Medicopolitical Digest

GMSC endorses registrars' recommendations on summative assessmentJuniors' contracts will have local flexibilityWaiting list figures publishedGMSC wants discussions over violence against doctorsDoctors given guide on assessing mental capacityExpert group will look at transplanting animal organs to humans

BMJ 1996; 312 doi: (Published 13 January 1996) Cite this as: BMJ 1996;312:126
  1. Linda Beecham

    GMSC endorses registrars' recommendations on summative assessment

    The General Medical Services Committee has endorsed the recommendations of its registrars subcommittee on summative assessment and agreed that unless and until the regulations are amended trainers should be informed by the summative assessment process but should not be bound by it.

    At the end of last year the GMSC, the Royal College of General Practitioners, the Joint Committee on Postgraduate Training for General Practice, and the Committee of Regional Advisers in General Practice in England agreed a way forward for summative assessment. This proposes that, although not legally mandatory, the process should be introduced during 1996. The general practice registrars subcommittee, however, remains concerned about the flawed method of introducing the scheme, including its introduction mid-way through many registrars' training, the undue haste of implementation, and the poor quality of advice given to registrars.

    The GMSC has endorsed the subcommittee's wish that no registrar or trainer should have their accreditation or training state questioned if they decide not to participate in summative assessment. It agrees that universal regulatory summative assessment should be postponed until 1997 at the earliest, subject to satisfactory validation and the necessary regulation changes.

    The subcommittee insists that all components of the summative assessment package should be implemented at the same time in every region and that all doctors entering the hospital component of vocational training should have clear and comprehensive information about the quality of training they can expect and the methods of assessment in operation.

    The registrars have also called for the chairmen of all the parties to the November agreement to sign a joint letter to doctors reinforcing the importance of the introduction of summative assessment and its present voluntary state.

    Finally, the GMSC has agreed with the registrars' recommendation that the booklet on summative assessment issued by the conference of postgraduate advisers in general practice should be rewritten and reissued to take account of their concerns and to remove inappropriate references to the membership examination of the RCGP.

    Juniors' contracts will have local flexibility

    The health secretary has insisted that when junior doctors' contracts are held by trusts from 1 April (a move opposed by the medical profession) there will be room for local flexibility. In a letter to the chairman of the Joint Consultants Committee the NHS Executive says that it cannot accept the comments about flexibilities and points out that the health secretary has spelt out specific safeguards.

    Junior doctors will continue to have a national model contract conferring existing national terms and conditions of service. But there will be a facility for local flexibility in either the contract or in terms of service provided that the regional postgraduate dean is satisfied that the variations would not adversely affect medical education and training and that the variations have been negotiated with junior doctors' representatives—for example, through the local negotiating committee where one exists.

    The chairman of the Junior Doctors Committee's negotiating subcommittee, Dr Peter Bennie, told the JDC last month that the BMA would need to ensure that junior doctors were adequately represented locally. Dr Ed O'Neill, chairman of the Northern Ireland JDC, said that the deans' support was the juniors' only safeguard and he suggested the JDC should offer them guidance.

    The NHS Executive says that the arrangements, which will be reviewed in 1998, are designed to provide for a proper contractual relationship between doctors in training and their employers and ensure that the conditions for high quality rotational training are maintained.

    Waiting list figures published

    The number of patients waiting for treatment in England on 30 September 1995 was 1040 152—a small reduction since 31 March 1995. According to figures from the Department of Health the number waiting for more than 12 months was 27900—a reduction of 55% since September 1994, when there were 62300.

    In the quarter ended 30 September 1995, 71% of patients were admitted to hospital within three months, 85% within six months, and 97% within a year of being added to the list.

    The information is contained in Elective Admissions and Patients Waiting: England at 30 September 1955, published by the Department of Health, price pounds sterling2.

    GMSC wants discussions over violence against doctors

    The General Medical Services Committee continues to be worried about the increasing incidence of abuse and violence against general practitioners and has asked the health departments to discuss the issue. It has proposed that patients who are persistently violent towards their doctors should be referred to secure premises which have special arrangements to deal with violent and aggressive patients. The committee realises that this arrangement would have to be handled carefully but emphasises that doctors and their staff must be protected and the risk of violence minimised.

    Since April 1994 general practitioners have been able to remove violent patients from their lists immediately but the GMSC believes that further action is needed. Last year a national survey showed that one in four inner city general practitioners had been physically assaulted in their surgery and 83% said that they had been verbally abused. A GMSC survey of London general practitioners two years ago showed that a significant number of doctors experienced assault and abuse in their surgeries.

    Doctors given guide on assessing mental capacity

    The BMA and the Law Society have produced joint guidelines on assessing mental capacity. They cover such issues as ability to consent to a sexual relationship, capacity to consent to and refuse medical treatment or research, and capacity to make a will, manage financial affairs, or even to vote.

    The book, Assessment of Mental Capacity: Guidance for Doctors and Lawyers, states the legal position in England and Wales on the rights and treatment of people who may or may not lack mental capacity. It explains that although it is customary to consult those who are close to a mentally incapacitated patient when trying to ascertain what they would have wanted, it is unnecessary and of no legal effect to ask relatives to sign a consent form on the patient's behalf.

    The guidance will be launched at a joint conference on mental capacity on 19 January at BMA House. It is available, price pounds sterling8.95, from the BMA bookshop.

    Expert group will look at transplanting animal organs to humans

    Professor Ian Kennedy, professor of medical law and ethics at King's College, London, will chair an expert advisory group, which will look at the ethical issues surrounding transplantation of animal organs to humans. The group will report to the secretary of state for health by the summer of 1996.

    The other members are Mrs Judy McArthur Clark, consultant in laboratory animal science and ethics; Professor Kay Davies, professor of genetics, Keble College, Oxford; Ms Nicola Davies QC; Professor Robin Downie, professor of moral philosophy, Glasgow University; Professor John Salman, retired professor of transplant surgery, University of Wales College of Medicine; Professor Herbert Sewell, professor of immunology, Queen's Medical Centre, University Hospital, Nottingham; Dr A J Suckling, director of scientific affairs, Royal Society for the Prevention of Cruelty to Animals; and Ms Polly Toynbee, columnist, the Independent.

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