Former BMA chairman leaves NHSGPs drop opposition to end point assessment of traineesRevised patient's charter promises shorter waiting timesConsultants plan for sanctions over local payImprovements announced for health promotionBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6974.264 (Published 28 January 1995) Cite this as: BMJ 1995;310:264
- Linda Beecham
Former BMA chairman leaves NHS
Dr Jeremy Lee-Potter, chairman of the BMA council from 1990 to 1993, is to retire early from the NHS because he is disillusioned with the government's response to doctors' concerns about its policies on the NHS. Writing in this month's issue of BMA News Review Dr Lee-Potter says that the present government is so in the grip of political dogma that it will not respond to any approach from the profession. “We are faced with an intransigent and unpopular government which continues to trample on our professionalism and ignore our advice.”
He said that for three years he tried to reestablish a working relationship with the government. But he failed, and he believed that the present chairman, Dr Sandy Macara, would also fail because the political dogma was that all forms of central administration should be replaced wherever possible by markets.
“Cannot health secretary Virginia Bottomley and her colleagues see the dangers of subjugating the profession?” he asks. “Being a doctor is not the same as being a business executive or an advertising man or an industrial worker.”
Dr Lee-Potter says that neither Mrs Bottomley nor his successor are likely to be allowed to do anything radically sensible about any of the issues which have forced the profession into confrontation. For this reason he believes that a Labour government may offer the best hope for doctors and the NHS.
The minister for health, Mr Gerald Malone, said that Dr Lee-Potter was describing a health service that he did not recognise.
GPs drop opposition to end point assessment of trainees
The General Medical Services Committee has reversed its decision taken a year ago that the proposals from the Joint Committee on Postgraduate Training for General Practice for summative assessment should be shelved and has dropped its opposition to the concept.
The joint committee, the Royal College of General Practitioners, and regional advisers have been discussing changes to the package: the only examination based component now is the multiple choice question test. The GMSC believes that if it is to influence the package it must be part of the discussions. But it remains adamant that the membership examination of the college should not be the end point assessment.
The trainees have continued to oppose any mandatory form of summative assessment based on examination, and their representatives set out their views eloquently at last week's meeting of the GMSC. But it has accepted the majority decision and will take part in future discussions.
The trainees subcommittee's chairman, Dr Will Coppola, explained that trainees favoured assessment but there was no evidence that an examination was a good test of competence. The training period was all too short and it would become less satisfactory if it was punctuated by tests. Another trainee, Dr Grant Ingrams, said that the modular system proposed would not fit in with some of the present arrangements and he was concerned about the fate of the trainees who failed the assessment.
Summative assessment might not test competency but it certainly tested incompetency, according to Dr Brian Keighley. Without the system in the west of Scotland he believed that some dubious candidates would have got through. But Dr John Garner did not want to change the policy. If a few doctors were getting through who should not it was the fault of the trainers. The solution was to change the trainers, not impose summative assessment.
The representative from the RCGP, Dr Michael Jeffries, pointed out that the membership examination was already modular but the college did not see it as an end point assessment. Nor did it want to take a view on what should be the minimum entry requirement for general practice.
Revised patient's charter promises shorter waiting times
The new patient's charter, which the health secretary launched last week, aims at 90% of patients being given a first outpatient appointment within 13 weeks and no one having to wait longer than 18 months for any operation. There is a new one year guarantee for coronary artery bypass grafts and associated procedures and a maximum three to four hour wait for admission to a ward from accident and emergency departments. The government wants this reduced to two hours from 1996.
In future patients will have a right to be informed if they are to be admitted to a mixed hospital ward, and patient preferences for single sex accommodation will be respected whenever possible. The charter specifies that parents can expect their children to be cared for in a children's ward other than in exceptional circumstances, when a named consultant paediatrician should be responsible for advising on their care.
There is a new standard on hospital food so that, among other things, patients' dietary needs and preferences are respected. The charter has been extended to cover new areas such as dental, optical, and pharmaceutical services and the hospital environment, including cleanliness and security.
The director of the National Association of Health Authorities and Trusts, Mr Philip Hunt, said, “Responding to the need for 90% of all patients to be seen in 13 weeks will be tough. But it is essential to achieve this if we are to ensure that the length of time between referral to first outpatient appointment and treatment is as short as possible.”
GPS' ANGER AT CHARTER ADVERTISEMENTS
The charter is distributed widely and has been translated into a dozen languages; as well, a national newspaper advertising campaign encourages the public to send for a copy. The General Medical Services Committee has reacted angrily to one of the advertisements (see below). The GMSC's chairman, Dr Ian Bogle, said that the government was spending huge sums of money to encourage healthy people to seek a three yearly health check when there was no scientific evidence that it was beneficial. But it would not provide equivalent sums for what was supposed to be the high profile “Help Us To Help You” campaign to remind patients that the out of hours service was for emergencies and to encourage them to use the service more responsibly.
Consultants plan for sanctions over local pay
If the doctors' and dentists' review body recommends a small or nil award in its 1995 report, leaving the way for NHS trusts to pay doctors what they wished, or if an enabling clause is imposed, which would allow trusts to move away from nationally agreed terms and conditions, the BMA will recommend a package of sanctions to consultants (17 December 1994, p 1606).
As a first step the chairman of the Central Consultants and Specialists Committee, Mr James Johnson, has written to all consultant members of the BMA asking them to look at their job plans and identify the work which they do in excess of the basic contractual commitment. This has been estimated at an average of 14 hours a week for each consultant and if consultants withdrew this goodwill work it would have a major impact. Mr Johnson suggests that consultants might find helpful some of the workload documents that the CCSC has produced, and these are being sent to the chairmen of local negotiating committees. He emphasises that at this stage doctors are being asked only to identify excess hours and duties. They should not take any further action.
The CCSC chairman says that any sanctions would be taken only after negotiations had broken down and there had been a ballot of BMA members. Negotiations were continuing to try to find a solution, such as changes to the distinction award system. Mr Johnson hopes that these will obviate the need for an enabling clause.
Improvements announced for health promotion
To reduce the administrative burden of the general practice health promotion programme, the health minister has announced that practices will no longer have to submit an interim report each year which sets out the progress that doctors are making towards achieving targets. Over 90% of doctors are now running programmes aimed at stopping smoking, preventing chronic heart disease and stroke, and managing diabetes and asthma. Mr Gerald Malone said that he had taken the step as a result of the evaluation of the first working year of the new arrangements. The next stage would be a more comprehensive review to reduce information collection and recording to what was essential and useful for individual practices.