BMA calls for clarification on EC directiveBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6957.812 (Published 24 September 1994) Cite this as: BMJ 1994;309:812
- L Beecham
The chairman of the General Medical Services Committee, Dr Ian Bogle, has asked the NHS Executive to clarify the position of locums, assistants, and deputies in general practice under a European Community directive, which requires that all doctors working in general practice on 1 January 1995 should be vocationally trained. The GMSC says that it was never the intention that these doctors should be included in the 1986 directive and has asked the NHS Executive to confirm this.
The vocational training regulations were introduced in 1980. Since that date anyone who graduates from a United Kingdom university and wants to enter general practice has had to complete two years in hospital posts and one year in general practice. General practitioner principals who qualified before 1980 and doctors who could show evidence of equivalent experience were exempt. The 1986 directive gave governments eight years to adapt their requirements to the vocational training obligations of general practitioners.
Recent reports in the press have suggested that many doctors, particularly part time women general practitioners, would lose their jobs. The European Commission in London has emphasised that this is not the case. “Neither practising general practitioners nor part time training for women need be affected by the directive,” the commission says. It says that there is nothing in the directive that bans practising general practitioners from continuing to practise after January 1995. The directive seeks to protect the principle of part time training. “If the government wants to cater for different categories of general practitioners in the NHS,” the commission says, “it is therefore perfectly entitled to do so.” Pressed by the GMSC, the commission has confirmed that its definition of practising general practitioners refers to all doctors working in general practice, including locums, assistants, and doctors working under the retainer scheme.
In the meantime a spokesperson from the Department of Health said that the department was investigating how the directive should be interpreted, and the Joint Committee on Postgraduate Training for General Practice has advised doctors considering part time training for general practice to seek advice from their regional adviser in general practice.
Merit award report should be published
The BMA has criticised the government's delay in publishing a report on distinction awards, which was completed some months ago, while it continues to press ahead with its plans to abandon uniform national pay scales. In a letter to the minister for health, Mr Gerald Malone, the chairman of the Central Consultants and Specialists Committee, Mr John Chawner, said that the BMA supports the principles of the distinction award scheme because it is part of a national salary structure and based on national criteria for recognising professional excellence.
Commenting on the BMA conference last month which overwhelmingly opposed the introduction of locally determined pay (10 September, p 625), the minister said that there continued to be confusion between basic pay and doctors' earnings. Mr Malone said that at any one time about 35% of eligible consultants held a distinction award and that over 70% of consultants earned between £1000 and £49 000 a year from private practice. The highest earners received over £400 000.
In his reply the CCSC chairman said that the 70% figure was incorrect; it should be 53% and that 40% of these earned less than £10 000 a year from private practice. He said that the consideration of total earnings was irrelevant. “What we are talking about is the arrangements under which doctors are employed in the NHS.” He told the minister that doctors regarded themselves as participants in a national health service which aimed to offer patients uniformly high clinical standards. A national framework for doctors' pay was crucial to this objective given the problems that would arise if there were large gaps between the pay offered by hospitals in different parts of Britain or between specialties in the same hospital.
Mr Chawner suggested that it was invidious for the government to attack the private erarnings of some consultants. He said that the arrangement was not dissimilar to that under which members of parliament were paid a salary for their parliamentary duties but were free to undertake paid work elsewhere in their own time.
Performance related pay cannot work for medical academic staff
Representatives of medical academic staff do not see how performance related pay can be applied to them and their medically qualified non-clinical staff in a way that will improve their performance. The BMA's Medical Academic Staff Committee has endorsed the association's campaign to oppose the introduction of performance related pay into the NHS. As well as a national conference on the subject (17 September, p 625) the BMA has organised several press conferences and encouraged members to write to their members of parliament.
An element of non-clinical staff pay is supposed to be performance related, but as MASC's chairman, Dr Colin Smith, pointed out the system failed because there was a finite pot. For any scheme to work there had to be flexibility. Dr Smith told the BMA's conference last month that for research staff the idea of performance related pay was to enhance research performance. But the number of grants had decreased and the amount of research that had got into prime journals had not increased. The money had gone to those who were already high performers. At the MASC meeting he said that there would be double jeopardy for medical academic staff. Since the university was their employer who would assess their clinical performance? If they performed well in one part of their work something else would be constrained and that would be teaching. Dr Smith said that some purchasers and providers were questioning the need for academic staff because many held merit awards.
One or two speakers at the MASC meeting suggested that merit awards were a form of performance related pay and that doctors could not oppose one without opposing both. To this argument Dr Smith pointed out that merit awards were the equivalent of promotion; they were not a year on year assessment of performance. To the suggestion that academic staff pay was determined to a large extent by the amount of income from grants, Dr Smith said that the salaries were still based on national scales and not related to performance.
Liberal Democrats want to remove competition from the NHS
A Liberal Democrat working party has prepared a discussion paper on the reforms in the NHS. The party will invite comments and then prepare a full policy paper for debate at a future conference.
Reiterating the party's support for a health service available to all on the basis of need the paper advocates the retention of the purchaser and provider split but wants to remove the element of price competition. It proposes the merger of district health authorities, family health services authorities, and local authority social service departments into single departments within democratically elected local authorities to plan and purchase the whole range of health and social provision.
NHS trusts would be retained as providers and there would be a common base for allocating funds to all general practitioners whether they manage the funds themselves or as part of locally based consortiums or whether they ask local authorities to manage the funds on their behalf.
The party sets out several options for health service funding, all of which it believes would allow the public to be directly consulted over the level of expenditure. The paper commits the party to funding the present level of NHS expenditure (in real terms) out of general taxation but to earmarking a new tax to pay for real increases in NHS spending. It suggests that a proportion of excise duties from tobacco should be assigned for health promotion. It proposes the abolition of charges for eye and dental check ups.
The discussion paper supports the recommendations of the Calman report on medical education and training and calls for a reduction in junior doctors' hours through a greater use of skill mix and more use of nurse practitioners.