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30 November, 2002
COMMENT FRONT PAGE The Exclusive this week is the declaration that the Royal Colleges have united to oppose the Milburn plan for a sub-consultant grade whilst still favouring reforms in medical training. Dr Bogle was anxious to know what Milburn plans lest it further disenchants doctors of whom there are too few anyway. One or two suggestions are made about the reforms one of which involved "getting rid of the term "consultant" Of more interest to GPs is the rightful opposition to the new certification of death proposals. It sometimes, no, often, seems that when something medical is thought to have gone wrong the pathetic Milburn has a Pavlovian response and creates yet another QUANGO, thinking to himself "That'll get the bastards". This latest seed of his genius consists of developing a department to oversee all patient deaths. There is to be a medical coroner, or whatever, who will examine two new death forms. The first, which would take the GP 40 minutes to fill out would be a fact of death form and the other a certifying death form which, using the patients notes and history would take over an hour. Now, I had thought there was at least one centimeter of space between the Milburnian temporal bones but it seems I was wrong. Otherwise, he wouldn't come up with such a time and money wasting scheme particularly when it's impossible to recruit "special" doctors to do the job or any job, come to that. But, then, that's Milburn all over. GMC regulation and changes are passing through Parliament. ELSEWHERE Medical Students are correctly getting anxious about top up fees considering the length of their course. However, with a government a stupid as this one, intent on having 50% of school leavers doing some sort of, often superfluous degree course, which it can't afford to fund, then somebody will have to pay for that political idiocy. Sorry about that sentence, a bit like 3-jags. The question to be faced is, do they want hundreds of students with degrees in crisp bag design or do they want doctors? I'm not sure why, but the College of GPs seems to like the idea of off-loading important parts of our job onto others. This time they have welcomed prescribing chemists. A nice little money maker for Mr Bloggs MPS who won't do it for nowt. Remarkably, GPC has some reservations. Well done, lads. Tory Health Man, Liam Fox, has rubbished the out-of-this-world claim from the "1cm temporal space" who has promised that within two years or so patients will be able to book their ops, out-patients appointments and choose their own doctor to do the op, all on-line. If he's lucky he may still have a few doctors in the NHS by then even if technology could advance so rapidly. Dr Bogle seems to be coming out of his torpor , to have taken off his rose-tinted spectacles and to have joined the very many of us in realising what a disgraceful, untrustworthy health department we are dealing with. This week he has defended consultants against lying (my word) government spin. GPC seems to have got the wrong message from their colleagues. It appears that, without any evidence that those colleagues actually want the new contract, they are telling government to speedily introduce it. With Chisholm saying it can't be priced it's more than likely both he and it will be chucked out ignominiously. Is this the precursor of more hard-sell from the Chisholm CBE entourage Roadshow Kids? My advice to them is to cool it. You don't want to look as daft as Peter Hawker, after all. A news tit-bit tells us that the government is introducing a new childrens' toy. Apparently aspirin, paracetamol and iron are to be put into new child-proof containers. The only people who can't get into the present ones are adults. The RCGP, in another bout of wisdom, has suggested that it pays off the student loans of GPs who work in deprived areas. Think a little more deeply and the unfairness of this to other equally hard-working GPs will be shown. Not to mention the handcuffing of the acceptor of this bribe whose family and he may hate both job and area. Any such bribery must be applied across the board. One hopes that "GP leaders" will turn it down although I await the Chisholm welcome speech. Alan Milburn has been rubbished now by the Danes to whom he attributed his Foundation Hospital scheme. To be honest he hedged his bets and involved the Swedes and Spain. We wait for their denial, too. Talking of hedging, so is the BMA which refuses to condemn or approve although Dr Bogle would prefer all hospitals to be equally rewarded. As this would make a mockery of the whole scheme why doesn't he come up front and call a spade a spade? That might upset Milburn but what has he got to lose that Chisholm hasn't already got? Milburn had a dream and the dream was the biggest QUANGO yet. Let's have a great big and all-powerful NHS University for life-long learning for NHS staff, he said. And so it came to pass that countless more billions of NHS funds were diverted away from patient care into glorifying the sacred Alan. The NHS University will open, if that's the word, in Autumn 2003 - if you can believe it. The BMA, as ever, doesn't want to upset the holey (sic) one and is thinking whether to respond. Come on, Ian, say it. You know it's crap. Readers are not told who Charles Johnson is but he's telling consultant colleagues to get involved with the BMA. That would be easier if that committee were restructured along GPC lines although the Chisholm cronies somewhat despicably cheated there, in the end, by only allowing approximately 50% of seats to be directly, regionally elected, thus ensuring their own indefinite stay in power. Shop-floor consultants MUST directly elect to CCSC. The days of toadyism and Muggin's turn are over - except on GPC. Second Opinion featured a disgruntled pre-reg HO having a go at GPs who upset him. Fair comment but not very helpful. We could all play at that game and in the end get nowhere. Both GP and the hospital doctor are stressed by labouring in a run-down NHS whose cash is being spent on QUANGOs. bma view this week is a well-reasoned piece by the "Juniors'" leader Paul Thorpe. He perfectly demolishes the Milburn threat and brainwave of the sub-consultant grade. Has the BMA chairman or Peter Hawker done this? I don't believe so. Mr Thorpe believes, rightly, that it all came about as a desperate measure by Milburn to fulfil his boastful and ludicrous promise to have 7,500 more consultants by 2004. The sub-consultant would do the trivial waiting list work whilst their "properly" qualified consultant colleagues would get on with the real work, opines Milburn. But Thorpe argues that there are not enough consultants to achieve compliance with the European Working Time Directive if the grade is split into two. With more spunk than his seniors in the BMA Thorpe says bluntly that his committee, the JDC, is not about to sit back and let all this happen. When's the next election for BMA Chairman? Sadly, when Bogle vacates the Chair. Opinion poll of "our panel of 300 doctors" reveals the unsurprising fact that 90% say there are too many targets in the NHS, 62% say they have distorted priorities to meet them and 81% say that priorities should be designed locally. By the by, who are these 300? Are they simply the members of various BMA committees? Who chooses them? Dr Bogle, as editor-in-chief? Non-political items include a discussion on the recent public autopsy by artist Gunther von Hagens; dogs sniffing out diseases; and a fascinating item about the Camerons and ballooning.
23 November, 2002 FRONT PAGE The headline story is one which appeared on countrydoctor some days ago, that applications for vacant GP posts have halved in two years and that many posts are still vacant 12 months later. Dr Chisholm, whom we remind readers is the GP leader, says that things will get worse as those Asian doctors who arrived in the 60s and 70s retire more or less together. That, of course, is neither the fault of Chisholm or Milburn but if we are to examine the reasons for the failure of recruitment and the increased retirement rate then Dr Chisholm and his predecessors - and that includes Dr Bogle and, going back even further, Dr Michael Wilson - carry a fair amount of responsibility. All of them were trusted with caring for the interests of GPs and all of them have signally failed to do that. All of them seemed more interested in relations with the various Secretaries of State and the condition of the NHS rather than the welfare of GPs. (Consultants can speak for themselves). Now the chickens are coming home to roost. Sadly, the BMA is losing members as a consequence. There is even serious consideration being given to a separate General Practitioners Union due to BMA's inadequacies. It was in 1978 Dr Tony Keable-Elliott (then Chairman of GMSC, GPCs predecessor) wrote to me enclosing a letter he had sent to the Telegraph. In that he said "The BMA is now a trade union - not because it particularly wanted to be one but because government made it one" - and, by God, it shows, even today. It is plain that neither Bogle nor Chisholm have any taste for trade unionism nor any aptitude for it. And doctors' interests are suffering as a consequence. But more of Bogle later. Those opposing foundation hospitals have found an unlikely ally in ex-Health Secretary Frank Dobson who says rather graphically that they will become NHS cuckoos. Milburn, in his wisdom, is blundering ahead. Dr Bogle once again says they are all right but all hospitals should be like them. ELSEWHERE The Chairman of the Bristol Royal Infirmary enquiry says that the clinical negligence system is dangerous because it encourages the hiding of mistakes from which all could learn. countrydoctor recognised this over two years ago and published an alternative system (Click here). The mentality of this Secretary of State will see that no such method will gain ground whilst he's in office. The CMO has proposals but for mysterious reasons their announcement has been delayed more than once. Surprise, surprise. Waiting list figures for in-patient treatment have risen. Having failed to adequately lobby itself on their behalf the BMA has issued an on-line guide telling GPs how to do it themselves. Scots juniors can have their say on the new consultant contract. The majority have already spoken and rejected it. The seniors have embraced it and Scots BMA is rushing to implement it. Some consultation exercise. More BMA style. GPs are to have extra training to learn how to keep some sick people at work, says the government. Instead of politely or even bluntly saying that it's none of their business and they have enough to do Dr Chisholm is discussing it. GPs can expect it soon to become part of their contract framework, I guess. The BMA is rushing into talks with the NHS Confederation and the Royal Colleges about working relationships. Dr Bogle said something but Confederation Chief Executive Gill Morgan showed a complete lack of understanding of the issue and of the seriousness of the problem. She said "...the medical profession has real concerns about a loss of autonomy and changing expectations of its role". This equates to Slide 9 which Milburn lied in public to say he hadn't seen. Better for the BMA to wait until - or if - the CCSC sorts itself out and once again becomes partially representative. GMC reform is to be rushed through parliament by the end of this month. bmanews reports that local authorities condemn Milburn's customary bully-boy tactics which will lead to authorities being fined over delayed discharges. The man really is a pain. Stamping his foot again, Milburn is intent on getting the controversial mental health bill through parliament despite objections by all responsible groups. The Tories have pledged to "kill the bill" in the Lords. Merging QUANGOs. Having wasted countless millions setting them up Milburn is yielding to pressure to merge the Commission for Health Improvement, National Care Standards Commission and the Audit Commission into one large QUANGO, the Commission for Health Audit and Inspection. Ah, but how many staff will be sacked and how much money saved? We should be told. bmanews publishes an anti-Iraq war item quoting Dr June Crown PhD who leads an anti-war organisation, Medact. No balancing item has been published. Dr Bogle is the editor-in-chief. Dr Crown was responsible for the eponymous Report which said chemists should prescribe but not dispense items they have prescribed. Recently she found it convenient to say that chemists can employ "checkers" in the same shop as the prescribing chemist. And who's going to argue with their boss, I wonder? The Scots BMA Council discussed moving the new consultant contract forward. There was opposition from juniors and GPs but, according to bmanews, a fair wind was given to move ahead. In other words, they were ignored. The BMA Regulation book would be examined to ensure that this could be done. No matter that a majority of juniors in the poll objected and that consultants in the UK, as a whole, opposed it. In Scotland unity counts for nothing. After all, that's what devolution is all about. A full page political biog deals with the Scottish Health Secretary, Malcolm Chisholm. The author's overall opinion is that he is well-liked and more understanding than his English counterpart. That wouldn't be difficult. He listens, is the impression given. The Opinion column, by Dr Ariyanayagam, gently warns CCSC and those who are standing for leader to be careful to represent the many not the few. He recommends the use of the untapped resource of the BMA Industrial Relations Officers during negotiations. CCSC must also listen to those whose work impinges on that of consultants. There is, he says, a problem for consultants in that two failed negotiators are standing for the Chair, Machin and Goodman. Both of these gentlemen have the arrogance to think they are perfect for the job !! Finally, he warns that the new leader should be without any vested interest. "Those who moonlight with NHS management or hold any important managerial positions should be aware of the conflicts of interest that arise". Now who, I wonder, is he thinking of? Now we come to BMA View by head honcho Dr Ian Bogle. I really do not know how he had the gall to publish this item. Remember, I sit on BMA Council and listen to these wallahs speaking. Talk
about being wise after the event. Bogle's piece takes the
biscuit. Here's a sample. Bogle then goes on to explain what consultants have been shouting at him for months. That management will control their lives. The message does eventually get through, then? After all, he said it was "loud and clear". Despite Milburn's belligerent reaction to a democratic vote against the proposed contract Bogle says "we (the BMA) are not in dispute". Maybe it will come as a surprise to Dr Bogle but Milburn is in open dispute with consultants. As mentioned earlier in this Commentary, the BMA is a reluctant trade union but it had better learn quickly. Milburn scorns quiet talks round the table.. He can manipulate them easily. Dr Bogle has first hand experience of this. The BMA has lost many members due to recent bungles and the Bogle View does not give much hope for the future. That reminds me, I once wrote an editorial in the DDA Journal entitled Bogle's Bungles. I was called to Head Office to explain myself. In the words of the song "When will they ever learn? The first FEATURE questions whether sperm and embryo donors should be named. Happily, the ARM rejected the BMA's ethical committee position of agreeing to the ending of anonymity. The "right to know" concept is pure and simple - and destructive - political correctness and must be opposed at all costs. Promising to ignore the ARM decision, ehtical committee chairman Dr Wilks has said he will keep the issue in the public eye (until the committee gets its own way?) FEATURE is by Dr Bogle's wife who is, with his bedside help, no doubt, refashioning the BMA. I have a serious problem with the Chairman and his wife working together in this way. Nepotism is never pleasant and the BMA is too important. Capable, Julie Coulson may be but she is, after all, the Chairman's wife. Her piece may be seen, I assume, on the BMA web-site. 16 November, 2002 FRONT PAGE The most startling feature of the front page is a photograph of a very unhappy-looking Dr Ian Bogle. This is repeated on page 7 with a similarly disgruntled picture as a centre-page spread. Has he read last week's Commentary, we wonder? However, as editor he presumably agreed to the pix being included. The lead article is an Exclusive which carries a warning from a group of Spanish doctors who told the Health Secretary that foundation hospitals failed in Spain and won't work in Britain. The above mentioned Ian Bogle said that the BMA didn't mind foundation hospitals so long as all hospitals were the same. Milburn ignored such comments. Unlike their consultant colleagues who grabbed the money and ran, Scots GPs have confirmed that they will remain united as UK GPs in a "fight for a fair contract". Milburn continues to parrot that there will be no more negotiation with consultants but he will talk about how best to modernise the NHS. With the exception of Junior's chairman Paul Thorpe, an unholy alliance of failures will meet Milburn next week - Machin, Borman, Smith and Bogle. The BMA says it is resolutely opposed to the introduction of the contract trust by trust. ELSEWHERE Following the belligerent response of Milburn light is dawning in the higher echelons of Tavistock Square. Dr Bogle, previously a Milburn fan, is disappointed that Milburn takes consultation so trivially. Opposition health secretary Liam Fox summed up Labour by saying they always see consultation as a PR exercise. Medical School applications are up by 30%, with 59% being female - for better or worse. Showing their contempt for their colleagues failed CCSC members are sticking to their seats rather than resigning en-bloc to seek re-election in a vote of confidence. However there is an election for Chairman and two of the three nominees, Machin and Goodman, were largely responsible as joint deputy chairmen for the fiasco. Will these people never learn? Goodman boasts in his manifesto that he has good relations with government. That is precisely why he is the worst man for post the of chairman of CCSC. That is, apart from Machin, who led the negotiations and still thinks he's best. Oh, dear ! Milburn is planning to impose a new sub-consultant grade. Joint Consultants Committee Chairman said it was not the solution to the perceived problems of the proposed consultants contract. Hardly a robust statement but, then, he's "old guard". Junior's chairman Paul Thorpe puts it more simply "We do not want it". Scotland and Ireland are talking with managers about implementing the contract. So much for BMA unity. In an article about the Review Body Bogle says GPs must have a rise of more than 5%. Odd that only a year ago that demand was for in excess of 10%. Ah, well. He continued that DDRB negotiations would only continue if the contract was accepted. Consultants are after 15%. A centre-page spread is devoted to Contract Letters and the malaise within the BMA. No wonder Dr Bogle looks like a penitent schoolboy waiting to have his hands slapped. Even past-GMSC chairman Tony Keable-Elliot has a go at the fiasco. Replying to Keable-Elliot's comments, Bogle agrees that something must be done and says that CCSC is consulting urgently. There were no letters in favour of the crisis. The Opinion column is penned by disenchanted anaesthetist, David Rutter, who sees the end of traditional consultants as being nigh. He blames it onto the Milburnian preference for organisation, assignment rosters and timetables set by managers with a factory floor mentality of productivity culture. Not surprisingly he sees this as being bad for patients. Up and coming star in the GP fermament, Andrew Dearden stresses the need for the BMA and for colleagues to get involved in running it. Hear, hear, say I. Let's get some new blood in at the top. The present incumbents are a bit of a wash-out. In "Off the Record" Scots Council Chairman John Garner turns the old maxim on its head to excuse his colleagues disuniting greed. "There is strength through diversity" he says. Two full pages are devoted to the experience of the deputy editor whose GP thought he had Marfan's syndrome although, in fact, he hadn't. Nothing else is of great interest to politicians.
9 November, 2002 COMMENT FRONT PAGE The consultant contract provides the lead story but one would be excused for believing that bmanews was not the organ of the BMA. There is mention of an "olive branch" from Milburn. Excuse me, but it is Milburn who is the bad guy here with his belligerent response. There is also mention of the BMA Chairman assuring him that the Association does not want to scupper reform and please can we talk? The BMA Juniors Chairman rightly says that industrial action will be considered if a solution is imposed. Whereas Bogle says that "the BMA will decide its own action". The cynics amongst us know the Bogle strategy - shout to keep the troops happy, accept a rebuff, talk about sanctions until it's too late and end up doing b****r, all leaving Milburn victorious (and hopes of a gong intact, the most cynical will say) The author of "Slide 9", which told managers that the BMA had got it wrong and that all the nasty bits of the contract would be acted upon despite assurances to the contrary, NHS Human Resources Director, Andrew Foster has been told to resign by individual consultants. Note that. Not by CCSC although slide 9 went a long way to wreck the contract by showing management in its true colours. The renegade Scots CCSC which immediately grabbed the cash from ministerial hands on the strength of a 54% vote in favour, may not accept the contract after all. Acting Chairman of CCSC, Derek Machin fears Milburnian machinations to impose the contract through the back door. ELSEWHERE Scots GPs may be successful in their campaign not to implement the 2000 Adults with Incapacity (Scotland) Act which forces even more bureacracy on GPs. The Act demands that GPs fully examine every patient who is incapable of giving consent, dements etc., and then fill out a certificate to allow themselves to treat them. Nursing Home patients would be a nightmare. 270 non-principal Welsh GPs have not registered for the supplementary list and face a complete ban from NHS work. Another example of government bureaucratic stupidity shooting itself in the foot by making the locum/principal shortage even more dire. Yet another Quango is trying to justify its existence and, characteristically, makes an ass of itself. The Medicines Control Agency (MCA) is insisting that all chemists and GPs photocopy patient information leaflets (PILs) despite the risk of patients getting the wrong PIL if several are left lying around. Eleven organisations involved in pharmaceutical supply are objecting. The MCA is ignoring them. More stupidity from government (and we're only on page 2). GPs will have to supply patients with copies of all letters they send about them to other doctors. And what about the letter GPs send with emergency patients following MIs, RTAs - and during busy surgeries when referring urgently to clinics? Apart from that all letters will be so anodyne as to be almost useless to the recipient hospital doctor. GPC may be learning from the consultants, after all. "GP leaders" have said that GPs must have a similar rise to that rejected by consultants. Ah, but to whom did they say it? If they just chatted amongst themselves or to GPs it means very little, but if they said it to Milburn then that is another, more meaningful thing. BMANews does not reveal the recipient of this wisdom but it wasn't Milburn. Appraisals? Try appraisals.nhs.uk or revalidationuk.info NHS Failures. OP waiting lists in Wales have reached a new high, rising by 13.3% in the number waiting more than 6 months between June and September. Casualty Watch has revealed a breach in government standards in 29 hospitals. GP waiting lists in Wales will grow due to an increasing shortage of doctors. "After the
storm...consultants etc etc" Another page is a kind of "What the Papers said" as the writer flagellated the Association. The only sense on the page came from the Tory and the LibDem Health spokesmen who put the blame fairly and squarely where it belongs. With the government. Derek Machin gives the BMA point of view on page 10. He actually admits that his colleagues were so angry about the contract proposals at the roadshows that he will never forget it. Then, once again, once must act why did he, Hawker and colleagues storm the country deriding its opponents? Then, he has the nerve to agree to become acting chairman of CCSC. He thinks there is a misperception amongst consultants of CCSCs views. Sorry, Derek, yours is the misperception of your colleagues' views. You were wrong. Not them. He asks for consultant support to put it right. But they don't trust you or your CCSC colleagues. Trust can only be regained after an election. The article was a gross failure. There was no hint of an apology or any offer of resignation. The message was still one of believing that they are the right people for the job of picking up pieces. Consultants are saying a big NO to that. Amazingly, there is a full page ad on page 12 blasting out the message "You've spoken - we've listened - we're still listening". Ah, but consultants don't want "you" to be listening. They want a new representative body. The new, dynamic Junior Committee Chairman, Paul Thorpe has an interesting page devoted to his political past, present but not future. The interviewer was staff writer Graham Clews.
2 November, 2002 FRONT PAGE Remarkably, since the result only came out yesterday, bmanews has managed to headline with the result of the consultant ballot - and, within the pages obtained a few comments from voters. Readers will know that consultants voted 2:1 against the recommended contract. This should have come as no surprise to anybody, let alone those oft-quoted "doctors leaders" who were so badly out of touch with their colleagues. The head of the chairman of CCSC has rolled although, despite having accepted re-election only last week, he says "fours years is perhaps enough". Many colleagues may think it's been too long. CCSC has now to learn a hard lesson and attempt the very difficult task of regaining the confidence of its consultant colleagues, many of whom have now resigned from the BMA. The government, too, has a major problem on its hands. The Health Secretary's immediate response was to bluster and threaten. Psychometric testing of Mr Milburn would surely demonstrate his complete unsuitability for the position he holds. The next generation of consultants, the "juniors", rejected the contract by 84% to 16%, posing an even greater problem for CCSC and government. There is suspicion that "doctors leaders" have been too close to government although bmanews does not express this sentiment. ELSEWHERE The BMA has warned government that its obsession with targets is counterproductive. Dr Bogle spelled this out at an ABPI conference last week - and in an earlier press release. Dawn is breaking. Does this herald a new era and the eradication of BMA leaders' sycophancy with this sleazy, incompetent government? Northern Ireland GPs are seeking talks with the new Health Minister now that IRA/Sinn Feinn has been removed from government by the imposition of direct rule. Dr Bogle says "Let's work together to find a way forward". The BMA Chairman desperately needs some good news as his tenure of office has hardly been sparkling, to date. As it is very possible that GPs will reject their contract to repeat yesterday's debacle, Dr Bogle should have prompt "words" with GPC "leaders" to ensure that they do represent their voters - not just themselves. An item comments that the CCSC had more than 100 roadshows "to answer doctors' queries" but, like the GPC roadshows their real purpose was to talk-up the contract. Indeed, the now ex-Chairman of CCSC spent his time threatening and bludgening rather than reasoning. CPC chairman, Chisholm, behaved similarly, frequently patronising those who opposed the given GPC contract. If that continues then the BMA will only be the loser. The idiocy of bmanews, which is edited by the BMA Chairman, is illustrated by the phrase in the same piece "the NO campaign" - diagram heading page 3. Lessons really do have to be learned. Page 4 is headed by a news item saying that consultant physicians want to reduce their working hours but cannot because it will badly affect patients and colleagues of they do. According to a recent survey these consultants work an average of 29 hours a week over their contracted time - unpaid. Milburn is in the process of denigrating "lazy" consultants, but, then, that's typical Milburn. As mentioned earlier, bmanews has quickly obtained the views of a number of voters. The No's disliked and distrusted managerial control and the two Yes voters were only marginally in favour. Just who, one wonders, did CCSC seek opinions before agreeing the contract? The government claims that waits in A & E are falling but a survey of the consultants and staff who actually work there has rubbished this view. The doctors are now considering how to improve matters. The BMA View on this occasion is by the public Health medicine chairman, Peter Tiplady. He, too, is disatisfied with government. No special money has been allocated by government for public health, PCTs are strapped for cash, so he does not expect much improvement in the service which his "craft" can provide. The vast majority of the rest of this edition is apolitical, consisting of articles on Burke & Hare, Dr Archie Cochrane and his contribution to Evidence Based Medicine. Sadly, nowhere within this edition is there any evidence of any contriteness of the BMA to consultants for getting the contract issue so badly wrong. On the contrary, the feeling is given that the consultants let the BMA down. The editor of bmanews is Dr Ian Bogle, Chairman of the BMA, who was quick enough to intervene personally recently over a trivial problem with a columnist, maybe does not feel that the Association has anything to answer for over yesterday's debacle. The many consultants who are leaving the Association appear to beg to differ. |
