Avon Local Medial Committee - Latest News

The Chairman of the BMA’s GPs Committee today outlined a range of areas which, due to the financial crisis, should be cut or reviewed in order to save the NHS money. In his speech to the annual LMC Conference¹, Dr Laurence Buckman acknowledged that, while there had been record investment in the NHS in recent years, there were “worrying” times ahead, “because government needs to ensure that the pursuit of major savings and efficiencies does not adversely affect patient care.”

With NHS Trusts under pressure to achieve up to £20bn of efficiency savings by 2014, Dr Buckman said, “Government must be determined to avoid wasteful and ‘un-evidenced’ policies.”

Dr Buckman listed a number of areas which could be “consigned to the dustbin of history”:

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  • Wasteful PFI schemes - The Private Finance Initiative is now funding over 100 new hospital schemes, valued at £10.9 billion, but set to cost the taxpayer £62.6 billion by the time the final payments are made in 2048².
  • Management Consultants - £308.5 million was the total spent by Strategic Health Authorities, Primary Care Trusts (PCTs) and NHS Trusts on external consultants in 2007/08. In some cases, the NHS is paying external consultants up to £1,000 a day³.
  • Some tiers of NHS management – Many management jobs seem to exist with the sole purpose of supporting successive NHS reorganisations and top-down initiatives of the previous government. Micro-management of GP practices is expensive and unnecessary.
  • The GP patient survey - Survey results have been consistent since 2006, yet last year alone it cost the government £13 million to run the survey. The view of the BMA’s General Practitioners Committee (GPC) is that detailed and relevant feedback could be more usefully and more economically gathered locally from patient participation groups or local patient surveys.
  • The bureaucracy of the NHS market - It’s estimated that the ‘internal market’ has increased NHS overhead costs from 8% in 1991-92 to 11% in 1995-96 and increased administrative staff by 15% and general and senior managers by 133%. Since 1995 Department of Health statistics show that the number of senior managers has risen by 91%, more than double the 35% increase in the total number of doctors and nurses.⁴

Dr Buckman also listed areas which should be reviewed:

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  • Parts of NHS direct - NHS Direct still refers many of its patients on to GPs or accident and emergency departments and there is little evidence that it relieves pressure on GP or hospital services. While the NHS Direct website is a valuable resource and should be retained, the cost-effectiveness of other parts of NHS Direct should be reviewed.
  • Choose and Book – Many practices find the e-booking element of Choose and Book useful. However, the “Choose” element is laboriously bureaucratic and requires a lot of expensive NHS staff time, and management. The system is now regularly used to ration demand and meet the 18 week waiting times target by PCTs. In practical terms it is often difficult for patients to exercise real choice.
  • The current ‘consent to view’ model of the Summary Care Record – the BMA agreed to the current consent model for the duration of the SCR pilots, on the basis that there would be a thorough independent evaluation before it was rolled out further. This is due to be published soon, and the premature roll-out of this scheme is costly and inappropriate.
  • The building of new Walk-in-Centres and Darzi Clinics - existing centres need to be properly integrated with local services. However, new centres should only be opened after adequate consultation and an assessment of local need has been carried out.

Dr Buckman also warned against “spending money we don’t have” on abolishing practice boundaries, which would not only be expensive but would “harm the NHS and patient care generally.”⁵

Addressing the profession, Dr Buckman said:

“We, and our hospital colleagues, will all need to pull together in order to agree, if we can, what can stop without damaging patient care. We may have to accept that some parts of patient care may have to change too. Nobody will want that, but if it has to happen, at least let us see how we can minimise the effects on our patients.”

View the full speech at:
http://www.bma.org.uk/whats_on/branch_practice_conferences/lmcconf2010.jsp

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Notes to editors:

1. Local Medical Committees (LMCs) are statutory bodies which represent GPs locally. The GPC organises the annual LMCs conference and represents family doctors at national level. There are approximately 44,000 GPs working in the UK (not all full time) and there are 127 LMCs across the four countries.
2. http://lookafterournhs.org.uk/wp-content/uploads/private-finance-initiative-no-links-01068.pdf
3. House of Commons Health Committee (2009) The use of management consultants by the NHS and the Department of Health
4. http://lookafterournhs.org.uk/wp-content/uploads/doctor-final-270110.pdf
5. The GPC has published its own proposals for how to reform GP practice boundaries: http://www.bma.org.uk/healthcare_policy/reformgpboundaries.jsp

Responding to the independent review of the European Working Time Directive’s impact on the quality of training, Dr Shree Datta, Chair of the BMA’s Junior Doctors Committee said:

“The review reflects the concerns raised by the BMA earlier this year when our survey¹ of junior doctors showed half were missing out on training opportunities following the change in working hours.”

“Many of the report's recommendations² will require a fundamental change in the way training and patient services are delivered. It is clear that employers must look again at the way in which junior doctors work to ensure all juniors have time to train, whilst also safeguarding high quality patient care.

“The report makes it clear that high quality training can be delivered within the constraints of the 48-hour working week, however, this is dependant on implementing the recommendations in full. It cannot simply be put on a shelf to gather dust and to do so would not be in the interests of junior doctors or our patients.

“It is also essential that there is an emphasis on resolving the problems faced by doctors working in specialties where the impact of the working time directive on training is most severe. The BMA has found that eight out of 10 neurosurgery trainees reported regularly missing out on training opportunities¹. It is essential that this is addressed. Seeking the input of those worst affected, such as surgical trainees, will be key in improving the opportunities for training at work.”

Dr Mark Porter, Chairman of the BMA’s Consultants Committee added:

“The review defines and calls for a consultant-delivered service. The BMA has long advocated a service organised in this way – it will assure a high quality of care for patients as and when they are in the greatest need. The challenge now is to work towards it in a systematic fashion instead of the current piecemeal approach, investing in consultant expertise to deliver high quality care.”

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Notes to editors

¹ BMA survey findings

14,754 UK junior doctors were sent an electronic questionnaire on 18^th December 2009. 1,567 responses were received which represents 5% of BMA junior doctor members.

Over half of respondents regularly worked in excess of 56 hours on average in a seven day period, primarily when working in hospital specialties. One in three respondents worked more than 65 hours in a week. Working more than 65 hours was more common for respondents working in neurosurgery, surgery and paediatrics. Respondents were slightly more likely to be working these excessive hours if there were vacancies on their rota.

Two in five respondents reported that there were vacancies on their rota. Vacancies were mainly for hospital and academic or research posts. The majority of vacancies were for ST3-8 grades. Respondents were more likely to have been asked to provide emergency cover or cover for long-term vacancies for longer periods if they were working on a rota where there were vacancies.

Over half of respondents thought that compliance with the maximum average 48 hour week had a negative effect on their training. Half of all respondents reported missing out on training opportunities since August 2009; this was mainly as a result of covering rota gaps.

Just over half of respondents indicated experiencing pressure to work additional hours that are not recorded.

Since the full implementation of the WTR in August 2009, 58 per cent of respondents had been asked to provide emergency cover and 12 per cent of these respondents had been asked to do so on more than ten occasions. 29 per cent of respondents had been asked to provide cover for long-term rota gaps and 26 per cent of these respondents had been asked to do so on numerous occasions or over a period of several months.

Two in three respondents had provided service delivery during rostered time off and two in five had needed to undertake formal training during their rostered time off.

Two thirds of respondents were concerned or very concerned that junior doctors could be pressured to opt out of a maximum average working week by their employer. One in ten respondents indicated that they had been pressured to opt out of the maximum average working week by their employers. Two thirds of those who had been formally asked to opt out had agreed to do so. The most common reason for opting out was to cover rota gaps.

Half of all respondents reported that they thought that it is possible to train in their specialty whilst complying with the maximum average 48 hour week.

² The review of the impact of the European Working Time Directive on the quality of training, “A Time for Training” recommended that the NHS should:

1. Implement a consultant delivered service
2. Service delivery must explicitly support training
3. Make every moment count
4. Recognise develop and reward consultants who are trainers
5. Regular planning and monitoring

Commenting on the Health Secretary’s announcement today (Wednesday 9 June, 2010) that the government will set out new measures to protect NHS staff who raise concerns, Dr Hamish Meldrum, Chairman of Council at the BMA, said:

“It often takes a huge amount of courage to raise concerns about patient care. NHS staff who speak out on behalf of their patients should be protected as much as possible, and it is outrageous that they are often either ignored or threatened with a range of sanctions. We welcome this commitment to greater protections for those who raise concerns, and look forward to seeing detailed proposals.”

Commenting on the announcement of a full public inquiry into failings at Mid-Staffordshire NHS Foundation Trust, Dr Meldrum added

“As everyone recognises, the failures in patient care at Mid-Staffordshire must never be allowed to happen again. The BMA has already taken steps to support members with concerns about quality of care, and looks forward to co-operating fully with the public inquiry.”

Notes to editors

1. BMA members seeking support on raising concerns can access a dedicated service on 0300 123 1233.

2. The BMA has published guidance for doctors on whistleblowing at: http://www.bma.org.uk/ethics/doctor_relationships/whistleblowing.jsp

3. Whistleblowing and the failures in patient care at Mid-Staffordshire will both be discussed at the BMA’s annual conference (28 June – 1 July, 2010)

Dr Hamish Meldrum, who has been Chairman of the BMA’s Council since June 2007, was re-elected unopposed today for the 2010-2011 session (Tuesday 08 June 2010).

Dr Meldrum said:

“I feel very privileged and honoured to be leading the BMA over the next 12 months. The upcoming year will be very challenging for doctors and the NHS and I will continue to represent the profession to the very best of my abilities.”

Dr Meldrum has been involved in medical politics since the 1980s. He joined the BMA’s General Practitioners Committee (GPC) in 1991, was Chairman of the East Yorkshire Local Medical Committee between 1996 and 1999, became a GPC Negotiator in 1997 and was Chairman of the GPC between 2004 and 2007.

Commenting on proposals to attempt to reduce emergency hospital re-admissions, outlined by the Secretary of State for Health today (Tuesday 8 June, 2010), Dr Hamish Meldrum, Chairman of Council at the BMA, said:

“We understand the intentions behind these proposals and look forward to more detail. However, simply using financial disincentives is likely to result in unforeseen consequences.

“One risk is that we get a situation where decisions about discharge are based not on a judgement about what is best for the patient, but on an attempt to avoid additional costs. This could result in patients being kept in hospital longer than necessary, when it might be better for them to be at home.

“The best outcomes are always likely to be achieved when primary and secondary care professionals are allowed to work together to achieve what is best for patients. We need models of healthcare that encourage co-operation rather than competition.

“We should remember that there can be a range of reasons that a patient is readmitted, many of them beyond the control of the hospital."

The BMA’s General Practitioners Committee (GPC) today (Thursday, 3^rd June 2010) announced a series of wide-ranging changes to the way sessional GPs are represented within the BMA, as part of a package of reforms aimed at bolstering the voice of this crucial group of doctors.

The report from the GPC Sessional GPs Working Group is based on conclusions drawn from a large-scale consultation process that included a survey of over 1800 sessional GP members and a review of the way Local Medical Committees (LMCs) represent these doctors locally. External stakeholders were also consulted and structured interviews carried out on representational issues with grassroots sessional GPs.

New reforms outlined in the report include:

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  • Delegating authority to the Sessional GPs Subcommittee of GPC (SGPS) so that sessional GP representatives act on matters wholly or primarily relating to sessional GPs.
  • The size of SGPS will be doubled to 16 members.
  • The formation of an SGPS executive committee, which will meet regularly and with the GPC’s negotiating team when necessary.
  • Four permanent seats on GPC for the SGPS executive committee, in addition to the sessional GPs already elected via regional and national elections.
  • New guidance for LMCs to help them improve their representation of sessional GPs locally.
  • A new strategy for communications aimed at improving the flow of information and discussion between the BMA and sessional GPs.

Speaking about the report, Dr Laurence Buckman, Chair of the BMA’s GPs Committee, said:

“The number of sessional GPs within the workforce has increased dramatically in recent years. This report, which was initiated more than a year ago, is the outcome of the most fundamental and timely review of national and local sessional GP representation we have ever conducted.

“I believe the recommendations will provide a real impetus for change, allowing sessional GPs to have a greater voice at every level in the profession, whether it is locally with LMCs or nationally through their strengthened voice in GPC.”

Dr Vicky Weeks, Chair of the GPC Sessional GPs Subcommittee, said:

“It is clear from the responses we received in our consultation that the BMA, as well as the rest of the profession, needs to do more to listen and act upon the views of sessional GPs.

“While sessional GPs had concerns about the potential conflicts of interest inherent in having one body represent employers and employees, they were also clear they didn’t want a separate committee. I feel this is a recognition of the importance of remaining united in order to best represent the entire profession, particularly in the difficult times ahead.

“We believe these reforms will address the concerns of sessional GPs, but they are by no means the end of the process. As part of the continuing work of the Sessional GPs Subcommittee we are going to keep under review how these changes work in practice. One of the significant lessons from the survey is that the GPC and the BMA also need to look at their communications in order to improve all aspects of our interaction with grassroots sessional GPs.

“It is vitally important that sessional GPs take advantage of these developments and get involved. We need sessional GPs to engage both with LMCs locally and GPC nationally, to represent their views and the views of the wider profession and to become the leaders of tomorrow.”