GP accommodation – minimum standards

By administrator at July 17th, 2014

by Sarah Moore

I am about to graduate from Cardiff Medical School; I have very much enjoyed my time on the Welsh Medical Students Committee. It has been an interesting year, the highlight being when I represented the WMSC at the National Medical Student’s conference in London, in April. I presented a motion which highlighted the need for minimum standards for student accommodation within primary care.

GP surgeries are allocated funds to provide suitable accommodation for students, but there are wide discrepancies in quality of provisions. The nature of primary care attachments is that they are very diverse, particularly in Wales. We are not discouraging diversity, simply requesting that there are minimum standards so that students are housed in a suitable safe environment whilst they are attached to GPs, whether in rural or urban areas. The motion was passed at the student conference, and later featured in an article BMA News.

This issue is not unique to students studying in Wales and over the coming months WMSC will be working closely with the MSC to work on this policy. Since the motion was passed, Cardiff Medical School have been keen to engage with the WMSC about this; outgoing WMSC Chair, Klara Brzyska and I recently had a meeting with university staff to discuss the development of the minimum standards for Cardiff medical students. We were encouraged by what has been drawn up and hope for successful implementation of these standards. The MSC may not adopt these on a national basis, but we are pleased that Cardiff Medical School are moving forward and listening to the student voice.

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Listening to staff and patients

By drphilipbanfield at July 16th, 2014

We are, perhaps, used to politicians saying one thing and doing another subsequently.  We all have our own favourite examples of this, such as the UK Coalition Government stating that there will be no ‘top down reorganisation (privatisation) of the English NHS’, while Sir David Nicholson, its Chief Executive at the time, declared that the change was so monumental that it “could be seen from space”.

The current contradiction taxing me is how Welsh Government arranged specifically for the term “and Wales” to be removed from the consultant contract – previously, “England and Wales”, now just “England” – but now seems to be attempting to rejoin a ‘UK’ negotiation because it feels that the Welsh Consultant Committee (WCC) has been unreasonable in rejecting potential pay-cuts for consultants as a pre-condition to contract talks in Wales.  WCC did this on the back of an unprecedented 450 e-mails from irate, upset and disillusioned consultants in Wales, many of whom highlighted just how much they are propping up a battered, creaking NHS in desperate need of repair.  Talks, as they say, are on-going.

This is about patients. We have to do all we can to attract doctors to Wales, not drive those we do have away; we must value the contribution of staff and patients in fixing what we know is broken in the NHS in Wales.

Thankfully, you don’t have to take MY word for it, for we have yet another report highlighting how the NHS in Wales fails to listen, and still has a prevailing air of secrecy, fear and bullying.  Let’s see what someone independent of both the NHS and politicians has to say – the ex-CEO of Panasonic UK, Mr Keith Evans.

You would expect someone so successful in industry to be good with words so let’s pick out a few from his review of the NHS Wales complaints procedure – Putting Things Right

First, he recounts his credentials and what it takes to be successful – put the ‘customer’ (patient) first.  Indeed, you must “humbly wear your customers’ shoes and place yourself in their position at all times”.  His comment about mistakes is also worth repeating: “From a customer perspective, it is important to accept graciously the kind assistance of those who have so far been patient with your shortfalls and let them teach you how to put them right”.

Instead of trying to sell us a commercial and managerial picture of the NHS he appears supportive of it;

“There is little that industry can teach the NHS with regards to delivering front line expert medical or clinical services.  The NHS continues to be regarded by many as a world leader in the field of advanced healthcare delivery”. I like this man – it is almost as though he ‘gets it’, unlike so many others making decisions that affect our NHS in Wales.

So what is going wrong? Well, does the NHS welcome comments, criticisms or complaints; does it really want to ‘put things right’? (Shout out now).

“An organisation of any sort – public or private – that cannot receive a complaint with heartfelt thanks and deep appreciation will never succeed in the long term”.  Indeed, “using the information gathered from users is a vital analytical tool in ensuring that the organisation is not arrogantly pursuing its own cause and direction…”

But we have changed our NHS, haven’t we?  We have listened and acted and all is well? If so, why, post-Francis, is Mr Evans unsure if staff are more frightened or more open?  Staff that, he says, are the “unsung heroes”… “giving of their very best to care for us when we desperately need it”.

Staff, like patients it seems, are also lost in that beast of a system that is the NHS in Wales.  For a while now, Welsh Council has been considering the view that the manager led approach to the NHS is wrong; it just plainly hasn’t worked. The perception is of deep divisions in opinion; doctors and nurses asking for support and means to treat the patients in front of them, and managers asking for more managers to manage the NHS out of trouble. Both sides of this divide are drowning in processes and paperwork, with inadequate IT systems and conflicting priorities and purposes that will remain while non-clinically driven targets are put ahead of clinical priorities in the scramble for a restricted pot of Welsh Government cash.

But, Evans’ observes of the NHS in Wales; “There are too many levels of horizontal and vertical management; it is probably the most complex matrix organisation I have ever come across and mostly of its own making”.

As Evan’s implies from his comments on business, the NHS is not like a supermarket either.  The introduction of General Management by Griffiths (from Sainsbury’s) in the 1980s started the burgeoning industry of NHS processes and management structures that have paralysed the health service in getting on with the job of treating and caring for patients and their families.  Perhaps Morrisons have it right, when, in this age of austerity, they have proposed massive cuts in management levels – in order to put more people on the shop floor.  It is, they point out, what their customers want.

Is this starting to sound awfully familiar? Ah, yes – it is what doctors in Wales have been shouting for a while now, so far to deaf ears, it seems.

Doctors believe passionately in our National Health Service for Wales.  We have a unique chance to extend Bevan’s vision. But Wales is also poised to get it wrong.  In delegating responsibility to Health Boards, setting an impossible task that sets finance against service, Welsh Government risks overseeing the decimation of our NHS.  In not joining up the work of Health Boards, Welsh Government, Welsh Postgraduate Deanery, Universities and partners outside Wales, incrementalism is eroding the core framework that would allow a sustainable NHS in Wales.  We will struggle to maintain piece-meal services and no-one will take responsibility.  It may already be too late, but we’ll certainly know before the next Assembly elections in 2016.

Surely it is obvious to put the patients first and to support directly those who care for them?  Evidently not.  Put – don’t talk – things right, so that our doctors can care with due compassion and humility, as our patients have asked of us.

If you want to run the health service well, ask the doctors for their prescription.  Do it now, please, while there is still an NHS in Wales to play for.  If you don’t want to listen to us, then listen to the independent reports – or perhaps we might listen to, and learn from, our patients, for it is them we all serve.

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A final word from this Welsh Council

By drphilipbanfield at July 10th, 2014

As we finish the term of this current Welsh Council, we find that there is much unfinished work and that the future of the NHS in Wales remains uncertain.  Of course, this is why many of us are standing for election again, and why we have been encouraging others to stand for the first time.  Our major achievements have been to formalise our guidance on service reviews and hospital reconfiguration, with our major paper “Creating a healthier NHS in Wales – openness, transparency and raising concerns – a prescription from Welsh Council” due to be published after the ARM later this month.

This is about our profession.  It is about standing up with our heads high and clearly visible above the parapet, with like-minded doctors who believe we are the solution not the problem to the future of the NHS in Wales; an NHS we have chosen to work in and support because we believe in patient care determined by need.

If we falter now, we are lost, and the managerialism that has seen so much resource diverted from front-line direct patient care will have prevailed.  We are the last bastion of Bevan’s vision; it is precious and should not be squandered through parochialism on the one hand and ambivalence on the other.

The BMA is now the only place where doctors of today and tomorrow, of all specialties, grades and place of work, come together.  Our political and managerial masters would pit each of us against the other.  It is our job, in Welsh Council, to see through this; to lead and to stand for the beliefs and values of the medical profession.  For it is in this way that sanity is brought to the chaos threatening our patients from inefficiencies, wasted resources and ill-conceived reconfigurations.

Ask a doctor what he or she needs to do the job they have been trained to do; what can be improved; what needs to be done, and you will see and hear with the eyes and ears of our patients.  In supporting us to do our work with our professional colleagues, you alter patient care and outcomes most often for the better.  Create the means to track our journey wisely, and even better benefits are possible. Fail to do this and the waste and needless suffering will continue. The problem is that those who decide will not listen to those with silenced voices, but seem to press ahead regardless.  For this challenges political face, and power still resides with the loudest and strongest, it seems.  We have decisions from those in power that affect others, but not them, without reference to those most affected.  This HAS NOT CHANGED, nor shows signs of doing so, despite the rhetoric.  We will wallow in the squalor that the NHS in Wales should otherwise been capable of extracting itself from. Sad is the day that laments these missed opportunities.

But until that day, we fight for what is right for patients, for this is right for doctors as well.

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Preparing for work seminar

By administrator at June 5th, 2014

Maimoona Ali, member of the Welsh Medical Students Committee and Cardiff 5th year student blogs about her recent involvement in organising a BMA seminar on preparing for work.

Matt and Nia (BMA Cymru Wales Employment Advisers) discussed the Preparing for Work seminar at the last Welsh Medical Students Committee (WMSC) meeting, which was a week before my elective to Malawi.  So it was a busy time with lots of to do lists and planning already on the go.

The idea was that me and Sarah (the other 5th year BMA Cardiff rep) would assist Matt in planning the event.  Matt had told us his best attendance for this annual seminar at Cardiff was 50 people.  Our aim was to beat this!  We had 3 weeks of lectures post elective before placement so we conveniently chose the second week to ensure maximum numbers at the event.  So a provisional date was decided before I flew off to Africa.

Whilst I was away on my elective I left my internet email accounts and admin for my mum to deal with as I knew I would have limited/no access to internet during my time in Malawi.  So my mum became my PA, a role which she took great pride in!  My mum (who types with one finger at a time) loved being my PA and replying to Matt’s e-mails about the Preparing for Work seminar!  She even rung me whilst I was at Liwonde Safari camp, Malawi asking me the questions Matt wanted answers for.

As we were away on elective for two months, we thought it would be best to use the power of social media via Facebook to advertise the event. The Facebook event was created five days before the seminar.  The weekend before the seminar whilst I was at the BMA medical students conference in London, the numbers confirming their attendance on Facebook rapidly increased to the point where we reached triple figures! Over 100 people said they were attending.

I think that our year were in a state of panic after been told where they were going to work for the next two years of their lives. Great timing for this seminar!  Fear tactics work.  This also meant Matt had to increase the pizza order as over 100 people were attending (he was still skeptical about numbers!)

Tuesday 6pm the lecture theatre began filling up quickly.  Record numbers attended – 137 was the final count!  The seminar was busier than most of our lectures this year.  Nia had handouts for her lecture, and we simultaneously gave out elective surveys to complete. The purpose of the survey was for students to provide details about their elective; the response to be collated as a resource for students going on elective in the future.  There was also a free prize draw for £20 Amazon vouchers – students love a good freebie!

Nia’s presentation was very informative and concise.  She also tried to highlight the differences between Wales and England where possible.  Not many people knew about banding and contracts so the presentation was an eye opener into the big wide world and the joys of working for the NHS.  The feedback from the seminar was very positive.  After the event pizza was served and Matt had a BMA stand.  He managed to recruit 4 new members as well.

This was the first BMA event I had helped to organise.  It was thoroughly enjoyable task which was of benefit to myself and the year-group.  My mum particularly enjoyed playing a part and making virtual friends with Matt!  From a WMSC perspective it was an opportunity for upcoming F1 doctors (the majority of whom are staying in Wales) to learn about the ways in which the BMA can support them through their careers.  This was just the beginning of the long journey to retirement and pension time!

A preparing for work seminar is held each year for final year students in both medical schools.

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A Reflection on volunteering

By administrator at June 4th, 2014

By Ben Masterman

Volunteering with disabled and disadvantaged children may not seem like a selfish activity, but when I consider what I’ve gained from it, it’s hard to believe that I’ve put an equal amount into it. My CV now has a measurable amount of experience in leadership, teamwork, teaching and in working with children and disabilities. I’ve gained training and qualifications in Advanced Paediatric Life Support, bullying, social inequalities and domestic abuse. And most recently I was awarded a national prize for my commitment to voluntary work.

The phrase “voluntary work” seems misleading to me as the “work” has involved accompanying children to things like climbing, cycling, bowling, swimming, archery, bowling, walks around the park, cinema and more bowling (all paid for if I would like). And the cinema wasn’t even always silly childish Disney films, many were rated 12 and above (and I enjoyed the childish Disney films more than I’d like to admit anyway).

The time issue has been surprisingly absent as well. I started during my intercalated year when I could commit more hours a week, but all the staff and families at Barnardo’s Community Links Service in Cardiff have been incredibly understanding, and I have only ever volunteered when I have had the time. Now that I’m in my final year that is usually only one 3-4 hour session in the afternoon or weekends.

If none of this appeals to you, or you think that you need experience before starting something like this, I’d suggest the opposite. Volunteering is a great way to fill gaps in your experiences, knowledge and CV. If you’re in medical school then you’re more than capable of picking it up, whatever it is. And in the larger charities like Barnardo’s they provide you with the necessary training. All that is required is a bit of your time and a lot of your enthusiasm.

What I’m most proud to have gained is the privilege to meet and be a part of many extraordinary families and young people, to have seen them grow and mature, often against great adversity, and to have felt a part of something much greater than myself; something a person like me may not have found otherwise.

So I strongly advise you to give it a go, go to your nearest regional or university volunteering organisation centre and see what suits you. You might stand to gain more than you expected.

If you are interested in finding out more about becoming a link carer or volunteer, call Barnardo’s Community Links project on 029 2057 1910

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BMA Welsh Council elections and you!

By drphilipbanfield at May 16th, 2014

The BMA exists for the benefit of its members.  For many, it might not always feel like that, but the relatively small size of the BMA presence in Wales gives greater opportunity for cohesion. As ‘health’ is a devolved power, the BMA in Wales has more direct access to Government, politicians and senior civil servants.  The healthcare environment in Wales is different, though no less challenging than in England; a collaborative, rather than ‘market based’ approach.  Ours is a ‘national’ health service, while England is (not so subtlety) being gradually privatised.

Individual BMA members can meet locally through a ‘Divisional structure’.  Although Divisions’ traditional role may have largely been superceded by social media, they still offer a way to feed into the ‘Annual Representatives Meeting’ (ARM), which makes overall BMA policy.  It is through this structure, and the challenges to service changes in north Wales made by my local Division, that I became involved in medical politics, and I haven’t looked back! Now I’d like to invite you to participate in our work.

The trade-union role – including Terms and Conditions of service – is largely dealt with at specific Branch of Practice committees such as GPs, Consultants, Academics, SAS Drs, Junior Doctors, Public Health, Armed Forces and Retired members. Welsh Council sits over many of these committees in Wales, with representatives from each, but it is expected to produce a cross-Branch of Practice perspective where required to do so.

Welsh Council has a simple vision:

“…to improve the health of the people of Wales by representing the doctors who care for them”.

In recognising that Welsh Council needs to reflect members more transparently, part of its membership is achieved by direct elections from the whole membership in Wales. In the last 2 years we have begun to push further to develop Welsh Council as the professional voice of doctors in Wales. As service and training reconfigurations have threatened profound change, we have, for example, been clear that the health needs of patients must come first and exposed the detail – sadly often lacking – that is required for the public and clinical staff to make informed decisions.

In the wake of the Francis Report, Welsh Council is engaged proactively in work on leadership, transparency and openness – for these remain common issues brought to our attention by members  – and our work on whistle-blowing and professionalism will continue in the next term.

There is an expectation that a member of Welsh Council is there to contribute.  The BMA Office staff in Cardiff are simply superb, but cannot replace the voice of members of the medical profession being heard directly.

Although we have a common aim and a team approach, we respect, value and appreciate the diverse views of our membership, and therefore those on Welsh Council.  In considering and working through differences, we arrive at a consensus position.  We have a personal and ethical code of conduct and behaviour that reflects our professional duties as doctors in Good Medical Practice.  This is the only place where medical students, junior or SAS doctors have an equal voice with their seniors. It demonstrates the strength of the BMA in shaping the future of NHS Wales, for it is only by breaking down barriers and silo mentalities that the necessary collaboration will take place – and this is good for doctors and even better for patients.  I follow immediately that we are ‘senior’ only (and most often) in age!

There is an expectation that the directly elected members will feedback to their respective Divisions, completing the circle to the members we serve.  In the age of social media, we are working on innovative ways to meet the modern expectations of members.

This is a pivotal time for NHS Wales.  We can and must re-establish the medical and other professions as leaders and change makers in the NHS in Wales.

The BMA is your organisation and Welsh Council is neither a club, nor exclusive, so we would encourage you to stand at the forth-coming election.  Welsh Council is a friendly place to be in a world that seems very contradictory and hostile to what many of us felt we came into medicine for – to care for patients, their families and our communities.

2014-2017 will see a new NHS in Wales.  We believe that BMA Welsh Council has a vital role in this – and we invite you to be part of that, too.

 

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Coming soon … Welsh Council Elections

By administrator at May 2nd, 2014

Keen to influence and debate the key issues facing the medical profession in Wales today? Then why not think about standing for election to Welsh Council? Elections for the next session 2014-2017 of the Welsh Council of the BMA will begin in mid May.

Welsh Council is the cross-branch of practice committee in Wales which deals with matters of concern to the whole medical profession in Wales. There are 15 directly elected members on Welsh Council.

Members are elected to Welsh Council for a 3-year term, with 4 meetings a year. Travel and associated costs are reimbursed in line with BMA expenses policy.

A formal notice will follow in the BMJ. In the meantime, for more information, please contact Sarah Ellmes on 029 2047 4604 or email: sellmes@bma.org.uk

 

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General Practice is stretched to breaking point

By administrator at April 22nd, 2014

by Dr Charlotte Jones, Chair, GPC Wales

Looking around me at the enormous challenges facing GPs across the UK with respect to the workforce, rising demand and ever lowering morale, it has made me reflect on some correspondence we have had from GP practices across Wales. As we all know, practices across Wales are experiencing significant recruitment / retention problems, and are seriously having to consider the range of services they offer to patients due to ever dwindling resources and feeling the pressures of ever increasing demand. What has been interesting is that some have reported that their Health Boards are supportive but waiting for Welsh Government, the Deanery and GPC Wales to solve the problem……interesting……..but this has highlighted to me that there is a lack of understanding about the role of GPC Wales.

GPC Wales is the elected body of GP representatives who have a statutory role in negotiating contractual matters with Welsh Government and others. In addition, GPC Wales has a professional advisory role raising wider issues affecting GPs, giving opinions and offering solutions / assistance where appropriate (eg our workforce paper, work on rural DES) or informing WG what will be the consequences (eg practice closures). GPC Wales does not have the gift or resource to put in place the solutions – this is for HB and WG, so it is disingenuous for HBs to imply they hear practices pain but are powerless to help. I think practices MUST go back and ask Health Boards “thank you for sharing our pain, now what are you going to do to help”? I believe LMCs need to push HBs to start addressing the issues that are impacting adversely on General Practice – GPC Wales cannot do it alone.

There is too little visible progress being made on General Practice matters – this is most definitely not down to inertia on the part of GPC Wales and the negotiating team who continue to use all avenues / opportunities to push the need to address issues to ensure the future of General Practice but it is simply not in our gift to solve these problems.

I believe that General Practice is stretched to breaking point – it feels like a “perfect storm” and a very real crisis on the ground across large parts of Wales and indeed across the UK. Without urgent intervention, this will lead to practices closing and patients having difficulty accessing General Practitioners. This is not what ANY of us want. WG and HBs cannot afford for this to happen.

Whilst I wanted to give a cheery message to those of you who will have a well deserved break over Easter – for those of you working OOH I will be sharing some pain – chocolate has been shown to improve a sense of wellbeing and happiness……I don’t think any amount of chocolate Easter eggs will solve the problems of Welsh General Practice no matter how much I eat on your behalf – time for practices and LMCs to push HBs to “act now”.

@MadameGPWales

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Macmillan Wales offers new free course to practice nurses

By administrator at April 16th, 2014

Guest blog by Dawn Casey, Senior Learning and Development Manager for Macmillan Cancer Support in Wales

Macmillan Wales is offering a free new course to practice nurses to support them to learn more about cancer patients’ needs and how to meet them.

We ran our first practice nurse education course last year in Brecon and 22 nurses from GP surgeries across Wales completed it.

After completing the course, every nurse said they rated their understanding of cancer as either strong or excellent.

Each participant also said they had either carried out or were going to carry out cancer care reviews to assess the needs of patients who had finished cancer treatment within the last three months.

This review includes assessing their emotional, financial and psychological needs in addition to their medical ones.

Feedback from nurses who completed the course included: “Previously I was not at all comfortable talking to cancer survivors or patients undergoing cancer treatment, mainly due to lack of knowledge.

“However, since starting the course and acquiring vast amounts of information, I will now initiate a conversation with patients. I will quite happily and confidently discuss matters that they wish to talk about.”

Another nurse said: “I have found this course so helpful, I hadn’t realised just how many of our patients with chronic conditions were cancer survivors.”

Macmillan hosted a celebration event for everyone who completed the course at The Barn, Brynich, on Wednesday 26 March to celebrate their successes.

We are now offering more dates for the course, which is made up of five one-day sessions covering topics such as cancer awareness, conducting a cancer care review and health policy in Wales.

We are running the course as more than 120,000 people in Wales are living with or beyond cancer and will need ongoing treatment and support at their GP practice either during or after their cancer treatment.

Results of the first Wales Cancer Patient Experience Survey, which the Welsh Government carried out in partnership with Macmillan, showed that only two thirds of cancer patients (67%) felt that GPs and nurses did everything they could to support them during their cancer treatment.

Macmillan wants to help GPs and practice nurses to feel more confident when supporting people living with or beyond cancer.

Courses will start at The Oriel Country Hotel, St Asaph, on Wednesday 21 May and at The Barn, Brynich, on Thursday 5 June with four further dates held every month.

Practice nurses wishing to attend the course will need to register in advance.

To find out more, or to register, call Macmillan Wales on 01656 867960 or email me via dcasey@macmillan.org.uk.

 

 

 

 

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Getting it wrong

By drphilipbanfield at April 15th, 2014

We must make more effort to define and address the unintended consequences of decisions on our health services.

A recent tweet about trying to ban mobile phone roaming charges in Europe, reminded me of one of my (many) times I ‘got it wrong again’. Quite a few years ago, I lectured in Moscow as part of work I was doing with the WHO European Office in Copenhagen, finding myself put up in a local hotel, with a matriarch guarding each floor and only one international phone in the lobby. It was character building, to say the least.

Determined to be more accessible next time, I took my mobile phone with me the following year. It worked much better in Moscow than it did in north Wales. Four days away from home; I limited my calls to brief hellos to the kids and quick updates on the trip. The Russians couldn’t get their research fellow to the next WHO meeting – I rang Denmark, feeling proud of negotiating $200 for their doctor’s airfare. Job done.

Back at Manchester Airport, I took to my ‘phone to confirm my arrival.

“Calls from this mobile are barred”, announced the automatic message.

I rang customer services from a pay-phone. After all, I had never defaulted on my £17/month plan.

Did I have a credit card on me? They would re-connect me if I paid £300. I asked – purely out of interest – what the actual bill was. £678!

I wanted the ground to swallow me up. I asked them to explain at what point they had noticed I was spending more than my monthly average and why they hadn’t phoned me to query the usage, but to no avail.

Mrs B took it in her stride, but then she’s a calm GP and like that. We found a way to pay off the bill over several months – and changed ‘phone company. In my zeal to be helpful to a Russian colleague, I had generated the unintended consequence of finding myself more out of pocket than if I had just paid for the ticket myself.

I mention this because this is what is happening to our NHS in Wales – a series of relatively isolated decisions with scant scientific or economic evaluation and practically no attempt to consider the unintended consequences, arising from reconfiguration of both hospital services and postgraduate medical training. Decisions made seemingly without consideration, understanding or appreciation of the impact they have on patients and their families.

Sadly, we are getting reports that those who highlight deficiencies or question motives, outcomes and practicalities are still encountering veiled threats of a disciplinary process! Instead of stopping to consider whether this minority may have a valid point, the tendency to steam-roller on through the security of ‘group-think’ seems to be prevailing under the umbrella that something must be done urgently to address short-comings in our creaking under-funded service, but this risks alienating clinicians dedicated to caring for their patients. Have we learned nothing from Mid Staffs?

We still seem to have NHS organisations that close their ears to criticism and which do not have the where-with-all or resources invested in actively listening – to patients or staff. And nearly a year on from the National Staff Survey many frontline clinical staff still report feeling unsupported while doing their job, even just a little bit better. In fairness, austerity measures really don’t help with this, but don’t get me on to HR policies, the locum bill and wasted resources again.

Perhaps it is my obstetric background that focuses my attention so firmly on individual patients; the decisions we make – and get wrong – affect a generation and whole families. Obstetricians spend a great deal of time reflecting on past mistakes and desperately trying to avoid making them again in the future. We live in the communities we serve, because we have to be immediately on hand in an emergency, constantly reminded of our fallibilities. It is no wonder that we care passionately about our patients. And I am sure that many other hospital specialties – and general practice – are the same.

It is much easier to take ‘tough decisions’ that affect others when we do not see and live with (and in) the consequences directly ourselves, either immediately or in the longer term. It’s similar to an earthquake; while those at a distance may experience it momentarily, it is those at the epicentre who have survive where havoc has been caused.

It is much tougher to admit that the evidence points to more challenging options – those that involve crossing boundaries, collaboration, forward planning and vision – for these involve a commitment to find new ideology and to breakdown the silo working. It is this failure of foresight which risks paralysing a country that otherwise should be able to find its way forwards unencumbered by the calamity of NHS commercialisation taking place in England.

The aim, after all, is surely to learn from others’ mistakes and not to dive headlong into a chaos that we have a duty to try to prevent. ‘Prudent healthcare’ signals an attempt to change the basic ideology of the medicine we practice, and we are committed to implementing itto the full, but the organisational cultures of some NHS and Social Services Organisations may be even more challenging to detoxify. Everything, it seems, has unintended consequences. In a country the size of Wales, shifting a problem around in circles helps no-one and just depletes the dwindling pot of cash more rapidly.

None of this can be, nor should be, considered in isolation and we want to hear from doctors at the grass roots – your experiences of what works, examples of what you see as good practice – and what is clearly failing. Call us – but be wary of your mobile charges. Perhaps it is best to tweet or e-mail. After all, my Internet works better abroad than in north Wales, too.

 

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Asking about clots to save more lives

By drphilipbanfield at April 3rd, 2014

You would expect me, as an obstetrician, to be obsessed with the risk of venous thromboembolism in pregnancy – relatively rare but obviously potentially very dangerous.

I am very proud of the 1000 Lives Improvement maternity work clinical teams in Wales have done over the last three years, because this has supported a ‘bottom up’ approach to solving the patient needs identified by front-line clinicians.

For example, the team on the Obstetric Day Unit at Glan Clwyd found that their thrombo-embolism risk assessments became persistently 100% only after the healthcare support workers were empowered to actively remind the doctors and midwives to do the assessments! But then, they have a ‘let’s do it together’ approach that makes this not seem out of place.

A new initiative from 1000 Lives Improvement is the Ask about Clots campaign.

There are more deaths annually in Wales associated with a hospital stay, than deaths from breast cancer.  Surprised?  It will come as no surprise that a large percentage of thrombosis-related deaths are potentially preventable. I have written previously, as Chair of Welsh Council, about the use of RAMI, mortality ratios higher than one might expect and avoidable deaths and therefore this is a priority for us in the NHS in Wales.

We cannot ignore (and usually don’t) that thrombosis poses a significant risk to many patients in our hospitals and in the three months after they are discharged.  We have probably all had patients present with symptoms who deteriorate rapidly and die from a massive embolism – it’s not common, but it is not as rare as you might wish for.

Ask about Clots is encouraging patients and members of the public to ask healthcare professionals about their risk of developing a thrombosis.  The campaign is particularly important as a recent survey reveals that 62 per cent of people in Wales believe that they are more likely to develop a thrombosis on an aeroplane than in hospital. This lack of awareness means patients may not be asking their doctors and nurses for an assessment when they should be having one routinely on admission and periodically during their stay.

Shifting the question to the public may be considered a form of the co-production approach to healthcare, so it will be interesting to see what happens next.  When people are informed and participating in their healthcare, the outcomes may be better; doctors and patients working in partnership to identify and negate health risks. As part of this we will need to check that our expectations of improvement are borne out in practice, by a proper outcome review for all our patients – a challenge up from the much more easily done audits of process.  Getting better clinical data on outcomes is a recurring theme for NHS Wales at the moment!

So what can we do to support this campaign? Being aware of the need to be responsive when people ask to have their risk of developing thrombosis assessed is a first step.  And we need to be ready to give the right type and level of thromboprophylaxis. Having thromboembolism on our differential diagnosis for symptomatic high risk patients keeps it in our mind’s eye.  If we are alert to the dangers, and working with people to address their concerns, we have the potential to save many extra lives.

Further details can be found on the Ask about Clots website.

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New Welsh Government arrangements for identifying and responding to serious concerns

By Richard Lewis at March 20th, 2014

BMA Cymru Wales welcomes the new arrangements for identifying and responding quickly to serious concerns about NHS organisations in Wales.

It is important that patients and health professionals are assured that when the health service shows signs of serious concerns, that these concerns are dealt with robustly and quickly to reassure staff who work in the NHS daily.

But the NHS needs to develop a culture that avoids serious concerns developing in the first place. This requires a change in attitude and values in senior management and those with leadership responsibilities, such that raising concerns by staff should be welcomed and positively reinforced so that it becomes routine and everybody’s business to identify and put right
early concerns wherever they occur to avoid the new arrangements announced today ever being required.

 

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