Medicopolitical Digest

Working lives of doctors must be improvedPublic health must not be sidelinedNI GPs must have primary role in decision makingBMA amends guidance on abortion

BMJ 1999; 319 doi: (Published 02 October 1999) Cite this as: BMJ 1999;319:925

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Working lives of doctors must be improved

There is a need to improve working lives in the NHS, including the working lives of doctors, the health departments state in their evidence to the review body for the 2000 pay review.

They say that they share the concerns of junior doctors and consultants about the nature of their current contract. “These contracts do not adequately or sensitively reflect workload or intensity of work. Nor do they allow rewards to match the contribution doctors make to the NHS The key focus of action on doctors' pay in the coming year is to modernise both contracts.” The key principles for modernising the junior doctors' contract are a modern, simple to operate pay structure; fair pay; recognition of the particular problems of junior doctors' working patterns; and recognition that non-pay elements play an important part in juniors' working lives (see p 869).

The departments emphasise that a balance has to be struck between the overall pay settlement and the need to ensure that the NHS has sufficient resources to enable doctors to deliver high quality services and to meet the departments' targets. They say that targets are “challenging but achievable” provided that the pay awards are affordable and realistic, which would allow the pay award to be implemented in full.

Public health must not be sidelined

Doctors have told the minister for public health that public health medicine must not be sidelined in the implementation of the proposals in the government's white paper, Saving Lives: Our Healthier Nation.

Ms Tessa Jowell attended the end of a day's conference organised last week by the BMA's Committee for Public Health Medicine and Community Health. Speakers told the minister that there was a need to celebrate the success of public health medicine, and although they welcomed the development of a multidisciplinary approach they were worried about the proposal to create specialists in public health, who would be of equivalent status to medically qualified consultants and could become directors of public health. Dr Steve Hagioff, a specialist registrar in north Thames, said that the proposal could have an effect on recruitment if there was a shortage of consultant posts.

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Ms Tessa Jowell, minister for public health

Mr Rajan Madhok, director of public health, Gateshead and South Tyneside, said that it was important for the profession and the government to work together on one or two key areas, such as housing or a nutrition policy. And Professor Steve Jarvis, professor of community child health at the University of Newcastle upon Tyne, suggested that the government should set up a national agency for injury prevention and control, which could develop national surveillance systems. It was pointed out that primary care trusts must receive good quality, independent public health advice.

The minister told the meeting that the white paper was an opportunity for the regeneration of public health. “We will have to define the core skills in public health and the new and developing role of doctors in public health.” She said that health authorities and primary care trusts would be left in no doubt that meeting public health targets was just as compelling as other responsibilities.

NI GPs must have primary role in decision making

GPs in Northern Ireland have called for all primary care professionals to have a key role in decision making about the delivery and funding of services

In its response to the green paper on the NHS in the province, Fit for the Future—A New Approach, the General Practitioners Committee (NI) is disappointed that the new assembly is not in place. As a result it believes that the service is suffering from policy inertia. The committee says that the timetable for abolishing fundholding by 1 April 2000 is unrealistic and that proper alternatives should be in place beforehand.

The committee organised well attended meetings throughout the province and there was support for the concept of primary care led commissioning, but the doctors believed that the commissioning of services should be kept separate from service delivery. It suggests that the commissioning arrangements should be piloted. The response highlights the resource implications for training for people who take part in the new arrangements, and emphasises that GPs who devote a lot of time to the work must be rewarded. The remuneration package for primary care groups in England would not be acceptable in Northern Ireland.

The GPC (NI) does not want primary care cooperatives and social care partnerships to be restricted to current geographical boundaries and believes that the basic building block must be the practice.

BMA amends guidance on abortion

The BMA's medical ethics committee has amended its guidance on abortion to take account of the resolution passed by the 1999 annual representative meeting, which abhorred the harassment of doctors “who conscientiously object to participation in termination of pregnancy.”

In its guidance, The Law and Ethics of Abortion: BMA Views, the committee has added the following paragraph: “Some doctors have complained of being harassed and discriminated against because of their conscientious objection to termination of pregnancy. The association abhors such behaviour and any BMA members who feel they are being pressured to participate in terminations of pregnancy contrary to their conscience, or are being harassed in this way, should contact their regional office for advice and support.”

The Abortion Law Reform Association has asked the BMA whether doctors should reveal their conscientious objection to their patients The guidance now includes the following statement: “Doctors with a conscientious objection to abortion should make their views known to patients seeking termination of pregnancy and should ensure that the treatment or advice they provide is not affected by their personal views.”


  • Medicopolitical digest is prepared by Linda Beecham

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