BMA in the News 2019-01-03

03.12.2018 Sup[plied by BMA Comms

Mental health cuts in Oxfordshire

In an open letter to Oxfordshire County Council, the county’s NHS and charity leaders warned that plans to cut funding for the county’s mental health services by £1.6m would have ‘devastating consequences’. They warned that the proposed plans to cut the budget from £8m to £6.4m by 2022 would leave some of the most vulnerable patients without access to vital support.

Commenting in the Oxford Mail, BMA mental health policy lead, Dr Andrew Molodynski, said: “The fact that there has been little if any planning means that OCC is playing a dangerous game with the safety of many of our most vulnerable residents- neighbours, friends, family members.” He added: “It is nothing short of shameful in this day and age.”

Missed GP appointments costing NHS millions

There was further coverage of the BMA’s response to the announcement by NHS England warning that more than 15 million appointments at GP surgeries in England are being wasted each year because of patients failing to turn up without informing practices in advance with mentions on BBC News BBC News channel,  BBC Radio Suffolk, Three Counties, Coventry and Warwickshire and Essex.

Comments from the BMA GP committee chair, Dr Richard Vautrey, featured in Pulse. Dr Richard Vautrey, said: “Every appointment at a GP practice is precious, especially at a time when GP services are struggling to cope with rising patient demand, staff shortages and inadequate budgets.” He added: “Practices will try many ways to address this problem, but ultimately patients do need to play their part.”

Warning over child sugar consumption

The Newcastle Journal reports on warnings by Public Health England that children could die younger if we can’t cut the sugar in their diets with the average 10-year-old in the UK consuming more sugar than they should consume in their entire childhood.

Commenting, the BMA North East regional council chair, Dr George Rae, said: “There is massive social responsibility on food manufacturers to get it right and to make labelling clear. In the supermarkets, for example, people might see products labelled as ‘low fat’ and think that’s great for their health, but often the low fat products are high in sugar.”

 

Government rules out GDPR exemption for GPs

Responding to a question tabled by Nottingham North Labour MP, Alex Norris, asking what assessment had been made of potential merits of exempting general practices from the GDPR, Pulse reports that the culture, media and sports minister Margot James has said that GPs will not be given the right to charge for patient information requests as it would ‘weaken the rights of patients’. Under General Data Protection Regulation, GP practices can no longer change a nominal fee for providing patient information.

BMA GP committee chair, Dr Richard Vautrey, said: “This reply therefore is no help to practices struggling with increasing numbers of SARs requests which leads to major unfunded workload.”

Other news

NHS England has said that it is better equipped to deal with the winter crisis thanks to the £420m funding boost which has been able to help struggling A&E departments and add extra bed capacity at 80 hospitals across the country, the iNews reports. Health minister Stephen Hammond said that the health and care sector has “spent this money wisely”.

The Sun reports on an investigation by the HSJ, which reveals that fifteen NHS trust chief execs were paid annual salaries of more than £250,000 last year.

 

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2018-12-01 UEMS Pathology Section

2018-12-01 The European Union of Medicl Specialist (UEMS) Section of Pathology Meting.

This full day meeting to place in the elegant and medieval setting of the Palazzia del Bo in Padua organised by Professor Ambrogio Fassina.

Attendees

Representatives from the Pathological Societies or Colleges of European nations were in attendance including from the following nations (up to two representatives per nation)

  • Austria        Sigurd Lax
  • Belgium      Claude Cuvelier
  • Croatia        Sven Seiwerth
  • Denmark    Carsten Rygaard and Karsten Nielsen
  • France         Phillipe Camparo
  • Hungary      Laszlo Vas & Janina Kulka
  • Germany     Gisela Kempny
  • Greece        Anna Batistatou
  • Italy,            Ambrogio Fassina (President)
  • Poland        Andrzej Marszalek
  • Spain          Aurelio Ariza
  • Portugal    Herminia Pereira
  • UK              John Firth

 Apologies were given by Holland ,Switzerland, Slovenia and Turkey

 Key issues of interest discussed:

This full day meeting to place in the elegant and medieval setting of the Palazzia del Bo in Padua organised by Professor Ambrogio Fassina. There were no facilities for videoconferencing.

A report was given on the state of Formalin restriction by the EU by Aurelio Ariza . The UEMS Pathology section has been instrumental in lobbying to avoid the total ban of formalin as there is no alternative for its use in the healthcare sector. It was noted the most important level of scrutiny of the amendment to the relevant EU directive was the EMPL committee which last met on 20th November 2018. There have been a number of compromises (1-14) of which compromise 8 9 and 10 have been approved by an overwhelming majority. Compromise 9 in particular is relevant which gives good visibility to pathology . There is no text from the European Commission. Aurelio Amize MEP has lead on this. Following this hurdle the compromises will pass through the European Parliament in December/January and European Council (Minister of Governments) after this. Then European Parliament and Commission. It was noted that the new levels of 0.3 ppm over 8 hours and 0.6 ppm short term exposure is significantly lower than currently. The likelihood will be a need for constant monitoring with evidence of this in pathology laboratories, embalmers and anatomy dissection rooms.

The President of the Pathology section is to send a letter of thanks to Laura Agea. It was noted a large numbers of MEPS are involved. It was suggested to contact national representatives. The UK representation Tim Aker MP and Jean Lambert MEP are UK MEPs with an interest.

The President of the Pathology section gave a report which include the following

  • recent UEMS Council meeting in Europe. where European Training Requirement in Radiology, Transplant Surgery and Wound Healing were passed. I mentioned that as part of my scrutiny of ETRs both the Transplant and Wound Healing ETRs mention the need to know pathogenesis and immunology but Pathology should be included in the updated versions of ETRs this was noted and accepted.
  • a number of Honorary UEMS awards were given out in Brussels
  • the new working Groups 1-3 were shown with Pathology in working Group 3 with Paulo Ricci as Chair.
  • The working Groups on Post Graduate Training, CME-CPD, ehealth digitisation were discussed.
  • UEMS EACCME which took place in Brussels 23-24 November
  • The Network of Accredited skills Centres in Europe (NASCE)  meeting took place in 4-6th October. The program is of interest to those in medical education consisting of a 1 1/2 day scientific meeting followed by 1 day train the trainer course for 12 participants
  • UEMS Council of European Specialists Medical Assessments (CESMA)is an advisory body of the UEMS created in 2007 with an aim to provide recommendation and advice on the organisation of European examinations for medical specialists at the European level.It was called in the beginning the “Glasgow group” referring to the first meeting held in Glasgow. It was then decided to adopt the name CESME (Council of European Specialist Medical Examinations). This name was finally changed to CESMA (Council of European Specialist Medical Assessment) Its main role is to:
    • To promote harmonisation of European Board assessments
    • To provide guidelines to the Boards on the conduct of assessments
    • To encourage take up of Board assessments as a quality mark
    • To offer an alternative to National assessments, where appropriate

https://www.uems.eu/areas-of-expertise/postgraduate-training/cesma

  • There was a discussion of income from EACCME accredited live and on line events. It was encouraged to discuss with national organisations. As UK representative of the RCPath and Deputy to the UK Delegation I said they maybe opportunities to explore accredited webcast. As an example there are free webcast available to BMA members. There might be a way of accessing these such that both BMA and UEMS Pathology Sections benefit financially from non BMA members accessing.

A report was given by Claude Cuvelier Treasurer of the UEMS Section . There was a general discussion regarding the finances of the UEMS which has assets of 8 million Euros (mainly in the Domus Medica) and now has a single bank account. There is a centralised National Contributions which are made by the National Medical organisations and National Societies to the Sections. I pointed out that the BMA has paid it bill 12 month in advance. There was a discussion about the contribution nationally to the sections contributions to central costs.

There was a request from one of the members to send a letter to request restitution of the loan given centrally by the section. This amounted to 25000 Euros in 2015 and is related historically to the finances of the Domus. This will be paid back to the section in 3 instalments

It is recognised that the income of the Pathology section is significantly than other sections such as Obs & Gynae who have a large number of transactions. An the Board does not have money coming in from an exam.  The sections balance in the bank as of November 2018 was 33,991 Euro  up from 29,343 Euros in January 2018. It was noted that a number of contributions from the National Societies have yet to be paid in the UKs case it is about 470 Euros. The invoice may have gone to an old address of the one of the UKs representative. It was noted by the group that sometimes the absence of payment does not get back to the representative to follow up.

A large amount of time was spent discussing the European Training Requirements in Pathology. Professor Fassina introduced the discussion by discussing the ETR in Radiology in depth which was passed by Council in October in Brussels. This included the process, timing, purposes content, structure, history, involved societies, revisions. The ETR in Radiology I pointed was not supported by the UK UEMS Council delegation on a number of counts. First it is very much a European Society of Radiology Document and does not conform to the UEMS ETR template. Secondly the document did not include the Royal College of Radiologists as co-authors as they had not (sic) been involved with its development and had sent a letter showing areas of concern about the document though this was only a month before the UEMS Council meeting. As UK Representative i suggested that if any document was to have a UEMS badge on it it should be produced by the UEMS section though gathering a wide group of stakeholders and views. I also said that there is also an expectation that a draft document would be circulated to a wide number of societies for feedback before submission. The draft ETR was set down at Berlin Poznan

A number of comments have been made by Arthur Felice (Malta) in writing

  • The ETR is concise practical and to the point.
  • More detail would constitute an improvement.
  • In the e-portfolio and logbook units of training should be competence based
  • Consider the concept of Entrustable Professional Activity (EPA) which he sees is a critical part of professional work that can be identified as a unit to be entrusted to a trainee once sufficient competence has been reached
  • One should not aim at the maximum number of competencies held in common in the various national curricula since this approach would inevitably lead to unacceptably low standards.
  • Theoretical knowledge content should be specified in detail
  • Competencies should be quantified and not qualified
  • In the schedule of training more detailed quantification is suggested The common trunk needs to be qualified in more detail to be of practical use.
  • The curriculum is just a bare outline. More specifics are suggested.
  • A good exposition of proposed assessments and their QA is missing.
  • The suggestion that trainees should spend a significant period in their training in foreign institutions of excellence is appreciated and suggested should become a rule

On this last comment I wondered whether UEMS had a role in the future in accrediting these foreign institutions.

There was a long discussion about subspecialty training and national variations in Cytology Neuropathology and Dermatopathology.

Questions asked about ETR in pathology included what numbers should be proposed in

  • Autopsies
  • Surgical Pathology Cases
  • Cytology Cases
  • How will Molecular, Informatics and Administrative and organisational issues be addressed

There was long discussion about content and how the European Board of Pathology Exam should evolve. Points discussed included

  • The value of a European Board of Pathology Exam
  • Who is it aimed at, what is the likely take up
  • The history of the exam (10 years CC has been involved he noted a high proportion of Middle Eastern nationals taking it)
  • Whether it would just parallel national exams or would it become a substitute
  • How the proposed exam compares with other national exams
  • The likelihood of national governments wantingto replace thir exam
  • The inclusion or not of OSCE type examination
  • Does setting the exam in English only penalise non English speaking nationals.
  • A Memorandum of Understanding with the European Society of Pathology
  • Letters to go to Cytology and Haematology
  • National view of Cytology Training in Greece
  • I asked whether ETRs should take into account trainees that are less than full time by stipulating pro-rata. It is noted in Belgium LTFT training is not allowed.
  • There were differences of opinion as how to count Cases, Number of Specimens, Number of slides.
  • National differences were noted in the length of time for each sub speciality
  • There was agreement to ensure inclusion of pathogenesis.
  • There is a need to collaborate with Radiology as both Radiology and Pathology have similar featurs of future developments
  • I suggested the RCPath 2015 Curriculum utilising assessment methods of DOPS CbDs and ECEs for Skills and Knowledge , and MSF for behaviours were very useful . The section recognised the advantages of the UK system though noted it nationally specific. I suggested there was a lot to potentially absorb from the RCPath the curriculum and I would be happy to explore if this was acceptable to the College. ACTION JF to discuss with RCPath stakeholders
  • There will be a need to have the amended ETR ready in advance of Athens meeting in May 2019
  • Expectation is that the Working group would have draft finished by the end of February
  • There is a need to have new bank of MCQ questions. I pointed out there will have to be note shared copyright on images. I pointed out that one has to avoid copyright infringement.
  • There was a discussion of standardised reports
  • It was noted that Breast Colorectal, skin and prostate have standardised reports in many countries. I pointed out that the RCPath had an extensive documentation and datasets which could be circulated.

Invitro diagnosis of medical devices 2017/746

See https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32017R0746&from=EN

A review is given in

https://ec.europa.eu/growth/sectors/medical-devices/regulatory-framework_en

This applies to diagnostic not processing except for immunochemistry

The Pathology Progress test was discussed. See

http://pathology.hu/en/news/1375/pathology-progress-test-2018

Other matters with insufficient time to discuss in depth included

  • The German representative submitted a slide which pointed out the requirement of DIN EN ISO/IEC 17020-2012 and technical criteria for their application for accreditation in pathology and neuropathology. The scope of the application is that  the rule has been drawn up by the Sector Committee Pathology/Neuropathology and serves as an interpretation for its application. A number of representatives where not aware of it,  Consequences are
    • Interpretation and recommendation
    • Subject specific criteria are stated
    • Their fulfilment must be proven by an inspection body for accreditation
  • Big Data
  • Artificial (Augmented) Intelligence

Future board meetings were agreed in Athens and Ghent

BMA in the News 29th October

All information supplied by BMA Comms

We need cleaner air

Over the weekend and this morning, there was coverage of the BMA’s membership of the UK’s Health Alliance on Climate Change and the demand for the government to implement the biggest shake-up of air quality legislation for 60 years in an effort to tackle the country’s growing air pollution crisis. The Times coverage focussed on the ask for the ban on new petrol and diesel cars to be brought forward by 10 years to 2030 and The Guardian took a broader view.

According to The Independent, there’s no doubt that the will of the people is to have a final say on Brexit.  The editorial talks about the BMA’s motion to back another vote and it even manages to weave in a mention of a song from Les Miserables, “Do you hear the people sing? Singing the song of angry men? It is the music of the people who will not be slaves again”

Closing the gender pay gap

Practice Business covers the recent Women in Academic Medicine conference in South West England. Dr Helen Fidler talked about the value of supporting local efforts to encourage female doctors to apply for CEAs. As the chair of the local negotiating committee in Lewisham, she is seeking to draw up a plan with her hospital trust to do just that.

Hospitals falling apart

A number of local papers, including, Dunmow Broadcast have written articles about local trusts requiring millions of pounds worth of repairs. The Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s Hospital, is currently sitting on a backlog of £101.5 million worth of repairs or replacements which should have been carried out on its buildings and equipment. We provided a comment from Dr Chaand Nagpaul, who said there was an “urgent” need for an injection of capital funding to address the NHS’ “impoverished infrastructure”.  This has been widely used at a local and regional level

Brexit is bad for our health

The ‘spectre’ of Brexit is already damaging our health service, according to an article in The House this morning and writer, Jeanne Freeman cites the BMA survey on EU doctors, working in the UK and making plans to leave since the referendum.

Mental health more prevalent than asthma  

Dr Richard Vautrey was interviewed on LBC radio on Saturday talking about the fact that GPs now wee more patients with mental health problems than they do with the traditionally more prevalent conditions such as asthma, high blood pressure and obesity.  One in ten patients has had depression diagnosed, as the condition overtakes obesity on GP records for the first time. The Times carried the story on Saturday, quoting Dr Vautrey. Depression is noted by doctors almost twice as often as it was five years ago as more attention is paid to mental health, according to official data from NHS Digital

In other news

£2bn for mental health

A large number of media outlets carry the news that the Chancellor is expected to announce an extra £2bn for mental health care in today’s Budget speech. Sky News says specially developed ambulances to treat people with conditions like depression, anxiety and PTSD are part of the new measures to ensure mental illnesses are treated as seriously as physical ones.

The Guardian says the commitment should lead to comprehensive mental health support being available in every large A&E department and the Mail Online claims that every school in Britain will get a mental health support worker to help pupils suffering from depression, self-harm and eating disorders.

#MeToo….not in the NHS?

Victims of harassment and abuse in the NHS are officially encouraged to speak out. In practice, this rarely happens, according to an article in the New Statesman. Written by a Cardiologist from South Wales, it says that the #MeToo phenomenon has not impacted the NHS as it has in other industries.

Medical Examiner in Cause of Death

INTRODUCTION OF THE MEDICAL EXAMINER POSITION IN ENGLISH TRUSTS

A report on the meeting held on 20th September 2018

Declaration

These are not official minutes of the meeting and are the personal view of the meeting by the writer. They therefore do not represent either BMA or Royal College policy or approval. See official sites for this.

Introduction

The Royal College of Pathologists hosted a meeting over the introduction of the Medical Examiner in Cause of Death (MEs) at the Royal College of Physicians on 20th September. This the second of its type this year and more are planned. The all-day meeting was introduced by President of the Royal College of Pathologists and immediate past president. The Royal College has been central in developing the training requirements, on line learning, job description and person description for the posts. After many years of frustration and delay these positions will be introduced in England from April 2019.

 

Topics covered in the all-day conference included:

  •  The role of the Medical Examiner
  • Working with Stakeholders
  • How will it work in practice?
  • Timetable for the implementation of MEs
  • Role of the National Medical Examiner
  • Appointment and role of Regional Medical Examiners
  • Accountability and independence – who will employ MEs and how will independence be assured?
  • Working with the Coroner
  • Changes to completion of cremation forms
  • The role of the ME Officer
  • Forms and data collection – update on digital support
  • Training of local MEs – e-learning and face-to-face sessions

The ME system will be phased within the NHS and now not by Local Authorities. It will be a non- statutory ME service and will include MEs and MEOs (Medical Examiner Officers) in salaried posts. ME systems will be phased into NHS secondary care from April 2019.  Implementation in primary care will require new statutory changes.

The Government are committed to moving to a statutory medical examiner process to include all deaths, but as yet it is unclear when this will be implemented. The decision to not take “a big bang approach” and implement the system statutorily from the 1st April enables Trusts and the government to introduce the system in a considered way which will allow for learning and the continued dialogue needed with all stakeholders to bring about positive changes.

No Trust is being forced to implement from the 1st April but from the oversubscribed conference it is clear many are keen to bring in the new system for the clear benefits it will bring to the families, professionals and services who feed into the process.

The NHS now have the learning from deaths programme and the safety programme which also need to be fed into the ME system.

There was also the decision to change the appointment of MEs from local authorities back into the Trusts. This still causes some concerns over their independence and accountability, but it is important to state that this is a process government will be learning from and there have been further levels of independence introduced into the roles to ensure this continues. MEs will be reporting to a separate line of accountability for malpractice. The success of this is to do with working with the pilot sites and early adopters.

Strategic overview

The conference was given a strategic overview by Jeremy Mean, Programme Director for Implementation who reports directly to Mark Davies

The DHSC has a strong commitment to the implementation and in October meeting of NHS England & NHS Improvement regarding finance will take place. There is recognition of the frustrations but there is a fresh commitment with a new vision of an ME service based in the NHS. In this initial stage it is a non-statutory service. Both the MEs and Medical Examiners Officers (MEOs) will be salaried in secondary care. There will be a process of reform and a move to a statutory system as specified in the 2009 Coroners Act. The interim period is unclear and the parliamentary process, complex. There is also a new impact assessment – which shows differences from the 2016 impact assessment.

This also links in with other patient safety developments such as learning from deaths encompassing all deaths.

The Medical Examiner lead will be appointed locally but there will be a separate line of accountability held centrally to ensure the need for an independent voice separately accountable to the Trust the ME is working within.

The DHSC is working with many to deliver on the following key objectives;

  • The bereaved, next of kin or informants are engaged and can raise concerns
  • There is joined up thinking with other departments
  • They are working with the pilot Trusts (some of which have been running for 10 years) and earlier adopters sites.
  • Working with coroners – MEs or Coroner with only two routes
  • Working with Registers of Death to avoid delay and ensure the cause of death is acceptable
  • Initial non-statutory approach with a move to statutory MEs over time
  • Improvement of recording of the MCCD
  • Improvement of the five-day timetable
  • For the future there will be a focus on urban and rural areas working with Funeral Directors and the BMA regarding deaths in the community.

Regarding IT support the government is committed to developing a system to provide a digital solution for the ME service. There are procurement arrangements in hand with DH Digital and a number of high quality bids for a digital solution we received. A decision has been made but not yet announced.  Input for implementation important as no one size fits all. The aim is for improve scrutiny and outcomes for the bereaved together with high quality data

Dr Aidan Fowler, is the newly appointed NHS Improvement National Director of Patient Safety and will working closely with the DHSC on this He is a surgeon by background and has already visited some of the pilot sites. Dr Fowler announced that the National Medical Examiner position will be advertised in October and will report to him regarding

  • Patient safety strategy
  • Insights
  • Infrastructure
  • Interventions
  • Ensuring bureaucracy remains relevant and manageable

Dr Fowler stated the need to improve the process for the bereaved when discussing the cause of death be a better experience of cause of death by relatives. Relatives want to know what the deceased died of and if it was an unexpected death. There needs to be an accurate recording of death recognising the importance of the current Coronial system and maternal and child death reviews. The aim is to assist in preventing excess deaths and spotting concerns earlier. There is also a need to know how data flow works.

Dr Fowler went on to discuss how the MEs are to be employed. They will be employed in the Trust they will be working within as this is practical however their reporting lines will be separate and independent. . There remains practical issues such as HR and pensions to discuss, but it is important that the jobs are desirable and those appointed have the desirable skills required for this role.

Role of the Medical Examiner and Medical Examiner Officer

Dr Alan Fletcher, Lead Medical Examiner in the Sheffield pilot gave an overview gave an overview of his role. Alan has been an ME in Sheffield since 2008 as one of the earliest pilots. Other pilots included Gloucester Mid Essex, Basildon, Brighton Hove and Powys, He gave a map of the current position of Medical Examiners that have been established in England. South Tees, Buckinghamshire, Lincolnshire, Barnsley, Norwich, Royal Devon and Exeter have all established MEs. He gave a background to the changes in the system that date back to the Harold Shipman case.

The purpose of MEs was defined as answering the following questions

  • What did the deceased die from?
  • Is the MCCD accurate?
  • Is there a need for a Coronial referral?
  • Is there a governance concern?

The steps of the ME procedure were highlighted as:

  1. An appropriate review of the medical records
  2. Interaction with attending doctor and enquiring of any concerns
  3. Interaction with bereaved.
  4. Confirmation of the MCCD

All this will be undertaken within 24 hrs. though it was stated Steps 2 and 3 maybe delegated to Medical Examiner Officers (MEOs)

Dr Fletcher gave a number of examples of poorly completed MCCDs highlighting specific areas that would either be queried or rejected by the Registrar of Death including “malnourished”.

He said there is often a need for clarification and to ensure relatives are engaged. Whilst there is a list of what to report to the coroner this may vary a little locally. It was noted that in the Learning from Deaths review the ME is not a replacement for national mortality case record reviewers, but the ME is seen as an initial filter, though independence and transparency is required.

In the pilot areas regarding Coroners referrals there appears to be no difference in the rate of referral but they (the Coroners) are said to be better informed. In most pilot areas the Form 5 forms are completed by the ME.

Part of the ME scrutiny is signposting which is currently undertaken by skilled people e.g. bereavement officers and therefore Trust are very much being encouraged to build on existing systems and good practice. The ME Dataset will include the usual demographics.

The ME training needs will be discussed and appraised. There are core sessions of e-learning (26) which have been refreshed recently by the Royal College of Pathologists.  Updating of all documents is taking place by the Royal College of Pathologists and will be available on their website shortly. There is a need to avoid inconsistencies in the system. The list of acceptable causes of death is also being refreshed and revised to emphasise the collaboration that is taking place. As well as e-learning there will be a face to face component 1-day event later this year and early next year which will include input from the faith community.

There were several questions from the floor and answers from the panel:

  • There was a discussion of what is a reasonable workload
  • In Sheffield there is 1 whole time equivalent ME for 3000 deaths and 4 wte Medical Examiners Officers. In addition to the bereavement officers already in place
  • Conversations with the bereaved will include hospital consent autopsy. But consented autopsy is not a replacement for coroner referral.
  • There is noted an increased level of complexity of referrals to the coroner
  • If there is a coronial referral this ends the MEs involvement.
  • MEs cannot instruct what the Qualified Attending Physician (QAP) writes but they are there to help advise them and agree wording that would acceptable to all. Ultimately it is the QAPs certificate, with the consultant in agreement.

There were discussions from the floor on:

  • the notion of independence of ME in Trust
  • training of junior doctors and medical students on completing MCCDs.
  • whether it was the fee from just Form 5 to be used for funding the MEs
  • The DHSC representative stated that when the statutory system comes in it there will likely be a fee introduced for all deaths (around £100 each)
  • The need or bereavement booklets for families
  • Out of hours scrutiny
  • The need for business continuity planning in the mortuary

Medical Examiner Officers

Medical Examiner Officers have a role to assist the ME in the three steps of scrutiny though this differs by location. They obtain the medical record which are looked at by the medical examiner. They also complete data entry.

MEOs do not replace bereavement officers but there is no reason why Trusts cannot combine the role. They don’t advise what to write on the certificate as this is still done by bereavement services. There was a discussion of what sort of MEOs, administrative, data entry, more clinical or combined role and who are we going to recruit. This can be a mix or work with what you already have. In one case this is a team of MEOs, nurse registration and bereavement specialties (7 part-time)

How does the ME scrutinise?

  • Medical Records reviewed, clinical letters, surgery, nursing note, safeguarding issues considered. This maybe electronic or paper or the combination of the two.
  • Conversation with the qualified attending practitioner (QAP)
  • Discussion with the bereaved
  • Conclude whether the death natural or unnatural

There will be a need for local solutions. The task of discussing with the QAP and bereaved maybe delegated to the MEOs as in Sheffield depending on whether the MEO is clinical or non-clinical.

Role of the Qualified Attending Practitioner (QAP)

At Gloucester the ME asks open questions about the deceased and is given an overview including, medication, procedure and terminal episode. Questions include are there any concerns? Has a coronial referral been considered? Has there been any conversation with coronial officers?

The MCCD is formulated by the QAP. Any fundamental disagreements (which are rare) lead to conversations with other members of the tea. The MEOs bleep the relevant QAPs in the morning for availability but there is a recognised need for flexibility.

There is a 24 hour ME service including out of hours. Though calls out of hours are uncommon. There is a need to cover paediatrics and organ donation.

Practical considerations discussed include:

  • who needs to see the body
  • who signs the cremation forms (Form4 – QAP  Form 5-ME)
  • Payment for Form 5 goes towards funding the ME service
  • The current Cremation forms remain in place
  • New forms

Administrative Information Form ME-1 (Part A)

    • Medical Examiner’s Advice and Scrutiny Form ME-1 (Part B)
    • ME-2 form
  • The QAP must complete death certification summary
  • Sheffield has an access database developed by Peter Furness (ME) which includes a summary of the record and medical examiners notes. This is linked to other reviews
  • Based on the Sheffield experience the ME time is on average 25 minutes but more complicated cases take longer.
  • As an example, review of records can vary between 12 – 15 minutes.
  • The ME interacts with both the QAP and with the family
  • Bereavement appointments are within 2 working days of death
  • Relatives need to have time to reflect often day after
  • Faith concerns, paediatric cases and organ donations are prioritised
  • The cremation waiting time is around 2 weeks
  • There are problems around availability of the QAP.
  • It is recognised that the ME system must be responsive as any delay might be directed at the ME system
  • The ME system avoids unqualified referrals to the coroner and the coroner receives more information
  • The Junior Doctor writing the MCCD gets support more easily.
  • It will take a while to embed the system
  • There may be an issue of long distances in some rural areas
  • Concerns – occasionally there is no agreement on the cause of death
  • Current pilots show no increase or decrease in complaints
  • Burial within 24 hrs – out of hrs service to facilitate release

Accountability of Medical Examiners

MEs will be regarded as Independent with different levels of accountability than within the Trusts and when introduced into Primary Care. Doctors will behave independently and professionally. There should be a minimal acceptable distance. There will be a need for peer review by a ME colleague. The MEs will be working with but not for the coroner. There will be collaborative working with MEOs. As with other specialties there will be professional accountability and annual appraisal. There will be a “channel of communication” of reporting to the National Medical Examiner.

There will be a need once established for a survey on how to make it a better system

Affects on the Coroner system

Increase or decrease number of inquests?

Sheffield – increase in inquests

Gloucester- no increase in inquests

 

Coroners PMs

There is a general reduction in coroners post mortem

Relationship between ME and Coroner

If there is a disagreement the ME has further discussions and a second opinion from another ME is sought.  In Sheffield this often arises out of a misunderstanding of the reasons of the report. If the law says so the case must be referred. It may therefore be a matter of improved explanation and polite reporting.

Cases of discrepancy where discussed in one area that had too few Coroners Officers and the fact that Doctors are moving areas with increased locum doctors.

In Sheffield there was a case where the ME was referred to the Coroner and then the case came back, but this is infrequent. There is therefore a need to ensure that the coroner is furnished with the right information.

The Coroner cannot tell a doctor what to put on the MCCD. There was a discussion of how you get the feedback. The MCCD does have a tick box to say that the QAP has discussed the cause of death with the coroner.

There was a general discussion on:

  • Examples of undue pressure in the event of a disagreement on a workable MCCD where there has to be an open investigation with a coroner’s autopsy or inquest
  • Communication – coercion.  “My consultant told me”
  • Pressure by hospital on healthcare acquired infections

 

 Interaction with the bereaved

 A leading MEO discussed their interaction with the bereaved. When a patient dies there is a booklet given out on the ward which explains the ME system and what steps will take place.

It is crucial the ME has a high level of empathy, be approachable and has good judgment. They are also there to inform the bereaved if there is a concern or if the bereaved raise a concern, understand what the issue is. In the Sheffield pilot care prior to admission is the most common concern raised. There is also a need to adhere to the local escalation policy.

There is a need to establish who needs to be involved in the conversations. Abiding by the openness of Learning from Death if a problem is identified, there needs to be discussions as to whether it will require independent review. If there is a duty of candour issue, sometimes not before death, the team would be there to address this and provide an open discussion without the fear of appearing to cover anything up.

The bereaved should also be asked if there are any problems they are aware of or what worries them and then reassure them there will be an investigation, but not undertaken by the ME.

The interaction with the bereaved has been very well received and all very much positive. But talking to relatives needs appropriate training as there is often a need to explain the terminology.  Skilled writing and plain language is also needed particularly when interacting with the bereaved. Bereavement staff have also welcomed an ME being there to talk to difficult relatives. Flexibility and empathy is needed with the bereaved and allowing them the space to process the death before approaching them with information.

Some of the following questions were discussed:

What happens if the relative doesn’t want to talk to the ME?

This is rare but may affect different members of the family. Sometimes this is because there are no concerns.

What do you do if relatives have concerns over their own mental health?

This too is uncommon and is a judgement call. There is a duty of care.  Are you the right person to speak to? Similar problems are seen in capacity issues.  Coroners also have much experience of facilitating challenging discussion and can offer support to MEs on this.

What will be the impact on the Registrars of England and Wales?

There is a need for collaboration at the outset. Registrars need to accommodate the changes. But engagement has been positive. Under non-statutory changes the registrar still has the statutory function with the 5-day target remaining. The Royal College of Pathologists is working with the registrars on the list of Acceptable and Unacceptable Deaths. These should be in place by April 2019 and there are now good channels of communication.

This is a new welcome level of scrutiny, but it is not a triage system. In Leicester there can be an MCCD release before the ME scrutiny takes (for deaths within faith communities). In a non-statutory system there is also flexibility for any urgent repatriation release.

A Panel discussion took place around the following

  • Current pilot schemes have varied some will differ to how it will work from April 19
  • Additional resources will be needed for a comprehensive system
  • MEs are likely to be part-time
  • A Job description will be place
  • As this is a non-statutory system the current system will prevail
  • There is a need for 7-day service – close to 24 hr consultant consultation
  • MEs are not bereavement counsellors but they have the ability to refer
  • There are workforce issues. For 2000 deaths which require up to 40 minutes a case Trust will need approximately 10 PAs.
  • A knock-on effect maybe an increase in hospital autopsy rate.

 

LATE AFTERNOON PANEL DISCUSSION

Panel included National SRO for wales, ME Bucks, Project Manager Lead ,

Senior SMEO.

Other topics discussed included;

  • Integration
  • ME in Learning from Death strategy
  • Mortality review ME involvement is critical as seen in Wales
  • Guidance in LfD for those for investigation.
  • ME is a flight path to a structured judgement review
  • Functions and oversight of ME
  • MEs are not working in sealed box if they send a case for a SjR
  • It is all about patient safety
  • MEs Involvement SjR
  • Involvement of ME in Trust Mortality group
  • ME recruited on the premise – multispecialty
  • Datix can be used for positive excellence
  • Evidence of recent ME experience
  • Talking for some time
  • Started planning mid May, November start
  • Planning training raising profile
  • Robust mortality review process is needed with positive input.
  • Set up a program of gradual role out (e.g start with 3-4 wards and progress to cover the whole hospital over a matter of weeks)
  • Link into mortality review
    • Scrutiny in the ME office
    • Spoken to family and qp
    • Document in electronic system that links to the mortality review. Promotes early review.

How to set up a Medical Examiner Service in a Trust

  • Consult with all stakeholders.
  • There is no need to begin with all deaths – no big bang is needed.
  • Identify how many medical examiners will be required in the trust?
  • How long should be taken on a case to do based on statutory roll out?
  • As this is not a statutory roll out the best we can do is “don’t do too many badly”
  • Initially review 50% – 75% deaths. Look at the number of cremations
  • DHSC is discussing additional funding for those deaths that result in burial and child deaths which will come to trusts centrally.
  • Need to look at Infrastructure, phones, territories, partnerships in the planning phase. Prioritising administrative support. There will need to be a full time administrative person and bring bereavement staff on board with review of job plans.
  • How this will work in primary care is under discussion. The Sheffield 23 GP practices are involved. IT solutions are important. The ME has access to GP records for 30 – 40 cases per month. The ME is based in the hospital as remote access to system 1 is easer.

What do Trusts have to do by April 19?

  • Don’t have to do anything
  • Trusts will want to work towards this
  • Roll out as quickly as able to do
  • Look at what your requirements would be
  • Work needs to be done by NHSE & NHSI
  • The enthusiasm and willingness of wanting to reform the system is the biggest incentive to deliver it and will show the benefits
  • Advert for National Medical Examiner set for this year

 

FOR THE FUTURE

Once embedded the next phase will be statutory implementation but this will need future legislation changes.

The official minutes of the meeting can be found at  Royal College of Pathologist’s Conference on the Medical Examiner System

 

 

BMA in the News 1st October

As supplied by BMA Comms

Evening and weekend GP appointments going unfilled

Today marks the deadline, set by David Cameron in 2014, for all areas to offer extended access GP appointments, yet according to an investigation by Pulse magazine, demand for the service remains low. Figures obtained under the Freedom of Information Act show that around 25 per cent of evening and weekend slots are going unfilled, while in one area only 3 per cent of its Sunday slots are being used.

Commenting on the statistics, Dr Richard Vautrey, BMA GP committee chair, said: “Because it has become a political must-do, everybody is jumping. We understand there is huge pressure from the centre on CCGs to demonstrate they are providing a full seven-day service.

“Sensible CCGs that want to use their resources in a better way are under pressure to maintain a service that really isn’t good value for money.

“That is ridiculous so I think we really do need to see much more common sense and pragmatic flexibility… if we had the luxury of resource and workforce then we could look at extending the service but until then we’ve got to focus on what is most important.”

Pulse’s investigation, and Dr Vautrey’s comments were also features in the Daily Mail, the Guardian, The Times, the Daily Telegraph and more.

Hundreds underpaid at hospital

More than 600 workers at East Suffolk and North Essex NHS Foundation Trust were underpaid – some by thousands of pounds – after overtime, expenses and unsocial hours were not taken into account this month. The Daily Gazette quotes a tweet from the BMA East of England regional junior doctors committee, which stated: “Hearing of significant problems at @ESNEFT with many members of staff of all professions being paid the wrong wages, many hundreds some more than a thousand pounds short.”

Dr Jeeves Wijesuriya, BMA junior doctors committee chair, said: “We know that junior doctors being paid incorrectly, or at times not at all, has become all too common for a workforce with lives, families, and financial commitments to meet. We hope the trust will work with us to swiftly resolve these issues.”

According to the paper, more than 500 staff have now been paid in full, with the rest expected in the coming days.

Pension rules now hitting middle earners

A news feature in the Daily Telegraph covered the growing protests against public sector pension tax relief cuts that have left middle earners worse off. The piece references BMA guidance which warns that NHS staff “with long service and or significant promotional pay rises” are most likely to be affected.

Missed appointments cost NHS millions

There was more regional coverage of statistics compiled by the Press Association on the prevalence of missed outpatient appointments and the subsequent cost to the NHS. Approximately 8.6 per cent of outpatient appointments in England were missed, rising to 18 per cent at some trusts. Breaking down the figures regionally, the story was covered by the Bridgnorth Journal, Hartlepool Mail, Kent Messenger, Medway Messenger, Oxford Mail, South Shropshire Journal, Sunderland Echo and the Hunts Post.

Responding to the figures, Dr Robert Harwood, BMA consultants committee chair, said:

“It is important that no appointments are wasted at a time when the NHS is under incredible stress. We should not stigmatise patients who may for legitimate reasons be unable to attend. However, we do need the NHS to emphasise through clear publicity to the public that given the current unprecedented pressure, patients should make every possible effort to rearrange their appointment so that another person is able to receive treatment in their place.”

Other news

Research released by the Labour Party has revealed that the NHS will suffer cuts worth £2.7bn after the government miscalculated the pension costs of public sector workers, the Mirror reports. The Labour party has said that the money lost could have paid for the salaries of over 61,900 nurses.

The Telegraph reports that an unpublished inquiry by the cabinet office reveals that police are illegally detaining more than 4,000 mentally ill people in custody a year because of a lack of NHS beds. Delays in finding a bed means that thousands of those being arrested and in need of mental health care, some as young as 15, are being held for up six days without charge.

An opinion piece by Wellcome’s director, Jeremy Farrar, in the science section of the Guardian warns that a no-deal Brexit would stall the NHS medical revolution. He argues that the NHS has thus far benefitted from being at the forefront of genomic medicine, largely because the UK has been an attractive place to “collaborate and invest in science”. A no-deal Brexit, he fears, would be hugely damaging for future research collaborations.

The Observer reports that the health secretary is expected to announce that the government is to produce the first official guidelines on the maximum amount of time young people should spend on social media in order to address mental health problems among children.

 

BMA in the news 18.09.2018  

BMA in the news all supplied by BMA comms

18.09.2018

Prevention must be the priority

Following the publication of the BMA’s prevention paper, the Worcester News featured a letter from BMA board of science committee chair Professor Dame Parveen Kumar highlighting the case for better lifestyle management and a focus on living healthier. “In the West Midlands, too many people are dying needlessly each from preventable long-term conditions associated with premature deaths. With the right intervention at the beginning, many lives could be saved,” she writes.

More support needed to help smokers quit

Professor Kumar also wrote to the Staines Chronicle and Informer in response to a recent Royal College of Physicians report on the decline in smoking cessation services. She said: “Patients in hospitals often receive advice and support to quit smoking but we must improve training and resources for health workers to ensure this becomes a routine part of caring for all smokers seeking NHS services, particularly for people with long-term conditions and mental health problems.”

Prescription fraud crackdown

The Lancashire Telegraph reports on a new NHS campaign encouraging patients to check before assuming they are entitled to free prescriptions. The Check Before You Tick campaign aims to reduce the £256m cost to the NHS caused by people wrongfully claiming free prescriptions. BMA council deputy chair and Lancashire representative Dr David Wrigley told the paper: “There is no harm in a patient information campaign to help patients know if they are eligible for free prescriptions or not.”

Rota gaps leave doctors stretched the limit

In a letter to the Yorkshire Evening Post, BMA consultants committee chair Dr Rob Harwood addresses the workforce crisis in hospitals, following the findings from the BMA’s recent rota gaps survey, which showed two-thirds of doctors had been asked to cover a more senior role or act down for someone more junior. He writes: “As doctors and other healthcare workers are forced to spread themselves more thinly, the cost to patient care is clear.”

A&E figures ‘paint a bleak picture’

Dr Harwood was also quoted in the Yorkshire Evening Post, in response to last week’s A&E figures, which showed attendances had grown by 22 per cent over the last 10 years. He said: “These statistics paint a bleak picture of what both staff and patients in A&E departments across the country face on a daily basis, and should serve as a warning for the future.

“They clearly show that the worrying increase in demand that doctors have been warning about for some time is now a reality – yet there is no additional capacity to meet this.”

Other news

The Guardian reports that researchers are calling for people in England to take part in a study looking at the link between genetics and anxiety and depression in what is expected to be the largest ever study of its kind. The project, by the National Institute for Health Research BioResource and King’s College London, is calling for 40,000 volunteers to send a saliva sample by post.

Midwives have called for women to be given official targets for how much weight they can gain during pregnancy amid concern about the risk posed to children by Britain’s obesity problem, the Times reports. The Royal College of Midwives wants limits to be set after research showed that too much weight gain by mothers could lead to babies growing into unhealthy schoolchildren, with guidance under consideration by the National Institute for Health and Care Excellence.

 

BMA in the news 10.09.2018  

As supplied by BMA Comms

Rush for post-Brexit deals could see NHS sold off to highest bidder

Ministers risk prioritising economic benefits over the health of the UK as the government races to secure international trade deals post-Brexit, warns the BMA in a new briefing paper. As the House of Lords debates the Trade Bill today, the BMA has detailed the  risks posed by Brexit, focusing on the danger future trade deals could pose to the delivery of care in the UK.

Dr Chaand Nagpaul, BMA council chair, said: “As the clock ticks down to our departure from the EU, the uncertainty surrounding post-Brexit Britain poses an ever more serious risk to the health service, its patients and its workforce.

Dr Nagpaul added: “With a no-deal scenario looking more probable every day and the UK facing the real possibility of having to trade under WTO rules, there will likely be an appetite from the government to secure new agreements that will go some way to minimise Brexit’s cost to the economy. However, these new trade deals absolutely must not put money ahead of the nation’s health.”

The news was covered in The Yorkshire Post and the BMA’s stance was echoed in an editorial by MP and family doctor Philip Lee forThe Independent.

There was further coverage of the BMA’s call for permanent residence for EU doctors and medical researchers in the UK to cope with the effects of Brexit in The Gloucester Gazette, The Wiltshire Times and The Weymouth Dispatch.

Amount of NHS land earmarked for sale is soaring, figures show
Ministers have been accused of “selling off the NHS family silver” after figures revealed that the amount of health service land being earmarked for sale to private developers is soaring. The Guardian reports The NHS is seeking buyers for 718 different plots of land or buildings it owns across England, prompting fears that underfunding has forced cash-strapped NHS trusts to dispose of vital assets.

Dr Chaand Nagpaul, BMA council chair, said: “These figure show a staggering increase in sale of NHS land in the last two years. This begs serious questions as to the reason for this surge. Was this land actually surplus or are these sales being used to plug financial deficits in hospital trusts as a result of a decade of underfunding?”

He added: “It is vital to safeguard the sale of NHS land and estate from perverse short-term financial incentives, and which may result in a reduction in estate and facilities that is insufficient to meet the future needs of patients. These figures demand scrutiny. Selling land shouldn’t be a way for the health service to make up for austerity-era cuts – especially if it could come at the expense of patient care.”


Study highlights racial discrimination in doctors’ pay

BMA council chair, Dr Chaand Nagpaul, was interviewed on BBC Asian Network yesterday in response to a study in the BMJ which found that senior doctors from black and ethnic minority (BME) backgrounds working in the NHS in England get paid less than their white peers. A clip from this interview featured on local news bulletins throughout the weekend on stations such as BBC Radio Nottingham and BBC Radio Wiltshire.

Public Health England heart health checker could see influx of pointless GP consultations

GPs have expressed concerns about Public Health England’s latest campaign, after they found that it tells anyone over 30 to go to their GP if their cholesterol level or blood pressure is unknown, Pulse reports.  BMA GP committee chair Dr Richard Vautrey said: “Improving a population’s heart health requires public health initiatives to encourage healthy eating, regular exercise and a change of lifestyle, including help to quit smoking and reduce alcohol intake.”

Dr Vautrey added: “However, with these services stretched, it is GPs and their staff, as the first point of contact for many patients, who bear the workload brunt when their local area’s health suffers.”

The comments come as PHE are also asking GPs to measure and record patients’ BMI routinely as part of a future strategy to reduce the prevalence of adult obesity. Speaking to Pulse, BMA GP committee clinical and prescribing lead Dr Andrew Green expressed his concerns that this would become a ‘screening programme’ without being agreed nationally.

Fears flu jab shortage could impact older people

The Daily Express reports fears of a flu vaccine shortage were raised by doctors who warned they are not receiving enough vital stock of the new job for the elderly.
BMA GP Committee chair Dr Richard Vautrey said: “The forthcoming flu campaign is going to be difficult for practices and patients because of the phased delivery of vaccine related to the limited availability.”

GP leaders warn of ‘conflict of interest’ for new record digitising services

The NHS Business Services Authority is launching a scanning service for GP practices to digitise old patient records but Dr Robert Morley from the BMA GP committee questioned a fully-owned government agency should be charging practices for a service they must use to adhere to national strategy. Read more in Pulse.

 

Meet three doctors who joined NHS on Day 1

Continuing this year’s NHS at 70 celebrations, The People spoke with three doctors who worked for the NHS from its first day. According to the paper, around 200 medics who witnessed the health service’s birth are still alive, and the GMC says 60 still pay a fee to remain on the register as non-practising doctors. Former BMA council chair, Dr John Marks, now aged 90, recalled being thrown in at the deep end in his first job at the now-closed St Leonard’s Hospital in Shoreditch. Read more about his experiences here.

GPs accused of ignoring NHS patients in favour of private clients

The Mail on Sunday claims GPs are driving up waiting times by seeing ‘lucrative’ private clients over NHS patients. One in 30 GP consultations is privately paid for, according to the latest available figures in a 2014 report by market research firm LaingBuisson, netting doctors £550 million a year.

We spoke to a GP at a west London surgery about the newspaper’s claims they could get an immediate appointment on app Doctaly to see her, but told by the receptionist the next available appointment for NHS patients wasn’t for two weeks, and supported them to provide an appropriate response. The article mentions a BMA motion to limit the number of appointments to maintain safe practice.
Cancer Connections book honoured with national BMA book award

The Shields Gazette speaks to the author of a book, Connecting with Cancer, lauded as the Chair’s choice at the BMA medical book awards earlier this month.

Co-founder of South Tyneside charity Cancer Connections, Reg Hall, said he was delighted to have won the award. Read our press release here.

Posh new building won’t make up for lack of GPs

In a letter published today, Avril Lake from Porthcawl wrote a letter to The South Wales Echo regarding the multi-million pound health complex which is to be opened in February 2019.

Avril writes “As a resident of Porthcawl, how is a multi-million-pound stylish, new building with a view of the duck pond rather than the car park going to improve access to health facilities I need to access? It is time for whoever sanctioned the spending of millions of pounds of public money on the new building to ensure those who will need to use the facility see overstretched GP services improved as well.”

Other news

Government health advisor and health writer Ben Goldacre criticises the NHS heart test as ‘ridiculous’ in The Daily Telegraph, suggesting the test will needlessly frighten millions of healthy people.

NHS staff will be able to voice complaints and express frustrations about their jobs and bosses in an online service set up by the government to tackle poor morale in the health service. Read more in The Times.

Thousands of NHS patients may have been subjected to serious harm after a massive IT blunder left GPs without vital medical information about hospital discharges, HuffPost UK can reveal. An urgent investigation has been launched by East and North Herts Hospital NHS Trust following the discovery that its Lorenzo software system at Lister Hospital in Stevenage had failed to send out up to 25,000 “discharge summary” letters to local doctors.

The NHS won’t pay for patients with a degenerative form of multiple sclerosis to receive a new drug which can slow the disease and give up to seven additional years before they need a wheelchair, The Independent reports.

2018-09-10 Deputy Chairs Report for MSC

The following is an amended version of the Deputy Chairs report for MSC

LNC Report

The issues that are currently under discussion with the management are:
1. The Raising Concerns policy:

The LNC interest in this policy revision arises from an instance when a group of consultants, who had raised concerns about a colleague in confidence, had their names disclosed to the person who was the subject of the concerns. This disclosure occurred at the very first meeting the individual had with the then medical director without any discussion with the whistle blowers. The Trust subsequently accepted that this inappropriate and agreed to revise the policy but only after intervention by the Chair of the Trust.  The LNC has provided to the Trust, a form of words that it hopes will prevent this from happening in the future.

2. Occupational Health issues:
This concerns the disclosure of sensitive personal medical information about medical staff obtained during visits to occupational health, being routinely copied to the previous Medical Director and to Human Resources without proper consent. The Trust has now put a stop to this practice after it was raised by the LNC. What remains unresolved currently, is how such personal medical information without adequate consent should be dealt with.

3. Job Planning policy:
Management side is there proposing a revision to the job planning policy and this will likely be a matter for the next committee meeting.

4. Trade union recognition:
The LNC represents all medical staff and this authority is recognised by the trust in a union recognition and partnership agreement. The trust is seeking to revise this and LNC will be providing appropriate input as required .

5. Junior Doctor issues:
Exception reporting etc are always am agenda item

 

BMA regional and national matters

There are a number of upcoming meeting some of them are open

 Upcoming  meetings

  •  London Regional Council ABM                          12th September Open
  • Professional Fees Committee                            13th September  (MEx Cod)
  • Medical examiner in cause of death                  20th September
  • NE London Regional Consultants Committee  26th September
  • UK CC                                                                      11th  October           
  • European Union of Medical Specialists            19TH/20TH October (ETRs)
  • London Regional Council Assembly                  23rd October   Open
  • BMA International Committee                          24th October
  • European Forum                                                   21st November

 

Education matters

NMUH has welcomed the UCL 6th Year who began on 3rd September. 5th Year Obs and & Gynae students start 17th September. 6th Year OSCE are set for    November 14th Wednesday am/pm and January  30th  Wednesday am/pm. The Real exams are on 14th March Thursday. Examiners and patients always needed. New examiners contact the education centre. The policy is that assessing for summative OSCEs can only occur if consultants have previously assessed at mock OSCEs. There is a the new teaching fellow here until end of July. He particularly has asked that consultants could scout for suitable patients for the clinical examination stations (respiratory, gastroenterology, cardiac and neurological) – preferably 10 to ensure there is a suitable number and as backups. He can be  contacted on

COMUNICATION ISSUES

There are two consultant email lists

Any maintenance of a List  on the Trust Computer should be the responsibility of the Trust to fulfill its duties of proper communication. It should be the responsibility of the Trust as laid down in a Standard Operating Procedure or Trust Policy who is responsible for uploading names at induction and removing names at retirement.  It is laid down in the trade union facilities agreement that The Trust should allow good communication with the Union members. It would be wrong to split the responsibility between the Trust duties for the LNC communicating with union members and communication to consultants by the MSC.  Whatever the Trust Policy or SOP on the matter, if there is one, should be adhered to.

 

 

 

ARE YOU A RETIRED BMA MEMBER ?

ARE YOU A RETIRED BMA MEMBER ?

The retired members meetings are organised to encourage retired members to convene and discuss common issues as well as providing an opportunity to meet colleagues and friends.

A report of the 2018 Retired Members Conference can be found at

https://www.bma.org.uk/collective-voice/committees/retired-members-conference/rmc-report

Richard Rawlins is the current chair of the Retired Members Committee

Most recent update is found at.

http://bma-mail.org.uk/t/JVX-54YB6-1BJCJOU46E/cr.aspx

with very useful information

 

WHAT ARE THE BENEFITS OF RETAINING MEMBERSHIP OF THE BMA AFTER RETIREMENT

 If you are thinking of retiring or have retired you will be aware that you can maintin your membership at a reduced subscription (Currently £166 per year  which can be set against tax)

Many of you having subscribed to the BMA for some years, and have had the benefit of representation and negotiation during your career. Please not stop your support now you are retired or thinking of retiring.

You are likely to need a motivated, dedicated medical workforce to care for you even more – and the BMA is the best insurance you can obtain to ensure our profession is not demoralised any further.

Your subscriptions maybe reduced, but they will materially help the BMA in its difficult task.

Without a vibrant and well supported BMA, the medical profession, and the patients it is dedicated to serve will suffer. The other benefits of membership are valuable, but your continued support of and membership of our profession’s best representative body is even more valuable as you advance further through the years.

The BMA provides a telephone counselling and advisory service specifically for doctors and medical students. It should be noted BMA membership is not required for this. This service is available 24/7 and can be accessed by calling 0330 123 1245.  There are also a vast amount of support services for both specific issues and general wellbeing on the BMA website  https://www.bma.org.uk/advice/work-life-support/your-wellbeing/sources-of-support  The BMA is also co-owner of DocHealth http://dochealth.org.uk/  a new confidential, not for profit, psychotherapeutic consultation service for all doctors. Although located in London the service is open to all doctors in the UK. It is supported by the BMA and the Royal Medical Benevolent Fund (RMBF).

For those who live outside of the UK or are planning to retire outside of the UK you can still be a retired member of the BMA  with the advantage of you keeping in contact with what is going on in the UK and potentially having small groups of BMA members in specific countries. (even if not previously a BMA member)

For more information

https://www.bma.org.uk/membership/subscriptions

 

Thanks to Richard Rawlins, David Curry and Ian Wilson for their assistance in the above piece

BMA In the News

20th August 2018 As Supplied by BMA Comms

BMA stands by Brexit warnings

Following the publication last week of the BMA’s briefing paper outlining the dangers to healthcare if Britain leaves the EU without a deal, Nigel Farage announced his return to political campaigning in an op-ed on Saturday for The Telegraph in which he cited the report: “[W]e are subjected to a daily stream of negative media stories about Brexit in an attempt to beat us into submission. The latest example of this was the British Medical Association suggesting that a No Deal Brexit would lead to huge numbers of people dying. This baseless claim proves only one thing: Project Fear is thriving.”

Responding to Mr Farage’s criticism, Dr Chaand Nagpaul, BMA council chair, told The Independent: “The consequences of a no-deal Brexit are potentially catastrophic – for patients, for the medical workforce and for the nation’s health. It is not scaremongering for us, Britain’s doctors, to be honest in warning about the real dangers – based on evidence – that crashing out of the EU could have on health services. We owe it to patients and the British public who have a right to be presented with the facts before having a final say on Brexit.”

The BMA’s warnings were further covered in The Daily Star, Channel 4 News and LBC.

Surgeon-general responds to BMA concerns over military GP IT systems

The Times followed up Friday’s exclusive story about IT problems in military general practice on Saturday, reporting on an upcoming meeting between representatives from the BMA’s armed forces committee and staff from the surgeon-general’s office. Responding to the concerns outlined by the BMA in the original Times article, the surgeon-general, Lieutenant-General Martin Bricknell, wrote in a blog post: ““The use of any medical IT system that poses even the smallest hazard to our people deserves our full attention. If there are problems, we are committed to addressing these in the most efficient way possible.”

The story was also picked up by The Guardian, The Sun and MailOnline. Watch AFC chair Dr Glynn Evans speaking with Forces TV about the issueshere.

BMA Scotland council chair to retire early over pressures

The Times Scottish edition’s front page reports that BMA Scotland council chair Dr Peter Bennie is to retire early from the health service over daily pressures and staff shortages.

In an interview with the paper, Dr Bennie, who will retire aged 55 after 32 years in the health service, said: “One of the things which makes my colleagues quite happy about retirement is that working as a doctor is increasingly stressful, because of the fear of what might go wrong and not being supported with that and the lack of sufficient colleagues to feel you can do the best job that you can.”

What should we call junior doctors?

The Times reports on a poll being carried out by Health Education England, asking healthcare staff and the public to propose an alternative term for junior doctors. The survey is being led by Scarlett McNally, a consultant orthopaedic surgeon, follows claims that the term is “discriminatory and belittling”. Commenting on the poll, BMA junior doctors committee chair Dr Jeeves Wijesuriya said: “While what we call [junior doctors] may divide some, we are united in our desire to tackle the more pressing issues affecting their lives, including unsafe rotas, low morale and unacceptable working conditions.”

Council’s bid to end period poverty

East Lothian Council in Scotland is putting free tampons and sanitary towels in all of its buildings to help those experiencing “period poverty”. The i Newsreferences the BMA’s ARM motion calling on the government to provide sanitary products for free.

Other news

A King’s Fund report suggests that some patients should be treated by admin staff when they visit their GP. Report author Beccy Baird told The Telegraph: “We need to look at different models. It could be a ‘microteam’  – where patients are assigned to a team, rather than to one GP, so that there is a nurse care manager, an admin worker and a care assistant doing much of the work, and the patient doesn’t always have to see a GP.”

Patients are avoiding visiting the GP over fears they will be told bad news or “lectured” about their unhealthy lifestyles, according to a study from University College London. The story was covered in MailOnline and BBC Breakfast.

EU migrants living in the UK will be given right to remain here, even in the case of a no-deal Brexit, according to leaked Cabinet papers. The Telegraphhas the story.

Dangerous syringe pumps allegedly linked to hundreds of deaths at Gosport War Memorial Hospital continued to be used in the NHS for eight years in a bid to cut costs, according to an investigation by The Sunday Times.