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22 February, 2003
FRONT PAGE The lead headline "Hopes run high as finishing touches are put to contract" belies what in fact really happened. In a welter of bungling incompetence, ineptness and broken promises first the contract was not to be announced, then it seems to have somehow happened. At 8.45 Dr Meldrum was interviewed on BBC radio about the contract, yet 15 minutes later the BMA website was telling the world it would be delayed by a week. This was followed by negotiators popping up like mushrooms in autumn fields in one studio after another giving details of a contract they seemed to think was super-duper wonderful. This despite a. promising not to announce it until it was finalised and b. promising not to recommend it. There was another small matter. The joint deputy chairman, Dr Fradd had given his word there would be no contract without an agreement on pensions. Yet Lord Hunt told R4 listeners at 1pm that there was no agreement on pensions. Did that stop the unctuous performances of Fradd and Chisholm? Not a bit. It later leaked out that HMG offered to take over the announcement of the contract and, rather naively, the negotiators trusted them. Game, set and match to Milburn. But who expected anything else? The consultants are getting a bit restive about their negotiations. Despite high hopes of the new CCSC matters are dragging. The new chairman, Paul Miller, said that if talks dragged on there would be other options. GPs are likely to want other options but their chairman has even denied them the right to see them. ELSEWHERE Rather obtusely the Scots BMA has welcomed a new complaints procedure - with reservations. The UK BMA and GPC under Chisholm simply welcomed their versions earlier. GMC urged to screen complaints anonymously because ethnic groups fear they are being treated worse. Following on last week's front page story about insurance companies and consultants, more doctors are putting their cases forward. Bed blocking fines were defeated in the Lords but Milburn says they will go ahead because he's going to overturn the Lords' decision. Singlehanded GPs feel at risk from their PCOs, says the Small Practices Association. No doubt they are. Corporate minds are closed and the medical reps are from large practices, so what chance have they? CCSC says that appraisals must be taken more seriously by ministers and NHS Trust Executives who must fund it better. Turkeys and Christmas come to mind. Anti-smoking campaigners are celebrating the end of tobacco advertising but seem to have forgotten that Tony's crony, F1 chief Ecclestone, has been given a 3 year moratorium. Remember, he was the one whose million pound bribe Tony accepted before being caught out. One is tempted to wonder if a promissary note is safely locked away somewhere. BMA medical students are still quite correctly bashing away at this ludicrous government's malicious and thoughtless fee plans. The Health Protection Agency is discussed in a feature article. It is designed to protect us against terrorist biological and chemical attacks. It is worth reading. On the BMA pages there is another attack on PFI and modernisation. The writer thinks it is a bad thing and isn't the answer to the problem. On Letter Page another doctor has a go at the BMA, feeling strongly, as he does, that "It is the role of the BMA to get the best deal for its members" rather than for the NHS. There is a standard contradiction from a very important person who feels that a healthy NHS leads to healthy doctors. That seems to imply that the BMA will treat the NHS first, as the source of the unhappiness, and doctors secondly. Is it not just a possibility that a close connection to a moribund, gangrenous NHS would be bad for doctors and that, despite the VIP's denials, his job is to look after doctors first? The ever pugilistic Milburn can look after himself. And that's that for this week. No doubt we can expect gushes of self congratulation about the GP contract next week.
15 February, 2003 FRONT PAGE The "exclusive" headline item covers the indignation of a consultant anaesthetist whose fees are not being fully covered by private insurer AXA PPP. There is no evidence from the item that any other consultant was affected and the one in question preferred anonymity. Nevertheless the whole wrath of the BMA is to be brought upon the company. This appears to be headline froth with little substance. The Royal Colleges are wanting to im of specialist registrars.itate the College of GPs and get into competency assessment. A number of LMC secretaries were asked about their advance opinions of the new GP contract and what it must contain. The replies covered controlling workload, closing lists , opt out of out-of-hours, pensions, no unilateral changes by government, pricing and controlling the badgering of practices. Hmm. We'll see. ELSEWHERE PCTs are withdrawing support from a triage system in Gloucestershire even though with the new contract they must take on that very same service. Apparently the doctors must compete with night nurses for funds. What hope for the future with such enlightened bureaucrats in control? Medical student funding rightly continues to boil. Education minister Margaret Hodge claims that students will not be deterred by debts of £50,000. One has to wonder how loud she would have shouted had Mrs Thatcher's government carried out an identical policy. But all this has come about due to the ludicrous, idiotic policy of having 50% of school leavers in university whilst not being able to fund such irrelevent and damaging idiocy. The BMA is ecstatic that tobacco advertising has been stamped out. But it hasn't. Millionaire New Labour donor (until they were caught out) Ecclestone's Formula 1 motor racing has another three years. Why? The stench is quite considerable. Consultant leader, Paul Miller and CCSC met Milburn and company last week. The meeting was described, in diplomatic terms, as "cordial" which probably means they weren't exactly spitting blood at each other. Ideas were exchanged and a further meeting is planned this week. Meantime, Northern Irish consultants' NICSC went on the defensive about their acceptance of the contract. A planned vote of no confidence was shelved. Foundation hospital Trust status is welcomed by some managers of 3-star NHS trusts because it would free them from "stifling and demoralising Whitehall bureaucracy". Will Milburn take note or even recognise this criticism of the monster he has created? What do you think? Many other managers have serious reservations. David Pickersgill, BMA Treasurer is honoured by a full page feature. A lot of pleasant things are said about him and this writer is happy to agree with them. Is a tax funded NHS likely to continue indefinitely, asks ex NHS mandarin Eric Caines? Answering his own question he thinks not considering that there is an, arguable "black hole" in revenue of £11billion ahead. Something will have to give. Or is it somebody? The fee-favouring Blair or the tax-favouring Brown? Or neither if the country is wise enough to kick them both out having finally recognised what a lying, cheating government we have under Blair. A & E consultant Charles Lamb is concerned that nobody is interested to take over head injuries and that his A & E colleagues are qualified to do so. He also criticises the lack of scan facilities and, perhaps, the attitude of staff. Sir "Sandy" Macarra utters his usual good sense. This time about the GMC elections which should be contested by doctors who voters trust and whose actions reinforce that trust. They need to be experienced and have a high standing outside politics and be either young or dinosaurs. He shares this author's great faith in the current President who should be re-elected to carry on the job of restoring confidence.. Dr Rob Johnson suggests a unique solution to the space shortage in hospitals. One which will allow the clinic backlog to be quickly cut. Why not, he says, turn the admin offices into clinics during the day and return them to their office function after 6pm? Managers could then come in late and work through the evening - as is proposed for doctors. Well, there's an idea. Another writer bemoans the fact that after paying for childcare she has only £35/week pay from the NHS. She seems to be suggesting that the NHS picks up her child care clinic bill in some way. But why should I, as a tax payer not needing that service, pick up the bill for it any more than others should, according to some, for the university education of my children? Destroying goodwill is the subject of the poll this week. 91% of respondents work beyond the call of duty, 92% believe that that is taken for granted by politicians (and patients?) and 73% can see a time when that goodwill will run out. Doctors believe that politicians haven't a clue about good will, have no idea how much extra effort all classes of doctors put in and don't realise that the NHS would collapse without it. Furthermore, they have no interest in finding out, as the consultants' new contract showed, just so long as doctors can be whipped into line all the time.
8 February, 2003 This edition is again riddled with pronouncements from the anonymous "doctors leaders". If these "leaders" have anything worthwhile to speak about and want to be taken seriously let them be identified. As it stands bmanews seems to equate their utterances with "God has said..." and let's face it, the "leaders" have feet very much of clay. FRONT PAGE Seniors' contract again leads the front page with a headline which implies that all that was wrong with the rejected contract could be put right by making unsocial hours working voluntary. What about all that fuss about managerial control ? CCSC leader Paul Miller is reported, in the meat, to have reservations about a fairer appeals process and concessions on private practice. If Miller is reported correctly in bmanews there are going to be some rather peeved consultants out there. Then there is a note about the GPC roadshows. Dates of the one in your area can be found on www.bma.org.uk. It is to be hoped that Chisholm and colleagues will restrain their enthusiasm and simply answer questions rather than hard-sell the contract. From samples of their recent utterances as reported in the medical press the indications seem to be that they have learned little from the demise of Peter Hawker, late CCSC chairman. Once again the government has bungled. It has degraded the forces medical service to such an extent that there will not be enough medics to staff field hospitals in the event of an Iraq war. ELSEWHERE Laming/Climbie has made yet more urgent work for GPs. Medical training must have a stronger medical input, says the BMA. That would seem to be speaking the blindingly obvious but not to the government. At present the Postgraduate Medical Education and Training Board (PMTEB) reports to Milburn (of course) but has no provision for BMA input, yet doctors must pay for their education and certification. Next week Milburn will turn up at The London to lecture on histopathology. CHCs have gone but have not been replaced. Yet another bungle? GMC Council elections look to be dominated again by all the yesterday's men who feel there must be continuity. Every one of the old lags seems to think that their presence is essential. I guess I can understand that. Simon Fradd showed that he hasn't grasped the potential impact of the recent OFT Report on the regulation of pharmacies. He seems to be concerned that local chemists will be affected and says "Access is much more important than shaving a penny off the price of a drug". Maybe that penny will drop with the realisation that doctors will be able to open pharmacies in their own premises. What could be better access than that? Milburn's obsession with targets is pressurising front line A & E staff and putting patients' lives at risk, says bmanews - and they may will be right. Our intelligent Secretary of State thinks that if there are 100 patients waiting in A & E, and 90 of them with trivia are treated, it matters not what happens to the remaining, seriously ill 10, some of whom may die. After all, he's set up numerous quangos to punish the failing doctors and to keep relatives happy knowing that compensation will follow. With ass-holes like Milburn in charge there's little wonder the NHS is a shambles. Well done, BMA and well done, Bogle for continuing to force the issue. Medical students are urged to lobby MPs about the irrational imposition of the enormous fee burden upon them. The government continues to spin (or should it be, lie) about this idiocy. It wants more doctors, particularly from poorer backgrounds, so it is landing them with anything up to £50,000 debts after the qualify and then, no doubt, the malevolent Milburn will attempt to insist that they work for the NHS exclusively for seven years. There's one good thing about that, he will be history and be held to ridicule as the way not to run the NHS. There will be NHS tutorials on him. The Climbie enquiry occupies a full page. Those who are interested should visit the bma site The GMC renewal fiasco is reported up by one "Daloni Carlisle". Who is he/she? A doctor or a cub reporter? In Letters a doctor Ian McDermott draws attention to Milburn's orders to reclassify A & E trolleys and couches as beds. The definition being, anywhere a patient can lay down. He correctly points out that patients can lay on the floor and that would create thousands of more beds. Actually, Dr McDermott, each A & E floor would be just one, shared, bisexual bed. He seriously suggests that the BMA should be shouting about this shortcomings to educate the public. An excellent suggestion. It's not often that this editor agrees with BMA notables but when BMA Welsh chairman, Tony Calland writes that the current and proposed arrangements for care don't work, your editor has little choice. He calls the systems "vertically integrated" as they consist of PCTs and Foundation Trusts. The trusts will take over everything after the PCTs have dealt with primary care (with or without the help of the contract). He draws attention to Milburn's attempts to control the profession but says the BMA has a responsibility to modify the plans for the sake of patients and professionals. Perhaps you should sit in Bogle's chair, Tony? Maybe you can instill reason into our lovely Milburn? Student loans occupies a double-spread feature as well it should. Education minister Charles Clarke joins the long gallery of thickos in this government. Men and women not capable of intelligent thoughts our even developing their own thoughts to the logical conclusion. The new arrangements, leaving post-grad medical students with debts of £50+thousands are, a deterrent to school-leavers who may have wished to enter medical school. For some obvious reason, they are too stupid, ministers cannot understand that the deterrent will work more against poor families. The government attempts to justify itself with lies and spin but that's all they can do efficiently. Lie and spin. Keep up the good work, BMA. The overall picture from this issue of bmanews is that the brown-nosing of earlier years is coming to an end. Better late than never. I hate to say "I told you so" but many of us have known for years that this is a corrupt, dangerous and very silly government.
1 February, 2003 FRONT PAGE The lead item quite correctly and responsibly draws attention to a gross ineffeiciency, not to mention danger, in todays hospital care, the sterilisation of surgical instruments. Many examples are given of procedures being cancelled and patients being woken from the anaesthetic unoperated upon because the instruments have debris from earlier operations on them. There is absolutely no excuse for this and some heads must roll. No doubt Milburn will set up another quango headed by another New Labour sycophant, perhaps Sterilisation: Hospital Instruments Team (SHIT) as he has already one called CRAP (see elsewhere on site, via Politics index) The Climbie enquiry and Laming recommendations get an airing. Whilst Milburn "welcomes" the report surprisingly there is, as yet, no record of John Chisholm welcoming it. Whilst on the subject, it may not be PC but a significant portion of the responsibility for the tragedy should fall on the shoulders of the child's parents. They chose the people to whom they entrusted the care of their child. Did they not "vet" them? Are British Social Services and other services to carry all the responsibility for others' folly? The GP shortage and recruitment crisis is aired again, quite properly on the front page. It is, of course, worse than the figures the DoH chooses to air. Not all PCTs responded to the enquiry for vacancy numbers but amongst the ones who did there was a shortfall of no fewer than 970 GPs. ELSEWHERE Missing cancer funds correctly trouble the BMA. Apparently the government's "cancer csar" has admitted that hypothecated cancer funds have been spent elsewhere. Are we surprised? No doubt Milburn will, with a great fanfare, announce that "additional" funds are to be allocated. He won't, of course, comment that the original funds went missing somewhere. Pay award must not exceed inflation rate says the UK health Department. So much for Milburn's promises and, isn't he the supremo of the DoH? Arguing from a position of utter weakness, considering the consultant and GP staffing crisis, Milburn gets tough. Will the new consultant committee roar or simply miaow and roll over for tummy tickling (or knifing)? Consultant contract update is discussed in some detail on page 3 but may be summarised by saying that Milburn has taken his somewhat wooodworm eaten bat home and is attempting to roar defiance hoping the noise will frighten the BMA. It must be said that such roars have always previously had that effect so who can blame him? They are taking their time about it but maybe the new CCSC has more guts than the old and isn't afraid of bullies with loud voices. Proposed student fees cause some annoyance as they display more idiocy from the Department of Bright Ideas. You know, the country is short of doctors so let's charge students £3000/year for 5 years tuition, plus maintenance charges and saddle them all with a debt of between £20,000 and £30,000 at the end of their course. Then keep their wages down. Tobacco advertising is to be banned from July 2003 together with all sport sponsorship by cigarette companies - except, of course, Blair's friend and Party sponsor, Bernie Ecclestone's Formula I racing which as another two years. A & E managers will continue to lie and cheat as they "fudge" waiting figures to please Milburn, says the BMA. Correct, because the managers are in fear of their jobs in today's Stalinist NHS. Drug budget overspends are due to NSFs, NICE and new drugs says Minister Lord Hunt. Ah, but will he pass that understanding down to the PCOs who are busy chastising individual GPs for, er, overspending their drug budgets. Consultants' leader, Paul Miller says he is not going to be completely tunnel minded by devoting all his attention to the contract. There are other matters which concern him. One of these is appraisal which consultants are not using properly. For instance, they should say where the system fails them in their job and education. He is also exercised about the work-life balance which is no longer acceptable to new and current consultants. Then there's the business of all the reputations ruined through unfair suspensions. Well done, Paul, but get the bloody contract right else all the rest will be irrelevant to the NHS as colleagues leave it in droves. Death Certification is set to be overhauled by the Shipman Enquiry's recommendations which demonstrate a tenuous link with the real world. The system is weak so let's replace it with an unworkable one so that nobody can be certified as dead. The proposed new scheme needs three long forms to be filled and at least two doctors to see every deceased. The item in newsreview is confusing but it does appear that the BMA spokesman, David Pickersgill favours it. Just as well for him that he has retired from GP work to become BMA Treasurer. The matter will be debated at the next BMA Council meeting. In "Letters" GP Peter Harvey draws attention to some disquiet he has about the contract proposals. "The GPC responds", justifying itself. I think we should know who wrote the response. Do they not have a name? Are they too scared to use it? If you have an opinion you think is worth printing then you should have the moral courage to put your name to it rather than cowardly sheltering behind "The GPC". The same applies to all the references in BMAnews to "doctors' leaders". Members should be told who make some of these assinine comments on our behalf. Only then can they be voted out of office at the next elections. That is, unless they have crept into office the coward's back door route. Paul Thorpe, the "juniors'" leader makes several valid points and constructive suggestions about changes in the BMA's constitution. They are well worth attention. A debate on Foundation Trusts has Minister Hutton proposing and Chaand Nagpaul opposing. The Minister says that such trusts will be fully independent yet subject to various statutory duties which limit their independence. He appears to believe that they will not be able to set their own pay rates because, he says, they won't be able to poach staff from elsewhere. That, he implies, would create a two-tier service. With such scrambled neurones heading the NHS is it any wonder it's in the pits right now? Chaand makes several valid points apposing the FT concept and, I believe, wins the argument but that wasn't too difficult. An extended role for nurses is discussed over two pages. GP Andrew Dearden, an almost risen political star, favours them as a "natural progression due to staff shortages (if there is an) appropriate level of training". Ah, but what when there is no shortage and doctors have been eliminated from many previous medical tasks? RCGP chairman, David Haslam agrees. As does a lead practice nurse who complains that doctors employ nurses and don't value their contribution. There are some suggestions that such devolution of care will lead to a declining standard of service whilst saving the NHS money. There are proposals that because there is a shortage of anaesthetists nurses should take on that role. Ugh!! Wait a minute. There's a shortage of nurses so where will they come from? And, in any case, it will be a doctor who bears the clinical responsibility for the particular case. The article summarises "all extended roles do is to demonstrate how short of doctors the service is". Enough said.
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