Medicopolitical Digest

Appraisal could provide information for revalidationPhysican assisted suicide: consensus reached on key issuesMany NHS changes have been coordinated by consultantsHImPs should be local authority based

BMJ 2000; 320 doi: (Published 01 April 2000) Cite this as: BMJ 2000;320:946
  1. Linda Beecham, Medicopolitical digest is prepared

    Appraisal could provide information for revalidation

    The Central Consultants and Specialists Committee has approved a draft document on appraisal, which will be the basis for discussion with the Department of Health. The committee believes that the process should remain confidential unless concerns about patient safety arise.

    The draft sets out the elements which the committee believes an appraisal system for consultants should contain. For example, appraisal should include an evidence based discussion of clinical performance, a confirmation that the doctor has tried to maintain successful professional relationships, and the outcome of investigated complaints.

    There should be confirmation of participation in continuing professional development, clinical governance activities, and training in emergency treatment if appropriate. There should be a discussion of professional development and a review of the doctor's job plan.

    The CCSC believes that appraisal should be an annual process, although not all issues need to be covered in depth each year. Everyone who acts as an appraiser must receive appropriate training and be on the register. The most appropriate person will be the consultant's clinical director or lead consultant or equivalent.

    Physican assisted suicide: consensus reached on key issues

    At its consensus conference last month on physician assisted suicide the BMA rejected a move to change the law (11 March, p 666).

    The meeting agreed that if physician assisted suicide were to be practised it would alter the relationships between doctors and patients, between doctors and those close to the patient, and between the medical profession and society. Although individuals who competently chose to commit suicide were not legally prohibited from doing so, it does not mean that they had the right to be helped to do so.

    It was agreed that doctors should not be obliged to continue treatment in which the burdens outweighed the benefits for the individual patient. There was strong support for continuing improvements in the care of the dying.

    In addition to the major ethical and moral issues in introducing physician assisted suicide, the meeting identified several practical problems. As well as a change in the law, implementation would require the distribution of drugs not normally used in general practice, and there was a danger of the dissemination of lethal drugs in the community. To conduct physician assisted suicide effectively, doctors would probably have to administer drugs parenterally. This would increase medical involvement and might be considered as moving towards euthanasia. The meeting decided that there would be considerable difficulties in identifying consistent criteria for deciding which patients could be considered for physician assisted suicide.

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    An explanatory leaflet about a proposed new contract has been sent to all junior doctors who are BMA members in the United Kingdom (25 March, p 824). Posts will be allocated into bands based on the results of questionnaires focusing on the banding criteria completed by postholders. The leaflet includes a flow chart which will help doctors work out which band or supplement level they would be in. The supplement is priced as a proportion of basic salary and the total salary would be a multiple of the basic salary. Trusts will not be able to increase a doctor's hours of work without the doctor's consent and the approval of the regional task force or equivalent.

    Many NHS changes have been coordinated by consultants

    Welcoming the chancellor of the exchequer's announcement of more money for the NHS (p 889), the chairman of the BMA's Central Consultants and Specialists Committee said that many changes had already taken place in improving the speed, accessibility, and services for patients.

    Dr Peter Hawker pointed out that many of the changes had been coordinated by consultants, and he denied that doctors had resisted change as the NHS Confederation had claimed. The limiting factors were excessive workload, shortages of nurses and doctors, out of date equipment, lack of beds, and, in some cases, poor management.

    Dr Hawker cited some of the changes that had taken place—aggressive management of strokes, with neurologists, geriatricians, physiotherapists, and nurses working in integrated teams; and one stop cardiology clinics.

    The CCSC chairman said that consultants were more than willing to play their part in identifying the priorities and leading and managing change. The new money offered the prospect of appointing more specialist nurses, which would lead to more intensive care beds being opened, and more consultants, which would lead to an improvement in waiting times.

    HImPs should be local authority based

    The all party parliamentary group on primary care and public health has called for health improvement programmes (HImPs) to be based on local authority, rather than health authority, populations and, where possible, integrated with local authority community plans.

    All health authorities have to produce annual HImPs for their populations in collaboration with local authorities and other health related organisations.

    The parliamentary group was set up in 1998 to enable members of both houses to be better informed of primary care and public health issues and has over 100 MPs and peers.

    The group is recommending to ministers that the government should do more to encourage joint appointments between health and local authorities and should provide more guidance on the status of HImP priorities. It would like elected councillors and non-executive directors to be used as conduits for public consultation and accountability. NHS regional offices, which are responsible for supervising the development of the programmes, should disseminate examples of good practice and possible pitfalls. The group believes that more public health skills should be injected into the process.


    • Further information about the offer and the detailed salary tables are on the BMA's website (

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