Survey shows junior doctors are still overworkedGovernment will commission research on NHS prescribingBritish tobacco curbs remain voluntaryHealth secretary promises blitz on practice paperworkNurses can prescribe more medicinesBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6972.131 (Published 14 January 1995) Cite this as: BMJ 1995;310:131
The preliminary results from the BMA's nationwide survey of junior hospital doctors shows that 300 are still contracted to work more than 83 hours a week—the ceiling that should have been achieved by 1 April 1993. The Department of Health maintains that there are only four posts in Britain over 83 hours. The survey was conducted so that comparisons could be made with the results from the regional task forces. By 31 December 1994 no junior doctor on an on call rota in a hard pressed specialty should have been working more than 72 hours. The survey shows that 22.8% of juniors are still contracted to work above 72 hours.
The preliminary results are based on a random sample of 3500 responses spread across all specialties and all regions. The survey showed that 2.2% of senior registrars, 1.5% of registrars, 0.3% of senior house officers, and 1.3% of house officers were contracted to work more than 83 hours a week.
Almost 60% of junior doctors are working longer than their contracted hours. The majority of these extra hours are unpaid. The department's official data do not take account of these extra hours.
The results show that the take up rate of partial shifts, a working pattern introduced to help to reduce hours, has been low. Most doctors (68.5%) remain on the traditional working pattern of on call rotas; only 5.4% are on partial shifts.
The survey asked about intensity of work and the results show that juniors are not receiving adequate periods of rest. Senior house officers and house officers are working at the highest intensity—70% of senior house officers and 83% of house officers received less than eight hours' rest during their most recent on call period.
A quarter of respondents in the sample said that they regretted embarking on a career in medicine. Among senior house officers the percentage was 27.7%.
Many junior doctors criticised the standards of accommodation, catering, and security in their hospitals—all elements of the new deal arrangements aimed at improving working and living conditions.
In a letter to chairmen of health authorities and trusts the health minister, Mr Gerald Malone, has announced tougher monitoring procedureson junior doctors' hours. From next month the reporting arrangements will require returns on contracted hours and hours of work to be collected and validated in partnership with junior doctors locally. Because some junior doctors have said that they are pressured by senior staff to work beyond the new deal limits the Department of Health has agreed to fund a “yellow card” scheme in the West Midlands which will allow juniors to communicate in confidence with the regional task force when they are concerned about the work they are required to do.
* Last month the health minister, Mr Gerald Malone, announced an injection of £14m to fund an extra 230 consultant posts to help to reduce junior doctors' hours. But, as the chairman of the BMA's Junior Doctors Committee, Dr Andrew Carney, points out, this would pay for approximately half a consultant per trust hospital.
Government will commission research on NHS prescribing
The government is to allocate £2.4m over four years for research into NHS prescribing and will invite proposals for projects. A group of external advisers has recommended that the Department of Health should commission research into issues such as doctors' perception of the patient's need for treatment with medicines, and the patient's own perceptions; ways to encourage doctors towards best prescribing practice; incentives for doctors to make the most of cost effective prescribing; factors which influenced doctors in their prescribing of new medicines; indicators to help improve the quality of prescribing; and ways of encouraging patients to take all their tablets and complete their course of treatment.
In 1993–4 the cost of pharmaceutical services was £3627m, of which £265m was met by charges. The NHS director of research and development, Professor Michael Peckham, said, “The research likely to be funded under this initiative would make a significant contribution to the better use of health care resources whilst continuing to ensure patients get the medicines they need.”
British tobacco curbs remain voluntary
The British government has entered into a new voluntary deal with the tobacco industry on advertising while resisting European Union moves for a statutory ban. The agreement aims at reducing young people's exposure to tobacco advertising and at making health warnings more prominent.
A new feature includes an undertaking by manufacturers that cigarette packaging will not have a greater pictorial appeal to young people than to adults. Posters advertising tobacco will be removed from within 200 metres of school entrances and will have more prominent health warnings. Most of the new measures came into effect on 1 January. A previous agreement, to remove all shop front tobacco advertising, will be fulfilled by the end of 1996.
The health secretary, Mrs Virginia Bottomley, argues that Britain's voluntary agreement has proved more effective than statutory bans on advertising in other countries. In Brussels she urged Europe's health ministers to raise tobacco taxes nearer to the level in Britain, which has the second most expensive cigarettes in Europe. In some countries, she said, the price of cigarettes was “shockingly low.” Cheap cigarettes were an affront to all efforts to cut smoking, Mrs Bottomley said.
The BMA criticised the government for relying on increasing tobacco taxation as its only significant policy to reduce smoking. “Mrs Bottomley cannot continue to claim that she is promoting health when sheallows the tobacco industry a free hand to peddle its lethal products, the BMA said.”
Health secretary promises blitz on practice paperwork
The health secretary, Mrs Virginia Bottomley, has commissioned an efficiency scrutiny to review and reduce the burden of bureaucracy in general practice. She hopes that it will remove unnecessary paperwork. The team will report by April with a plan and a timetable for implementation.
Mrs Bottomley said, “The scrutiny will be short and to the point. It will look at such issues as how computerisation and modern management systems can cut paperwork and save time. It will be based on field work. The team will get out and about talking to doctors about the problem and how it can be overcome.” The minister said that she hears increasingly from family doctors that paperwork eats into the time that they have to spend with patients. But because they are self employed they inevitably face a certain amount of necessary paperwork.
The scrutiny will be carried out by a team of four people, assisted by two practising general practitioners working part time. The team will visit practices of varying sizes, both rural and urban; examine the forms currently used; and look at the information requirements to establish what is needed for patient care. The team will be led by Ms Shaun Brogan, regional primary health care manager, Anglia and Oxford Regional Health Authority, and Mr Robin Naysmith from the NHS Executive. The scrutiny is part of the prime minister's plan to reduce the bureaucracy in key public services.
Written submissions to the scrutiny team should be sent to Ms Liz Morton, NHS Executive, Anglia and Oxford Regional Health Authority, Old Road, Headington, Oxford OX3 7LF (tel 0865 226746)
Nurses can prescribe more medicines
- Linda Beecham
Community nurses, who are taking part in the nurse prescribing demonstration project, can now prescribe several prescription only medicines provided that they have a health visiting or district nursing qualification and have satisfactorily completed nurse prescribing training. The extension to the Prescription Only Medicines Order is the final phase of the project. The drugs are preparations to promote wound healing, certain laxatives, and treatment of oral infections, and the list has been tailored for nurses with day to day clinical responsibility for elderly people, those who are terminally ill, and for child health.