October 26, 2002
There is some slight hope that realism is breaking out within the GPC. Slight, but it's there. Both Eric Rose and Laurence Buckman have criticised the recent government paper, Delivering the NHS Plan. Eric said it was "a fantasy" and Laurence "an unsatisfactory document". The lead item discloses that the government is in total confusion with NHS Chief Executive, Nigel Crisp, admitting that their target of 2000 extra GPs was not going to be met whilst the "fantasy" document mentioned above was based on the false assumption that the target would be met.
Still on the Front Page, Chisholm and crew are working with government in the assumption that the contract vote would be "Yes". Well, they would, wouldn't they?
There will scarcely be a GP in the country who will be surprised to learn that 999 calls take precedence over the urgent requests for ambulances they make. Another case of "targetitis" getting in the way of common sense and caring for patients. The politicians have virtually said that it is better for a seriously ill patient, diagnosed by a doctor, to die at home rather than an ambulance fail to respond to a 999 in the arbitrary 8 minutes allowed. In such cases I have frequently advised the patient's family to dial 999 whilst explaining the system which otherwise permits the ambulance to arrive many hours later.
Wales is likely to suffer from a lack of locums from the end of this month as over 100 have failed to register on the compulsory supplementary register. Some may see this as an own goal for the centralist government.
More crisis this time in Northern Ireland where there are vacancies for 69 consultants.
Somerset PCT is asking GPs what is stressing them and for ideas on how to combat the stress. Countrydoctor refrains from adding its two-pennorth here to the debate.
Readers should note the face of Dr Teck Khong. He is a Leicester GP who will shortly come to prominence relating to Doctors' Chambers.
The BMA says that targets distort clinical priorities. See the item on countrydoctor Front Page.
NHS managers have been told that they should have set up occupational health services for GPs. 76 PCTs don't give a damn about their doctors and haven't bothered.
A junior doctor is campaigning against the enormous rise in the compulsory GMC retention fee . It was £80 in 1998 and is now £290. The doctor may be contacted at firstname.lastname@example.org.
Stating the glaringly obvious, except, that is, to government, medical students and academics say that the plan to charge medical students £10,500 a year tuition fees, plus living expenses (as a loan) would be a "huge disincentive" to study medicine. This, in turn, will sabotage government plans for a massive increase in the numbers of doctors. Some medical school have already indicated their plans to charge such a fee. The BMA Students Committee deputy Chairman has a long, sensible piece on this problem later in the edition.
Milburn says single-handed GPs are safe with him. Oh, yes?
In one of bmanews' longer articles consultants and managers are urged to work together. There is, at this time, great mistrust by consultants of managers over the way they would implement the new contract. The mistrust was stoked by a leading manager who stalked the country lecturing other managers on the contract. He made a point of saying that consultants can and will be made to work at weekends and unsocial hours and that they will only be paid standard rates. This is what Dr Hawker's infamous contract permits although he doesn't think managers will take advantage of the clause.
Asylum seekers, including financial immigrants and dodgers, heed healthcare. This will involve trained interpreters, information on the NHS, training for GPs. Not that it is any of the BMAs business, the writer says they should not be held in detention centres.
Mr Postlethwaite, on letter page, says that hawker and Co must stand down if the contract is rejected. He says he is not alone. Indeed, figures on another source, say that the BMA has already lost 200 members due to consultant contract "mishandling".
Brough GP, Paul Charlson was impressed by Tory Liam Fox at the Conservative Conference. He says that the Tories will remove targets from the NHS. We have seen, above, some of the serious disadvantages of targets. Managers are now said to exceed the number of beds within the NHS and the Tories would do something to correct that by removing some of those not associated with clinical care. Dr Charlson agrees that patient choice should come higher on the agenda but that it should be accompanied by patient responsibility. He also favours tax breaks for those who subsidise the NHS by taking out private insurance. Subsidise in the sense of not using the NHS.
Psychiatrists amongst the bmanews readership may be interested to read the 2-page article about and by the British Pakistani Psychiatrists Association
October 19, 2002
As the result of the consultant vote comes closer it receives headline prominence this week. It appears that there is to be a "grassroots review" of relations between consultants and staff and the CCSC whatever the outcome. They will decide on 31 October "how best to implement the wises of the profession". That shouldn't be too difficult to decide - they must honour those wishes. One member of CCSC said that "the committee will never give up". One hopes that if , as all predictions expect, there is a No vote that Dr Hawker, chairman of the Committee, at least, will have the honour and humility to "give up" by resigning. Sadly, these BMA committee chairmen are issued with superglue for their pants when they take office. Hawker has just been re-elected unopposed.
Meantime, Chisholm says the new GP contract may not survive if it's not resourced properly. He went on to say that there were a number of issues which are absolutely critical. Indeed. And we are watching you, John, with a certain amount of due scepticism.
Incredibly some GP colleagues and their staff are still being taken in by rogue firms masquerading as Data Protection experts who relieve them of £100 or so to "register" them under the Act. There are no such bodies. For information about registration visit <www.doineedtonotify.co.uk> or call 0870 902 7522
There's a disturbing out-of-focus picture of Milburn on page 2. Ugh!
Scots GPC has agreed to appraisal - if funded.
Talking of photographs, there's another on page 3. This time of two prancing naked males who have little to be happy about as their dangly bits seem to have been removed.
There are two items suggesting more DoH failures - waiting times and Scots flu vac policy which seems about to collapse.
More deceit from Milburn's dept as the government senior medical officer disguises modernising the SHO grade as a method of creating a sub-consultant species. BMA President, Tony Grabham, describes it as the most worrying government paper he's seen in a long time. Read it on <www.doh.gov.uk/shoconsult>
GMC President Catto says revalidation may start next April if all goes "well". Appraisal must come first.
Reforms in Northern Ireland have been cocked up by the duplicity of the IRA/Sinn Fein's espionage activities. The Assembly has been suspended by Blair, when he should have expelled Sinn Fein and allowed the Assembly to continue. However Blair, nicknamed "Naive Idiot" in private Sinn Fein documents, prefers to continue to appease thus justifying that soubriquet.
Avon LMC, worried about a forthcoming GP shortage, has rather optimistically told their PCT to sort it out. Meantime, anxious GPs may ring a BMA support-line on 0870 765 0001. The line is open 36 hours a week but bmanews does not say which 36 hours.
More pro-contract propaganda is provided for doubting consultants in a full-page piece on "the vexed history of consultants' pay". Predictably Peter Hawker says that a window of opportunity must not be allowed to close. A list of CCSC members is given on page 8 under the heading "Contract Deal in their hands". Somewhat naively I thought the voters had it in their hands. Am I right or am I right?
A shortish item warns GPs that they must be prepared to respond to bioterrorism. It gives a brief history of agents such as gasses and microbes whilst reassuring GPs that they could only be protected against a very few. Nevertheless, GPs will be crucial in managing such situations.
Dr Ian Bogle gives the "BMA View" and quite rightly has a go at managers and politicians (no less). All these have, he says, "muscled in on the doctor patient relationship". The NHS is, he continues "underpinned by production-line values pushing doctors into becoming a bunch of technicians at the beck and call of ministers, whose worth is measured in terms of output and nothing else" He carries on to attack targets as being rubbish (hear, hear) and berates managers for chipping away at clinical freedom. What a pity that he put his/our name to that blueprint of crap the NHS Plan and he has acceded to virtually every demand from Milburnia. Still, better a late dawn than none at all! We'll be watching. As a chairman of the BMA Dr Bogle does not rank highest in my esteem.
The rest of this edition bears looking at but is not of a political or news nature.
October 12, 2002
The Health Department grabs the main headline by agreeing that medical experience will count when a doctor is admitted to the specialist register. As the Staff and Associates Specialists Committee Chairman said, it looks as though the international recruitment drive has failed.
Once again the Consultants' contract is front page news. This time it is revealed that a special body has been created to help introduce it in the (optimistic) expectation of a Yes vote
As Prof Catto told Council this week, GMC will be introducing other ways of paying its (exorbitant) fee than an annual lump sum. The fee has escalated from just £80 in 1998 to its current £290. It will not increase in 2003.
PCTs have now taken over the funding and commissioning role.
Northern Irish GPs were distressed and amazed to be trapped in their on-call premises last week by a gang of hooligans throwing rockets at the building and damaging cars. They have asked to be moved from their Craigavon premises to a safer environment. They may it difficult carrying out their duties from Guildford.
The Shipman Enquiry grinds on but happily the GP crisis has caused a change of heart in Milburnland so the media is being kept in rather firmer check.
A small piece on the Tory Conference mentions their proposal to fine non-attenders to GP surgeries as well as tax-breaks for those with private insurance. The former is not sensible and the latter is.
NHS managers are in fear of their jobs and are aware they are mispending ring-fenced funds.
Milburn's obsession with targets is featured as new ones are created. They are not worth mentioning further.
Scots humour is displayed by a news item which confirms that more doctors will be needed to fulfil the Scots Coronary and stroke strategy demands which will (?) come on stream in election year 2004. Odd how that year keeps cropping up.
More humour from Gloucestershire LMC which says that practice nurses need more training and it should be funded by PCTs.
Prof Fine has been appointed to NICE and says he is privileged to contribute to improving the quality of NHS healthcare. So that's what NICE is about?
The DoH has revealed that figures, provided by managers fearful of their careers and thus "improved" before submission, show that the government is on-target.
A full page is devoted to a Labour Conference fringe meeting at which Mr Hutton spoke in defence of PFI and his enthusiasm for freedom, choice, innovation and enterprise whilst attempting to distance himself from Mrs Thatcher's version of the same. Money will follow patients, said Mr Hutton, echoing a Tory phrase.
Again a full-page is devoted to the Consultant Contract as the great and the good attempt to influence the vote in favour of Yes. Odd that bmanews hasn't featured any of the possible majority who are intending to vote against it. There have been accusations of bias raised against the publication. Shurely not with Dr Bogle as editor in chief. This time the President of the RCP of Edinburgh says it isn't his place to try to influence voters but the standing of the profession depends on their answer. Which he seems to think should be in favour.
A correspondent to Letters page has a bash at the "badly informed" Prof Maynard. It's not worth it. He's blind and deaf. Another writer has a go at "the spin, propaganda and misleading figures perpetrated by the Consultants committee" to advance their case. The editor, not the CCSC chairman, replied that the writer has a "fair point".
A retired Belfast paediatric surgeon, Stephen Brown, is given space in Second Opinion to comment about risk management. He opens with an attack on "the rather hysterical reaction of successive health secretaries" over PM organ retention. Hear, hear. Mr Brown then progresses to lash the DoH over its over-reaction to baby abduction from obstetrical wards. No-one knows the scale of the problem yet millions were spent "solving" it whilst creating the even greater one of fire risk in locked units. Then, he says, there's the policy of using only disposable instruments for tonsillectomies for fear of nvCJD even though there is a greater risk with these of post-operative bleeding. He doesn't seem to be an enthusiastic supporter of government policy in this direction.
The CCSC psychiatry sub-committee chairman attacks the mental health bill in BMA View. He believes that it has gone "horribly wrong". It erodes civil rights, he says.
Head2Head covers the subject of whether doctors should continue to be exempt from jury service. Dr Gamble, against, says doctors may start to believe in their own omnipotence. What, in today's knocking climate? Get real. Dr Cottam, for, is pragmatic and says the country is too short of doctors to afford to lose any for extended periods in trials.
Patient Safety and Welfare is discussed by airline captain, David Johnson who is helping to change clinical governance from name and blame along more effective lines. A similar system was put on-line on this site a couple of years ago. The article is worth a read. It covers Team Resource Management skills: communication, awareness, feedback and error trapping. He also emphasises that so far as flying goes, and he implies, health, the tradition of blaming crashes on pilot error led to cover ups. Countrydoctor said this years ago but the biggest obstacle in the way of progress is the Health Secretary himself, Alan Milburn. Psychometric testing must show his unsuitability for the job.
October 5, 2002
[Missed from last week's edition:
The lead item describes a DoH cock-up. It seems that Milburn's lot have no idea how many "flexible trainees" there are. They think there are 1,000 whereas, in fact, there are 1,500. The DoH is now threatening not to pay them a full basic salary from the "pool". There is now uproar in the Junior Doctor's' Committee and, unlike the CCHC and GPC, they have guts and determination. I would not hesitate to place a wager that HMG will pay up.
There is some rightful concern about an EEC Directive which would allow any doctor from the EEC to work in this country unregistered for 16 weeks. Dr Bogle objects and the BMA is lobbying to have the directive scrubbed.
The consultant's contract gets a mention. Dr Hawker, their leader, said he believed they will be able to move the framework forward and tackle any difficulties. Ok, so you don't know what he meant either.
In the meantime, the Juniors committee voted down the contract with none against and one abstention.
Cherie Blair (sorry, Booth) graces the front cover - if that's the right word.
At their conference the LibDems have resurrected hypothecated taxation for the NHS.
GMC and government says that pre-reg house officer training falls below standard. It appears that they carry out tasks which non-medical staff could do; they are too busy to attend lectures; their accommodation standards are poor and, finally that communication with the universities is poor. So, what's changed?
Fearing the No vote, NHS managers are flexing their muscles and interfering in the democratic process by threatening to impose the new contract without any increase in salary, if there is a negative vote. No wonder the consultants don't trust the bloody managers. One hopes that if that is the case as many consultants as can leave the NHS and set themselves up in private chambers, contracting their services directly back to the NHS at their rates. It's for sure the NHS needs them more than they need the NHS.
Juniors are hoping that the European Working Time Directive will be implemented in their favour so that they may have "statutory" rest periods. That man who said "crisis what crisis" about GPs, Health Minister Hutton is, however, refusing to budge - yet.
The gist of George Rae's speech to the Labour fringe is printed He tried to tell delegates at their conference that equity is more important than patient choice.
The LibDems agree with the BMA that doctors should be able to keep patients alive artificially to preserve their organs. Relatives should not be able to over-rule the deceased's wishes. Presumed consent with safeguards is the way, they said.
Another page-long piece condemns the much disliked Mental Health Bill, although the Scots are happier with their version.
In the edition of 21/9/02 GP Dr Swinyard's anxiety over the Disabled Discrimination Act was featured. He felt that it would cost GP or the NHS millions to implement.An auditor member of the National register of Access Consultants, Ian Watkins, tells GPs not to worry. It is the service which has to be accessible. The design of the building is only important if it denies access to the service. The page is worth reading infull.
LETTERS are a treat this week. A consultant condemns bmanews for being biased over their contract. It is. He says it misreported roadshows by omitting to mention the strength of opposition to the contract. No doubt the editor in chief forbade it.
Another draws attention to BMAS being taken over and the BMA assurance that members will notice no difference in quality. He hopes that won't be the case because he's found it pretty crappy.
Another couple of letters attack the self-important, smug health guru Prof Maynard.
Second Opinion is by a newish non-principal who sat in on a GPC meeting and thinks she'd like to join them. Please do. They need fresh brains at the top. There is an accompanying picture of the Council chamber. Your editor's seat is on the second row group of four, third from the left. Close enough to keep an eye on the Chairman.
A member of the BMA Committee chairmen's mafia, academic Colin Smith, shows his solidarity by enthusing over the consultants' contract and recommending it to his academic colleagues. He and his colleagues have had "helpful talks" with "cooperative" spokesmen in the Department. To an outsider, like your editor, none of Colin's bullet points were relevant to the contact and they took up half of his long piece.
Junior doctor, Josephine Oliver describes, in a somewhat gory story what conditions are like in South Africa. Apparently with the help of a nurse anaesthetist, an untrained scrub nurse and another untrained auxilliary they managed to resecure the head of a "patient who was a third of the way to being decapitated". At the time of writing, despite an episode of surgical asystole, he was sitting up in bed smiling.
GPs nowadays are being attacked so regularly that many are demanding "safe havens" in which to treat known violent patients. All HAs are now supposed to provide these but most don't. The article here discusses one such haven, in Cardiff. Patients who attack GPs are removed from the GP's list and allocated to the Alternative Treatment Centre. Once allocated, patients are told why. From then on they must phone a special number for appointments but if they need a home visit the doctor will go but only with a police escort. Patients who attend the centre are searched and scanned for weapons. Following pressure from the Welsh GPC and others a directive has gone out instructing all authorities to set up identical systems.
Conservative MEP John Bowis, their health spokesman, is featured.