Anatomage Anatomical Display Table

 Anatomage Anatomical Display Table at NMUH

The Anatomage Table is in the NMUH Ferriman Library for four weeks beginning February 19th . It is available for initial demonstration and then use in reserved time of 1 hour sessions. A number of you are already booked as individuals or as part of a group that your organiser will have informed you. For any others interested see available times please go to

To submit a reservation request, please send an email to

Booking will not be confirmed until you receive an e-mail. Links to various helpful documents and videos are shown at the end

There may me some flexibility in attending demonstrations already booked (blue) depending on numbers.


It has been reported that there has been a reduction in the teaching of anatomy over the years at Universities were increasing numbers of medical students have less opportunity to perform cadaveric dissection


There has been a significant drop in hospital requested autopsies over the last 30 years. It is also been suggested that the level of anatomy knowledge in postgraduate medical and other healthcare trainees maybe inadequate. There is therefore a need for innovation for vocational training requiring anatomy and morbid anatomy learning. Though it is unlikely to replace cadeveric dissection the Anatomage table is a virtual cadaver showing life-sized male and female bodies that is described by its makers as a “unique, life-size interactive anatomy visualization table for the medical community” . This device allows undergraduate and postgraduate students to investigate the human body by virtually dissecting it.

Reference  See article in Daily Mail

The Anatomage table has some distinct advantages. In the UK and elsewhere around the world legislation regarding the donation and use of human bodies and tissue is in force. Also the material used for preservation of cadavers is also under scrutiny for health reasons particularly in the EU. Being virtual these laws and codes do not apply. Whilst the cost of the table is substantial this should be viewed in the context of its potential use in both undergraduate and postgraduate teaching of a wide variety of healthcare professionals that are expected to have an understanding of anatomy and morbid anatomy. This virtual cadaver table allows the user to explore real, three dimensional images of the human body (both male and female) through a touch screen interface. With this in mind the I have been given the opportunity to assess the Anatomage Table. North Middlesex Hospital has been  loaned a demonstration model of the  Anatomage Dissection table for four weeks. In this short time the aim is primarily to assess the value of the table for a number of groups and how useful these groups found the table.

Current features of the table include

  • Zoom and rotate the body and structures,
  • Remove and virtually slice organs
  • Adding or remove veins, arteries, nerves or other tissue
  • Layer and segment the anatomy.
  • Notes and observation maybe added to identify anatomical structures
  • Image projection onto a separate screen using the external slots
  • Import and display data from MRI and CT scans of patients which can then be recreated into virtual cadavers

 Potential and future potential

  • Create and integrate programs and quizzes,
  • Integrate with tablets
  • Feedback devices for the table to allow users to touch and feel the virtual bodies.
  • Library of anatomical images of cadavers of different genders, BMI and ethnicities
  • Incorporate curriculum examples
  • Public education eg through sixth form and
  • The table could be integrated into numerous courses eg
    • Anatomy revision for Surgical and other Postgraduate medical trainees
    • Anatomy courses for Healthcare Students without access to cadavers
    • Induction courses for Anatomical Technicians and Embalmers
    • Integrate with Morbid Anatomy (Anatomical Pathology) training of undergraduate students and junior trainees

There is also an opportunity to assess where would be the best site for the table

Where should it be sited?

  • Anatomy Department
  • Medical Library
  • Pathology museum or department
  • Other museums


The Anatomage dissection table is a novel and innovative way of learning anatomy and morbid anatomy. Using a life size touch screen three dimensional images allow the learners opportunities normally associated with cadaveric dissections. As the start up cost of the device is not insignificant the aim of the study is to assess the ease of being trained to demonstrate the model and to how wide a group of clinicians and students could use it. The hope is by integrating it’s use with clinical practice it would make it financially viable.

Useful Links

Quick start guide

The extensive image library

The full manual

Extensive playlist of tutorials





Upcoming Consultants Conference

The annual Consultants Conference will take place in London on Wednesday 28th of February in which motions submitted by Regional Consultants Committees, Medical Staff Committees and Local Negotiating Committees that have been submitted in time and (here is the rub) passed by the Agenda Committee are debated and voted on by representatives of the UK Consultants body. Nearer to the time I will blog about what is going to be debated. The debates are actually Webcast live.

In accordance with the rules I have submitted two motions that may or may not get through the Agenda Committees oversight. The first motion has been accepted by our MSC and NELRCC and the second by NELRCC and our LNC


The much delayed position of Medical Examiner (ME) in Cause of Death will most likely commence in April 2019 in England and Wales. It is expected that the  800+ doctors from all branches of practice will be employed by Local Authorities. In order to ensure that these posts are fit for purpose this conference :-

i) Calls for the BMA to negotiate clear, satisfactory national terms and conditions for this position with the appropriate government and local government bodies.

ii) Calls on BMA to consider the mechanism for local or regional negotiations for enhancement of national terms and conditions for these positions.

iii)  Believes that there should be full support and involvement from the appropriate BMA secretariat and policy units

iv) Believes that these new positions should be represented at appropriate local, regional and national committees of the BMA.



Whilst the UK is expected to leave the EU in March 2019 any transitional arrangements may mean EU Directives still need to be enacted under UK Law. As the European Commission is considering a third amendment of the Carcinogens and Mutagens Directive (2004/37/EC), which may include a modification to the classification of formaldehyde, this conference

i) Supports the joint statement issued by the European Medical Organisations on the use of Formaldehyde which  strongly requests that the European Commission refrains from any classification of formaldehyde that could restrict its use in Pathology Services and threaten the future health and diagnostics of patients.

ii) Asks that the Board of Science reviews the evidence that is being used by the European Commission to justify this change

iii) Supports the BMA’s European Office and relevant Committees’ work to avoid the change in classification of formaldehyde without suitable and affordable alternatives.


2017-12-14 LNC

The staff side LNC took place on Thursday 14th December 8 – 9 am I have previously blogged about the constituent and function of this commitee that includes Consultant SAS and Junior Doctor representatives that meet every six weeks and  four times a year with management on the joint Local Negotiating Committee. Mr Sunil Trakru is the Chair. This was followed by the joint LNC with Management

The following are my notes of the proceedings. These are not minutes of the meeting (these are circulated to the members of the committee by the secretaries of each).

Matters discussed in the sLNC  included the following

  • The role of the Guardian of Safe Working
  • The Junior Dr Forum (frequency ToR, who is invited)
  • Recent meeting between the Chair and Management
  • Proposed Acting Down Policy
  • Occupational Health Policy and adherence to it
  • Minutes of the previous Joint LNC meeting 21/9/17 for accuracy and action points
  • The Agenda of the JLNC meeting to follow

Matters discussed in the jLNC  included the following

  • Minutes of the previous Joint LNC meeting 21/9/17 for accuracy and action points
  • Occupational Health Policy and adherence to it
  • Proposed Acting Down Policy
  • Mandatory Training , compliance, hardware issues and time allowed to do it
  • Annual Professional and Study Leave sign off
  • SAS and Trust Doctors List and E-Mail Groups
  • Training needs of Trust Doctors
  • Managing conflict of interest

Supporting info for this from NHSE

  • The Junior Dr Forum (frequency ToR, who is invited)
  • Royal Free Group Update
  • Re-stablishment of BMA Noticeboard Board.
  • GMC / HEE and Staff Survey to be an item on upcoming agendas



2017-12-07 UK Consultants Committee

The December meeting of UK CC took place on  Thursday 7 December at BMA House

Introduction and apologies were given by the Acting Chair. Minutes of the last CC meeting and the CC Exec away days were noted. Through the day the following items were discussed including a completion of a CC Directory,  discussion on Conflict of interest and Collective responsibility. Administrative items and updates given from the devolved nations. I am particularly interested in NI with the ongoing issues concerning Brexit and Hard/Soft/Semi-firm border.

The upcoming Consultants conference 2018 is on Wednesday 28th February. The conference needs motions from MSCs LNCs and RCCs. There will be workshops on bullying and harassment, pensions and electronic job planning. There is a January 19th deadline for these motions which must be sent through a named person.

An action from Professional fees committee was discussed in the context of the list of fees that the BMA can negotiate on. The BMA can recommend fee levels in a large number of fees (mainly in GP practice) . These are professional fees work attending doctor can do, but are negotiated fees with bodies and councils.  Many fees are out of date or no longer functioning. There is a poor estimate of how long they take based on time. A range of time it takes can be estimated from  90 minutes to  3 hrs.  UKCC will have its own audit and how long will it take to do the work – this will help in negotiation.

An update was given by a member of the negotiating team. What was originally planned as 6 months of negotiations is now 27 months. Topics covered

  • Consultant Contract Negotiations including the most up to date information
  • Clinical Excellence Awards

A presentation was given by the BMA Head of Specialist Member Relations on pensions. He pointed out that Doctors as a group are probably the worst effected by pension legislation but there is lots of information of the BMA and HMRC websites on quite a complex area. Update were given by the healthcare policy subcommittee and the development, communications and professionalism subcommittee

A recent European forum  meeting is  organised by BMA but has representative from the royal colleges GMC NHSC etc. There was a noticeable absence of at least two royal colleges (pathology and radiology) and faculty (intensivist). As there is a need to supporting and engaging EU Colleagues these colleges and faculties will be approached to send representatives to next May meeting

The Annual Representative Meeting takes place Sunday 24 – Thursday 28 June 2018 in Brighton



2017-12-05 London Regional Council Exec

The BMA London Regional Council executive took place  on 5th December 7pm-9pm and was well attended by all branches of practice eg Consultant representatives from North and South Thames, Gps Members elected at the ABM, representative from Public and occupational Health and Junior Doctors. Gary Marlowe, is the chair and Jackie Applebee is the secretary. Andrew Barton is the IRO.

The recent GLA meeting with Dr Onkar Sahota Chair of their Health Committee. The  points discussed included the resent Memorandum of Understanding with  the Mayor of London in which the Mayor will be in charge of a London Estates Board. The Mayor currently does not have significant control over London Health and does not have a deputy Mayor for Health. There were three members from the Royal College of Nurse and three from London Regional Council. Discussed in the GLA meeting and at the LRC meeting were the STPs and Capped Expenditure Program as it effects London. A lobbying of London MPs is expected on January 22nd sponsored by a North London MP. It is noted that the Parliamentary Health Committee is undertaking an inquiry into Sustainability and Transformation Partnerships (STPs) and Accountable Care Systems (ACOs).

Related to this George Rae introduced a webinar took place  lasty month on STP and including Gary.

See link

A personal review of NWLondon STP was given. Ealing Hospital is (sic)is downgrading very fast. How can doctors work together. How can the LNC influence.

A talk was given by “Doctors of the World”. They run clinics and advocacy programmes in Bethnal Green and Brighton that provides medical care information and practical support to excluded people.  As well as providing healthcare, they register those who are facing barriers with their local doctor. Patient data for these group of patients is not confidential and put the people off to see a doctor. Primary care remains free but Government intend to include primary care.  DH is intending to phase charges.

Read their report

 Health Campaign Together

HCT is now supported by Unite and Unison. Conference in Hammersmith November attended by 400. BMA are not officially part of it. Started by keep our nhs public. TUC has accepted HCT. There was a discussion as whether LRC can affiliate





2017-11-29 North Thames LNC Fora and NELRCC

Notes on  North Thames LNC Fora and NELondon Regional Consultants Committee  took place on Wednesday, 29th  November  2017 at BMA House,

Present were representatives from  North Middlesex (Chair LNC Fora),  Whittington, Chelsea and Westminster , CNWL , Barts , Lewisham,  RFH

Points discussed

  • Background to invitation to South London LNC members to NTLNC Fora
  • Benefits of a London wide LNC Fora
  • Possible problems
  • Length of meeting, need to start earlier so as not to clash with RCCs start time
  • Job planning tool kits
  • Electronic leave application Zircadian/ Allocate , lack of training , miscalculation inbuilt in the systems
  • Annual leave forms
  • Policies introduced without Consultant input or oversight
  • Lack of CEA rounds in some Trusts
    • In one Trust the value of a CEA award has been halved but if £50 million in savings are made the full amount would be paid.
  • Poor CQC reports in some Trusts
  • Whistleblowing policies and Freedom to Speak up Guardian
  • Ongoing affect of STPs and those in the Capped Expenditure Process
    • Loss of Orthopaedics and GUN specialties
  • Variability of deficits and some surplus Trusts
  • S136 assessments
  • Infrastructure problems in certain Trusts struggling with three tier rotas.
  • Use of Long term locums discussed
  • Dislike in some Trusts for on call work by SAS doctors
  • Junior Doctor Rota Gaps leading to increasing “Acting Down” of Consultants
  • Acting down policies being discussed in various Trust remuneration in Trusts vary between 2 – 3x normal pay. Specialities particulary effected Paediatrics Oncology and A&E.
  • Increase request for “Fitness notes” in the OPD setting rather than in primary care.
  • Section 49 reports for people in care homes
  • Group models of care discussed
  • Some of the larger Trusts have 3 GoSW and one for GP trainees
  • In one Trust significant loss of Car Parking spaces has taken place to cater for LAS
  • At one Trust non standard grade Doctors present for > 2 years numbered 80 – 100
  • There was quite a Variability in the numbers of exception reports per 100 trainees
  • Some Trusts there is a reluctance to engage in Junior Doctors Forum
  • In some of the large Trusts there are large numbers of non deanery trainees (fellowships) with a high overseas contingent often being long term employees of a team.
  • Changes in the provision of Congenital Heart Disease in on Trust with a working agreement to establish from north of the river to south of the river.
  • Establishment of a pan London Junior Doctor Locum rate
  • Not all Trusts have signed up to the SAS Charter
  • Variability in information coming from GoSW
  • Need to re-engage with Junior Doctors
  • Most Trusts have removed the “additional to contract” ie unpaid work in Job planning software.
  • The recommended split of 7.7 DCC to 2.5 SPAs were discussed

European Forum 13th November 2017


The European Forum took place on 13th November . Though taking place in BMA House it has a wider number of attendees to discuss European matters affecting UK Healthcare.In attendance were representatives from BMA Secretariat , BMA INTL – International Committee , BMA GPC – General Practitioners Committee,     RCGP , BDA ,  BMA MASC  , JDC BMA NI  BMA Scotland, BMA Wales , RCOA ,RCS, RCN ,RCEM , RCPhy . I attended as UKCC elected representative

The minutes of the meeting held on Thursday 11 May 2017  were confirmed. For future meetings it was agree the latest  EJD president who is British will be invited.  The Chair indicated he was standing down and asked for expression of interests be made to the secretariat from members of the committee.

A presentation on Brexit and EU health policy – the Norwegian model was given by  Maren Ringstad Widme, Counsellor for Health and Food Safety, Mission of Norway to the EU.  Norway is in the EFTA and EEA (Lichenstein and Iceland are also in EEA). The EEA is a homogeneous economic area with freedom of goods,  person,  services and capital and includes competition. There is closer cooperation with the EU with harmonised with directives on blood cells and tissue. There is mutual recognition of professional qualifications. The EEA is not a customs union. Norway can pursue its own Trade agreements. It has its own Justice Policy but is in Schengen . It is a consensus driven dynamic agreement with 12000 acts of which 5000 are enforced.  There are 8 meetings a year to agree on which acts to agree to. Following an EU directive there is then consensus on an EEA agreement through a joint committee decision. Norway implements in national legal order the  Law and Secondary legislation. It can take months or years. But there is no parliamentary or council representation. Norway can be part of health programme such as the health programme and Horizon 2020. It pays an annual contribution based on population. Norway has good expertise in some areas. It participate also in commission working groups on public health and health security committee as we see the work here as important work. There are Informal health ministers meeting .  There is lobbying toward institutions and bilateral contact with member states. Contact and influencing the EU is through international agreement.

This presentation was followed by a question and answer section

Question and discussion included the following:-

  • The degree of the Norwegian influence outside of EU
  • Working as constructive partners
  • Norway has expertise in fishing and health
  • There is an action plan in antimicrobial resistance
  • There is a need to work differently as it is difficult to influence the process in the parliament and council
  • There is an Annual program of work towards to EU
  • Norway has an easier relationship than Switzerland
  • Through agreement with national expert in the commission, good contact points.
  • When the commission appoints new people there is a need to be informed about the agreement.
  • EEA agreement on solidarity and cooperation involves EEA grants
  • Thee EEA Grants and Norway Grants that Norway pays is1.5 billion + 1.3 billion = 2.8 billion Euro paid annually in total
  • Receiving countries are in east and southern parts of Europe.
  • 2014 – 2021 the five main topics are innovation research education and competitiveness
  • Environment issues – energy, climate change, low carbon
  • Justice and home affairs
  • Regarding the European Health card – Norwegians have the same rights
  • Norway has an EFTA court next European Court of Justice
  • The European Court of Justice does not cause problems in Norway.
  • Switzerland is not part of health security
  • Norway is more integrated than Switzerland but is not part of the decision process.
  • There is a possibility for veto in EEA but this is not used.
  • Norway has full harmonisation with the European Medicine Agency – but only as observers
  • It was noted that Norway has a higher GDP per head of population compared with the UK although Norway has only 8% of the UK population it has over 1.6x the GDP per capita,

Chair report

The chair gave a personal view of his working in both the North and South of Ireland. The BMA has a neutral view.  He discussed a number of issues

  • Finance
  • EU citizenship
  • The Irish boarder – roaming chargers drop has had a financial benefit this could be jeopardised after Brexit
  • The uncertainty, change and consequences of the border with best estimates of a soft moderate to hard Brexit
  • The cost of indemnity, how will it change ?
  • GMC information
  • Pharmaceuticals account for 54% of exports
  • There is a trend of movement of labour from NI to south
  • The £ has fallen 20% against the Euro
  • Social care workers are moving to the republic
  • Pension changes and Residency problems examples given
  • In a recent survey 42% of EU doctors are thinking of leaving the UK


There was an Update on EU Initiatives and Activities given from European Forum members about European organisations of which they are members.  The following were discussed

Royal College of Emergency Medicine

Staffing, Patient Demand and the implications of Brexit was published

Consultants and Academics

Concerns were raised over the retention of Consultants who are EU nationals. There are higher proportion in some specialities such as Surgery and Ophthalmology. It was accepted that there is a responsibility on the employers to help retention of staff and make them welcome. For the future it is worrying that the number of Junior Doctor applying for specialty training has dropped significantly. There is a   6% decrease in students form EU applying to universities in the UK. Concerns were raised over the future status of consultant representation on various European bodies. There is a proposal to consider the ban of formaldehyde by the EU next year.  One institution has estimated  By 2020 the NHS will spend £135 less per head of population. The Consultant contract negotiations was stated “ are ongoing”. In UK Medical academia 34% are over 54 years compared with 18,2 % of NHS consultants. Concerns ere raised over the loss of access to the EU clinical trial database, the loss of influence over European Medical Agency., future cooperation in dealing with pandemics  , the loss of  and possibly reimbursement of research money. Euro trans fat legislation is on going .  Scotland minimal pricing of alcohol judgement is imminent and needs to be circulated.


Meeting related to Brexit were discussed.  Mention was made of  the Nuffield Trust sharing information and that Brexit will potentially be a disaster for Social Care . Migration Matters Trust is a cross-party group of  politicians, business executives and trade unionists including high tech and retail industry whose aim is to establish an open and honest debate about the issues of migration which it sees as positive.  As a lobbying group it has difficulty in getting through the door. There is some anxiety in not being able to influence.


Is part of the Cavendish coalition. There is a scoping affect on membership

Royal College of Anaesthetists  statement to MAC can be found at  RCoA-Response-MAC-EEAworkforce

Nurses  more Nurses are leaving than coming into the country

Public Health

Employment is as Public Servants. There is a shared concern with the Health sector. Concerns include whether training will be recognised. In numbers 100s will need to be allowed to maintain their employment.

Junior Drs

There is a new British elected President of the European Junior Doctor Committee. There are concerns over workloads, rota gaps issues. JDC supports the Polish Junior Doctors strikes


The BDA is a member of the Cavendish Coalition. There is no fall of numbers as yet and there is no increase in dental student numbers. Linked are concerns over the mutual recognition of qualification. There are costly alternative exams. The GMC are approaching the dental degree differently. There is a “Tooth whitening issue” in that under 18 year olds not allowed. New data protection regulation is coming in


The college is committed to European networks including being part of UEMO membership of which does not require membership of the EU. There have been  two recent UEMO meeting.  The Royal College is an active member of the World  Organisation of Family Doctors.  The RCGP’s  10 year international strategy is maintaining a European Direction and the council is agreed to remain committed to UEMO.


In Scotland 13 % of consultants are from the EU. The Scottish Executive wants to repatriate legislation EU to Holyrood. There was a warning of being prepared for no deal.

Northern Ireland

EU Brexit chief negotiator Michel Barnier has said that the UK needs to come up with solutions on how to avoid a hard border between Northern Ireland and the Republic of Ireland.. Northern Irish are applying for Irish passports with the impact on the £ and a drive for a new border poll.  NI has the highest rate of EU doctors and there is concern over mutual recognition of medical qualifications  and how the boarder will operate. The BMA NI has undertaken political lobbying having met with all the the MEPs



BMA IC 18th October

The role of the BMA International Committee has been mentioned in previous blogs

The latest meeting took place at BMA House on 18th October . Attendance included representatives of Junior Doctors, European Junior Doctor Chair, UEMO Chair,  UEMS chair, Academic Committee Chair, Ethics Committee Rep, UKCC rep  amongst others

The following are notes of the meeting

There was a  discussion on

  • Maintaining the profile of the committee.
  • The recent BMA Book Awards included a prize for the WHO Cultural contexts of health: the use of narrative research  .
  • Meetings with Migration Matters in July . Their co chairs are Barbara Roche a Labour ex-MP and  Conservative MP Nadhim Zahawi and Liberal Democrat Lord Navnit Dholakia. Migration Matters  is seen generally as a counter weight to Migrationwatch.
  • The Nuffield Trust report on Brexit Preparing for the unpredictable be prepared Social Care is likely to suffer more than healthcare with loss of staff but if this is the case this would have a negative impact on the NHS.
  • The BMA Board of Science Meeting . Items included How to increase the Boards profile and Ethical procurement. There was a focus on strategic issue “Where what and how”. How the BMA functions, How to revitalise the committee.
  • Review of ARM resolutions 2017  and workplan
  • General discussions of keeping the public healthy and valuing current and future doctors.
  • International trends and health security,
  • Health needs of refuges (there is a scoping review),
  • Support for International Medical Graduates, International GP recruitment programm
  • Global Health priorities,
  • Ill treatment of prisoners ( medical ethics and Forensic and Secure Environments Committee are also involved)

Brexit  An update on Brexit  was given.  There is Parliamentary focus on the Bill, the Irish Border and Mutual Recognition of Professional Qualifications. The prospects of no deal scenario would be catastrophic (sic) and would profoundly affect healthcare. A BMA briefing is coming out (see link below)

BMA key asks are

  • Permanent residence for EU doctors and medical researchers currently in the UK
  • A flexible immigration system which supports UK health and medical research
  • Mutual recognition of professional qualifications and measures which protect patient safety
  • Ongoing access to EU research programmes and research funding
  • Consideration of the unique impact Brexit may have on Northern Ireland’s health service


The brexit briefing can be found at

European and International Meetings  The European Junior Doctors Permanent Working Group (EJD) autumn meeting will take place in Malmo on 27 – 28 October 2017. A report EJD policy activity was given with leading on work in Brussels on post graduate training and leadership.

 CPME (Standing Committee of European Doctors)  CPME is the umbrella body for the whole profession at European Union level, and aims to promote the highest standards of medical training and medical practice in order to achieve the highest quality of health care for all patients in Europe.. The CPME statutes required a country to be in the EU, EEA or a signatory to free movement to become a member, but there was some ambiguity about asking a country to leave.  An update on CPME policy activities was givenConcerns

  • The proportionality directive impinging on the ability of national regulators
  • Information sharing and confidentiality regarding e-health.
  • A harder Brexit is more likely to challenge the UK’s membership of CPME.
  • The use of off-label pharmaceuticals was discussed,

UEMS  addresses the quality of specialist care and represents the interests of medical specialists. It has two parts, the Management Council (with representation from the BMA and Royal Colleges) and the Specialist Sections and Boards (with representation from the Royal Colleges.)

Points discussed :-

  • The UK’s future membership of UEMS was a similar position to CPME.
  • The current statutes would not allow the UK to join after Brexit, but it was unclear how to remove a member. It would likely require a majority to remove the UK.
  • The secretary general wanted the UK to remain a full member, but there appeared to be split views amongst other national associations.
  • Changes to the UEMS statues would need to be proposed, at either the spring or autumn meetings in 2018, and the focus at the moment was on building support for these proposals.
  • Membership of UEMS and other European medical organisations would be important in any transition period from 2019 onwards
  • Membership of these bodies would help to secure access to the EU and the continued representation of the medical profession.


UEMO (European Union of General Practitioners)  represents the interests of GPs at the European level. The BMA and Royal College of GPs represent the UK. An update was given on UEMO matters. UEMO membership did not require EU membership. There was a hope that a memorandum of understanding could be agreed at the board meeting before the next general assembly.

Points mentioned :-

  • UEMO had met at BMA House in May.
  • Chaand Nagpaul had given a successful speech, saying that there were stresses across Europe.
  • A cross-border care working group had been established.
  • A statement from UEMO had been sent to Michel Barnier on cross border care, calling on the EU to ensure co-operation on the safe provision of care, the free movement of patients across the border, recognition of qualifications across borders in Ireland and clarification of funding for joint initiatives.


World Medical Association (WMA)  is a confederation of national medical associations worldwide. It promotes co-operation and consensus on professional and ethical issues with meetings held every six months. The general assembly meeting took place in Chicago on 11 – 14 October 2017. A number of policies had been passed and the BMA had managed considerable input.


  • New wording had been agreed for the declaration of Geneva.
  • Policies such as those on therapeutic abortion, health and climate change, medical tourism, and telemedicine would be going to further consultation.
  • Policies on child abuse and neglect and the paper fair medical trade had been accepted
  • There had been a breakout session on ethics and professionalism, which provided an opportunity to highlight the BMA’s ELCPAD work
  • Other issues covered were undergraduate education, with common themes emerging around insufficient resources, pressure on academics and ensuring quality.
  • Work by the WMA could be promoted to BMA members.


Commonwealth Medical Association (CMA)

The CMA is a confederation of national medical associations within the Commonwealth. It aims to assist and strengthen the capacity of its membership to improve the health and wellbeing of their communities and countries. Meetings are held triennially, with the next meeting taking place in 2019. The BMA was looking to engage with the CMA on policy issues. There would be a Commonwealth heads of government meeting taking place in 2018 which would provide opportunities for engagement. More information would be available at the January committee meeting.

European Legislation and Initiatives

There was an Update from BMA European Office. It was highlighted the importance of lobbying  as the European medical profession.  The EU was amending the carcinogens directive and it had come to light that this had the potential to include formaldehyde. The European Office are working to avoid this being written down and this appeared to be going well, but they were retaining a watching brief. In particular was noted the Joint statement on use of Formaldehyde and Note the European Chemical Agencies report of March 2017 FORMALDEHYDE AND FORMALDEHYDE RELEASERS . Brexit was taking up most of their time. Issues included transfats, junk food and alcohol labelling.

Immigration Policy, Lobbying and Advice

Included updates on immigration policy and lobbying work, and what the BMA is doing to support international medical graduates (IMGs).  Current immigration policy and lobbying activities  was discussed

Refugee doctors

Included updates on

  • refugee doctors initiative
  • refugee doctors and dentists liaison group

what the BMA is going to support this group.

 International development

Fair Medical Trade  The International Department leads on the campaign to promote ethical procurement in the NHS and other health systems around the world.  An update on fair medical trade activities was given

Global health challenges  The BMA is involved in a number of activities that fall under the heading of ‘global health challenges’ these include environment, governance, health promotion, and health security. An update report on current activities was given

Additional information

European Brief  go to this link for full information


Recent meetings


 A staff side Local Negotiating Committee took place on Thursday  21st September 2017 chaired by Sunil Trakru (LNC Chair)

The following items were discussed or referred to

  • There was a discussion of the recent e-mail regarding exception reports. There needs to be agreements on a number of matters. The Junior Dr forum now has paediatric representation but needs other representation from juniors.
  • Acting down policy is under discussion with management
  • SAS issues discussed included training,  CPD development.
  • A new staff side LNC Constitution is being developed
  • The number of Trust Grade and SAS at the Trust to be reviewed
  • SAS charter discussed
  • CEA new guidance not agreed by sLNC
  • The Guardian of Safe Working gave a briefing of his work and discussed the role of Educational Supervisors and the introduction of an HR “Exception reporting officer”.
  • The changes to the interpretation of the contract needs to be locally agreed.
  • The different reporting systems DRS4 versus Allocate.
  • The number of PAs the GoSW has is 1.5 for 250 juniors
  • The appointment of “flexible training champion” for less than full time doctors


The following are edited notes on the proceedings (full notes have been sent to the sLNC }. This meeting took place from 9 am – 10.45 am

Tribute to Dr Asim Ray

The Chair gave a short tribute to Dr Asim Ray who had been a Clinical Oncologist at NMUH for over 25 years and an elected member of the LNC for over 12 months. Dr Ray passed away suddenly whilst on holiday in India in August.  The Chair asked that the sadness of the committee was recorded in the minutes. It was agreed a joint statement of condolences by the co-chairs should be sent to those organising the book of remembrance via an e-mail tribute to Oncology. (also stated at the staff side meeting)

Other items discussed at the joint LOCAL NEGOTIATING COMMITTEE.

The recent news that the NMUH Chief Executive is to be replaced with Sir David Sloman being made the Accountable Officer was referred to. The Executive Question time at 11.30 would give more information (see below)

Acting Down Policy

Is still under discussion

 Mandatory Training

Management stated that there should be “adequate time” for mandatory training and this should be in the job plan.

Leave policy

The staff side stated that this has not been agreed as the 2 days for 2 stat days has not been agreed. It was agreed to put a sentence in as a footnote.

Study and professional leave

The document was signed off.

Joint LNC Constitution

Accepted with minor changes

Organisation changes

Changes to the organisation of the Trust were presented. An up to date organogram will be uploaded to the intranet

Junior Doctors Contract

There was a discussion about the new JDr contract. There have been delays in issuing work schedules. Lack of information from Paediatrics T&O and Urology. Rota gaps O&G and Surgery is very good , some gaps in medicine. All should now have work schedules. There is need to learn from good examples. There is a lack of knowledge of who are the ES of trainees. FY1 and FY2 are known. College tutors should be aware of them. There is a miscommunication with the Education Centre for >CT1. DRS4 has been up for exception reporting. FY1 and FY2 all have contracts. Exception reporting guidance is under discussion. Some of these changes will be discussed at the JDr forum at 12.30 pm the document will be sent back to the Staff side LNC. There is a need for the flexible training champion (NHSE/BMA guidance)

Update on Car Parking

New Car Parking Management Company  – Car Park Management UK

  • Automatic Number plate recognition will be installed October 16th
  • There will be a White List (including all consultants) recognised by cameras
  • There will be a 4 – 6 weeks bedding in period
  • a phone number to phone in the event of problems
  • an appeal system for penalty charges
  • an internal and external hospital payment system for patients and staff
  • 4 hours allowed to pay extra time
  • There will be car parking attendants
  • Salary payment scheme (salary sacrifice) is no longer available
  • Any fines are linked through the DVLA
  • There is a mechanism if using an alternative car
  • The staff side LNC suggested paper tickets were still useful as an aid for how long patients or relatives had parked.
  • There will be concessions for patients though they will still have to register.
  • Community & heath volunteers are free

SAS Doctors

The staff side LNC has requested a list of SAS and Trust Doctors to allow communication with them. It was agreed that the SAS Doctors e-mail list will be updated. Previous review (about 4 years ago) showed some long term locums. This was said by management not now to be the case. There are 101 Trust Doctors and 34 Associated Specialists 2 of which are on fixed term contracts.

Issues discussed include

  • O&G Middle grade who do not have a job plan
  • Misunderstanding of what is a Trust Doctor. Finance makes them Specialty Doctors, there is the wrong use of Specialty Doctors with a confusion of different grades
  • a need to look at different posts
  • Contracts need to be right and up to date


RFH Partnership

Regarding the RFH group partnership there is question time at 11.30 (see below)

The memorandum of understanding with RFH defines the relationship with the Free.  The clinical partnership with the Free will result in working with the clinical pathways, working more closely, developing clinical practice groups. This will be a full membership. Royal Free Group Structure currently has three Chief Executives. There is a Group Board overseeing. There is the benefit of relative locality. The Group board will determine the services needed on each site. Previous examples of changes seen in Trauma, Stroke and Cardiology.

Occupational Health

There was a discussion about Occupational Health reports


The following are my notes of the meeting of the JDr forum that I attended at 12.30 on 21stSeptember. Five Junior Doctors, a minute taker, HR representative  and the GoSW were present with apologies from the PGDME and the BMA IRO. The minutes of the last meeting in June were accepted. The meeting was chaired by the Junior Dr Representative on the LNC. There was a discussion of the need from representatives of SpR O&G and Less than Full Time. O&G inductions take place next week and this is a good venue to bring up the need for representation. The aims and objectives of the Junior Doctors’ Forum was discussed. This will be taken back to the LNC and Executive. The Guardian of safe working (GoSW) has not written any quarterly reports yet. Problems are in the rota gaps there is no “business intelligence”. Some of this is with HR but not all of it. There was a discussion of the production of the Annual Report by GoSW, the timing and inclusion of any safety issues. The Terms of Reference is under review. Another e-mail has been sent out regarding Work Schedule Reviews. There was a discussion about the frequency of the formal JDrForum and whether to have an alternating informal forum. It was agreed for a formal forum every 2 months. It was agreed it would be an agenda item at each LNC. There was a discussion on Exception Reporting Guidance

  • The use of the word exceptional
  • The use of bolding
  • The need to modify slightly
  • The problem of how exception reports should be looked at and escalated.
  • Sending the exception report to the Clinical Director as well as the Education Supervisor does not abide by the wording of the contract
  • It was pointed out that any guidance that differs from the wording of the Junior Doctors contract changes local terms and conditions and therefore must be negotiated with the Local Negotiating Committee.
  • There are problems some FY not having logins yet
  • Because of not knowing who the Educational Supervisors are of CT1 and above no logins yet
  • Pointed out that college tutors will have the lists. PGDME not present for comment.
  • Inductions need some improvement
  • Noted that GP Trainees hav e supervisors not in the Trust though whilst at NMUH the paediatricians will act as ES.
  • Time of in lieu (ToIL) has to be agreed with the Rota Co-ordinator or Clinical Supervisor and accrued within a certain time.
  • It was emphasised that ER is not a paper exercise and must work.
  • It was pointed out that at the recent PGFaculty meeting the PGDME said that there was no relation to the number of exception reports and those specialties with heavy work loads
  • It was noted that GP Trainees are paid by Royal Free Hospital and ther would have to be a mechanism of recharge.
  • There are 36 exception reports made so far – 14 closed and not agreed and 22 open of which 19 are overdue.
  • Mandatory Training for Advanced Life Support if done on a weekend then they can be taken as lieu days.



North Thames LNC Fora and North East London Regional Consultants’ Committee


The North Thames LNC Fora and North East London Regional Consultants’ Committee took place on 14th September. At BMA House (3- 6.45 pm)

The  LNC Fora  was chaired by myself  and the NELRCC by Dr Simon Walsh (Barts). The fora was attended by LNC representatives across the North Thames LNCs whilst the NELRCC was represented by NE London Trust Consultant reps. I have  blogged about the previous meetings . The following notes are an amalgam of the two meetings.

  • There is a streamlining of training for new LNC members with completion of on line training followed by two face to face meetings. This should be an agenda item for all staff side LNCs to discuss. Trade Union training is part of Trade Union duties.
  • There was a discussion of the difference between Trade Union duties and activities with the IRO supplying a useful document but the meeting emphasised the ACAS document Time Off for Trade Union Duties and Activities paragraphs 12 and 13 was the most helpful
  • The Guardian of Safe Working (GoSW) for Junior Doctors have been established in all Trusts. There was a largevariability in completion of quarterly reports and whether they have been seen by LNCs. The annual reports of GoSW is due. There was discussion of the PA allocation per GOSW per number of trainees with some variation. Problem of one Trust covering many sites with significant travel distance for the GoSW

The various Trust reps highlighted the following points

  • Problem with a maternity return to work policy
  • Difficulties with new Junior Doctor Contract
  • Terms of reference of JDr Forum are not present in all Trusts.
  • Guidance in Exception reporting some Trust just refer to the NHSE site, other Trusts the GoSW is developing or has developed a guidance. It was discussed that any guidance should adhere to the phrasing of the JDr contract. Any changes that alter this have to be negotiated with the LNC. Some Trusts have viewed it as a benefit in showing where changes need to be made and improvements made to rotas, others are pressurising JDr not to exception report. Exception reports in each Trust have varied. Their number and frequency were discussed . JDr should not be  dissuaded from submitting exception reports. There is a need to share quarterly reports with the forum
  • Some Trusts have yet to give their Junior Doctors their contracts
  • CEAs have been held in various Trusts though in one Trust they are dealing with year 2014-15. Some variation in the mechanism and guidance on CEAs
  • Variability in acceptance of SAS Charter by Trusts
  • Some Trusts do not allow SAS Doctors to be appraisers.
  • Introduction of electronic Job Planning at some Trusts with significant teething problems. The presence of an “Additional to contract” should not be present and if it is,this is an LNC matter.
  • General feeling that Consultaants are not being listened to.
  • Job planning described “as a struggle” at one Trust. Job Planning appeals panel list is held by BMA and NHS England and has been of use in several Trusts
  • Some Trusts have difficulty with study leave in one case there was evidence that this would be unlawful under the Equality Act and BMA Solicitors are being asked for an opinion.
  • Consultants Acting to Preserve Service is a better phrase than Acting Down. These policies are under consideration at a number of Trusts. This was discussed in a number of ways. They should only occur exceptionally and monitored and reviewed. (In one Trust there was a significant use of it because of insufficient doctors on the rota), Consultants act as Consultants not as Juniors and therefore may well not have some practical skills. This may be a MDU/GMC matter if not addressed by Trusts and the document. In the end if it is a safety issue the Department has to close. The remuneration rate has to be punitive to avoid abuse. A minimum is an SpR Locum rate. BMA documents suggest 3PA=1PA. Some Trusts 2PA = 1 PA. If a Consultant On Call Acts down then another Consultant has to be the On Call Consultants. In one Trust the “Acting Down” was described as “a bit of a mess” with severe problems caused by shortages. Three tier rotas have become 2 tier.
  • Consultant Contract remains unclear. The IRO gave a review of the most up to date information
  • There was a discussion of Consultants and ST3 and above being balloted on any contract offer, which has yet to be tabled. The role of UKCC and BMA Council was discussed
  • A new declaration of interest form is to be signed for those on BMA committees. There was a discussion on two particular requests for information
  • Changes to the constitution of all LNC that all should be BMA members.. HSCA is only nationally recognised, if locally recognised HCSA would have to gain recognition on JSCs or have their own local negotiating committee.
  • In one Trust there is a debacle regarding payslips on all staff not ending up with them through the post.
  • One Trust has informed their CCGs of six months notice of withdrawal of provision of a Dermatology Service. Consultations are taking place involving another Trust and/or Private provision on a temporary basis..