BMA gives evidence to review bodyNew groups will advise on medical manpowerUniversities are losing clinical staffIsolated areas need help to provide out of hours careGPs are concerned about checks on medical recordsBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7060.823 (Published 28 September 1996) Cite this as: BMJ 1996;313:823
- Linda Beecham
BMA gives evidence to review body
The BMA has given evidence to the Doctors' and Dentists' Review Body for the 1997 pay round, estimating that doctors need a pay increase of 53% to restore their comparative position to that of 1980 (p 769).
The BMA has expressed concern at the problem of translating the NHS pay award for clinical academic staff—they have not yet received the 1996 award—and the review body has been asked formally to recommend to the government increases for clinical academics in line with NHS doctors.
Junior hospital doctors are concerned about the discretionary nature of the top two points on the specialist registrar scale and want the review body to base the scale on the full range of registrar and senior registrar pay, but with seven incremental points. They have called for full shift additional duty hour rates to be paid to those doctors working full shift intensity on on call rotas or partial shifts.
On behalf of doctors working in public health medicine and community health the BMA has asked the review body to maintain the link between the salary scales of clinical consultants and consultants in public health medicine; revise the supplements payable to directors of public health to take account of the major changes in the number and size of health authorities; recognise the increased workload resulting from the drastic shortfall in consultant posts in public health medicine; recommend an increase in the out of hours supplement for trainees in public health medicine; and maintain existing relativities between the salary scales of community health doctors and the rest of the profession.
New groups will advise on medical manpower
Regional directors of public health have been charged with establishing local medical workforce advisory groups in each deanery by 31 October to advise regional offices, trusts, and purchasers on medical staffing arrangements in individual trusts. They will also act as a forum for purchasers, trusts, and the medical profession to discuss and comment on trusts' medical staffing strategies in the context of a national quality framework, which will be published later this year. The groups will replace existing regional medical manpower committees and will begin by considering individual trusts' medical staffing profiles based on medical workforce census data for 1995.
The groups will include one member nominated by the BMA's Junior Doctors Committee; two members from the relevant deanery nominated by the regional consultants and specialists committee; the regional director of public health; and a general practitioner.
The JDC has reservations about the new groups because their role will be advisory and they have not been given executive powers. But regional JDCs have been urged to nominate members because the new deal on junior doctors' hours will be one of the quality issues with which the groups will be concerned. The future of the regional task forces on juniors' hours is still in doubt and the JDC has suggested that representatives on the task forces should be considered for membership of the local medical workforce advisory groups.
The national quality framework will enable trusts and purchasers to be held accountable to the NHS Executive in adhering to medical staffing policies, such as setting ratios of consultants, juniors, and other doctors by specialty group and type of hospital. The BMA's Central Consultants and Specialists Committee had been concerned that trusts were making many non-standard appointments in the non-consultant career grades. The CCSC recognised, however, that existing controls, such as the 10% staff grade limit and the prohibition on clinical assistant jobs for more than five sessions, were not working and it proposed to the NHS Executive that an overall ratio of consultants to non-consultants should be prescribed. Trusts whose ratios differ significantly from a national norm will have to account for them. When the new framework is published the remaining central controls on non-consultant career grade staff will be abolished. The CCSC hopes that the new system will stop trusts creating new grades to circumvent manpower controls.
Universities are losing clinical staff
Fifty seven or one in ten professorial clinical chairs in Britain are vacant, and the BMA has warned again of an impending crisis in patient care. Clinical academics spend at least 20 hours a week in direct patient care and make up 10% of the NHS consultant workforce. The BMA points out that some specialist services are provided entirely by university departments. Hepatology services in Wessex are provided by the University of Southampton, and the renal transplant units in Oxford and Cambridge were set up by professors of surgery. At the Institute of Ophthalmology in London five out of six pathologists are academics.
Despite the longstanding agreement, endorsed by parliament, that clinical academics should receive the same pay award as their NHS colleagues and the fact that the universities recognise that pay parity is essential they have failed to honour the 1996 pay award. They claim that they cannot afford to pay the award and have refused to meet the university doctors to discuss a way forward. Less than half of the academic posts are funded by the universities; 55% are funded by the NHS or by charities. But the failure to negotiate is holding up a pay award for all university doctors.
The BMA has tried approaches to the education secretary and the prime minister but with no success. The chairman of the BMA's Medical Academic Staff Committee, Dr Colin Smith, said, “Universities cannot retain their academic staff, morale is at rock bottom and the workload pressures from unfilled vacancies are mounting. If we fail to keep pay parity with our colleagues in the NHS it will sound the death knell for academic medicine with grave consequences for patient care.”
Isolated areas need help to provide out of hours care
The 1996 local medical conference called for priority to be given to helping general practitioners in geographically isolated—not necessarily rural—areas provide out of hours cover. The changes agreed in 1995 did not provide satisfactory arrangements for all doctors and the General Medical Services Committee set up a task force to make recommendations. Last week the committee agreed with the task force's proposals. Health authorities, health boards, and local medical committees should distinguish between localities where deputising services and cooperatives were feasible and those where they were not. Where they were the negotiators should try to achieve additional funds to provide deputising or cooperative cover. Where cooperatives or deputising services were not feasible the task force suggested that rather than a radical flying doctor solution there should be an increase in the number of associates and principals and more salaried doctors. The aim would be to eliminate singlehanded practices and produce on call rotas of one in three or better. In addition the committee wants the NHS Executive to issue guidance on the location of paramedical staff, nurses, and transport in isolated areas so that during the triage process leading to referral a patient was normally travelling in the direction of the district general hospital and not away from it. The task force proposed that if island populations did not justify three doctors consideration should be given to remote medical cover.
GPs are concerned about checks on medical records
General practitioners are worried about the arrangements for the post-payment verification of item of service claims introduced under the government's plans to reduce unnecessary bureaucracy. Under these arrangements health authority staff will be able to examine patients' medical records to confirm that particular forms of treatment have been given. Although the health authority staff are bound by a confidentiality clause the General Medical Services Committee is concerned that doctors might be breaching the General Medical Council's guidance on confidentiality by allowing the staff access without their patients' consent. The committee accepts that there is a public interest in ensuring that no false claims for public money are made, but it has asked the chairman to approach the GMC for further guidance on the issue.