Medicopolitical Digest

GPs respond to Blair's challengesDecision made on EU directive for junior doctorsJunior doctors call for action over “subconsultant grade”

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1081

GPs respond to Blair's challenges

GPs have welcomed the extra resources which the government has put into the NHS (1 April, p 889) and say that they will work with the government to get the maximum benefit from the money.

In the General Practitioners Committee's initial response to the prime minister's five challenges for the NHS (1 April, p 889) the GPC's chairman, Dr John Chisholm, says, “GPs will deliver a shared quality agenda if we are allowed to work with government to develop that agenda and are given the resources to improve the way we are able to work.”

He said that GPs wanted to help eliminate unacceptable variability in the delivery of care, but full funding was needed for evidence based prescribing, particularly in areas such as coronary heart disease, diabetes, and asthma.

Under the partnership challenge, where there is a need to increase the availability of direct access investigations for GPs, the GPC says that this is particularly true in relation to physiotherapists, where delayed access to treatment—for example, for back pain—means that many patients who could have returned to work are converted into chronic invalids.

Decision made on EU directive for junior doctors

Junior hospital doctors will have to wait up to 12 years before they are included in the European Union's 48 hour working time directive.

In an agreement between the European parliament and the council of ministers member states will have to incorporate the European legislation into national law. In the next five years they will have to bring the average working week down to 48 hours; the European Commission will grant an extension of up to three more years. The council had proposed a 13 year transition period with even longer hours than at present for the first seven years.

The UK government said that the staged implementation would give the NHS time to train the additional 8000 doctors needed to compensate for the shorter hours. The BMA, however, said that too many of the 35 000 junior hospital doctors were working dangerously long hours—more than one in six work more than 56 hours a week—and it would be “very, very disappointed” if the government took 12 years to implement the directive

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Junior doctors call for action over “subconsultant grade”

Junior doctors have called on the BMA to ballot all its working members on industrial action if a “subconsultant grade” became a reality.

Members at the BMA's Junior Members Forum in Bristol recently were angry at the rumour purported to have come from the Royal College of Obstetricians and Gynaecologists for a career grade open to doctors who have acquired their certificate of completion of specialist training (25 March, p 878), and called for the resignation of the college's president unless he retracts his proposal.

Asked about the rumour the NHS's head of human resources, Hugh Taylor, told the forum that if the NHS was to be delivered by fully trained doctors “the present situation will not stand up.” But he called for a cool debate on service delivery and said that there was no intention to impose a decision from on high. The important thing was the way the service was delivered and not what doctors were called (see p 1025).

Not enough doctors are being trained

Addressing the meeting earlier, Mr Taylor said that it was agreed that not enough doctors were being trained to deliver the kind of service required. He questioned whether access to training was as broad as it should be. As well as increasing numbers other changes were needed. The senior house officer (SHO) grade was unsatisfactory, and he suggested that progress through the grade could be linked to milestones to enable the doctors to move at their own pace.

Mr Taylor believes that increased specialisation is irreversible and this is forcing young doctors to specialise early on. Improved career counselling and retraining packages were needed. He accepted that management was an unpopular word, but he said that leadership skills were an essential part of medical training and development—“we need doctors in the lead in managing change.”

In response to a question Mr Taylor said that the prime minister did not want to control the NHS. The government wanted to empower frontline staff, and the fact that it had mortgaged a large part of the nation's wealth on health was a sign that it wanted to participate with the profession.

Consultant expansion will solve juniors' problems

Massive consultant expansion should be the rallying call for all junior doctors, Dr Andrew Whitehouse told the forum.

Dr Whitehouse, assistant postgraduate dean in the West Midlands, said that 10% expansion a year was needed. One solution had been to reduce the number of senior house officer posts and put the money into consultant posts, but this would be cutting off the seed corn.

Addressing the problem of bottlenecks in training, Dr Whitehouse said that the time was right to restructure the SHO grade. He suggested that all training programmes should be the responsibility of the postgraduate dean. There should be proper appraisal and assessment with proper use of the record of intraining assessment.

Dr Whitehouse pointed to the disparity between the number of SHOs and the opportunities for higher training. In the West Midlands there were 111 applicants for each higher training post in surgery, 75 in trauma and orthopaedics, and 49 in cardiology. The SHO block was patchy, and he wondered if there were some specialties which junior doctors did not know about. There should be better careers advice and consideration given to a postregistration year in general practice for everyone and perhaps a year in the armed forces.

Medicopolitical digest is prepared by Linda Beecham

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