Todays blog includes information from BMA Comms, upcoming events , some recent documents and a summary of the Friday Medical Staff Committee and changes to national tariff


There was a large amount of national and regional media coverage of BMA analysis and a survey of doctors on the government’s sustainability and transformation plans (STPs). The Telegraph, Guardian, Mirror, ITV Online, Sun,  iNews and a large number of regional publications report that the BMA has warned that despite STPs having the potential to generate more collaboration and the longer-term planning of services based on local need, doctors are concerned that they will be used as a cover for cuts. Dr Mark Porter said: “Improving patient care must be the number one priority for these plans. Given the scale of the savings required in each area, there is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resource and patients of vital care.” He added: “It is extremely concerning that the majority of doctors have not been consulted on the plans, particularly as ministers have been so keen to insist that all stakeholders would be involved.”

Dr Porter was also interviewed on ITV’s Good Morning Britain this morning discussing the implications of STPs and what this could mean for the NHS and patient care.

Following a Panorama report into care home failings, BBC News Online, Express and the Plymouth Heraldreport that filming shows one nurse saying she will give morphine to a resident “to shut her up”. Commenting, Dr Peter Holden, said: “I’m horrified. Morphine is not there to be a cosh on patients. That won’t have been prescribed for that and would never be so.”

BMA online/trade

Two-thirds of doctors not consulted over transformation plans

Daily Telegraph, Monday 21 November 2016, (Dr Mark Porter)

 BMA says transformation plans cover for NHS

Guardian, Monday 21 November 2016, (Dr Mark Porter)

Tory neglect is killing the NHS

Daily Mirror, Sunday 20 November 2016, (BMA Mention)

NHS plans could be cover for cuts

ITV Online, Monday 21 November 2016, (Dr Mark Porter)


Plans for cuts could see hospitals close

Sun, Monday 21 November 2016

Councils unable to cope as elderly care in crisis

Express, Monday 21 November 2016, (Dr Peter Holden)

 NHS faces fresh £22bn cuts plans

Huffington Post, Monday 21 November 2016, (Dr Mark Porter)

 NHS in danger of starving patients of vital care

iNews, Monday 21 November 2016, (Dr Mark Porter)

 NHS in danger of starving patients of vital care

iNews, Monday 21 November 2016, (Dr Mark Porter)

 Secret film exposes care home failings

BBC News Online, Sunday 20 November 2016, (Dr Peter Holden)

Councils unable to cope as elderly care in crisis

Express, Monday 21 November 2016, (Dr Peter Holden)

Care homes under investigation

Plymouth Herald, Sunday 20 November 2016, (Dr Peter Holden)


Good Morning Britain, Monday 21 November 2016, Dr Mark Porter – Transformation Plans

 Other news

Elderly and children dying because of ambulance delays, claim GPs
Pulse, Monday 21 November 2016

Four in five local authorities struggle to provide older people’s care
The Guardian, Monday 21 November 2016

‘Five a day’ advice should be abandoned because fruit and vegetables are expensive
The Independent, Monday 21 November 2016

The secret to NHS success: openness and cooperation


 Reducing infections in the NHS DoH 10th November

 Plans to prevent hospital infections include more money for hospitals who reduce infection rates and publishing E. coli rates by local area.

Further info

Other stories


Interesting Radio

Inside Health – Radio 4

Dying at home     Familial Hypercholesterolaemia    Delerium

Patient power – Choosing Wisely Wales

The four points for patients to consider and ask are

  • What are my options ?
  • How is the treatment likely to benefit or harm me?
  • Do I really need it?
  • What can I do to help myself?

The Poster

The Toolkit

Kings fund report

BMA information

Upcoming meetings I will blog on

Monday      Meeting organised by Freedom From Torture on “Proving Torture” attending on behalf of Forensic Medicine Committee

Tuesday      London Regional Council Executive meeting

Wednesday North Thames LNC For a and North East Regional Consultants’ Committee



It is not often that my blog includes the item Medical Staff Committee (MSC)  but as I was asked to do the minutes of the North Middlesex on Friday lunch time it is an opportunity to blog about it. As the minutes have to be accepted first by the next meeting the following can only be described as a brief reflection by me and any additional comments to the notes taken at the time I make are my own in italics.

For those without an understanding of the MSC in a hospital it is a monthly opportunity for Consultants and SAS Doctors to hear information about what is happening in the Hospital, any developments that may be taking place and what the future holds. The MSC has a Chair, Deputy, Treasurer and Minute taker/secretary. All senior doctors of the Hospital are invited to attend. The Medical Director and/or Chief Executive or deputy usual give a talk.

 The meeting was well attended I have not got the list yet by probably over 30 people

The usual apologises and review of the previous minutes all the matters arising were on the agenda. The MSC Chair gave a short report which noted the Consultants Annual Xmas Dinner is on 10th December and there were a few tickets remaining for the same venue as last year. Those NMUH Consultants interested should contact the MSC The Treasurer briefed us on the new system of deducting the MSC fee from salary and asked that people should ensure they cancel any standing order.

There was in update on Post Graduate Education by the PG-DME.  One part of the Junior Doctors new contract was the appointment of a “Guardian of Safe Working” . For those on the new JDR contract there will no longer be diary carding. So far due to the variations in implementation dates only three NMUH O&G registrars are on the new JDr contract.

By December all FY1 will be on the new contract. And by August 2017 all juniors will be on the new contract.

The new Guardian of Safe Working (GSW) discussed his position and the involvement of Educational Supervisors in the event of exception events. He said there will be cooperation between GSW & DME.  Exception reporting will be in an electronic way. JDr would be required to upload the information eg on extra hours and the Educational Supervisor has 14 days to respond. It is not only extra hours worked but also educational issues that can be reported. It is up to the Educational Supervisor to sort the problem out though GSW and PGDME accepted that there would be involvement of the clinical supervisor and the service manager. In the event of the Education supervisor not being able to sort it out  then the GSW would then become involved. Each JDr must have a work schedule which would be discussed at the first Educational Supervisors meeting with the Junior Doctor. The GSW is required to give regular and annual reports to the Executive Board. GSW said for those who may be affected by loss of income there is pay protection for up to 4 years. There have been discussions with other Trusts who have implemented the contract for O&G Juniors in which there were 8 exception reports out of 21 juniors

Questions from the floor:-  there was a request for a “Noddies Guide” to the JDR contract and responsibilities of the ES.

The Medical Director accepted that the new changes and requirements of the JDR contract have come in quickly. She said that the concept is right but implementation may be difficult. The protection is there for inappropriate hours.

Questions from the floor  – Why not a swipe card.   MD/PGDME responded that this is not a time sheet.  MD said that we need to address and flag up areas where they (JDrs) are working beyond their contract as sensible diary carding will be difficult. NR pointed out that in the event of imposition of fines (determined by the GSW) these will be used to improve the lot of junior doctors. The fines are not funded centrally but paid by the Trust. These may amount to 4x amount owed to the Doctor. In the event of any Education issue exception report these are directed to the PGDME.

Questions from the floor  : – who makes decision over fining?   The MD stated the system is very new and the management are having conversations about it. The GSW will receive all exception reports

Questions from the floor  :  What if the ES is  not in the department of the JDr. PGDME said that there needs to be cooperation with the Clinical Supervisor regarding the work schedule. As it is a novel way of working this will be a challenge for the next 12 months. PGDME said the work schedule must be completed in a timely way. There will be a presentation to Educational Supervisors in due course. The electronic system for exception reports needs a log in and is being trialled at the moment. There have been no exception reports from O&G juniors so far.

With regards to the above I have previously blogged on this were I have itemised out of the new JDrs contract all reference to Education Supervisors


 PGDME pointed out that the Junior Doctors have a time limit for reporting exceptions. The Emergency Department is “looking good” and the new system of keeping in touch with trainees is working well and may be expanded to other areas.

Info regarding  Core Medical Trainees will be in 6 monthly slots from year 3 and will be doing clinics and specialty work.

The Medical Director gave an uodate. The new Nursing Director Debora sends her apologies cannot attend today but will attend soon. .

On the 13th December is the next Consultant development morning. Each one of these is different. The GMC are running the next  morning with the theme is about behaviour with each other and colleagues

A new round of CEA awards will take place. The current guidance is being “tweaked” but will be coming out next week. The round is for 2015-16

Consultants need to be appointed to the panel. There is a lot of work in reading and scoring.

Job planning needs to be signed off. Some specialties are at the end of it others need to engage in it. CC said there will be another think of how it is done next year

MSC Chair said that she has had a number of approaches from colleagues say that the Job planning was not fare. She queried whether some group job planning should go the Local Negotiating Committee

MD said the problems need to be solved and best done by getting together as a team and be prospective in the planning process. Job planning needs to more evidence base around activity.

Regarding CQC  there is a draft report soon. When received as a draft it will not be circulated widely as the Trust must respond to the draft before the final report is published.

Regarding NMUH Car parking there are revised prices and these are with staff side and LNC


A trust representative gave a review relating to the land sale. The trust made the decision to sell a portion of the land that includes the pathology building and trust headquarters at the end of the financial year 15/16. Land has been sold with peppercorn rent being paid. Work has been ongoing to prepare for clinical and non-clinical teams to move since then as there is a need to vacate the area by June 17. The Education Funding Authority (EFA) who purchased the land are experiencing  delays in completing their necessary assessments of the site and progressing to planning permission.  There is therefore a pause on the relocation of Alexander Pringle Centre and Sickle cell unit. The development of the education centre and the move of some corporate teams to Enfield Civic Centre will continue. There will be a review of the current proposition and schedule of clinical and non-clinical moves within a wider review of how we use our buildings and space on the site.

At this point (2pm ) I had to leave for a teaching engagement but I understand the meeting lasted another 10 minutes.


NHS Improvement has published its finalised plans for the National Tariff for 2017/18 and 2018/19in England. The BMA has drafted a response to this, drafted by the Policy Directorate’s Heath Policy team.

The main points the response covers are:

  • There are currently huge funding challenges facing the NHS which must be taken into account when setting the national tariff.
  • Although the 2% efficiency factor is lower than in previous years it is still unachievable taking into account the current savings that NHS services are having to make. It is crucial that it does not result in providers having to make savings that they cannot afford.
  • Although setting a two year tariff could help with stability and planning, uncertainty in economic forecasts could result in 2018/19 tariff prices being set at unsustainable rates. NHS Improvement must ensure that the tariff can be revised to reflect any major changes and consult on any changes to the tariff before it is issued.
  • We welcome progress made in moving from HRG4 currency design to phase 3 of the HRG4+.
  • We are disappointed that the marginal rate for emergency admissions has not been reviewed and is remaining in place.

The full response is available from me as I don’t think it is on the BMA website yet.