Having detailed a few BMA meetings I have attended of late I should include an item from a week or two ago. Last October I was elected the UK-Consultants’ Committee representative of the International Committee. This meets three times a year.
The BMA’s International Committee includes representatives of all the main branches of practice, and discusses European and international issues of interest to the medical profession.
It has discussed and campaigned on issues such as:
- Mutual recognition of European medical qualifications
- The effects of Government changes to the immigration rules on BMA members
- Protecting the health and rights of workers manufacturing medical products used in the NHS
- Healthcare Information for all by 2015 (a global health campaign)
The European brief provides updates on eg :
- European Court of Justice supports minimum unit alcohol pricing
- Transatlantic Trade and Investment Partnership (TTIP) update
- Tightening EU rules on advertising to protect vulnerable viewers.
European funding brief
The 3rd EU Health Programme is the main EU funding instrument to support and underpin the development and implementation of EU health policy. The 2015 call for proposals includes, among other, the following topics:
- Measures to reduce the availability alcoholic beverages
- Early diagnosis and treatment of viral hepatitis
- Common assessment methodology on quality, safety and the efficacy of transplantation therapies.
European and international medical bodies
The BMA has been active in European affairs for over 30 years and is a member of a number of European medical associations. In addition, the BMA Brussels Office provides a key link between the BMA and the European institutions and is responsible for enhancing the BMA’s reputation and impact at a European level. The BMA has produced a list of the organisations which, although not exhaustive, covers the main medico-political and professional bodies.
Information on the International Committee
News archive on International Development
Humanitarian Fund Previous Projects
World Medical Association
World Medical Association On the road to Paris (Climate Summit 2015)
WMA – Medical Profession Urged To Do More On Physicians’ Ill Health
Toolkit for the collection of evidence of knowledge and skills gained through the participation in an international health project
End water povity
The last BMA International Committee took place at BMA House on 24th February 2016 10 am – 3 pm. This was my second time at the committee as the elected representative of the UK-Consultants Committee 2015-16. The usual apologies and confirmation of the previous minutes took place.
The composition of the committee was discussed. This consists of Elected Representatives from all branches of practice, co-opted members and members of BMA Staff. It was emphasised that representatives should represent the views of the committee that elected them and be aware of the views of their constituents. There may be times when members of IC are speaking in their personal view versus their representative view. Feedback to their constituents and other groups is expected.
In the discussion this it was noted that the BMA Council had identified 7 priority areas for the BMA
- Terms and Conditions of Service
- Devon Manx (engage influence support and inform members)
- Future of the NHS (including 5 year forward plan) and the development of a BMA vision
- Population health (defending public health and the effect on austerity
- Saving General Practices/Surgeries
- Addressing the funding shortfall
Priority settings for this session of the IC were discussed. Activities such as supporting our delegations to European meetings and the international delegations to the ARM would continue. In advance of the IA meeting each of the representatives sent in ideas priorities. There was a general discussion considering the role of the International Committee and what the members felt they would like to achieve. The discussion was looking at the International Committee’s central and important roles rather than the BMA’s International Department. But it was agreed that future work must be more interconnected, interconnecting issues and overcoming the challenges. There was a discussion of confidentiality of meeting but also a need to communicate to the constituents of the representatives and the wider membership.
General Points were noted in the discussion. Strategic priorities of the international committee were discussed. Aim was “Listen Act Support”. With different BoP the relevance of the committee is related to different expectations. The question also asked was “What can the committee be doing better”
The following general points on the role and priorities of the International Committee were put forward and discussed. These issues and priorities are to be identified at the beginning of the year and taken forward. Possibly using task and finish groups.
Building advocacy and lobbying in cooperation with other committees (Advocacy of individual causes, policy development by individuals, relevance to the Branches of Practice, relevance to the BMA membership)
Avoiding replication with other committees
Working with international bodies
Sharing the load of the committee ( Outward – Liaison – International)
European issues (Brexit, Professional qualification in Europe and Abroad, Involving MEP in lobbying eg related to Tier 2 visas, European office , New Bill of working time directive, Effect on the NHS, Public affairs – overseas Doctors )
Global Health ( Water Poverty, Ethical procurement , Unblock the blockage eg sponsorship, Globalisation , Climate change and health, Networking, Access to healthcare is it a human right ? )
Communication ( To council, To BMA Members , Wider audience , Sharing IC reports
Improving the IC website
International Committee Newsletter
BMA communities (increased activity/better use)
Addressing policies passed by ARM
These motions may need cross collaboration
How are these allocated to committees
Refugee Doctor Initiative
Immigration Policy, Lobbying and Advice
The Enquiries report (IC 19, 2015-16) was received. The Current immigration policy and lobbying activities (IC 20, 2015-16) was considered
It was noted that the Tier 2 visa route still won’t achieve the government’s aim of reducing immigration, There were Key concerns regarding Doctors on Foundation program on Tier 4 and Specialty training on Tier 2 visa.
It was stated that International Medical Students (UK trained at UK Medical Schools and elsewhere) will struggle to progress into higher training. It was pointed out that the salary threshold for working visa has increased to £30k for Tier 2.
If Doctors on Tier 2 or Tier 4 are working less than full time this may be a problem. There was a discussion that the NHS wopuld not be able to attract FY2 on visas. Also the Migration Advisory Committee (MAC) has proposed an Immigration Skills Charge on Tier 2 to the employee of £1000. For Tier 2 – 4 trainees this would be HEE as sponsor. This is potentially £2,000,000 cost for HEE.
A letter from Dr Mark Porter on the 16th February has been sent giving the BMA’s position.
The Government has not said when this is being implemented. The BMA is trying to get exemption to members and is collaborating with other stakeholders eg RCN. There was concern in the committee that significant numbers of undergraduate international students would return home. Representatives said that the Royal Colleges and Medical Schools are very aware and are concerned. It was said that the GMC did not (sic) have a view.
It was discussed that ten days unauthorised leave leads to the loss of visa. This affects International Undergraduate Students on T4 and International Medical Graduate on Tier 4 Visa in Foundation Year as well as Tier 2 Post Graduate Doctors. Industrial Action is classified as unauthorised leave but JDr have a legal right to strike. However Industrial Action is unauthorised leave but is unlikely to be consecutive. There was a debate to whether there maybe a legal challenge on the basis of equality law. It was noted that on average 7.5% of universities have IMG and Health Education England currently sponsors 809 trainees. There is no good information around 3000 doctors on Tier 2 visas
Refugees and asylum seekers
The report of the Refugee Doctors and Dentists Liaision Group which took place on 20 January 2016 (IC 21, 2015-16) was received
In these difficult times the position of refuge Doctors was discussed. It was pointed out that there is a lot of information on the BMA Website which is more informative than the GMC website. Refugee doctors get good support in Scotland and Wales though there is variation in support in parts of England
It was noted that the Home Office has a Syrian Refugee project
The good work of the Council for At-Risk Academics was noted
as was the Rose website for refugees
The committee did note that there was an absence of data from the Home Office.
Standing Orders for the International Committee were passed after a little debate on minor changes.
European Legislation and Initiatives
An Update from BMA European Office (IC 23, 2015-16) was presented.
There was a general discussion about the forthcoming referendum in the UK on UK membership of the EU
It was noted that a recent YouGov poll showed 49% Stay 51% leave
There was a discussion of the following:-
- potential effects on the following European Working Time Directive
- If the UK left thw EU it is could to take 5 – 10 years to disentangle the laws.
- the issue of full independence or being part of European Free Trade.
- The BMA being apolitical will inform its membership without taking a stand.
- EU provision of funding for Health research.
- Effect on the professional workforce (11% are overseas eg 30,000)
- In the event of Brexit the UK attracting less qualified
- Effect on free movement of labour
- Effect on Free trade agreements
- TTip and Tisa are with the EU – the UK would have to negotiate separate aggrements.
- What affect on the Commercialisation of Health provision.It was discussed that those countries outside of the EU have access the single market eg Norway and Switzerland. But they must who abide by EU law yeat not influence it. All trade and competition law will apply in or out.It was noted that the European Parliament voted on TiSa in excluding Health. The BMA are calling European Commission to exclude health in all free trade agreement. TTip is delayed. The TTip agreement us not likely before the end of President Obamas final term and another 2-3 years for any final text (~ 2020). It was pointed out that the European Parliament hold the final right of acceptance or rejection. In public health there is a European Commission draft proposal to limit TransFats in the EU. This has the support of some big business. Regarding the minimum unit pricing of alcohol it was noted that the European Courts of Justice ruled that it is up to the Scottish courts to decide if this is legal. It is expected that the Scottish Courts will rule later this year. The Professional Qualification Directive includes an alert mechanism disseminated across the EU. The European Professional Card requires secondary legislation. The BMA believes in better safeguards to guarantee patient safety and not dilute the role of the GMC. ? 2018 implementation. See https://eupha.org/
- There was a discussion regarding age 16 – 18 law can be overridden by parents and whether sale and resale of data is being looked at as part of Data Protection
- New EU data protection legislation to replace the current EU (1995) directive is ongoing. To be concluded in April. The BMA has been asked for contributions. Identification of patient ID is secured. The “Right to be forgotten” does not apply. There will be “broad consent” for medical research rules together with “time consent” and different implementation rules as well as explicit consent. It was stated that GP practices will be excluded from the scope of some of the Directive. It was noted that the UK/EU has almost 200 bilateral agreements. There was a discussion on European Ethics Policies and health implication. The European Public Health Association was discussed.
European and International Meetings
The BMA withdrew from the PWG in 2009. Since that time the EJD has ben making efforts to resolve the issues that led to the BMA resignation. The IC agreed in February 2014 to recommend to the JDC that the BMA rejoin subect to provisos of several finance-related matters. This was endorsed by the JDC at its meeting in March 2014. The BMA was offically welcomed back to the EJD at the General Assembly in Oslo on 23-24 October. The next meeting will take place on 13-14 May 2016 in Lithuania. The next meeting is in Lithuania in May. It was noted that Barts and London are associated with a Malta Private Hospital. Report of the meeting which took place on 23-24 October 2015 (IC 24, 2015-16) was received
- CPME (Standing Committee of European Doctors)
CPME is the umbrella body for the whole profession at European Union level. It works with the UEMS, UEMO and EJD and meets twice a year. The BMA represents the UK at the CPME and delegates are chosen from amongst International Committee members by the Chair of the Committee and Head of Department. A report of the meeting which took place on 30-31 October 2015 had The next meeting will take place on 8-9 April 2016. There has been a change of presidency of CPME from Iceland to Switzerland. The BMa is on good terms with the French and Dutch Vice Presidents. There is a practical point of view regarding TTip. The CPME position on TTip is the same as BMA policy. The CPME demands are based upon BMA Policy. It is expected there will be greater transparency with the new Secretary General of CPME
- UEMS (European Union of Medical Specialists)
UEMS addresses the quality of specialist care across Europe and represents the interests of medical specialists. It has two parts, Board and the Council. The BMA has a seat on the UEMS Board and UEMS Council. Also attending UEMS Council are the UEMS Specialist Sections and Boards (which have representatives from across Europe. The UK representatives to UEMS Sections and Boards are approved by the BMA on the recommendation of the UK Medical Royal Colleges, Specialist Societies and the Academy of Medical Royal Colleges). The next meeting will take place on 22-23 April 2016. Dr Andrew Rowland’s report of the previous meeting discussed by the IC on 21 October 2015. There is a resolving financial situation – one lone has been repaid and an extra member of staff has been appointed. Consultation November 2015 – was not received by BMA. A Common Training Framework (CTF/CTT) enshrines training framework.Two curricula have been submitted sent by UEMS one on Intensive care medicine , has not yet been approved. That on Sports Medicine was out of date with errors. UMES asked European Commission to attend but EC not interested in CTF/CTT. This was not deemed OK by the BMA representative. Some partners think the UK is in some ways troublesome. There is a view that UMES is increasingly secretive. The financial situation of Domus medica was discussed. It was discussed that Tier 2 visa restrictions will be discussed by the European Parliament. There was a need for the BMA European Office to discuss with varuious groups. An English MEP Vick Ford was mentioned as a helpful member of the EuP.https://en.wikipedia.org/wiki/Vicky_Ford
- UEMO (European Union of General Practitioners)
UEMO represents the interests of GPs at the European level. The BMA and Royal College of GPs represent the UK. Report of the meeting which took place on 20-21 November 2015 was discussed. A new president will be visiting BMA House 17th March. Discussion that took place included Antibiotic resistance, accreditation process for European wide GPs, Specialists in Family medicine. There was a discussion of the distance between UK and European GPs. European GP’s have a poor understanding of appraisal, revalidation and CQC . It was noted EU GPs do not treat children under the age of 4. Diabetes is treated in secondary care in Europe. It was noted the importance of the various BMA representatives at UEMO and CPME, being able to give additional influence and influence change. There is a possibility of service offer by the BMA European Office. There was debate of how priorities are decided.
More information on UEMO http://www.uemo.eu/
Global Health Challenges
The BMA is involved in a number of activities that fall under the heading of ‘global health challenges’ these include, but are not restricted to, environment, governance, health promotion, and health security. An update on BMA global health activities (IC 27, 2015-16) was considered
There was a discussion of the HiFA Steering group which is supported by the BMA with £10,000. It has been BMA policy since 2015 to support HiFa. The WHO is also an official collaborative.
There is also a submission at the Geneva Health Forum BMA/HiFA April 2016
There was a discussion of Doctors as Volunteers
The Belfast Annual Representative Meeting June 2016 poster competition has had 90 have been submitted and 36 accepted. There was a discussion about having a vote for the best poster with a small prize. It was recognized that there was already a competition for Health related photography but it was decided it was worth pursuing.
There was discussion on Environmental Advocacy and re-ignite work in Climate Change. The BMA own Carbon foot print is being addressed.
The End Water Poverty campaign. The Chair of IC recently gave a Q&A
Water Action Month is in March 2016
Coming under the Keep Your Promises campaign, Water Action Month will be EWP’s biggest mobilisation to date, a month of sustained global action, coinciding with World Water Day on 22 March.
Fair Medical Trade
The International Department leads on the campaign to promote ethical procurement in the NHS and other health systems around the world.
Consider: Update on BMA Fair Medical Trade activities (IC 28, 2015 – 16)
There was a discussion on Fair Medical Trading and disposable medical gloves
The next meeting International Committee will be on 24th May 2016