Medicopolitical Digest

BMA starts sanctions against Benefits Agency Medical ServicesConsultants continue to criticise underfundingEfficiency savings affect Ulster's health serviceConsultants will review 10% limit on private practice

BMJ 1997; 314 doi: (Published 04 January 1997) Cite this as: BMJ 1997;314:79

The BMA has “black boxed” the Benefits Agency Medical Services because it has been unable to secure improvements in the pay and terms and conditions of service for doctors who work for the services. The agency has been put in the Important Notice in the BMJ which advises doctors to contact the BMA before applying for jobs with the agency.

The BMA council agreed to the sanction after the agency introduced, without consultation, a new form of contract for doctors who are employed on a sessional basis to conduct medical examinations of claimants for benefits, particularly disability benefit, the disabled living allowance, and attendance allowance (2 November 1996, p 1150). The BMA objected to the fact that there is no notice of termination of contract, no disciplinary or grievance procedure, and no payment when sessions are cancelled. In addition, the service receives reports from general practitioners on a fee paid basis and has refused to accept the BMA's upgraded rate for these fees. The last pay settlement was from 1 April 1995, and the service says that there can be no increase in the current year unless it was funded by greater efficiency–that is, doctors would have to do more examinations per session.

Consultants continue to criticise underfunding

Patients continue to be disadvantaged by the perverse operation of the internal market, particularly when purchasers run out of money. Consultants from around Britain reported at last month's meeting of the Central Consultants and Specialists Committee that fundholding general practitioners were telling providers that they did not want their patients to receive elective treatment even when they had reached the top of the list and the hospital had the capacity.

Dr Basil Hudson, a consultant anaesthetist in Derby, said that doctors in his area felt that this situation was leading them to lose control over their patients who were no longer being treated on the basis of clinical need. Lists had to be organised weeks in advance and the teaching of junior staff was being affected.

Another anaesthetist, Dr Bob Buckland from Winchester, also reported that fundholders had asked the hospital not to admit their patients; these included those waiting for joint replacements. This restriction meant that the hospital was not meeting its targets and a further problem was that bonuses were written into the targets.

“The internal market is a nonsense,” Dr Peter Holden, a fundholding general practitioner in Derbyshire, told the committee, “but we must not fight among ourselves.” He and his colleagues were telling their patients why their hospital treatment was delayed and giving them pro forma letters to send to their members of parliament to complain about the underfunding. Recognition for ophthalmic training had already been withdrawn from one of the provider units because of the fall in throughput and he feared that gynaecology might soon follow. “We must take some positive action,” Dr Holden said, “and find out how many hospitals are not achieving the patient's charter targets on waiting times.”

Efficiency savings affect Ulster's health service

Fifteen of the 19 NHS trusts in Northern Ireland are experiencing difficulties because of the need to achieve 3% efficiency savings each year.

An inquiry by the Consultants and Specialists Committee in the province has found that restrictions have been put on elective surgery in short stay hospitals and that some patients with cancer have had to wait up to six weeks for treatment. The committee also found problems in community trusts. They have to care for highly dependent patients who are discharged from hospital without specific funding. There have been reductions in domiciliary visits, professional training time, and fewer home helps.

The committee points out that the province will not automatically receive any of the £500m growth money allocated to the NHS in Britain. It hopes that the allocations for 1997-8 will be increased to prevent any further deterioration to the service.

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Dr Ailbe Beirne, the committee's chairman, said: “Efficiency savings are cuts by another name and this constant haemorrhaging of funds has seriously weakened healthcare in the province. We were disturbed to learn that some hospitals are having to restrict operations for non-urgent cases and that in others there is little money available to buy new equipment in order to meet efficiency targets. We intend to take our findings to the minister and the chief medical officer in the hope that the current round will not be so harsh that it impedes good clinical practice.”

Consultants will review 10% limit on private practice

Consultants' negotiators will have a relook at the options for changing the present restriction that the right of consultants who are on a whole time contract to undertake private practice is limited to 10% of their gross income. The restriction was brought in as part of a compromise in 1979 when negotiations on a new contract broke down. Fifty seven per cent of consultants (12 510) hold a whole time contract and 25% (5540) hold a maximum part time contract.

At last month's meeting of the Central Consultants and Specialists Committee consultants were divided on whether there should be a change. There is a perception that the 10% is not adhered to and it is generally recognised that there is no difference in the contractual work commitment of whole timers and maximum part timers. Maximum part timers lose one eleventh of their salary, one eleventh of any discretionary points or merit awards, and so receive a reduced pension and lump sum.

On the other hand, many whole timers accept a much smaller overall income than their maximum part time colleagues. Raising the maximum part time salary to meet the whole time salary would therefore cause considerable grievance among whole timers.

The negotiating subcommittee will look at the following options: abolish the 10% limit and appoint all consultants on a whole time basis with no restriction on private practice; abolish the 10% limit with some adjustment to the whole time contract whereby all consultants would move to a standard 10 notional half days contract; compromise between the two above options with a standard 10 notional half days contract and transitional protection of salary; adjust the limit by increasing it to 20%; or increase the use of temporary notional half days by maximum part timers to enable them to receive payments for 11 notional half days without sacrificing any private practice.

Medicopolitical digest is prepared by Linda Beecham

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