The BMA London Regional Council Executive met on Tuesday 22nd November 2016 at BMAHouse. The LRC provides a forum for discussing matters of regional interest and issues affecting the profession across all branches of practice across London. Any BMA member can raise issues with the LRC via email: abarton@bma.org.uk. All members in London can attend the autumnal annual business meeting from which representatives to the executive are elected in addition to the representatives already attending from the branch of practice committees. Below are my notes of the meeting (not minutes).

The meeting was chaired by Gary Marlowe with Jackie  Applebee Secretary and Deputy Chair Anna Athow. Andrew Barton  and Emma Bennett where present from the BMA office. There were also three GP representatives , Consultants representatives, a Public Health representative  and invited members of the Royal College of Nursing and CHPi. A patients representative was present who also sits on the patients’ group at BMA House

There was an update on work plan activities. The LRC Work-plan for 2016/17 includes the following:-

  • Assist, co-ordinate and evaluate regional implementation of Industrial Action in relation to proposed new contracts (Terms and conditions of service).
  • Monitor implementation of the 5 year forward view & 5YFV for GPs with particular reference to the five London STP Footprints and LWABs.
  • Survey London GP members on “STPs, CCGs and their democracy”. Build a campaign/joint meeting with GLA Health committee. Consider effects of Brexit on London.
  • Survey LRC membership on STP understanding and build awareness of Dev0-capital issues and LRC Assembly meeting in September.
  • Develop support and plans for increased engagement of members in emerging areas of London (NWL, NCL, NEL, SEL, SWL) pulling in active division members whilst widening participation of others and considering electronic website/app presence to provide portal to information.
  • Build relationships with other health related unions in London and engage with patient groups, Health campaigners together & Health watch.
  • Have a patient representative on LRC executive.
  • Reach out to the 291 refugee members in the capital to ascertain what support they need from the BMA.
  • Develop and improve the communication & engagement of the LRC with its membership
  • Consider assisting medical students to consider the politics of medicine in the curricula.

 The meeting at City Hall which I have already blogged  about was discussed. Over 60 people attended and many wished to attend but there was a number restriction due  fire regulation.

The outcome of the meeting and the conclusion of LRC executive was that there should be a greater effort to inform as many Doctors and members of the public as  as possible what they (STPs) stand for. There is a cross body support from RCN and UNISON .  The reality changes in the NHS means that working together will  be more effective.

A  number of meetings have been organised concerning London STP’s.

NE  London STP                            Whipps Cross                   28/11/16

NW London STP                            West Middlesex               6/12/16

NC  London  STP                           BMA House                      5/12/16

SW London STP                            ? venue                               8/2//16

Members of the Royal College of Nursing present. The official RCN view can be found at

https://www.rcn.org.uk/employment-and-pay/integrated-care-in-england/sustainability-and-transformation-plans

Also attending the LRC meeting by invitation were Professor Sue Richards, Professor Colin Leys and Vivek Kotecha  of the Centre for Health and the Public Interest (CHPI). CHPI is a health and social care policy think-tank. It gives objective appraisals  based on evidence. Full details can be found at https://chpi.org.uk/about-us/ .  The meeting had a far reaching discussion about STP’s five of which cover the London area. Without attributing who said what I have detailed some of the discussions points.

  • Many of the plans are a rehash of rejected ideas.
  • Efficiencies are required between health and social services.
  • These huge savings/ cuts amount to between 4 – 5 % per annum
  • DoH has abandoned staff planning.
  • Concerns were made over patient care and aspects of patient safety.
  • The pace and scale of change, dilution of roles and “blending of ways” were all mentioned.
  • It was noted that London has a significant shortage of nurses (~10,000).
  • There are potential detrimental changes between hospital and community environment.
  • New skills are required, creating new capability. New and improved staff roles may occur but deskilling is a possibility.
  • The position of physician’s assistant both in general practice and hospital have many questions to answer. Who are they accountable to, how will they be trained.
  • Physician assistants are unregulated. It is unknown what this will have on other professionals.
  • It is said Physician Assistants would be on £50k after two years. Nurse Associates will be on £16k. There are questions about indemnity and accountability.
  • In the context of GP practices is there a likelihood of increased risk ?
  • It is all about taking money out and doing things more cheaply. There is a potential that the NHS would appear to be a “second rate service”. This will blow back on the profession.
  • There was a discussion of the “extra legal context” of STP’s and whether there needs to be legal rules and whether CCG’s will be pressurized to make new contracts.
  • If there is no legal framework what is the impact ? What can the BMA do ? Who is responsible for patient pathways ?
  • STP must be signed off by the CCG and local authorities too, but these are having significant cuts in funding.
  • There were questions over the involvement or lack of involvement of the Health and Welfare boards
  • Social care is not properly funded (significant cuts over 5 years)
  • The tariff changes to hospitals will have a significant impact on reorganisation.
  • National audit office report released on the morning of the meeting was noted.
    • “With more than two-thirds of trusts in deficit in 2015-16 and an increasing number of clinical commissioning groups unable to keep their spending within budget, we repeat our view that financial problems are endemic and this is not sustainable. It is fair to say aggressive efficiency targets have helped to swell the ranks of trusts in deficit over the last few years. The Department, NHS England and NHS Improvement have put considerable effort and funding toward stabilising the system, but have a way to go to demonstrate that they have balanced resources and achieved stability as a result of this effort. Therefore, value for money from these collective actions has not yet been demonstrated.”   Amyas Morse, head of the National Audit Office, 22 November 2016
    • See https://www.nao.org.uk/report/financial-sustainability-of-the-nhs/ for full details

 

The meeting sees the implication of the STP’s is of devolving power. It was agreed that many members do not know what is happening and the LRC has some responsibility to educate members more widely.

The next LRC meetings are in April and July

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