BMA and other information

The following is part of my regular update on BMA activities and information relevant to North London

STP information

David Stout is the Senior Programme Director North Central London STP (Now called Sustainability and Transformation Partnership) and he gave a report to Haringey Clinical Commissioning Group Governing Body Meeting.


Report to Haringey CCG July 2017

Note the North London Partners in Health & Care website is up and running at

Note their Newsletter

2017-08-10 Newsletter


 The Joint Health Overview and Scrutiny Committee (JHOSC) engages with the NHS on the North Central London Service and Organisation Review and scrutinises the strategic changes relating to health service provision across the five boroughs. The committee is made up of the Chairmen of the Health Overview and Scrutiny Committees from five London boroughs: Barnet, Haringey, Camden, Islington and Enfield. The following are the current members.

Councillor Alison Kelly (Chair)

Councillor Pippa Connor (VC)

Councillor Martin Klute (VC)

Councillor Richard Olszewski

Councillor Graham Old           

Councillor Alison Cornelius    

Councillor Anne-Marie Pierce

Councillor Abdul Abdullahi   

Councillor Charles Wright    

Councillor Jean Kaseki          

BMA information

For regular information from the BMA about your area join the BMA communities group for London (sign into go to connecting doctors) eg the following recent item



 London news update: 20 July 2017

  1. NC London STP and its CEP.Three of the five STP areas in London have been subject to the Capped Expenditure Process (CEP (NW London, NC London and SE London). Following a FOI request by BMA news the NC London STP have expressed their concerns over being told to find a further £61million savings by March 2018. The STP has drawn up radical plans that would be needed to support the savings but have told the BMA they do not support the plans and felt frustrated over this latest process. However, the NHS England chief executive, Simon Stevens, has said organisations in the capped expenditure process “need to get on with” making planned savings, with the current search for further “hard choices” completed in most of them. He added, “They now need to get on with it, don’t they, because we’re in July… The longer you leave it the tougher it is.”
  2. Royal Brompton & Harefield.This Trust is having exploratory discussions with Kings Health Partners in moving their services to the St Thomas’ site. The Trust is facing losing their heart surgery services in a national proposal from NHS England. Royal Brompton and Harefield Trust, which has another site in west London, faces losing some of its services as part of NHS England’s congenital heart disease surgery review. The trust says if it is forced to stop performing Paediatric CHD work the knock-on effects would render other services unviable.
  3. North East LondonAfter seeking advice from lawyers, City and Hackney Clinical Commissioning Group has sent a letter to sustainability and transformation partnership leaders reminding them the agreement between providers and commissioners “does not create any new legal entity, and each organisation remains sovereign”. The partnership proposal was for a single accountable officer to be appointed across the seven CCGs with the CCGs only having one representative on the partnership board. The letter was written in response to the East London Health and Care Partnership agreement, which was created in May and covers 20 organisations in the North East London STP patch. City and Hackney and Waltham Forest CCGs are the only two NHS commissioners yet to sign the agreement. In the letter, City and Hackney CCG makes clear the new partnership board must “talk to” individual CCG boards and adds “the governance at STP level needs to reflect the fact that organisations cannot be bound by majority vote”. Although the partnership agreement said it does not intend to be legally binding it, it does propose that the board’s scope of authority includes “major system changes” such as the system control total and financial strategy, Whipps Cross Hospital redevelopment strategy and the system-wide estates strategy.
  4. North East London STP funding.The £325 million announced in the Budget has now been allocated to 25 schemes across 15 STP areas. Up to £5m has been earmarked to fund the redesign of the urgent care centre at King George’s Hospital in North East London. It is expected the changes will improve facilities for patients and staff, and support the hospital to improve wait times.


The BMA communications team has produced a helpful link to reflect the range of activities that took place at this year’s ARM (Annual Representatives meeting) which I recently blogged about. The digital feature

selects some inspiring and memorable motions and speeches from the event which will be relevant and accessible for both the representatives that attended as well as the wider BMA membership.

Upcoming meetings

 I will be attending on behalf of the North Thames Regional Consultant Committees the July 25th London Regional Council Executives meeting. Items on the agenda for discussion include the following

  • A report from  ARM
  • Updates from the Branches of Practice,
  • NHS structures for medical students
  • Planning  for the Annual business meeting of LRC which takes place on  12 September 2017, note all BMA London Members can attend this and can stand for election to the ececutive.
  • LRC lobbying MPs on STPs,
  • The Capped Expenditure Process  for London


BMA ARM Bournemouth Thursday

MOTIONS THURSDAY MORNING  (my views in italics)


Received: Report from the BMA consultants committee acting chair (Rob Harwood).

View Rob Harwood’s Speech to ARM  It is 6 minutes long  Acting Chair of UK-CC

View  Mark Porter’s speech to ARM 2017 From Monday 25 minutes long,   Outgoing Chair of Council

 Motion 124 proposed by Jan Wise CONSULTANTS CONFERENCE:

That this meeting believes that the new (2016) junior doctor contract impinges on the working lives of many consultants in England and demands that NHS Employers agree an adequate programmed activity (PA) allocation for the following roles:- i) guardians of safe working; ii) educational supervisors; iii)clinical supervisors.

Motion 125 proposed by NORTH WEST REGIONAL COUNCIL:

That this meeting believes that all consultants, members on the specialist register and junior doctors of ST3 and above should be balloted on the new consultant contract proposals.

Passed 56% to 44%


Report from the BMA public health medicine committee chair (Iain Kennedy).

Motion 127 proposed by Ellis Friedman NORTH WEST LONDON DIVISION:

That this meeting deplores the severe funding cuts being made to public health services and calls for:- i) government immediately to stop further reductions in public health budgets; ii) a mechanism to ensure the consistency and equity of nationwide public health provision; iii)the reinstatement of public health within the National Health Service.


Peter Holden Chair of BMA Professional Fees Committee gave his report

Motion 130 proposed by Grant Ingrams EAST MIDLANDS REGIONAL COUNCIL:

That this meeting instructs council to sort out and modernise the “collaborative fees” structure in respect of work done by doctors on behalf of local authorities.

I need to review his talk and ask for his speech


Receive: Report from the BMA international committee chair (Terry John).

Started 10.20 am 10.25

 Motion 132 proposed by Jackie Applebee TOWER HAMLETS DIVISION:

That this meeting:- i)   condemns the UK government for reneging on the Dubs amendment so that by April 2017 only 350 unaccompanied minors had been allowed into the country; ii)  demands that the government respects the Dubs agreement and admits the children; iii) demands that the UK take a proportionate share of the international obligation to provide sanctuary to people fleeing from war and persecution.

Motion 133 proposed by Umar Hanif MEDICAL STUDENTS CONFERENCE:

That this meeting calls on the BMA to:- i)   recognise the current global refugee crisis and the unique health challenges that face refugees and asylum seekers; ii)  campaign for better access to healthcare and health education for this group; iii) promote research into the physical and psychosocial aspects of refugees’ and asylum seekers’ health.

Motion 134 by Rachel Pickering FORENSIC MEDICINE COMMITTEE:

That this meeting regarding the ill treatment of prisoners:- i)   notes that the Council of Europe’s Committee for the Prevention of Torture publishes standards, which contain thresholds for defining various types of ill treatment within European secure environments; ii)  notes with concern that there are no published worldwide standards regarding the prevention of prisoner ill-treatment by which national signatories to the United Nations’ Optional Protocol to the Convention Against Torture must abide; iii) calls for the United Nations’ Subcommittee on Prevention of Torture to publish standards that define various types of ill-treatment within worldwide secure environments.

 This was an interesting motion that I fully supported.  Following its visit in 2016 The European Committee for the Prevention of Torture published in April this year their report on the United Kingdom. Regarding the prisons they visited their report

  • raised serious concerns over the lack of safety for inmates and staff in prisons in England
  • They expressed deep concern about the “severe generalised violence” in the UK prisons they visited.
  • none of the prisons visited could be considered safe by CPT.
  • They noted a considerable number of prisoners spending up to 22 hours per day – and sometimes more – locked in their cells.
  • They also highlighted the inadequate safeguards to protect patients in mental health settings

The government has yet to respond to these concerns and the CPT’s numerous recommendations

Related hyperlinks

CPT holds high-level talks in London              CPT publishes report on its UK visit:



Motion 135 proposed by Andrew Mowat LINCOLN DIVISION:

That this meeting acknowledges the decision to leave the EU,  and believes that the movement of doctors in and out of the UK strengthens health services in the UK and abroad, and calls on the BMA to lobby the UK government to uphold: i)   the right of residence to be granted to EU doctors and medical academic staff who are working in the UK; ii)  the right of residence to be granted to UK doctors and medical academic staff who are working in EU states; iii) the right of medical students from the EU currently enrolled in UK medical schools to continue to live in the UK and work and train in the NHS after qualification; iv) the mutual recognition of professional qualifications; v)  the common framework for training and standards; vi) the alert system for raising fitness to practice concerns.

Carried unanimously


That this meeting believes that the close ties between the health service in Northern Ireland and the Republic of Ireland in terms of training, service delivery and research have been of mutual benefit and must be protected to ensure that doctors, medical students and patients are not disadvantaged in any post Brexit settlement. This meeting believes that:-  i)   doctors and students from either jurisdiction must be able to move freely to care for and treat patients; ii)  the existing open border arrangements must be maintained;  iii) mutual recognition of medical qualifications must continue;  iv) all-island health services must be maintained to ensure patients in Northern Ireland have access to specialist care.

Carried unanimously


Motion 137 proposed by Chris Williams SHEFFIELD DIVISION:

That this meeting is concerned about the funding cuts that HEE is being forced to make and demands:- i)  the UK government address this immediately instead of passing the buck to arm’s length bodies; ii) that HEE guarantees the support for trainees, trainers, educators and clinical/educational supervisors is increased in these testing times

Motion 138 proposed by Anumita Dhullipala SCOTTISH COUNCIL:

That this meeting calls for the BMA to work with and lobby key stakeholders to ensure the compulsory inclusion of a community based placement within foundation training PASSED

and that this should have a majority of its time in NHS General Practice.   (as a reference)

Motion 139 proposed by Haldane Maxwell CONFERENCE OF LMCS:

That this meeting insists that there should be nationwide protection for doctors undertaking the hospital component of GP training to ensure that all training posts provide the necessary training which will be required in general practice and are not simply used to fill gaps in secondary care rotas.

Motion 140 proposed by MANCHESTER & SALFORD DIVISION:

That this meeting regrets that the Oriel application system, and speciality recruitment offices only provide email as means of contact for applicants. This meeting:- i)  rejects that email communication alone is sufficient for time-critical communication; ii) calls upon the relevant parties to provide clear and easily accessible contact details, including a telephone number for the most urgent enquiries.


Motion 37e  by Stephen Watkins NORTH WEST REGIONAL COUNCIL:

That this meeting calls for social care to be available free at the time of need, financed out of general taxation and provided as part of the comprehensive health service.

Motion 362 proposed by David Wrigley NORTH WEST REGIONAL COUNCIL:

That this meeting opposes charges for patients:- i)  to see a GP; ii) if an appointment is missed.


That this meeting notes that the single shareholder of NHS Property Services (NHSPS) is the Secretary of State for Health in England and that NHSPS and agencies acting in its name are:- i)   seriously threatening the financial viability of many NHS GP practices; ii)  causing massive psychological distress and managerial work for GP partners diverting them away from caring for the sick; iii) behaving very badly as landlords in a manner unbecoming of either a publicly quoted company, or as one of Her Majesty’s Secretaries of State.


That this meeting recognises the evidence that the policy approach of full decriminalisation of sex-work, as adopted by New Zealand, has resulted in public health benefits for both sex workers and wider society. This meeting therefore calls upon the BMA to:; ii)   develop educational resources to enable doctors and medical students to better understand and respond to the specific healthcare needs of sex workers, such as CPD events and BMJ Learning resources;

Motion 542 proposed by Robin Arnold SOUTH WEST REGIONAL COUNCIL:

That this meeting notes that retired members are the only branch of practice not represented by a standing committee and:- i)  believes they need and should have a standing committee; ii) calls on the organisation committee to bring forward proposals to set up a standing committee for retired members.



The leader of the nation’s GPs has warned that general practice is on the brink of collapse as GP services face a climate of funding cuts, staff shortages and rising patient demand.

Speaking at BMA’s Annual Representative Meeting in Bournemouth, Dr Chaand Nagpaul, GPC chair, said: “Despite annual contract improvements, general practice remains on the brink of collapse, since fundamentally demand totally outstrips our impoverished capacity. We’re carrying out 50 million more consultations in general practice compared to five years ago, with more care moving into the community and a growing elderly population, yet latest figures show that today we have fewer GPs per head than then.”

Dr Nagpaul’s comments were reported in The Daily Mail, The Daily Mirror, Pulse and Press Association.

 There was also substantial coverage of a motion calling for the creation of hospital-style ‘black alerts’ for GP surgeries enabling doctors to stop admitting patients should they become too busy.

The motion was covered in The Daily Mail, Pulse and i News. 

You can read the press release in full here.

Other motions were covered by online publications such as a motion calling for the gender pay gap to be squashed in i News

Dr Phil Banfield, BMA Wales committee chair, was interviewed by ITV Wales. His speech was also covered on BBC Radio Wales’ Good Morning Wales.

 A&E cuts will hit 23m people says the BMA
BBC News Online, Wednesday 28 June 2017, (Dr Mark Porter)

NHS bosses making cuts given £10m a year – 150 execs hired to oversee proposals which could see A&E wards closed
The Daily Mail, Wednesday 28 June 2017, (Dr Mark Porter)

1 in 4 GP services are pointless.. and are pushing surgeries to the ‘brink of collapse’ leading doctor says
The Daily Mirror, Wednesday 28 June 2017, (Dr Chaand Nagpaul)

Union backs vote for exhausted GPs to close their doors when they are too busy
The Daily Mail, Wednesday 28 June 2017, (Dr Richard Vautrey)

Doctors tell BMA conference to stop the increasing gender pay gap
I News, Wednesday 28 June 2017, (BMA mention)

Sicknote UK – One in four GP visits avoidable and taken up by form-filling
The Daily Mail, Thursday 29 June 2017, (Dr Chaand Nagpaul)

GPs ‘at mercy’ of private providers if partnership model topples, says Nagpaul
Pulse, Wednesday 28 June 2017, (Dr Chaand Nagpaul)

Dr Nagpaul: “Government has turned a cruel blind eye to patients”
Pulse, Wednesday 28 June 2017, (Dr Chaand Nagpaul)

Why UK abortion laws must be scrapped: BPAS
The Daily Telegraph, Wednesday 28 June 2017, (BMA mention)

BMA backs calls for ‘black alert’ style system for GPs

The Daily Telegraph, Wednesday 28 June 2017, (Dr Chaand Nagpaul)

GP practices able to issue black alerts after BMA vote
Pulse, Wednesday 28 June 2017, (Dr Chaand Nagpaul)

GPs call for introduction of hospital-style ‘black alerts’
I News, Wednesday 28 June 2017, (Dr Chaand Nagpaul)

Doctors told GP services on ‘brink of collapse
Press Association, Wednesday 28 June 2017, (Dr Chaand Nagpaul)

Kent trust sends hundreds of people with mental health problems out of county for treatment
ITV News Meridian, Wednesday 28 June 2017, (BMA mention)

Doctor blames anti-vaxxers and Andrew Wakefield for her son catching measles
The Independent, Wednesday 28 June 2017, (BMA mention)


BMA ARM Bournemouth Wednesday



Motion 67 proposed by Richard Vautrey YORKSHIRE REGIONAL COUNCIL:

That this meeting believes the current workload pressure in general practice is unsafe and unsustainable, that a rapid expansion in the general practice workforce is required to deal with this and therefore calls for sustained investment above the commitments made in the GP Forward View to be made available as a matter of urgency.

Motion 68 proposed by EDGWARE & HENDON DIVISION:

That this meeting applauds NHS England for the changes to the primary and secondary care interface within the standard hospital contract which came into effect on 1st of April 2016, with subsequent additional requirements in 2017. However it is dismayed to note that despite the national levers, there are trusts and CCGs that do not appear to acknowledge or enforce these changes. We call on the BMA to create a communications work stream which is focussed on reaching out to trusts, CCGs, different branches of practice to communicate the interface changes.

Motion 69 proposed by Peter Holden EAST MIDLANDS REGIONAL COUNCIL:

That this meeting notes the regular declarations of “black alert” by hospitals and demands that a similar reporting system be created for general practice to indicate that maximum safe capacity has been reached and conference instructs BMA council and the GPC to construct such a system with or without government cooperation.

Motion 70 proposed by Guy Watkins SOUTH EAST COAST REGIONAL COUNCIL:

That this meeting feels that the Multispecialty Community Provider contract framework does not go far enough in:- i)   protecting the liability of individual contract holders from the implications of pooled budgets; ii)  preserving the tenure of GMS and PMS contracts; iii) protecting GPs from further unfunded work being transferred from secondary care.

Motion 65  proposed by Ryan Devlin  JUNIOR MEMBERS FORUM:

That this meeting believes that parity between physical and mental health will only be achieved if the stigma against mental health problems among medical professionals is addressed. We call on the BMA to create a national campaign to eliminate mental health stigma among medical professionals.



Motion 71 proposed by Jackie Appleby TOWER HAMLETS DIVISION:

That this meeting notes and deplores the recently signed memorandum of understanding between the UK Department of Health, NHS Digital and the Home Office, which agrees to the transfer of patient administrative details including address for the purposes of immigration enforcement, without the consent of the patient and the knowledge of the GP. This meeting believes:- i)   this is a breach of patient confidentiality that undermines trust between patient and doctor; ii)  this Is not justified by the public interest; iii) that this may result in patients not coming forward for treatment with consequences for public health; iv) and calls on council to call on the Department of Health to cease this practice.

Motion 72 proposed by Farah Jameel EDGWARE & HENDON DIVISION:

That this meeting believes that there is an urgent need for the development of an electronic prescription service for hospitals, to enable hospital clinicians to prescribe remotely for patients to collect their prescription from a nominated community pharmacist, thereby enabling clinical responsibility to rest with the prescribing clinician, as well as reducing inappropriate demands on GPs to prescribe outside their competence.

Motion 75 proposed by Pradeep Sanghi LINCOLN DIVISION: That this meeting welcomes the working party report “Every breath we take: the lifelong impact of air pollution” produced by the Royal College of Physicians [London] and Royal College of Paediatrics and Child Health, and we call for:- i)   further research into the economic impact of air pollution; ii)  clearer information for consumers on emissions produced by new vehicles, including information on ultrafine particles and oxides of nitrogen; iii) effective monitoring of air quality and pollution; iv) the NHS to become an exemplar for clean air and safe workplaces; v) empowerment of local authorities to take remedial action when air pollution levels are high

Motion 76 proposed by Mark Pickering YORKSHIRE REGIONAL COUNCIL:

That this meeting:- i)   notes the widespread problems of abuse and addiction with pregabalin amongst users of illicit drugs; ii)  notes the contribution of pregabalin to bullying and violence in prison populations; iii) calls for the BMA to lobby the appropriate authorities to make pregabalin a controlled drug.

Motion 77 proposed by Farah Jameel EDGWARE & HENDON DIVISION:

That this meeting in the wake of the measles outbreak that swept Europe in March 2017:- i)  condemns anti-vaxxers who deny immunisations to their children (as a reference); ii) calls upon the BMA to present a position paper to the government on the potential advantages and disadvantages of childhood immunisation being made mandatory under the law. (as a reference);

Motion 81 proposed by Gillian Beck

proposed by BUCKINGHAMSHIRE DIVISION: That this meeting extends its full support to the GPs of Northern Ireland for their robust defence of the provision of safe care to their patients.

Motion 83 proposed by Anne Carson NORTHERN IRELAND COUNCIL:

That this meeting believes that reconfiguration of services in Northern Ireland must::- i)   be evidence based and result in better outcomes for patients; ii)  be carried out in an integrated way, taking patients’ primary, secondary and social care needs into account and not confined to local HSC trust level;  iii) include full and meaningful clinical engagement with doctors at all levels.

Motion 84 proposed by Sara Hedderwick NORTHERN IRELAND COUNCIL:

That this meeting recognises that the lack of full implementation of the recommendations from numerous workforce planning reviews has contributed directly to the current shortage of doctors in Northern Ireland. This meeting believes that the Department of Health in Northern Ireland:- i)  must be held accountable for ensuring there is the appropriate medical workforce to deliver care to the population of Northern Ireland; ii) must recognise that increased investment in the medical workforce is required to ensure that Northern Ireland is an attractive place to work.


Motion 86 proposed by David Bailey WELSH COUNCIL:

That this meeting notes the observations of the OECD in its 2016 report comparing health systems of the four UK nations that:- i)  Welsh health boards do not have sufficient institutional and technical capabilities and capacities to drive meaningful change; ii) a stronger central guiding hand may be needed.  This meeting therefore calls upon the Welsh government to take what steps are necessary to provide such a central guiding role, thereby ensuring that health boards and NHS trusts are subject to greater direction, scrutiny and accountability so they are clearer and better able to deliver what is expected of them.


Motion 88 proposed by Bethany Threlfall SAS CONFERENCE:

That this meeting:-  i)  commends BMA Scotland for setting up a ‘respect at work’ helpline to offer support and advice to members with problems relating to bullying, harassment, discrimination and dignity at work; ii) calls on the rest of the BMA to follow this example.

Useful link

BMA Work life support, your wellbeing


Motion 78 by Sara Hedderwick CONSULTANTS CONFERENCE:

That this meeting acknowledges the global threat to human health posed by antimicrobial resistance and the firm linkage to inappropriate usage both in human health and in agriculture.  As such we call on the BMA:- i)   to continue supporting the vision of the UK 5-Year Antimicrobial Strategy (20132018); ii)  to support stakeholders in making sure that there is a subsequent strategy following on from 2018; iii) to support the One Health approach to antimicrobials, recognising that usage in human health only accounts for 50% of usage worldwide and encouraging responsible use in agriculture, engineering and other industries aside from human health; iv) to recognise their own part to play by ensuring, where possible, that subcontracted catering suppliers used for BMA meetings use antimicrobial-free produce by preference.  (as a reference)


Motion 92 proposed by TREASURER: That the annual report of the directors, treasurer’s report and financial statements for the year ended 31 December 2016 as published on the website be approved.

Motion 93 proposed by TREASURER: That the subscriptions outlined in document ARM1A (appendix IV) be approved from 1 October 2017.


That this meeting believes that the expenses, reimbursements and honoraria of all BMA committee and council members should be made available to:- i)   individual members on personal request;


Motion 97 proposed by  Emma Runswick MANCHESTER & SALFORD DIVISION):

That this meeting:- i)   recognises the significant contributions and personal sacrifices made by medical students and junior doctors during the course of their degree and further medical education; ii)  recommends that the government should seek to understand why junior doctors might leave the NHS; iii) rejects the secretary of state’s proposal that doctors should be required to work for the NHS for 4 years after registration or pay back the “cost of their training”; iv) opposes any move to impose a minimum period of NHS employment.   

 Motion 98 proposed by Samira Anane NORTH WEST REGIONAL COUNCIL:

That this meeting notes the on-going gender pay gap and consistent under-representation of women in leadership positions and:- i)   insists that employment contracts do not contain clauses which discriminate against women; ii)  insists that equality impact assessments have equal status to other documents when considering contracts; iii) calls for the BMA to encourage improved diversity in representation locally, regionally and nationally.

Motion 99 proposed by Ian Hume EASTERN REGIONAL COUNCIL:

That this meeting is appalled by the delays that are being reported by practitioners, in payment of doctors’ pension lump sum and even delays of payments of regular pension payments and calls on the BMA to:- i) undertake a full inquiry into the size of the problem and reasons for these delays; ii) ensure that doctors are awarded full financial compensation for any loss as a result of any delay; iii)ensure that the NHS Pensions Agency pays interest on delayed pension lump sums.

Motion 100 proposed by Selwyn D’Costa DARTFORD GRAVESEND & MEDWAY DIVISION:

That this meeting recommends that members who are forced to withdraw from the NHS pension scheme on breaching their Life-Time Allowance should be refunded future NHS employer contributions

Motion 101 proposed by Gordon Mathews CONSULTANTS CONFERENCE:

That this meeting believes the NHS funding crisis cannot continue to be managed by pay restriction.


Motion 103 proposed by Ham Mekhael SOUTH WEST REGIONAL COUNCIL:

That this meeting warmly welcomes the publication of the document “SAS Doctor Development” in partnership with the Academy of Medical Royal Colleges, Health Education England and NHS Employers and calls upon all these agencies to use their collective best endeavours to ensure that the principles outlined in the document are fully realised such that the disadvantaging of SAS doctors in terms of career development and leadership opportunities becomes a thing of the past.

Related information

2017 NHSE SAS doctor development workshops and survey

2017 SAS development guide.

Motion 104 proposed by Reshma  Khopkar SOUTH CENTRAL REGIONAL COUNCIL:

That this meeting has concerns that currently there is a lack of SAS representation on the Local Education and Training Boards and the appointments of Associate Deans for SAS doctors are not being continued. It therefore calls on Health Education England to ensure that:- i) there is appropriate SAS representation on the Local Education and Training Boards and; ii)the appointments of Associate Deans for SAS doctors continue and that they are appointed from within the SAS grades.


Motion 107 proposed by Chandra Kannrganti NORTH & MID STAFFORDSHIRE DIVISION:

That this meeting, in the light of increasing personal injury awards and rapidly increasing medical indemnity costs:- i) supports the introduction of a system of no-fault compensation for medical injuries; ii) supports the principle of annual care payments to the injured, rather than lump sum payments; iii)seeks the direct reimbursement by government of medical indemnity costs relating to NHS treatment.

Motion 55 Proposed by  Gorden Mathews  BUCKINGHAMSHIRE DIVISION:

That this meeting believes, in respect of eligibility for NHS treatment of overseas visitors:- i)   government publicity about the cost of treating overseas visitors is a distraction from the under resourcing of the NHS;  iii) urgent clinical care should not be delayed or prevented by eligibility checks; iv) medical staff should not be involved in ascertaining eligibility of patients for NHS treatment.



That this meeting welcomes the Law Commission proposals to simplify the Deprivation of Liberty Safeguards procedures and urges the government to make legislative time for such primary legislation despite Brexit.



Motion 110 proposed by Nick Swift FORENSIC MEDICINE COMMITTEE:

That this meeting regarding the mental state examination of children under arrest in police custody suites:- i) is concerned at the lack of forensic physicians possessing membership of the Faculty of Forensic and Legal Medicine; ii) considers that it is non-equivalent compared with the care given to non-detained children; iii)calls for increased out of hours provision of child and adolescent mental health service (CAMHS) and youth offending teams to facilitate prompt liaison and diversion.

Motion 111 proposed by Nick Swift FORENSIC MEDICINE COMMITTEE:

That this meeting supports the Royal College of Psychiatrists’ urging of the government to amend the Prison and Courts Bill to include a statutory requirement of prisons to protect the mental and physical health of offenders.  (as a reference)


Motion 113 proposed by LOTHIAN DIVISION:

That this meeting calls on the BMA to improve awareness of student mental health in medical schools. The BMA should do this by:- i) utilising its growing local networks to host mental health talks and events for local medical students; ii) calling upon medical schools to improve support for student with symptoms of mental health illness Iv) reporting back on progress and responses from medical schools.

Motion 114 proposed by Grant Ingrams LEICESTERSHIRE & RUTLAND DIVISION:

That this meeting, in light of the NHS medical recruitment crisis, is appalled by the decrease in medical student applications and calls for:- i) places to be given on merit without financial barriers; ii) the cost of a 5-year medical degree to be realigned to meet the cost of an average undergraduate degree in a comparable subject; iii)the government to increase medical student numbers and resource universities appropriately.


That this meeting condemns the proposed increase in tuition fees and calls on the BMA to:– i) support other organisations campaigning against the proposals; ii) oppose excessive rates of interest charged on student loans and lobby for any interest charges to be in line with the governments’ long-term borrowing costs


Motion 118 proposed by Daniel Redfern CONSULTANTS CONFERENCE:

That this meeting continues to support junior doctors, and:- i) calls upon consultant members of the BMA to endorse exception reporting as a tool for the improvement of terms and conditions of trainee doctors; ii)asks its members not to suppress in any way the fair use of the exception reporting mechanism by junior colleagues.

Motion 119 proposed by Jonathan Fenwick MANCHESTER & SALFORD DIVISION:

That this meeting calls for a mandatory nationally agreed minimal period of protected administrative time (relevant to the level of training and duties) built into junior doctors work schedules. This would be above and beyond that protected for teaching and training and intended for the purpose of completing paperwork tasks, mandatory training, portfolio tasks, audit, guideline reviews and other required educational, teaching or management tasks currently having to be completed in that doctors own time without recognition or pay.



Motion 122 proposed by Alex Freeman SOUTH CENTRAL REGIONAL COUNCIL:

That this meeting notes the publication of the green paper ‘Improving Working Lives’ and:- i) regrets the short timescale for consultation; ii)supports initiatives which encourage occupational health support and workplace assessments for employers designed to keep people in employment through periods of ill health or to enter the workplace where possible; iii) believes that any additional burden of workload and costs with respect to implementation of the recommendations should fall to the DWP and not the NHS.



There was an opportunity for representatives to ask questions of the BMA treasurer.


Received reports from

BMA general practitioners committee chair (Chaand Nagpaul).

BMA board of science chair (Parveen Kumar).

BMA Northern Ireland council chair (John D Woods).

BMA Welsh council chair (Philip Banfield).

BMA Scottish council chair (Peter Bennie).

BMA private practice committee chair (Derek Machin).

BMA civil and public services committee chair (Alan Mitchell)

BMA charities committee chair (Andrew Mowat)

BMA staff, associate specialists and specialty doctors committee chair (Amit Kochhar).

BMA medico-legal committee chair (Jan Wise).

BMA forensic medicine committee chair (Rachael Pickering).

BMA medical students committee co-chairs (Charlie Bell and Harrison Carter).

BMA junior doctors committee chair (Jeeves Wijesuriya).

BMA occupational medicine committee chair (Nigel Wilson).

BMA treasurer (Andrew Dearden).


Victor Horsley Scientific lunch time meeting III

Given by Tom Rapanakis  ‎Service Coordinator at British Medical Association and Dr Clare Gerada

Useful links         Doctors wellbeing back from the brink

Young doctors seek more help

Bullet points of Dr Gerada’s talk

  • Doctors are taught to be invincible
  • Doctors are 3x as likely to die from suicide and a greater risk of mental illness
  • They have a high divorce rate
  • There is often a triad of doubt guilt and responsibility
  • Associated factors include bullying at work and exposure to dangerous drugs, anxiety and unrealistic views of patients
  • Doctors suffer a heavy psychological burden
  • Doctors are poor attenders, present late or in a crisis or not at all and may be blind to their own distress and often treat themselves
  • Doctors as a group create behavioural norms – doctors don’t get ill !
  • Confidentiality or lack of it is an issue as doctors often report personal details shared
  • She discussed PHP a bespoke mental health service established in 2008 it contrasts with physician health programs in the US which has since become more a probation service. There is a noticeable increase in suicide rate in US Doctors . PHP UK is the largest in the world,  treating whole person and working as a single team. PHP saves money as well as lives
  • The electronic record is not linked to the NHS. They provide prescription and alcohol de-toxification . Allow doctors space and time in confidence. Service is now national. Doctors can self-refer and through facebook and twitter. About 3000 doctors have used the service as example for anxiety, depression NHSitis, practice meltdown

Addicition disorders (with the latter only 6% relapse rate)

  • All age groups but especially 30 – 39 age group are affected
  • She asked why is there an increase in mental health problems in doctors
    • The need for the right support
    • Doctors thrive in adversity but everyone has a breaking point
    • Patient live longer and are more active participants
    • Medical authority is disappearing and doctors are less confident in their role in society
    • Lack of shared spaces eg the doctors mess, the firm, groups that needs belonging
    • Industrialisation of craft

How to deal with this she said

  • “I do” –  create a balance and reduce stress,
  • Taking holidays, time with friends , know your limits , seek help
  • “We do” :-  teams , reduce stress were possible , attend to each other , meet learn and respect

She ended by discussing the legacy of Victor Horsley

Tom Rapanakis (BMA)  discussed BMA counselling staffed by counsellors with 300 calls a month and a doctors advisory service with peer support.


Useful reads relevant to ARM motions

Useful reads relevant to BMA ARM motions

Neglecting their health to help others by Tim Tomkin

Out of area beds a new low by Andrew Molodynski BMA consultants committee mental health lead

Mental health patients being sent hundreds of miles Daily Mail,

Almost 6,000 sent out of area for mental health treatment Guardian,

Patients put at risk over mail blunder  BBC News Online,

Patients potentially harmed by failed mail delivery Guardian,

Health Secretary kept NHS mail blunder quiet Telegraph,

Patients relying on crowdfunding for wheelchairs Independent,

Doctors back decriminalisation of abortion Peter Blackburn’s article

Doctors horrified by staff costs Peter Blackburn’s article (STPs mentioned)

BMA documents related to STPS (thanks to Anil Jain for the info):



BMA ARM Bournemouth Tuesday



A special session took place with a facilitated discussion on the role of the criminal law in the provision and administration of abortion. This was in relation to healthcare professionals and to women who procure and administer abortions for themselves.

Representatives were asked to familiarise themselves with the discussion paper Decriminalisation of abortion: a discussion paper from the BMA

Discussion Focus 1

In what if any circumstances should health professionals who participate in the provision of abortion be subject to criminal sanctions

Discussion Focus 2

In what if any circumstances should women procure and/or self-administer an abortion be subject to criminal sanctions


Reports were received from

BMA medical ethics committee chair (John Chisholm).

Medical Ethics Report for ARM 2017

BMA committee on community care chair (Gary Wannan).

Report from committee on community care for ARM 2017

Andrew Dearden was re-elected as BMA Treasurer



MEDICAL ETHICS                                                                                     

Motion 50 proposed by Coral Jones THE CITY & HACKNEY DIVISION:

That this meeting:-

  1. supports the principles set out in part three of the February 2017 BMA discussion paper on decriminalisation of abortion;
  2. believes that abortion should be decriminalised in respect of health professionals administering abortions within the context of their clinical practice;
  3. believes that abortion should be decriminalised in respect of women procuring and administering the means of their own abortion;
  4. believes that decriminalisation should apply only up to viability in respect of health professionals (as a reference);
  5. believes that decriminalisation should apply only up to viability in respect of women procuring and administering the means of their own abortion (as a reference);
  6. believes that abortion should be regulated in the same way as other medical treatments.

Motion 52 proposed by Stuart Blake LOTHIAN DIVISION:

That this meeting:-

  1. believes that the Human Rights Act is fundamental to the primary role of doctors in advocating and caring for patients;
  2. urges the UK government not to repeal the Human Rights Act.


Motion 53 proposed by Zoe Greaves NORTH EAST REGIONAL COUNCIL:

That this meeting is concerned by limitations to healthcare provision in immigration and detention centres in the UK and calls for government:-

  1. to invest further in provision for those who must be detained; (as a reference)
  2. to limit the use of detention to only those cases where not doing so represents a threat to public order and safety; (as a reference)
  3. to replace the use of immigration detention completely with alternate more humane means of monitoring individuals facing deportation.

Chisholm discussion is of interest to Forensic Medicine Committee of which I am a member

Motion 54 proposed by Zoe Greaves NORTH EAST REGIONAL COUNCIL:

That this meeting opposes the use of isolation for children and young people who have been detained within the criminal justice system, save where such measures are used for their safety or protection, and calls for the government to similarly condemn this practice.


Motion 56 proposed by Cristina Costache THE SALISBURY DIVISION:

That this meeting notes the recommendations from the review of revalidation by Sir Keith Pearson and:-

  1. particularly welcomes the recommendation that local organisations should “avoid using revalidation as a lever to achieve local objectives above and beyond the GMC’s revalidation requirements; and
  2. calls on the BMA, medical royal colleges and GMC to reflect these recommendations in their guidance on appraisal;
  3. demands that the appraisal process is made simpler and less time-consuming;
  4. requires that the revalidation process be equally accessible to all doctors, regardless of the context of their medical practise;

Peter Maguire said there has been a better consultation and working with the GMC working party. Mark Porter discussed the meeting with Sir Keith Pearson

Motion 57 proposed by Mary McCarthy WEST MIDLANDS REGIONAL COUNCIL:

That this meeting demands, following the statement from the GMC and the joint statement from the BMA and the RCGP, that the government enacts legislation such that within the Medical Register general practitioners are treated equally with doctors in other specialties and are listed as specialists in their own right.

Motion 58 proposed by Amir Landeck of the EDGWARE & HENDON DIVISION:

That this meeting, with respect to Care Quality Commission inspections, calls for:-

  1. the BMA to challenge unrealistic standards;
  2. recognition of the context and resources in which services are delivered;
  3. clarity of requirement for necessary data collection to be undertaken before the inspections.




That this meeting believes that mental health is in crisis, and that there has to be a root and branch review by the UK government of commissioning arrangements, beds and community provision

Motion 64 proposed by Alex Freeman SOUTH CENTRAL REGIONAL COUNCIL:

That this meeting notes that the BMA safeguarding vulnerable adults toolkit was last reviewed in 2011 and recognises that the Care Act 2014 placed adult safeguarding on a statutory footing and makes certain requirements of local authorities as the lead agency. We therefore call for:-

  1. the BMA safeguarding vulnerable adults toolkit to be updated to reflect new legislation, case law, and standardised processes as required by the Care Act 2014;
  2. the BMA to be a participant in any update of the national framework for adult safeguarding (Association of Directors of Social Services 2005).


The Victor Horsley Scientific Session II

This took place in the Tregonwell Hall during lunch time on Tuesday at ARM. The subject was “Emergency Medical Humanitarian assistance – is any help better than no help” given by Professor Anthony Redmond.  His bio can be found at Tony Redmond. He is Professor of International Emergency Medicine at Manchester University and President of The World Association for Disaster and Emergency Medicine (WADEM) a multidisciplinary professional association whose mission is the global improvement of prehospital and emergency health care, public health, and disaster health and preparedness. Professor Redmond is Deputy Director of HCRI See and  and facebook


Below are bullet points from his talk

  •  The popular moral belief that “any help is better than no help”, Professor Redmond identified this as  one of the causes for the severity and widespread nature of the problem.
  • That there is an ethical requirement for all healthcare workers who respond to disasters and major emergencies to ensure that what they do is evidence based, open to scientific scrutiny and framed in such a way as to reduce the vulnerability and increase the capacity of the affected communities.

    any help is not always better than no help, especially when delivering medical care, but altruism blended into skilled preparation and training can go a long way to ease the suffering of those most in need.

  • Many patients treated by these doctors undergo unnecessary procedures, such as amputation, due to a lack of specialist skill or knowledge, this is in comparison to local doctors and those who work as part of more established relief efforts.
  • The principle that Emergency Department are no longer places where those in need of training go to gain experience from those in need of care but rather those in need of care go to gain from experience of those already trained needs to be extended outward to the management of large scale international emergencies.
  • The 1988 Armenian earthquake was the first occasion were there was a request of large scale international response. INSARAG and UNDAC were formed after this.
  • INSARAG includes registration, classification,accreditation training and retraining
  • In terms of rescue
    • Most are people rescued by fellow survivors
    • Remainder resqued by local and national team
    • Few if any are rescued by international search and rescue
  •  In the Haiti earthquake the most vulnerable could not easily select what they needed
  • In the 2008 Sichuan earthquake there was the need to be authorised to practice but this was efficiently done
  • He discussed Global Health Cluster’s Foreign Medical Team Working Group regarding classifications and standards and a 2010 report were the amputation rates varied bewtween less than 5% to greater than 45%. A sad example shown of a patgient with a guillotine amputation of the leg with poor rehabilitation outcome.
  • He discussed issues of consent and authority to practice.
  • Medical teams are cost effective
  • His involvement in the response to the Typhoon in Philippines which included HMS Daring and HMS illustrious
  • The pressure to medivac patients
  • The need to work with the local health authority and incorporate local workers into the team, do not put people out of work
  • There is a GP Humaritarian Fellowship also upcoming one in Emergency Medicine
  • Registration and verification process for international medical emergency team UK-EMT
  • Can the resource be deployed nationally ? NHS passport being developed .

The Following were referred to

See also




Professor Pali Hungin, BMA President gave a Presentation and led a discussion on

“The changing face of medicine and the role of doctors in the future”

(hyperlink to the report)

Pali Hungin introduces the project in BMA News

Read the news report from a recent symposium


Documents from yesterday’s ARM not  linked to in my blog (requires BMA membership)

Report from Armed forces committee

Report from Medical academic staff committee





Introduction was given by Chair of conference by Anthea Mowat followed by Dr Mark Porter’s final speech as Chair of Council see

Transcript            Dr Mark Porters speach

Video                       Chair of BMA Council Speach


ARM MOTIONS PASSED  (edited & comments by me in italics)


Motion 11 Proposed by Dr Chaad Naepaul of THE EDGWARE & HENDON DIVISION):

That this meeting deplores the current blame culture in the NHS and:- i) believes that the woeful government underfunding of the NHS coupled with continued austerity cuts is the greatest threat to quality and safety in the NHS; ii) believes that the crisis in NHS hospitals has been consciously created by the government, in order to accelerate its transformation plans for private sector takeover of health care in England; iii) firmly believes this scapegoating is a deliberate attempt to distract the public from an under-funded service under severe and intense strain.

Motion 12 Proposed by Peter Bennie THE SCOTTISH COUNCIL):

That this meeting:- i)   supports the principle of integration of health and social care;  ii)  calls on politicians from all parties UK-wide to stop raising false expectations regarding what integration can achieve when it comes to reducing the admissions of elderly patients to hospital; iii) calls for government to provide enough hospital beds and social care to meet the demands being placed on these services; iv) calls for government to acknowledge that this cannot be done properly without adequate additional funding;  v)  calls for government and NHS lead bodies to have an open dialogue with the public and patients about what services the NHS should provide for the funding available and what services can no longer be provided by the NHS

Motion 13  Proposed by Philip Banfield THE CLWYD NORTH DIVISION):

That this meeting reminds governments and healthcare organisations that they serve and are accountable to patients and the public. This meeting calls upon healthcare organisations to:- i) conduct business in public, with open and free access to reports and papers so that appropriate scrutiny can be undertaken; ii) provide verifiable evidence for changes to practice and / or services before decisions are made; iii)stop extrapolating claims beyond evidence and applying hyperbole to justify their actions without appropriate evaluation; iv)publish full accounts where services are paid for through general taxation in order to provide public accountability.



Motion 16 Proposed by Rob Bleeke THE WELSH COUNCIL):

That this meeting recognises the acknowledged links between poor medical engagement with risks to patient safety and poor outcomes for patients and:- i) recognises that promoting greater medical involvement in the design and planning of healthcare is crucial in ensuring that improved patient

Motion 17 Proposed by Hannah Barham-Brown JUNIOR DOCTORS CONFERENCE:

That this meeting notes with concern the increasing numbers of patients resorting to crowdfunding their own wheelchairs due to delays and cuts in wheelchair services, and the recent suggestion from Muscular Dystrophy UK that a ‘postcode lottery’ pervades such services across the country. We call on the BMA to work with NHS England, the Association of Directors of Adult Social Services and other relevant bodies to ensure that would-be wheelchair users have timely access to chairs suitable for their individual conditions. ices are properly designed and effectively implemented; ii) calls for radical change of the management culture in the NHS from the current hierarchical focus on narrowly based targets towards a clinically based system adapted to the needs of patients; iii)calls for all NHS organisations to agree and sign up to a new medical engagement charter that will facilitate the positive involvement and engagement of doctors who are willing to work in close cooperation with other clinical and non-clinical healthcare staff.

Motion 19 Proposed by Phillip De Warren-Penny THE SOUTH WEST REGIONAL COUNCIL:

That, with regard to referral management systems, this meeting:- i)   notes with concern that many Clinical Commissioning Groups operate referral management systems to constrain referrals of patients to acute care; ii)  notes that these systems have the potential to undermine sharing decision-making and to harm patients by delaying their management; iii) deplores the blanket application of referral management policies; iv) calls on the BMA to publicise tick-box referral management systems as rationing; v)  calls upon the BMA to lobby for the abolition of referral management systems.

 Motion 20 Proposed by Robert Scott-Jupp SALISBURY DIVISION:

That this meeting supports the concept published in the GPC document “Quality First” that one specialist should be able to use their professional acumen to refer directly to another specialist and asks for its promotion and implementation by NHS England and the devolved departments of health.

This is an important motion relevant to Hospital Doctors and Primary Care



Motion 23 Proposed by John MacKInnon THE SOUTH EAST COAST REGIONAL COUNCIL):

That this meeting is concerned about the health and wellbeing of our medical colleagues particularly; stress, fatigue, burnout, substance abuse and low morale. This meeting:- i) congratulates the BMA and the Royal Medical Benevolent Fund on establishing the pilot DocHealth programme and supports an extension, following successful evaluation of the pilot; ii) calls for the establishment of a comprehensive workplace policy and code of conduct, within the framework of health and wellbeing, to help prevent and reduce the risk of harm caused by alcohol and substance misuse amongst employees; iii)calls for a fully functional and resourced occupational health service for all NHS staff; iv)calls on the government to raise morale amongst NHS staff.

This is an important motion relevant to all Doctors. Ian Wilson is involved with DocHealth

Motion 24 Proposed by Zoe Greaves NORTH EAST REGIONAL COUNCIL:

That this meeting recognises that in an increasingly stretched and resource-starved health service, doctors are increasingly asked to work beyond their capacity, and that in so doing mistakes, errors and oversights become inevitable.  We call on the BMA to lobby the GMC to amend its guidance to acknowledge that even good and competent doctors may cause harm to patients when working in such an environment, and to acknowledge that such mistakes can be a product of the environment and not the fault of the practitioner.

Report “A promise to learn a commitment to act” mentioned by Dr Mark Porter See


Motion 25 Proposed by Andrew Mowat THE LINCOLN DIVISION

That this meeting demands that the UK government act to avert future crises in workforce availability including reviewing the Shortage Occupation List and investments into specialties at particular risk including: – emergency medicine, general practice and paediatrics.

Motion 26 Proposed by Lucie Crocker JUNIOR MEMBERS FORUM:

That this meeting mandates the BMA to work with relevant bodies to ensure that where extended role practitioners (ERPs) and doctors share clinical duties:-  i)   there is an evidenced need to recruit an ERP; ii)  the training needs of both groups are fully considered and clearly defined; iii) both groups have appropriate supervision, responsibility and safeguards in their roles.


ARMED FORCES                                                                                     

Motion 33 Proposed by Kevin Gallagher ARMED FORCES COMMITTEE:

That this meeting is deeply concerned by the persistent and increasing faults with the Defence Medical Information Capability Programme (DMICP), which affect patient safety and undermine the professionalism of clinicians. We call on the BMA to lobby the Ministry of Defence to take urgent action to rectify the following issues:- i)   insufficient number of available IP addresses resulting in delayed start-up or an inability to access the system entirely without frequent software crashes or total loss of IT; ii)  failure of the system to load previous history, as well as save current consultations; iii) system failure with regard to printer integration, leading to potential patient safety and confidentiality issues; iv) lack of secure integration with NHS IT systems.

Motion 34  Proposed by Brendan McKeating ARMED FORCES COMMITTEE:

That this meeting requires the BMA to request that Defence Medical Services research is fully supported to ensure that military clinicians are able to provide the best medical care to patients on and off operations, both now and into the future.


NHS FINANCES / FINANCING                                                              

Motion 36 Proposed by Geoffrey Lewis THE LEICESTERSHIRE & RUTLAND DIVISION):

That this meeting demands governments urgently rectify the severe and chronic underfunding of health and social care which:-  i)   places extreme pressure on services and the workforce; ii)  puts at risk services to patients and the health of the public; iii) undermines sustainable, publicly provided, universal healthcare; iv) is not addressed by the unrealistic savings of sustainability and transformation plans

Motion 38 Proposed by Mary McCarthy THE SHROPSHIRE DIVISION

That this meeting calls on UK governments to commit to funding the NHS to at least the average levels spent on healthcare by comparable leading European countries.

Motion 40 Proposed by THE CORNWALL DIVISION

That this meeting believes that NHS funding allocations should take account of:-  i) the increased costs in rural areas of providing, and for patients of accessing, NHS services; ii) the increasing costs of financial compensation for clinical negligence consequent on the changes to the discount rates.



Motion 41 Proposed by Russell Walsh THE SCUNTHORPE DIVISION:

That this meeting believes that sustainability and transformation plans have not produced a sustainable funding model for the NHS in England, and the BMA calls for:- i)    the maintenance and improvement of the quality of patient care to be the absolute priority; ii)   patients and the public to be consulted on realistic, evidence-based STPs; iii)  there to be no further reduction in inpatient beds until after a comprehensive assessment of the clinical needs of the local population; iv)  clinical education and training to be protected and promoted; v)   any service reconfiguration to be clinician-led;  vi)  at least one doctor appointed by regional councils to be engaged in a meaningful clinical forum with each STP;  vii)  lost viii) STPs to be fully funded to achieve true transformation.

Note two publications are available on BMA website


That this meeting condemns the woeful manner in which STPs have been progressed, turning them into vehicles to try to legitimise further cuts to vital NHS services, and proposes STPs are abandoned.

Overwhelmingly carried



That this meeting approves the bye-law amendments to the membership and election to UK council in the manner shown in appendix III of document ARM 1A. [NB: 2/3 majority required].

Proposals passed include expanding council to have better regional representation and allowing for increased number of female representatives.

BMA STRUCTURE AND FUNCTION                                                    

Motion 45 Proposed by CORNWALL DIVISION:

That this meeting wishes to see increased BMA policy feedback and engagement locally and asks the BMA to consider a move to an element of regional representation on council.

Motion 46  Proposed by Andrew Mowat THE LINCOLN DIVISION:

That this meeting congratulates the association on its ‘Living Our Values’ campaign, and urges the BMA to:- i) produce a code of conduct for all members and representatives; ii)review how the articles and byelaws should be amended to support members working together constructively.


That this meeting congratulates the association on the progress made through the Member Voice and Democratic Structures review, and calls for:- i) the treasurer to report to the 2018 ARM on the outcome of the recently-begun pilot of direct reimbursement of divisional expenditure through Concur; ii) the treasurer to report on the lessons learned from phases 1 and 2 of the local engagement pilots;


That this meeting believes that retired members need more recognition in the structures of the BMA if their potential is to be realised and their membership retained.

Reports were received from

The BMJ publishing group chair (Joseph Lippincott) / chief executive (Peter Ashman).

The BMA Armed Forces Committee chair (Glynn Evans).

The BMA medical academic staff committee co-chairs (Peter Dangerfield and Michael Rees).

Speeches and hustings took place for the candidates in the election of treasurer

Candidates were invited to make a speech in support of their nomination.

This was followed by a hustings Q and A.


LNC and other matters


The staff side NMUH Local Negotiating Committee met prior to a Joint LNC on Thursday 15th June. The following are my personal views and interpretation of the proceeding which exclude confidential information and are not official minutes

NMUH Staff side LNC consists of the following

Sunil Trakru                                     Chair

John Firth                                         Deputy Chair & Minutes

Piyusha Kapila                                Cons. Paediatrician

Mohammed Anwar                         AS Orthopaedics

A K Ray                                             Clinical Oncologist

Devesh Sharma                              A&E Consultant

Wai Yoong                                        Consultant Oncologists

Gopakumar Sudhir                         Consultant Anaesthetist

Hawa Petkar                                    Consultant Microbiologist

Nicola West                                     SHO Oncology (Jr Dr Rep)

Rosemarie S MacKenzie                 BMA IRO attends

 Matters discussed at the sLNC include the following

  • Exception reporting

The sLNC has not yet seen the quarterly report of the Guardian for safe working to be submitted to  the NMUH Executive Board. It is recognized that not all trainees are on the new contract yet.

  • sLNC Constitution

This need to be update to conform to recommendations from BMA House. One requirement is that all members of the sLNC must be BMA members.

  • Middle Grade Doctors List

There is a need for an up to date list of middle grade Doctors. Lists on the list server are inaccurate and not up to date. There is also a need to review how many long term locums are in the Trust again (last done 4 years ago)

  • Annual leave policy discussed

Previously 2 statutory days were converted to 3 days annual leave on the grounds that 2 “bank holiday days” is equal to 2.6 Pas

For new starters from October 2016 this has been reduced to 2 additional days. The sLNC does not agree with this.

  • Trust Grade Doctors

There are no national Terms and Conditions for Trust Grade Doctors. There was a discussion of how this affects them locally.

  • Car parking
    • The car parking survey performed by the Chair of the LNC was discussed as was a meeting that took place between the Chair and Deputy Chair of the sLNC with the Chief Executive and Finance Director on 12th June
  • Land Sale

The south east part of hospital land was sold to the Education Funding Agency in March 2016 for the site of a new free school. As planning permission was withheld by the local authority the EFA is looking for alternative uses which would include selling on the land.

It was noted that RFH had sold some of its land to RFH Charities and Ealing Hospital has sold land for housing.

  • Ongoing discussions

An Acting down policy has been put forward by management. The sLNC will respond in detail in due course before the next joint meeting

CEA guidance on the Trust network states this has been accepted by the sLNC. This is not the case.

The joint LNC followed 9am – 10.30 pm

  • Apologies were given by amongst others the Chief Executive and the Medical Director

Items discussed

  • Car Parking
  • Previous suboptimal planning by management was accepted
  • Management recognises
    • There is a need to be open and transparent
    • the strength of feeling regarding car parking fee increase
    • Senior doctors work hard and this should not be eroded
  • Comments from the survey were noted
  • Taking in all costs including overheads and depreciation the Trust estimates the overall cost of parking is £1 million.
  • Of the direct costs of staff parking the costs are £250,000 of which £100k is recovered leaving a deficit of £150k there is thus a need to close the gap
  • The forthcoming proposal will be the final proposal when the final set of fees will be issued, these will be sent out on Monday 19th June

Other points from management

  • There will be an informal discussion of the staff side union next week
  • There are lessons to be learnt “on all sides”
  • There will be automatic plate recognition to be implemented.
  • There will provision for arrangement for on call
  • Pro rata will be included in fee structure
  • Allocation criteria will be introduced
  • The renewal system will be more efficient
  • There will be no change to the charge for the lowest grades

As part of the open and transparent it was asked whether these fee structures will be included in information to those doctors interested in applying for jobs at NMUH.

Other items discussed

  • Agreed the number of Trust Grade who are in post for a long time needs to be reviewed at sLNC and jLNC
  • sLNC was to be noted at the lack of management side involvement since these dates are scheduled well in advance. The management pointed out unscheduled important meeting today and some attendees are part time
  • The SAS Charter has been accepted by the Trust but they are still awaiting the extra 2 days annual leave.
  • Mandatory training includes now an additional 3 items. This particularly affects SAS Doctors with only one SPA. It was accepted that this is a Job Planning matter and extra time should be allowed for mandatory training.
  • There are problems with mandatory training on most computers in the trust requires a screen shot of the final page to let the LeAD manager know completion.
  • CEA review – there is one appeal being assessed
  • The CEA new guidance was not agreed by sLNC
  • It was noted that CEA needs volunteers but it was accepted that the review process takes a lot of time.


I will attend Annual Representative Meeting June 25-29th June

If anyone is interested Join the BMA committee visitors scheme

FROM BMA COMMS (all below from BMA edited)

In his speech to the NHS Confederation conference in Liverpool, Jeremy Hunt pledged to secure the rights of EU nationals working in the NHS as Brexit negotiations get underway as he said that “they are part of the NHS family”.

Responding to the Health Secretary’s speech, Dr Mark Porter said: “The Government must ensure that NHS funding keeps pace with other European nations, that EU doctors in the UK are protected from the impact of Brexit, that general practice is properly supported, that policies which protect and enhance the public’s health are implemented and that the pressures which affect the day-to-day delivery of high-quality patient care are tackled.” Dr Porter’s comments were included in iNews, Mail Online and The Daily Express.

You can read the full response here.

GP Online reports that a survey of BMA sessional GPs has revealed that two thirds of sessional GPs say they have no interest in becoming a partner because they would not have control over their workload. Commenting, , BMA GP Sessional subcommittee chair, Dr Zoe Norris, said: ‘This wide ranging survey lays bare the real workload crisis that is threatening to overwhelm the locum and salaried GP workforce. It cannot be healthy that more than half are suffering from the impact of work related stress that is clearly being caused by a working environment starved of resources despite rising patient demand.


BMA online/trade

EU staff belong to the NHS family

iNews, Thursday 15 June 2017, (Dr Mark Porter)

Jeremy Hunt pledges £100m to struggling A&E units after claims some have been shut overnight
Mail Online, Thursday 15 June 2017, (Dr Mark Porter)

David Davis to start formal talks to leave EU on Monday
The Daily Express, Thursday 15 June 2017, (Dr Mark Porter)

Majority of sessional GPs would not like to be partners

GP Online, Thursday 15 June 2017, (Dr Zoe Norris)

Former partners make up half of locum and salaried GPs

Pulse, Thursday 15 June 2017, (BMA Mention)

Jeremy Hunt hints at lifting pay cap for nurses
The Guardian, Thursday 15 June 2017

‘Monumental’ NHS U-turn on pioneering breast cancer drug is hailed by patient groups
The Daily Telegraph, Thursday 15 June 2017

Shocking documentary shows moment Westminster terrorist died on stretcher
Mail Online, Thursday 15 June 2017


This morning, as Brexit negotiations are due to commence in Brussel, the BMA warned the government must put healthcare front and centre. With the NHS at breaking point, The BMA called on government to protect patient care by giving EU doctors and medical researchers permanent residency in the UK among other things.

BMA council chair Dr Mark Porter said: “Leaving the EU poses several risks to healthcare across the UK, not least in its staffing as almost half of the 10,000 doctors working here are considering leaving in light of the referendum result. These doctors have enhanced the UK’s medical research, brought expertise to the NHS and higher education, and filled shortages in specialties which may otherwise have been unable to cope.”

Dr Porter’s comments were reported in The Guardian. You can read the press release in full here.

The BMA signed a letter with the Royal College of Nursing and other health unions demanding an end to the one per cent pay cap introduced in 2010 to limit NHS staff pay increase. The letter stated, “By your own admission, austerity, and a lack of investment in the public sector was a significant factor in the general election result. Many have said that the pay freeze in the public sector was in part to blame for your failure to secure a parliamentary majority.” It was reported in The Guardian, The Daily Mirror, Press Association and Politics Home.

BMA Board of Science chair and former president Professor Parveen Kumar has been knighted in the Queen’s Birthday Honour List. Hindustan Times reports she is only the third woman of Indian origin to receive such an award.

On Friday the BMA responded to quarterly statistics published by NHS Providers which showed trust deficits had been slashed by two-thirds. Dr Mark Porter said: “These figures are yet another warning about the financial crisis that is engulfing the NHS. Let us not forget that this is yet another failed NHS target – the deficit was supposed to be reduced to £580million by now.” You can read the press release in full here.

Health unions urge Prime Minister to ditch NHS pay cap
The Guardian, Monday 19 June 2017, (Dr Mark Porter)

Wave of pay industrial action ‘set to hit Britain’ amid public sector fury at 1 per cent rise
The Daily Mirror, Monday 19 June 2017, (BMA mention)

Healthcare unions come together to urge end to “detrimental” 1% pay curb
Politics Home, Monday 19 June 2017, (BMA mention)

Professor Parveen Kumar awarded damehood in Queen’s Birthday Honours List

Hindustan Times, Saturday 17 June 2017, (BMA mention)

Four-day-week GPs fuel national shortage as “millennial” medics prefer to work part time
Mail Online, Friday 16 June 2017, (Dr Chaand Nagpaul)

Would you pay £145 to see a GP? NHS GPs offering ‘fast track’ appointments
Daily Star Online, Sunday 18 June 2017, (BMA mention)

Up to 500 doctors to debate ending time limits on abortions
The Daily Mail, Monday 19 June 2017, (BMA mention)

GP training courses being axed due to funding squeeze

Pulse, Friday 16 June 2017, (BMA mention)






UK Consultants’ Committee Report

The BMA UK Consultants Committee (UKCC) took place on Thursday 8 June 2017, from 10am to 5 pm. There was a one minute silence for those killed and injured in the recent events in Manchester and London. Below are notes taken by me with confidential information removed and material added from open sources

European Union of Medical Specialists (UEMS) President address

Dr Romuald Krajewski, UEMS president addressed the meeting. Dr Krajewski was born in Elk, Poland, 1952 and qualified in 1981. He is a specialist in neurosurgery. His biography can be found at Romuald Krajewski and in Polish Romuald Krajewski

In Europe there are 1.6 million medical specialists.

The European Union of Medical Specialists (UEMS) :-

  • Represents national associations of medical specialists in the EU and associated countries
  • was established in 1958
  • Promotes free movement, addresses training, CPD
  • Has 39 members (National Medical Associations) including four from the Council of Europe  see UEMS National Association Members 20171002.pdf
  • The UEMS structure consists of Council responsible for and working through 43 specialist sections and their European Boards 14 multi-disciplinary joint committees, 4 thematic federations. The Executive consists of  the President,( Dr Krajewski) and Secretary General  who also attended the meeting (Professor Vassilios Papalois) as well as a Treasurer and Liaison Officer
  • Has an annual income budget of 1.4 million Euros.
  • has strong links and relations with
      • European Institutions (Commission and Parliament),
      • other independent European Medical Organisations
      • European Medical / Scientific Societies.
  • Has active participation, of just under 1000 medical specialists
  • has greater strength through mutual co-operation;
  • is a unified voice in the international representation of medical specialists;
  • has international excellence in key areas of relevance to the medical profession;
  • is an effective interaction and support between NMAs and the UEMS, and between individual specialities and the UEMS;
  • addresses interdisciplinary issues in emerging areas of specialist medical practice;
  • is setting the basis for the robust accreditation of the educational meetings attended by our colleagues
  • promotes the development of new, harmonised models for the training of the next generation of medical specialists, and of high standards of clinical practice, hence improved care for patients throughout Europe.

Key activities of the UEMS include

  • political lobbying (Commission, Parliament, support of NMAs)
  • standard setting for training and practice in individual medical specialities;
  • accreditation of CME/CPD.

UEMS achievements include

  • European training requirements
  • European examination
  • Effective interdisciplinary cooperation on a voluntary basis
  • Managing complexity
  • Domus Medicus
  • New rules on procedures
  • A growing membership

UEMS Challenges

  • Promoting co-operation
  • Harmonisation CME/CPA and Post graduate training
  • More collaboration
  • Erasmus – for training
  • Annex versus updates
  • Implementation of Luxembourg statement affirming the principle that professional development of doctors has to remain in the hands of the medical profession
  • Added value of collaboration
    • European excellence
    • Interdisciplinary approach
    • Harmonised model
    • Effective interaction

Issues regarding Brexit discussed were

  •             How to avoid a downgrading of British collaboration
  •             that there is a better hearing of BMA views in Europe than at home
  •             Maintaining engagement with European bodies.

Examples of non EU member involvement was given of CPME President is a Swiss national

Dr Andrew Rowland speech to UEMS was noted see

The UEMS Council Spring 2017 meeting was noted


A BMA European Office Report and Brexit update paper was received

See also

BMA European Brief May 2017

Other items on the agenda

Apologies were given. This was the last meeting of the session  for Els Draeger and Peter Maguire last session. They were congratulated for  their involvement. Additional secretarial structural support was noted. The minutes of last meeting accepted

Consultant conference motions

  • There was an update on actions taken on the 2017 UK Consultants Conference
  • Regular updates are to be given to CC
    • There is an upcoming press release in 2 weeks regarding transfer of adult mental health patients

Judges pensions actions

  • An action brought by 200 judges has succeeded on the grounds of age discrimination). In the discussion at UKCC it was noted
    • Judges didn’t have tiered protection
    • Judges can’t go back to being barristers
    • Firefighter had a similar case lost – but this was not as well presented to the court
      • One noted difference was the requirement for fire fighters need to be physically fit
  • An update was given by Mark Porter on the judges’ pensions action


National Committees (Scotland Wales and Northern Ireland)

  • Updates from the national committees were noted including that there are 422 consultants posts vacant in Scotland noted.

Chairs report

  • An oral report from Keith Brent was given
    • Rota gaps project will be a pan branch of practice
    • Sleep deprivation – conference policy is to be taken forward by the BMA Science Committee

CC subcommittee structure

  • Proposed changes to the CC subcommittee structure for the 2017-18 session was considered
    • This has only been going 6 months

CC devolution

An update was given by the deputy chair for healthcare policy regarding proposed devolution of CC issues raised include

  • How many members are represented
  • Will the UK CC be a decision making
  • There is a need to change but retain a UK wide forum for consultants
  • Absence of route from RCC to English arena but there need is a need for a forum
  • If there is an English CC what is the role of UKCC
  • A proposal that UK-CC would have first a subcommittee EngCC


Elections of the deputy chairs of the committee

The following elections took place for the session 2017-18 beginning ) October.

  • Deputy chair for negotiations – Dr Rob Harwood (unopposed)
  • Deputy chair for healthcare policy TBA
  • Deputy chair for development, communications and professionalism  – Dr Helen Fidler


Doctors’ and Dentists’ Review Body (DDRB)   

An update was given on the BMA approach to the DDRB by Rob Harwood

A discussion paper on pay was noted

DDRB noted the problems with retention and recruitment

A BMA letter to the Review Body has been sent to DDRB by UK-CC

The BMA has given a submission of evidence for the 2018 round

Specialty leads

Minutes of the meeting of specialty leads on 10 May 2017 was noted and a paper on the review of specialty leads discussed. The specialty leads are the means that CC communicates with the various colleges and specialty associations


Healthcare policy subcommittee

There was an update from the healthcare policy subcommittee by the deputy chair for healthcare policy. Areas discussed.

  • Primary – secondary care interface
  • Sustainability and Transformation Plans
  • Conflict of interest

Development, communications and professionalism subcommittee

There was an update from the development, communications and professionalism subcommittee by the co-chairs

Regarding “Members services” included helping with LNC  Chairs responsibility.

There is now an “IRO of the day telephone”

Document store is now active  –

Regional consultant committee list server and fora list server should be more widely used.

Videos for consultants eg Influencing skills are available

Consultant survey results will be out soon, sub analysis is still being done

Job planning app. Web based initially then for the interface about 4 weeks


Negotiating subcommittee

There was an update by the deputy chair for negotiations

Due to general election little work is to report back on. There are a lot of unknowns.

Time for external duties information from Academy of Royal Medical Colleges noted

NHS Improvement advice inaccurate on Job Planning. A letter to LNC chairs is about to go out.




BMA Scotland responds to ISD workforce information on consultant figures BMA NI warns a hard border will risk patient care

Patient care in Northern Ireland and the Republic of Ireland will be put at risk if the next government fails to maintain a ‘soft border’ following Brexit, warns BMA

Ahead of next week’s general election, the British Medical Association is calling on politicians to protect the future of patient care in Northern Ireland and the Republic of Ireland following Brexit, by ensuring that a ‘soft border’ is maintained.

The existing open border arrangements, alongside an expansion in the provision of all island healthcare, provide a number of benefits for patients1, including access to both specialist medical services and to highly trained clinicians. This access risks being lost if border restrictions are introduced following the UK’s withdrawal from the EU.

The BMA is warning that cross border health services and patient access to healthcare, including the cooperation of emergency services and other organisations in response to major emergencies and public health risks, must not be impeded following Brexit.

Dr John D Woods, BMA Northern Ireland council chair, said:

“Northern Ireland is too small a health economy to efficiently provide some smaller specialist services; the Republic of Ireland is our natural partner for many of these services allowing both countries to work at a scale to provide benefits to patients on both sides of the border.

“We have seen several large scale success projects here such as the cancer centre in Derry and the all-island children’s cardiac service. Such projects mean that on a day-to-day basis doctors across Northern Ireland and the Republic of Ireland will be in contact with each other; getting professional advice, sharing knowledge and collaborating on patient care.

“Any border restrictions imposed after Brexit would risk reversing this progress and would damage patient care. We must maintain a soft border after Brexit to help ensure that cross border health services and patient access to healthcare are not affected by leaving the EU.”

The BMA is also asking that doctors in Northern Ireland and the Republic of Ireland maintain the ability to move freely between both countries, and that the mutual recognition of medical qualifications between Northern Ireland and the Republic of Ireland continues.

Dr Peter Maguire, a consultant anaesthetist who lives and works in Newry in Northern Ireland but also works across the border in Monaghan in the Republic of Ireland, said:

“I am one of a number of Northern Ireland doctors who regularly travels south of the border to care for patients. If a hard border is introduced following Brexit, it will present a number of difficulties for the health service, and will leave me with no choice but to leave the NHS and move to the Republic of Ireland.

“It’s not just cross-border movement that will be an issue for patients. 54 per cent of the exports from Ireland are pharmaceuticals and huge amounts of medical equipment are made and come from Ireland. What will happen if there are tariffs? What will happen to the cost of drugs with the change in the Euro?

“Medication that I already have to make a business case for to access in Northern Ireland will potentially become even less available to patients who truly need it.”

Dr Sara Hedderwick, a consultant in infectious diseases; “During the Ebola outbreak in 2015 it became clear to medics working on this issue that collaboration on an all-Ireland basis made most sense. For example, we faced difficulty in transporting potentially infectious samples by air to Great Britain. It proved much easier to send the samples by road to Dublin where our colleagues provided a critical rapid diagnostic service.

“If we were going to be in the position of dealing with an outbreak of Ebola, we needed to address it right across the country, in terms of setting up isolation units and diagnostic laboratories, and sharing information.”

Dr Tom Black, chair of BMA NI’s GP committee added, “The European Union of General Practitioners [UEMO] agrees that Brexit is a key issue for primary care, particularly in relation to the provision of cross border patient services and the free movement of patients and health professionals. We also need clarification on funding for joint medical research initiatives.”

BMA info

The British Medical Association has today announced that Dr Chaand Nagpaul will become the next BMA council chair. Dr Nagpaul will take over the post from Dr Mark Porter, whose five-year term as chair ends on Thursday 29 June 2017.

Dr Nagpaul has been a GP for the past 27 years and is a senior partner in his practice in Stanmore, North London. He is currently chair of the BMA’s General Practitioners Committee (GPC) having been elected to this position in 2013. He has been a member of the GPC since 1996 and was a member of its UK negotiating team between 2007 and 2013. Dr Nagpaul is also Chairman of his local BMA Division.

Dr Nagpaul has been a Local Medical Committee (LMC) member for more than 25 years and vice-chairman for the past 12. He is a Fellow of the Royal College of General Practitioners, and a past member of its Council. In 2015 Dr Nagpaul was awarded a CBE for his services to primary care. Commenting on his appointment, Dr Nagpaul said:

“It is a tremendous privilege and honour to represent the medical profession as BMA council chair. The challenges facing doctors and the health service in which we work have never been greater. Doctors are at the sharp end of chronic underfunding, staff shortages and rising demand on the NHS, and see firsthand the devastating impact these pressures have on patient care. I will work to ensure that the BMA supports doctors facing these pressures, and will lead the charge for an NHS that is properly resourced by the next government, so that doctors can provide the safe, high-quality care patients deserve. I want to pay tribute to the hard work and leadership of my predecessor, Dr Mark Porter. The BMA has always proven itself to be a strong, independent voice for both doctors and the patients we serve and with the NHS at breaking point, this is more important now than ever in holding politicians to account. I  look forward to continuing with this vital work at a pivotal time for doctors across the profession and for the NHS as a whole.”