Medicopolitical Digest

Junior doctors are still hard pressedBMA's concern over performance billJunior doctors to retain employment rightsGPs urged to take part in out of hours ballot

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6990.1336 (Published 20 May 1995) Cite this as: BMJ 1995;310:1336
  1. Linda Beecham

    Junior doctors are still hard pressed

    More than 96% of junior doctors now comply with the new deal targets for contracted hours, according to a parliamentary written reply. The number of hard pressed on call posts contracted for more than 72 hours a week—which should have been eliminated by the end of last year—was 771 in February. A year earlier it was 6524. The rate at which these posts are being eliminated more than doubled in the previous four months.

    Health minister Gerald Malone, who gave the figures, said that the regions were making good progress in reducing junior doctors' hours, but there was still more work to be done. He believed that a ceiling on contracted hours had been established, though there were still too many junior doctors under pressure to work too long. A total of 1776 doctors in non-onerous posts were still contracted for more than 72 hours a week. Mr Malone said that the priority was to ensure that no junior doctor worked on average for more than 56 hours a week.

    Regional figures for hard pressed posts contracted for more than 72 hours range from nil in the North West Regional Health Authority to 189 in Anglia and Oxford. The details are: Northern and Yorkshire 162; Trent 60; Anglia and Oxford 189; North Thames 178; South Thames 95; South and West 20; West Midlands 67; North West 0. Total: 771.

    Commenting on the figures the chairman of the BMA's Junior Doctors Committee, Dr Andrew Carney, said that while working conditions had improved the new deal as a whole has not been delivered on time with many of the December 1994 targets not yet reached. “Cultural and organisational change is needed in the NHS with a detailed examination of the way patient care is delivered. The disappointing uptake of the new, more flexible working patterns shows that fundamental change has not taken place.”

    BMA's concern over performance bill

    Although the BMA supports the objectives of the Medical (Professional Performance) Bill, which is now going through the House of Commons (6 May, p 1202), it still has several concerns and is seeking assurances, particularly on the following issues.

    The government says that it intends that the new procedure should be remedial rather than punitive. If it is really serious about rehabilitating doctors the NHS must fund, in full, retraining and counselling costs for salaried doctors and general practitioners and the Department of Health must direct NHS trusts and health authorities to meet these costs.

    The BMA wants assurances that doctors' employment rights will be protected adequately whether they work in NHS trusts or directly managed units. The Department of Health must make arrangements whereby the services of doctors are retained until they have completed the remedial procedures and are able to return to medical practice.

    There should be no direct connection between medical audit in the NHS and the performance procedures. The BMA would like the minister for health to ensure that this distinction is upheld. Medical audit is an educational exercise and its findings are confidential to the individual concerned.

    The bill envisages that in many cases where the assessment panel recommends some form of remedial action the postgraduate dean will be involved through the continuing medical education machinery. The BMA would like a clear indication about the role of postgraduate deans in this area and the support to be given to them to discharge this role.

    Junior doctors to retain employment rights

    A government amendment to the Health Authorities Bill will ensure for junior doctors and other training grade doctors currently employed by regional health authorities the same continuity of employment rights as they enjoy at present, after NHS regions in England are abolished in April 1996.

    Junior health minister Baroness Cumberlege said in the House of Lords last week that the aim was to safeguard the employment rights of staff who had to undertake rotational training programmes requiring them to move between different NHS employers. While contracts were held by regional authorities there was no problem, but after next April the continuity of employment of trainees would be broken on any subsequent moves. That could affect the employment rights which depend on serving a minimum period of continuous employment—for example, protection against unfair dismissal and the right to return to work after maternity leave.

    Lady Cumberlege said that staff in training must move regularly between employers in order to gain a high standard of professional training, and there should be no obstacles to discourage them from moving. That was what the amendment was designed to achieve.

    It would in no way pre-empt consultations just completed about the future employment contracts of junior doctors. The government's preferred option was for the contracts to be held by the employer, usually an NHS trust. That was still a matter for discussion, but the minister hoped that the amendment on continuous employment would offer staff a significant reassurance.

    GPs urged to take part in out of hours ballot

    Ballot papers on the offer for resolving the out of hours crisis in general practice were sent to principals in general practice this week. They must be returned to the Electoral Reform Society by Monday 5 June and the results will be reported to a special meeting of the General Medical Services Committee on 8 June.

    To ensure that all doctors are fully informed of the key points the GMSC has set out some questions and answers.

    What happens if the offer is rejected by the majority of doctors? This is the government's final offer so the GMSC would proceed to a ballot on the implementation of sanctions by the profession.

    What happens if the offer is accepted by the majority of doctors? The offer will be implemented and there will be further discussions between the profession and the government.

    Is the pounds sterling45m development funding being taken from the cash limited general medical service funding? These extra funds will be new to general practice. They will be taken from the overall NHS budget.

    Is there a commitment to continued development funding? The government is committed to providing development funding in future years.

    Will family health services authorities (FHSAs) and health boards all receive a share of the money? The Department of Health will distribute the money equitably.

    How can some of the pounds sterling45m be used to help isolated and rural doctors? Authorities and boards will be expected to use the funds to reduce the out of hours burden of these doctors—for example, by encouraging developments in premises, staff, and new technology. Where appropriate, some locum fees may be reimbursed.

    Is the offer aimed only at doctors working in cooperatives? No. All doctors will be able to apply for development funds.

    Is it true that deputising doctors will not generate the pounds sterling20 consultation fee? No. Those deputising doctors who are principals will be able to generate the fee.

    Will the pounds sterling20 be payable only for home visits? It will be available for any face to face consultation during the “night visit period” at a primary care emergency centre, surgery, or the patient's home by a principal, assistant, associate, or trainee.

    Will the pounds sterling2000 be paid in full only to those doctors with 26 hour availability? All principals will be paid the pounds sterling2000 allowance irrespective of their hours of availability, apart from job sharers who will receive pounds sterling2000 between them.

    Is it true that doctors cannot be relieved of their out of hours responsibility altogether by transferring it to a doctor who uses a commercial deputising service? No. Any doctors will be able to accept a transfer of this responsibility from another doctor, subject to FHSA or health board approval, including principals using a commercial deputising service.

    Will individual doctors be paid their share of the pounds sterling45m directly? No. They will have to apply to FHSAs or health boards for reimbursement of expenses to improve the provision of out of hours care.

    As the offer relates only to England, Wales, and Scotland ballot papers will not be issued in Northern Ireland.

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