BMA Junior Research Articles

BMA supports junior doctors who boycott training reforms

Junior doctors unanimously backed a vote of no confidence in the UK government's reforms to their training at the BMA's annual junior doctors' conference in London on 8 May. The BMA pledged support for junior doctors who boycott new training programmes, expressed concern over the possible lowering of professional standards, and intends to lobby for a delay in implementation of new reforms. The government describes its reforms--Modernising Medical Careers--as a means of improving “the quality of training for …

Junior doctors oppose 48 hour limit for all Junior doctors want guidelines on study leave BMA warns Liberal Democrats about shortage of doctors More specialties move into new grade BMA NOTICES

# Junior doctors oppose 48 hour limit for all {#article-title-2} Junior hospital doctors have conceded that a limit of a 48 hour working week would be impractical for all doctors. At present doctors in training are excluded from the European Union's directive on working time, which specifies a 48 working week. The European Commission is expected to issue a white paper shortly setting out options for the excluded groups. Many junior doctors believe that they should be included but the BMA's Junior Doctors Committee has decided that its policy will remain the target set out in the new deal on hours of work—that is, that by 31 December no junior doctor should be working for more than 56 hours. The decision will please those surgical trainees who had criticised the new deal for reducing their training opportunities and believed that the JDC was not representing their interests. The JDC has already agreed to negotiate and promote the use of the “English clause” which enables trainees in appropriate specialties to be contracted for a maximum average of up to 83 hours a week—their hours of actual work should not, however, exceed 56. The deputy chairman for hours of work and manpower, Dr Andrew Hobart, supported a motion from a surgical research registrar—“This committee does not wish to see a 48 hour limit on hours of work to be applied to all junior doctors.” There was a case for limiting the hours of preregistration house officers but it would not, he said, “be in the best interest of doctors to restrict hours to …

NHS is being dismantled, BMA chairman declares Junior doctors call for new medical school Changes made to consultant appointment procedures

# NHS is being dismantled, BMA chairman declares {#article-title-2} Five years after the NHS reforms all there was to celebrate was “the disintegration of the NHS with its fragmentation into several thousand ‘purchasers’ contracting with some 480 competing local businesses,” the chairman of the BMA council declared last weekend. Speaking at the BMA's Junior Members Forum in Edinburgh Dr Sandy Macara said that this was despite a tripling in management costs in no way matched by a comparable increase in productivity. He did not blame the managers because they were bound to construct or attract deeply flawed contracts based mainly on secondhand historic patterns of demand and supply unrelated to any satisfactory assessment of relative clinical need. The inferences in the changes, he said, were insulting to the profession and to managers. The chairman's evidence that the service was being dismantled was that money was not following patients. Patients had no choice but to follow the money until it ran out and no voice to exercise any effective influence. Inequity in secondary care was endemic. “We now have two national lotteries: Virginia Bottomley has taken invaluable experience from the first, the NHS, to the second.” More and more treatment depended on where and whether a contract had been placed. Dr Macara described as the “ultimate fraud” the manipulation of waiting lists ensuring that the more serious cases had to wait longer while less urgent cases received priority. The profession continued to emphasise that it was not opposed to change but “the competition for …

Junior doctors are still hard pressed BMA's concern over performance bill Junior doctors to retain employment rights GPs urged to take part in out of hours ballot

# Junior doctors are still hard pressed {#article-title-2} More than 96% of junior doctors now comply with the new deal targets for contracted hours, according to a parliamentary written reply. The number of hard pressed on call posts contracted for more than 72 hours a week—which should have been eliminated by the end of last year—was 771 in February. A year earlier it was 6524. The rate at which these posts are being eliminated more than doubled in the previous four months. Health minister Gerald Malone, who gave the figures, said that the regions were making good progress in reducing junior doctors' hours, but there was still more work to be done. He believed that a ceiling on contracted hours had been established, though there were still too many junior doctors under pressure to work too long. A total of 1776 doctors in non-onerous posts were still contracted for more than 72 hours a week. Mr Malone said that the priority was to ensure that no junior doctor worked on average for more than 56 hours a week. Regional figures for hard pressed posts contracted for more than 72 hours range from nil in the North West Regional Health Authority to 189 in Anglia and Oxford. The details are: Northern and Yorkshire 162; Trent 60; Anglia and Oxford 189; North Thames 178; South Thames 95; South and West 20; West Midlands 67; North West 0. Total: 771. Commenting on the figures the chairman of the BMA's Junior Doctors Committee, Dr Andrew Carney, said that while working conditions had improved the new deal as a whole has not been delivered on time with …

Junior doctors' fears for the future BMA proposes alternative models for the NHS GPs should consider a list of preferred drugs Defence medical services to be halved MPs question whether performance bill will work

# Junior doctors' fears for the future {#article-title-2} Failling morale among doctors featured widely in the debates at the recent meeting of the BMA's Junior Members Forum. The NHS seems to be attracting more doctors from other European Union states while recruitment in Britain is dropping. One doctor told the forum that 25-30% of the students who graduated with her had gone to Australia, and there were reports of general practitioner vocational training courses being unfilled. The lack of flexible and part time training does not help, particularly for women graduates, who now account for over 50% in most medical schools. To try to discover future doctors' intentions the BMA is to ask a cohort of final year students what their plans are and to follow them for 10 years. But it is the lack of progress on the Calman report on specialist medical training that is causing major frustrations, and the meeting condemned the lack of consultant expansion and called on the government for more central funding. “Failure to abide by this commitment must result in the whole profession supporting the juniors in their refusal to continue formal negotiations on the terms and conditions of the unified training grade.” The forum also resolved that because the overall employment position of doctors in the NHS had deteriorated to such an extent the BMA's health policy unit should investigate alternative ways of employing doctors. “This motion arises out of despair,” one of the Junior Doctors Committee's deputy chairmen, Dr Paul Miller, told the meeting. The meeting defeated a proposition that charging patients for general practice consultations would encourage a more responsible use of services. According to Dr Jonathan Reggler, who practises in the Oxford region, patients now saw demands and needs as rights, as the government encouraged them to go to their doctor. “We should be bold and think …

Junior doctors asked for more data on hours worked

The BMA's Junior Doctors Committee is asking all hospital junior doctors to supply details of the actual hours they work and the intensity of work so that comparisons can be made with the returns from regional task forces. The committee, which is asking for questionnaires to be returned by 30 November, believes that there are still major problems in reaching the target set for 31 December. The government's figures are based on the hours for which junior doctors are contracted to work and do not, according to the JDC, reflect the hours doctors are working once time spent on early starts, late finishes, and cover for colleagues' absences is taken into account. Under the new deal on doctors' hours no doctors should be on their feet and working for more than an average of 56 hours a week after that date. The hours should be reduced to 64 hours for those on a partial shift and to 72 hours for those on an on call rota. One of the questions asks for information about the amount of rest doctors get when on call to show whether or not the majority of doctors are working an appropriate working pattern and being paid at an appropriate rate. If they are able to do so the JDC would like doctors to name their base hospital or NHS trust so that details of problem posts and specialties can be sent to the relevant task force. A new subcommittee of the BMA's Central Consultants and Specialists Committee has been formed to represent clinical and medical directors. …

BMA chairman has seven point plan for NHS

The chairman of the BMA council, Dr Sandy Macara, has proposed a seven point plan to help repair some of the damage which he believes has been done to the NHS by the internal market and the development of a two tier service. “There is despair about the fragmentation of the NHS as competition vanquishes cooperation and privatisation looms large,” he told the BMA's Junior Members Forum at its meeting in Edinburgh last weekend. All sections of the profession were concerned about the future, Dr Macara said. Students were uncertain about their future careers. Although junior doctors' hours were coming down they were faced with shorter, more intensive training and inadequate consultant expansion. Senior hospital doctors were facing ambitious managers and desperate purchasers strapped for cash. General practitioners have had to cope with a 10% increase in workload and face ever increasing out of hours demands fuelled by the patient's charter. Public health physicians had largely become prisoners of an ideological system which had been their historic duty to challenge, and clinical academic staff were being crippled by performance norms which distorted the balance between teaching, research, and service. The BMA chairman proposes that the profession should resurrect and reinstate a consensus about its aims and objectives. As a general confession it should join with the government, managers, and the public in declaring its failings and shortcomings. Secondly, there was a need to restore the objectives which underpinned the consensus, and the profession could use the aims in the Health of the Nation to achieve this. Thirdly, the profession …

Focus: Edinburgh: The media: help or hindrance to medicine?

Opinion polls continue to rate doctors right at the top in the eyes of the public, way above estate agents and car salesmen and also above journalists. But how much does the medical profession owe to the media in maintaining this position and how have relations between the two changed? While agreeing that newspapers, television, and the radio now played a much greater role in reporting medical stories, speakers at the recent meeting of the BMA's Junior Members Forum in Edinburgh had different answers influenced by their jobs or personal experience. Some doctors now feel that they are being tried by the media and with health considered more as a commodity more medical decisions are being questioned. This is the view of Dr Jonathan Gabe, a senior research fellow at Royal Holloway University, London. The patient's charter has encouraged more people to complain and litigation has increased. He doesn't think …

BMA criticises juniors' new starting dates

The BMA's Junior Doctors Committee (JDC) has reacted strongly to proposals from the NHS Management Executive that in future preregistration house officers will start their employment on the first Tuesday in August and senior house officers on the first Wednesday in August. This will enable doctors to attend a compulsory induction course and allow for handover arrangements. The committee will ask for the circular (EL(94)1) to be withdrawn. Although the JDC supports a uniform starting date and induction courses, it has complained that its comments on the draft circular were not taken into account. The committee'spolicy is for a Monday starting date so that doctors can travel from one job to the next over the weekend. The committee believes that the new proposals are unnecessarily complex and will not be flexible enough to deal with problems, such as the availability of clinical tutors on afixed day of the week. It points out that the new starting date means that doctors would have to continue in their old post for an extra two days and would lose two days of theirnew pay rate. This could have a knock on effect later in the doctor's career. Furthermore,if house officers have to stay in post for an additional two days the senior house officer post will remain unfilled. The management executive proposes …