Dr Hamish Meldrum, BMA Chairman of Council
He says the British Medical Association wants the NHS to have more independence from party politics.
Day 5
The NHS is one of the most significant institutions in the UK. It is far too valuable to be used by competing politicians trying to outbid each other with extravagant and unrealistic claims.
What we need to do is transform the culture of the health service from one of politicisation to one of professionalism. This would ensure greater accountability to patients, and give NHS staff greater freedom to do their day-to-day work efficiently, without Government interference.
This is why the BMA thinks that the Government should have less say in the day-to-day running of the NHS in England.
We believe there should be a formal constitution for the NHS, and with it greater independence from party politics. Health professionals, in consultation with patients, should have much greater involvement in the management of the NHS.
Under our proposals, the NHS would operate under the guidance of a Board of Governors. The Department of Health would see its control over day-to-day operational matters significantly reduced, with the focus of its remit shifting to public health issues.
Parliament would have a greater role in the scrutiny of NHS strategy, for example in resolving disagreements over the strategic direction of the NHS.
The BMA is committed to an NHS that is free at the point of use, and funded by general taxation. However it’s important that we develop a “social contract”, where patients have rights – for example to confidentiality and choice about treatment - as well as responsibilities.
People deserve a clearer idea of what they are entitled to from their health service. We all want the very best for patients, but we must be honest and realistic about what any health service can do and what it cannot achieve.
An NHS constitution would renew and strengthen the public’s trust in an institution which they value very highly.
Day 4
Drinking is very much part of British culture and the BMA is not trying to overturn this but we do want to change the way many people behave.
Sensible drinking is enjoyable, social and can even be good for you. However, as a GP, I have witnessed the individual consequences of alcohol abuse.
When patients come to see me for help, there is chronic shortage of specialised services to help with their treatment. They can wait weeks if not months for specialist help and in this time their problems can spiral out of control.
We need much more funding for the treatment of alcohol misuse. But, of course, as with so many things, prevention is better than cure.
When I read the BMA report I was struck by the bigger picture of alcohol abuse. How ironic that when the NHS is struggling to cope with patient demand it is spending so much money on trying to manage the consequences of a preventable diseases.
Speak to any nurse or doctor about working in A&E at the weekend, or worse still, Christmas or New Year’s Eve. They have to cope with drunken and violent abuse; they patch up wounds and stabbings following drunken brawls and they often have to admit patients suffering with alcohol poisoning.
Then there are the longer-term problems of liver, heart and many other diseases I would not be surprised if these health professionals asked themselves: “Has all my training been for this?” I am not blaming individuals, but, for an increasing number of the population, alcohol misuse is getting out of control in this country. It destroys health, lives and costs the NHS and the legal system millions of pounds.
If the government is serious about tackling alcohol misuse it should start with tough decisions like focussing on cost and availability, the promotion of alcohol to the young and bad practices such as two-for-one offers and happy hours.
Awareness campaigns in themselves will not work, nor will simply hoping that the alcohol industry will put its own house in order. It’s time for leadership in this area and I hope the government is ready to show it.
Day 3
Plenty of Government NHS reforms have angered the medical profession, but none more so than the flawed imposition of the 'Modernising Medical Careers' training programme for junior doctors last year.
A radically different system was rushed in, despite repeated warnings from the BMA, that a disaster was looming.
And a disaster did happen. The computerised, centralised application system failed spectacularly to identify the best candidates for training posts. A website glitch left sensitive personal information of medical students open for anyone to view.
Utterly demoralised, facing career stagnation, and worried about unemployment, some of our best doctors left the country to try their chances overseas or even considered leaving medicine altogether.
The irony is that we're pushing talented medical staff out of training when the NHS needs more doctors, as anyone on a waiting list could tell you. Long term, we need more consultants and GPs - doctors trained to their full potential - to provide a high level of specialist care to their patients.
At the root of the problem is a lack of workforce planning. We need to take a long-term view, and meet the need for an expansion in consultant numbers by ensuring that the right numbers of doctors graduate from our medical schools, and that they, in turn, can get onto postgraduate training programmes.
The failure to undertake this kind of long view was one of the many problems identified by Sir John Tooke - who led an independent review of what went wrong last year.
One of his recommendations was for the creation of a new body to oversee medical training, reducing the Government's say in it. We hope the Government will do what they didn't do last year and not just listen to but act on the advice from their doctors.
Day 2
One of the greatest advances in medicine has been the success of transplant operations using donated organs from patients who have died.
Obviously each individual story provokes extremes of emotion. On the one hand someone has died, leaving partners, families and friends to cope with the loss and shock of bereavement.
On the other hand, another family or partner is grateful that their loved one has been given the chance for life.
Families who agree to donation often say that the fact their loss gives someone else a chance of survival, helps them deal with their bereavement.
Each case is different and the BMA strongly believes that everyone has the right to decide what happens to their organs when they die.
However, while most people support organ donation, only a minority sign to be on the organ donor register. This is not very surprising. No-one likes to think about their own mortality.
But it means many people who would have donated their organs do not do so because they never got round to signing the register. This is a tragedy for them and also for the thousands of people waiting and literally dying for an organ.
This is why the BMA supports moving to a system of presumed consent, but with safeguards. Such a system would presume that people want to donate their organs unless they opt out or their relatives were aware that they didn't want to donate, even if the deceased had not formally withdrawn from the scheme.
It would be essential for real safeguards to be in place for people who do not wish to donate their organs or whose family would be seriously distressed if donation were to proceed.
The BMA has been lobbying for a change in the law for many years and will continue to do so but in the meantime if you support organ donation, don't wait until tomorrow, sign up today - www.uktransplant.org.uk.
Day 1
In the next month two groups of doctors will be voting on issues of great importance to the NHS. Although each topic is different, both are marred by clumsy Government handling.
Very few people will be unaware of the current debate over doctors' extended hours. The BMA was never against GPs responding in this way but we wanted a solution where extensions to the service were properly funded and flexible to the needs of local patients.
A practice in a rural town, for example, whose patients are primarily elderly, may require different opening arrangements to a practice in an urban area with a large number of commuters.
The BMA offered a deal that would have achieved this but the Government rejected it and effectively gave the profession Hobson’s choice of two proposals, both of which would leave patients with a poorer service, and GPs with difficult working conditions. The BMA is polling GPs to find their views on the Government’s actions.
Another poll in the coming month will be held amongst the Staff and Associate Specialists (SAS) group of doctors. These experienced hospital doctors are crucial in providing vital patient services, including operations and helping to staff key departments like A&E wards.
Despite this vital contribution, for many years they have not been given appropriate pay awards or career recognition.
The BMA sought a fair deal in a new contract for these doctors, but unfortunately the government once again interfered with the negotiation and caused major delay to its potential implementation.
It is very disappointing that in both cases the Government has mishandled each situation through its high-handed and, some might say, bullying approach. The BMA is now polling all GPs and SAS doctors to assess their views and decide the best way forward.
In both cases we hope the Government will see sense, listen to our members and work with us to deliver a better service for patients.
Quote
'Very few people will be unaware of the current debate over doctors' extended hours. The BMA was never against GPs responding in this way but we wanted a solution where extensions to the service were properly funded and flexible to the needs of local patients.......
The BMA is polling GPs to find their views on the Government’s actions.' end quote
Yes but the poll asked will you accept the out-of-hours package being forced on you by the goverment or choose to say no and be financially punished for your temerity. Of course 92% of GPs went for the first option - who wouldn't? And what's the result? The Government is now using this poll to 'prove' that the GPs support extended opening hours. Of course many GPs don't want extended hours for many valid reasons, but the wording of the poll didn't give them the option to express this. Why couldn't the BMA come up with a poll that couldn't be twisted to suit the Government's purposes but rather accurately reflected what the GPs really think?
The Government gave the GP's more money than they expected to because they got their figures wrong as they didn't expect the GPs to work so hard, get the full points and get the full money on offer. Now they need to justify the salary increase that they created and thet're doing that by insisting on extended opening hours. Plus, it's got nothing to do with helping patients. This whole excercise is just a way for the Government to save face because they got the GP's pay wrong in the first place. They hope to be able to say, 'yes we gave the doctors a huge pay rise but we've made them open for longer - so that's OK isn't it?'
Typical Government spin tactics when THEY make an mistake!
I've been a GP's wife for 30 years and I'm sick of the bad press the GPs get all the time when all they want to do is get on with treating sick patients. I can't wait for him to retire.
Posted by: Sheila - S Wales 6 Mar 2008 17:20:17
Dr Hamish Meldrum, chairman of the BMA has written valid comments regarding drinking in Britain, but to raise the price of alcohol is certainly not the answer to our binge drinking problem. I have lived in Canada and the USA where alcohol is much cheaper than here and the drink problem is so much less than it is here. I wonder if the fact that booze was so expensive at one point in Britain and now people are making up for the fact that it is now cheaper.Booze is also much cheaper in Europe, hence the booze trips to bring it back home. There is obviously some drink problems in places in Europe as in places in North America but it appears that we are leading the way. Surely the answer is education and gentle persuasion, not heavy handed responses such as raising the prices. If people are bombarded with education regarding responsible drinking then they will eventually respond positively.
The carrot rather than the stick.
Posted by: Fred Mason. Cumbria 21 Feb 2008 18:34:27
I have seen so many changes in such a short time with in the medical profession that it makes me dizzy.
It all started about 1998, when the on slought against doctors started. Some justified and some totally in appropriate. What we got from this is a mess and a chaos. Yes I aggree that things have deffinitely improved for the patients, in particular the waiting times to see a specialist. We have to ask if this is really due to a shift in work culture or rather due to massive payments by the trusts to get the waiting lists down.
This has been achieved at a cost, a cost that will become clear in long term. Poor training for the junior doctors, poor working conditions with unsocial shifts and little support from the seniors. I am sure this will emerge as a big problem for the future as the training is now seriously affected. the funds and the study time for the jouniors have been cut and there is more service commitments for the jounior doctors.
I can only hope that some one looks at the biger picture rather than the short term gains of reducing waiting times and saving funds to maintain zillions of managers in the NHS. If patients want to be treated by the best trained doctors in the future then they have to be interested in their training as well. It will not help any one if the bright students choose other proffessions as the shine from the medical profession fades away.
Posted by: kerry, scotland 20 Feb 2008 12:49:45
The diverse human habits alongside many a [Doctor Riddims] has long endured the policy surrounding medical care where suited as oppose to when required.
In reality many a visit does entail the process of repeat prescriptions, which can be best served no matter where the patient is, if all doctors update the mass BMA database, as 90% of patients have to travel from work many miles away to see their GP. Thereafter, many an infleunza can be dealt with by the removal of such matters of stress, allowing local GP's to facilitate emergency surgeries in order that (if it cannot be dealt without due consideration to hospitalisation of [Reggae Riddims]), waiting times can be further made comfortable by such donor provisions, leaving govern mental ethics aside.
Posted by: Khalid 19 Feb 2008 19:29:35
Iretired from G/P last year and am aware of the benefits of the new contract-including the huge difference of no out of hours responsibility. I regard a few late opening hours an extremely small price to pay for no nights/weekends on call. The real unjustice in the NHS is the continuing abuse of junior doctors who are propping up a bankrupt hospital service by working
busier shifts day and night,being manipulated by hospital managers.The majority of consultants do little to support their juniors against this abuse. The job at the end of training looks less and less worth having after prolonged post-graduate training and exams (with goalposts continually changing)Many are
leaving their chosen pathways
to seek better remunerated posts with more humane conditions. This includes moves to G/P where the grass is definately greener.
Don't continue to ignore the plight of junior doctors-soon there will be a backlash of no
one going into the specialities.G/P cannot survive without a viable service to man the out of hour problems that G/P is all to ready to refer.
Posted by: Dr T.J.Moodie 19 Feb 2008 11:00:27
I asked our local chemist if they will stay open longer to cover surgery hours they said NO. so if I get a late appointment, get given a prescription my nearest chemist will be 9 miles away!!
I agree the hours may be good for city centres, but not village locations.
Posted by: Gill UK 19 Feb 2008 08:41:22