Intended for healthcare professionals

Medicopolitical Digest

Consultants' leaders spell out NHS spending prioritiesDoctors are becoming disillusioned with NHSPatients should be involved in quality improvementMedical students issue standards for medical education

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7243.1214 (Published 29 April 2000) Cite this as: BMJ 2000;320:1214

Consultants' leaders spell out NHS spending priorities

In the wake of the creation of the government's modernisation teams for the NHS (15 April, p 1027) BMA consultants' leaders have set out some immediate spending priorities.

As an immediate step consultants want to see an increase in the number of consultants in obstetrics and gynaecology. This would improve the care of mothers and babies and help to reduce the costs of litigation. The BMA has argued that waiting times are more relevant than the number of people on waiting lists and the consultants say that consultant expansion in all specialties must be a high priority.

There should also be an increase in the number of consultant radiologists and an investment in support staff and modern imaging and radiotherapy equipment to help meet the targets on waiting times for people with cancer.

Another priority is for an increase in intensive care beds and an expansion in specialist training for expert nurses to provide one to one, round the clock nursing support. The government could improve older people's experience of health and social care by implementing the recommendations of the Royal Commission on Long Term Care of the Elderly.

The chairman of the BMA's Central Consultants and Specialists Committee, Dr Peter Hawker, said, “Patients are putting up with a patchy service from overstretched doctors and nurses, often in grim surroundings and with out of date equipment. We have a unique opportunity to make some dramatic improvements in the short, medium, and long term.” He warned against creating completely unrealistic expectations of what could be delivered in the short term.

Doctors are becoming disillusioned with NHS

Doctors are leaving medicine because of poor working conditions and lack of job opportunities, according to the latest report of the BMA's cohort study, which traces the careers of doctors who qualified in 1995 over a 10 year period.

The fifth report shows that doctors are becoming increasingly disillusioned with the NHS. Many have decided to change their specialty, work overseas, or leave the NHS.

The study, which is made up of 545 doctors in training, shows that 31% of those surveyed plan to enter general practice, nearly double the proportion who wanted to be GPs when they graduated. The main reason is to find a better working environment and a reduction in out of hours work.

Competition for training places in many specialties is causing many doctors to change their career plans.

The study also shows that a doctor's desire to practise medicine diminishes once he or she starts to work in the NHS: 67% of the cohort consider themselves to have a strong desire to practise medicine, compared with 85% on graduation.

Several of the doctors surveyed said that they were considering working less than full time; 3% were currently working part time.

The chairman of the BMA council, Dr Ian Bogle, said, “If the needs of the future workforce are to be met there must be a thorough review of the current situation. The report identifies priorities for the NHS workforce and gives clear warnings to workforce planners and policy makers of potential problems in the retention and recruitment of doctors.”


Embedded Image

(Credit: JOHN COLE/IMPACT)

Many of these doctors will not stay in the NHS

Footnotes

Patients should be involved in quality improvement

The BMA has published guidance to encourage doctors and other healthcare professionals to involve patients in their quality improvement programmes.

Involving patients in quality improvement activities has been produced by the BMA's clinical audit committee.

The document points out that involving patients in the NHS is a key priority of the government and an important element of clinical governance. It acknowledges that it will have resource and time implications, but says that as it becomes common practice studies that do not take account of patients' views will seem impoverished.

Patients' advocates, patient and user groups, and individual patients are all candidates for participation. The BMA recommends that patient identifiable information should be removed by the doctors concerned and that all participants should sign a confidentiality code.

Footnotes

  • Involving patients in quality improvement activities has been posted on the BMA's website (web.bma.org.uk)

Medical students issue standards for medical education

The BMA's medical students committee (MSC) has produced a set of standards on students' experience at medical school and the principles that students and medical schools should uphold.

The statements cover admission and selection; the undergraduate medical course; the learning environment; health and safety; support and welfare; and careers advice.

The statement on selection emphasises the importance of equal opportunities and says that medical schools should monitor applicants on the basis of gender, ethnicity, and religion, and conduct audits of selection procedures. It suggests that medical schools should develop mentoring programmes with schools and sixth form colleges in order to encourage suitable applicants who would not otherwise consider a medical career.

During their undergraduate course students should be given regular updates on their progress, and the statement says that consultants and other doctors teaching students should be trained in teaching and assessment techniques. The MSC sets out the conditions under which students should undertake clinical attachments.

There are sections on harassment and bullying, antisexist and antiracist policy, and complaints and disciplinary procedures.

The committee believes that medical schools should provide easily accessible and confidential stress counselling services and that schools should foster open learning environments in which students can address concerns and difficulties.

Footnotes

  • The statements are on the BMA's website (web.bma.org.uk)

    Medicopolitical digest is prepared by Linda Beecham

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