Medicopolitical Digest

Accident departments can appoint more staffHelping GPs to provide better out of hours servicesHuman rights will be emphasised at Istanbul meetingMaintaining Medical Excellence will impose new costsIn brief

BMJ 1996; 312 doi: (Published 20 January 1996) Cite this as: BMJ 1996;312:188
  1. Linda Beecham

    Accident departments can appoint more staff

    NHS trusts and health authorities are being allowed to appoint more staff grade doctors outside the agreed national ratio to consultants of 10% to ensure full cover in accident and emergency departments. In a letter to trust and authority chairmen the minister for health, Mr Gerald Malone, said that this would help those hospitals which might face difficulties in filling senior house officer (SHO) posts next month. These appointments will also free up sessions to allow the SHOs more time to take advantage of educational opportunities and improve the training element of the posts. SHOs will also be offered the opportunity of year long posts (instead of six months) linked to other inpatient specialties.

    In a separate letter to chief executives of NHS trusts the medical director of the NHS Executive, Dr Graham Winyard, has recommended that hospitals review the work patterns in the accident and emergency departments. For example, patients with clear cut diagnoses or sent in by general practitioners could go direct to the appropriate team and patients could be seen directly by the relevant inpatient doctor and bypass the SHO.

    Dr Winyard suggests that the working capacity of SHOs could be improved by providing dictaphones, secretarial support, reducing non-clinical and administrative tasks, and arranging for other appropriate staff to arrange discharge and follow up. As much as possible of the administrative workload of senior doctors should be transferred to non-medical staff.

    The chief medical officer, Sir Kenneth Calman, is to review emergency care services outside hospital. This will focus on the organisation and delivery of services and the role of different professional staff including general practitioners. The aim is to ensure that “the spectrum of care delivered to patients is coherent, effective, and seamless across the primary and community care sectors.” The CMO will report to ministers in six months time (p 140).

    Helping GPs to provide better out of hours services

    The NHS Executive has amended general practitioners' terms of service to help them provide a wider range of out of hours services. Doctors can now apply for funds to buy communications equipment, develop primary care centres for out of hours use, meet the costs of arranging rotas, cover some locum costs in isolated rural areas, and meet some of the costs of using commercial deputising services. The family health services authority (FHSA) will have to be assured that each application offers cost effectiveness and represents value for money. The FHSA will decide the merit and priority of each application after consulting the local medical committee. The changes are set out in FHSL(95)68.

    In FHSL(95)75 the NHS Executive announces changes to general practitioners' night visit fees. In the new rules the executive says that it aims “to prevent primary care centres situated in casualty departments or similar being used as ‘drop in’ centres by patients, or by casualty staff as an alternative to advising a patient to visit his or her general practitioner the following day.”

    Until the amalgamated claim form is introduced in July doctors should continue to use current forms. For superannuation purposes the executive advises that these payments should be created as existing night visit fees.

    Human rights will be emphasised at Istanbul meeting

    The issue of human rights will be given a high profile in the programme for the BMA's annual clinical meeting in Istanbul in September. There will be two sessions on the subject and the association is looking at the possibility of a half day training session, which will be offered free to Turkish doctors.

    The Turkish Medical Association, which is cooperating with the BMA on the programme, has said that it would welcome a training session. It has taken a firm stand on human rights and wants to educate its members in detecting and documenting abuses.

    Dr Judy Gilley, a general practitioner in north London, told the BMA council last week that human rights abuses had worsened in Turkey over the past four years and were not just directed to the Kurds. Torture was routine in prisons and police stations; in 1995 there had been 29 deaths in custody as a result of torture and British companies were supplying electric shock batons. She welcomed the stance taken by the Turkish Medical Association but asked that a leading member of the Turkish Human Rights Association should be invited to the training session.

    “The Turkish government will try to make use of the BMA's presence,” according to Dr John Chisholm, a general practitioner in Henley. It was important to publicise the programme in Turkey and in other countries of the European Union, which Turkey wanted to join.

    The BMA's stance on the need for doctors to protect human rights was set out in Medicine Betrayed and this will shortly be translated into Turkish. A new report will look particularly at ways of reinforcing positive actions by doctors and their associations.

    Maintaining Medical Excellence will impose new costs

    In its response to the report Maintaining Medical Excellence the BMA is worried that some of the recommendations will impose additional costs on the NHS. The report was prepared by a review group set up by the chief medical officer in 1993 to review guidance for identifying and dealing with doctors whose performance falls below an acceptable standard. The association says that there are already procedures in existence, operated by the General Medical Council, which cover the maintenance of good medical practice.

    The association does not support the introduction of a contractual obligation on doctors to report colleagues whose performance is poor. This is because doctors already have a professional duty, laid down by the GMC, to report colleagues when there is evidence to suggest that their “conduct, performance, or health is a threat to he patient].” The BMA is worried that some doctors will be reluctant to admit to the underlying causes of poor performance, such as ill health or stress, because of fears that a colleague will feel obliged to alert employers.

    The BMA says that additional funding would be required if a mentoring system, as proposed by the review group, is introduced. Such a system should take the form of a review of all aspects of the service provided by a specialist unit and not just the performance of the individual working within it.

    The association welcomes the suggestion for a formal role for local medical committees in maintaining standards in general practice, but points out that they will need adequate resources in terms of time and funding.

    The report recommends that the arrangements for appointing members of disciplinary bodies in the NHS should be reviewed to ensure that there is an effective voice for overseas doctors' views. The BMA supports this but points out that there is likely to be an increase in the number of doctors from other European countries and they will need to become familiar with the British system.

    While welcoming the idea of evaluating the use of performance data as a means of measuring standards the BMA has asked for the profession to be consulted about the results of the evaluation and for a guarantee that such data should not be linked to disciplinary procedures.

    On the suggestion that the BMA should be invited to set up a national helpline to provide confidential advice on aspects of poor medical performance the association has emphasised that it already provides such advice to its members.

    In brief

    • The BMA has entered into contract negotiations with a specialist counselling company to provide a 24 hour telephone stress counselling service for doctors on a year's trial basis. Details are being worked out and will be announced when the service is launched in the spring

    • The BMA council has endorsed the report by Dr Ross Anderson, Security in Clinical Information Systems, which was summarised last week (p 109)

    • The chairman of council and the chairman of the Committee of Public Health Medicine and Community Health, Dr Stephen Watkins, will meet the health secretary to discuss the effects on public health of the 5% cut in management costs

    • A company has been set up to provide specialist accountancy, taxation, and advisory services to BMA members in the south Thames area as a pilot project.

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