Crisis looming for the NHS in Wales in 2014

By drphilipbanfield at December 31st, 2013

I am writing this blog because we must stimulate a public, professional and managerial debate on the future of the NHS and junior doctor training in Wales – the foundations on which the NHS stands are being weakened even as I write.

I apologise in advance, for what is necessarily a long blog, as I touch on the inter-related issues of service provision, medical training, geography, cost, and – above all – urgency. Please bear with me!

The problem is that NHS Wales’ current dependence on junior doctors (primarily here for training, but used as the foundation for service delivery) is unsustainable. This is about recruitment, retention and variation in the standards of training in Wales.  A previous report into training (Calman) envisaged patients being seen less often by trainees and more often by specialists and consultants, but this has not materialised in many Health Board areas, particularly in the acute and emergency specialties.

I worry that so few people have an over-arching appreciation of just how many different factors need to be aligned to dig the NHS in Wales out of its current predicament or how soon this needs to be done.

It is clear to me that the NHS in Wales must take immediate action to decouple the NHS from training in some hospitals. Failing that, both emergency and acute services in the NHS face imminent collapse from August 2014, because of an apparent failure of the service to plan far enough ahead for anticipated reductions in trainee numbers in key specialties.

The time is upon us for action – neither delay nor prevarication can be the response.  There seems to have been a lack of prospective action by Health Boards over the last 3 years, despite being warned several times of the reductions in trainees.

It is possible that the newly published Greenaway Report (on the future shape of medical training) will help with training in Emergency Medicine, Paediatrics and Psychiatry in the medium and longer term, but this will take time to implement.  The time for that to translate into outcomes just does not exist for the NHS in Wales.

The challenges in north Wales demonstrate the dilemma faced by rurality on the one hand whilst having cross border services geographically near by for those in the East, but three acute hospital sites on Welsh soil.  Here, the challenge will be to have junior doctors on sites that can deliver training specific to their identified training needs, with a faculty of qualified trainers – most likely on two of the three acute sites.  Different levels of trainees could be found on one tier of a rota at one hospital and others at another.  This is not an all or nothing solution – services can (and must) be maintained on 3 sites with consultant and SAS Doctors, some of whom may wish to work towards Certificates of Eligibility for Specialist Registration. The value of this work needs to be clearly recognised.  Yet the main topic of conversation seems to be of who will and will not be able to keep their bit of service open.  This is unhelpful because it does not put the needs of patients first.

We cannot allow the changes in training and services to widen health inequalities, yet the needs of our patients do not seem to be at the forefront of many of the current discussions and future decisions being tabled. We seem to be moulding the patients to fit the NHS rather than building an NHS based on the needs of the population of Wales. Put bluntly, it is completely unnecessary, in my view, to make large numbers of patients have to travel 60-80 miles for relatively straightforward conditions or services (such as having a baby, for example).

There are new opportunities for academics and researchers to bring a different focus on each site and within different departments. North Wales has strong links with several universities, but the ‘U’ (University) in UHB remains unexploited for the benefit of the people of north Wales.

The timescale for the Deanery reconfiguration plans are ahead of those in the service and relocating or concentrating services on alternative sites takes both time and resources (financial and staff) to set up.  Current gaps are often bridged by expensive locum staff, for example, so there will be a need to train non-medical practitioners, but we would suggest valuing and building on the excellent service given by Staff and Associate Specialist doctors throughout Wales.

The recent sums of money announced by Welsh Government to support transition are welcome, but seem designed only to prop up an existing service creaking at the seams, rather than address the needs of the massive reconfiguration phase staring us in the face.  Now more than ever, the public needs to debate with politicians, both locally and nationally, to obtain clarity about what the future holds.

We cannot ignore the need for high quality postgraduate medical training in the solution. BMA Cymru Wales understands and supports the need to enhance and protect postgraduate training in Wales. The Wales Deanery has seen its funding cut and many training posts go un-filled in less popular services such as Emergency Medicine and Psychiatry, especially outside Cardiff and Swansea.  This exposes rural parts of Wales to the prospect of the collapse of several services unless something is done urgently to join up the strategy across both healthcare and higher education sectors – for the benefit of the whole of the Welsh nation.

The matching of trainees to qualified trainers is more appropriate than broad-brush 1:11 training rotas that cannot possible provide enough clinical cases in the average hospital; which form the backbone of the NHS in Wales.  It is perfectly possible, given the will, for the NHS to protect a smaller number of trainees such that rotas can be 1:8 in line with those in other UK Deaneries. The problem arises when trainees are used to fill gaps in service rotas, such that their training suffers – hence building the oft-touted 1:11 rotas becomes one challenge too far.  An alternative would be for each Health Board to make the commitment for non-training doctors to bridge such gaps.

As a profession, we cannot continue to ignore what is going on .The alternative is to see the slash and burn of many elective, and some emergency, services and even more prolonged waiting lists, while the service catches up with the junior doctor staffing crisis that it has had warning of for several years.  As now, the solution to this may end up being patchy, reactive, and ad hoc. Creating hugely expensive waiting list initiatives or transferring patients either to England or the private sector isn’t the answer. Each can be equally wasteful of Welsh NHS money.  That is not to say, of course, that some specialised services couldn’t be provided with closer links with partners across our border, where this has clear benefits for Welsh residents.

There is absolutely no reason why the NHS in Wales should be re-shaped by a “collapse by default”, so 2014 will be a pivotal year – we will either be lamenting the removal of substantial portions of the NHS for many patients, or we will be celebrating a unique NHS for our nation that could be the envy of the world.

Let’s be clear – it doesn’t have to be like this. Only by collaboration and co-operation will the NHS in Wales plan and train it’s way out of this impending disaster.

Yes, there are commentators who believe that the devolved nations can avoid copying the fundamental dismantling of the NHS in England. Our solution to a population living longer and having more complex medical and social needs should have “Made in Wales” written through it.

BMA Cymru Wales remains committed to professional and intellectual engagement during the transition from our current unsustainable position to the new NHS in Wales.

I’m reminded of one of my favourite film lines, where Lord Scrumptious said to Caractacus Potts in the children’s film Chitty Chitty Bang Bang “Had your chance, muffed it”.

As we enter 2014, let us hope that the same cannot be said to those creating the future of the NHS in Wales.

Philip Banfield

 

 

 

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Chairman’s Christmas message 2013

By drphilipbanfield at December 24th, 2013

Dear Member,

Doctors in Wales have spent a great deal of the year examining the state our NHS in Wales is in and where it is going.  Before Francis, Welsh Council had already started to debate the culture that exists within the NHS in Wales and how it needs to change. Fear breeds secrecy, but openness fosters blame if those responsible at the top do not take time to understand how the system as a whole has failed those caring directly for our patients. There is much to learn, yet NHS Wales fails to do so with regular monotony; the ‘system’ remains largely a poor listener.  Whereas it could and should welcome and act on continuous feedback of our service, it seem to have become over-complicated and stifled individuals’ ability to make things better, in favour of a bureaucracy for complaints, concerns and whistle-blowing.  What should be a matter for a continual desire to improve, remains an adversarial-based cumbersome machine, with no prompt mechanism for sorting out what went wrong, for learning why it did, nor for putting it right in a timely fashion. That is what makes a difference to patients and front-line staff.

Any new way of working means understanding how groups and teams best work; how to make broken teams better and how to build cohesion out of a system that seems to be encouraging fragmentation of the continuity of care that was the hallmark of yesteryear. I suggest that part of the answer lies in the professional role of doctors being re-visited and valued – and this is our challenge for the year ahead.  Many of us seem to have become resigned to an acceptance that the future is not in our hands.  I disagree and I know that many of you do too.

Key to me making this statement is that doctors are central to providing clinical leadership in NHS Wales.  This goes way beyond the traditional consultant firm, into the new territory that is the multidisciplinary environment we find ourselves in.  But it is vital to understand what a leader is – “someone who is able to influence those who will follow”, and it becomes necessary to then link it to followership – “the ability to influence those who lead”.  The NHS spends millions on the former and pays scant attention to the latter, then wonders why leaders can’t lead and the front-line staff feel disempowered and under-valued.

At a recent leadership event, organised by the DCMO in Cardiff, the dropped penny was finally revealed. Our ability to lead is not just based on a set of skills and learned accomplishments, but on behaviours and feelings – valuing the people we are asking to do extraordinary work, often in challenging circumstances, every day.  If you don’t care about the carers you cannot expect them to provide the sort of quality and compassion you would wish for. Check out

http://www.leadershipacademy.nhs.uk/discover/leadershipmodel/ not necessarily for the complete answer, but for an interesting take on a new direction that shows great promise, I think.

So in 2013, BMA Cymru Wales has helped move forwards the debate on reconfiguration and service reviews, with the publication of specific guidance on both. Our lobbying strengthened both the Human Transplantation (Wales) and Active Travel (Wales) Acts and we influenced the Public Accounts Committee report on the consultant contract when we highlighted the need for training in job planning. Numerous BMA members have also been supported through their individual problems in the work place.

Our task for 2014 will involve effective union action on consultant and junior doctor contracts, but also the professional contribution we can all make as doctors to take the NHS in Wales forwards, not backwards.  I’m frequently asked “what makes doctors different?” It is intangible and defies easy definition, but I know of no doctor who does not feel that the transition from student to doctor and beyond has not affected them fundamentally. It is this difference that cannot be consumed by apathy or resignation to an NHS that does not work for our patients.  This is why we must not give up on the NHS in Wales, for it needs us more than ever – precisely because doctors are different. And that matters.

I wish you and your families a happy and peaceful Christmas.

Dr Phil Banfield

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Officials stay vigilant for flu over Christmas and New Year

By administrator at December 20th, 2013

By Public Health Wales

In the run up to Christmas and the New Year, health officials in Wales have urged all those in ‘at risk’ groups to protect themselves against flu and stay protected throughout the winter too. This includes all those aged 65 or over, pregnant women, and those with long term health conditions. The usual rounds of coughs and cold are circulating this winter, but health officials are wary that flu could start circulating at any time. For those meeting in large groups of people, or travelling a lot over this festive period, the message of hygiene and ‘Catch It. Bin It. Kill It.’ is especially important.

Dr Richard Roberts, Head of the Vaccine Preventable Diseases Programme at Public Health Wales, has commented: “For most healthy people, influenza (or ‘flu’) is usually an unpleasant, but uncomplicated illness, which usually means a few miserable days at home. However, for those in ‘at risk’ groups flu can sometimes result in serious complications, and can even be life threatening. Because we haven’t seen a serious outbreak of flu for a number of years, people can forget how serious flu can be. These ‘at risk’ groups should be especially careful this winter to avoid catching flu, whilst others should be vigilant not to spread it to others if they have it. By following the ‘Catch It. Bin It. Kill It.’ motto, you can help protect yourself and others from catching flu. Every time you sneeze or cough, catch it in a clean tissue and then immediately throw it in the bin, and clean your hands with soap and water or hand sanitizer. Once flu is spreading widely, apart from vaccination, hygiene is the only method that can help prevent spread.”

The annual flu vaccination programme aims to ensure that the people who need it most get free protection each year against the flu. This includes everyone aged 65 and over and people with certain long term health conditions, as well as pregnant women. This year for the first time a flu nasal spray vaccine was offered to children who were two or three years old on 1 September and school year 7 pupils. The younger children had the spray in their GP practice while Year 7 children received their nasal spray vaccine in school.

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Doctors and Mental Health Survey

By administrator at December 5th, 2013

Guest blog from Dr Debbie Cohen OBE

 

The Centre for Psychosocial Research, Occupational and Physician Health at Cardiff University has launched a new survey to understand doctors’ in Wales attitudes to their own mental health.

 

Doctors are recognised as an ‘at risk’ group for developing mental ill health and there is a growing recognition that this requires closer scrutiny if we are to support doctors effectively in the workplace.  At present we have only a rudimentary understanding of doctors’ attitudes to disclosure of their own mental health concerns and their perceived obstacles to disclose to their workplace.  Understanding these obstacles is important if services in Wales are to deliver effective and timely support.

 

This survey aims to address some of the gaps in our understanding and provide evidence for how such services should be developed and delivered. This anonymous survey is for all doctors, regardless of whether they have personally experienced mental ill health.  If you are a doctor working in Wales and you wish to share your views, please complete the short online anonymous survey available here: 

https://www.surveys.cardiff.ac.uk/doctorsdisclosing 

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Bywyd Doctor FP1: Amser I FEDDWL

By administrator at December 2nd, 2013

Dr Holly Kirk

“A yw’r swydd mor wael a mae’r rhaglen deledu Junior Doctors yn ei bortreadu?”

Daeth y cwestiwn ar amser perffaith i fyfyrio tra’n teithio ar y tren ar brynhawn dydd Sadwrn heb straen gwaith a chloch y beep yn tarfu ar yr isymwybod.

I fod yn hollol onest, mae’n anodd i fi ateb y cwestiwn yn gywir gan ‘dwi byth ‘di gwylio’r rhaglen! 

Roedd fy nychymyg yn byrlymu o hunllefau o beth oedd yn fy ngwynebu ar Awst y cyntaf – y diwrnod cyntaf fel meddyg go iawn.  Doedd dim angen unrhyw gefnogaeth gan y cyfryngau  - diolch yn fawr iawn. 

Y gair Saesneg amdano yw ‘hindsight.’

A dyna’n union fydde wedi bod yn berffaith ar y diwrnod cyntaf  hwnnw – deufis yn ol – ynghyd a’r stethoscope a’r bathodyn GIG. 

Dim dagre, dim bod ar ddihun trwy’r nos, dim chwysu wrth bendroni am y ‘diwnod cyntaf’ bondigrybwyll.

Un o’r gwersi mwyaf anodd i’w ddysgu yn y misoedd cyntaf, yw bod y bod y cleifion yn y gwely ar y ward yn bobl go iawn.  

‘Dyw salwch ddim wastad yn codi’n syth o lyfr meddygol:  mae pobl go iawn yn marw er gwaetha’r gofal gore ac er gwaetha pob ymdrech i’w trin.

Mae’r addysgu yn ôl pob sôn yn para trwy gydol gyrfa a ‘dwi wedi dysgu llawer am fy nghryfderau a gwendidau dros y misoedd diwethaf.

Mae fy ngolwg ar fywyd wedi dechrau newid a bydde fe’n anodd –  bron amhosib i rwystro rhag ‘neud ‘ny i fod yn deg.

Mae’n anrhydedd cael rhannu a chymryd rhan fechan ym mywydau pobl ond hefyd atgoffa ein hunain a herio ambell i ffordd o fyw.

‘Dwi heb weld unrhywbeth sy’n haeddu stori mewn rhyw ffilm arswydus eto, sy’n gwestiwn sy’n codi’n aml. 

Mae pwyslais arbennig ar y gair ‘eto’mewn meddygaeth,

“’Dwi heb gweld un o rheini eto…”
“’Dwi heb wneud y job ‘na eto…”

Mae addewid y dieithr yn bodoli a mae rhaid dod i barchu hynny a’i gyfarch fel sialens.   

‘Dwi eisoes wedi cael nifer o brofiadau emosiynol.  Dyma eto sgil anodd i’w fabwysiadu: y sgil o ddangos emosiwn a theimlad ar orchymyn ac nid trwy reddf.  ‘Dwi’n aml yn egluro i bobl fod gen i ddau ben: un meddygol ac un personol ac mae hyn yn rhoi rhyw fath o gysur i fi ac i’r claf fel arfer. 

Er gwaethaf fy ymdrechion gorau wrth adael yr ysbyty gyda’r nos, mae’n amhosib troi ‘nhefn ar yr atgofion, y teimladau a’r  amheuon, a mae hynny’n aml yn llawer mwy poenus a blinedig na’r gwaith ei hun.

Er gwaetha hyn oll, fydden i byth yn newid fy swydd. 

Mae’r  profiadau yn wobrwyol ac yn ostyngedig, gyda’r  pwer i ysbrydoli rhywun.  Mae gwers newydd i’w ddysgu o sut i ddelio â phob un claf.  Wrth gwrs ‘dwi’n mwynhau fy niwrnodau rhydd, ond ‘dwi hefyd yn mwynhau fy niwrnodau ar y ward.

Felly, i geisio ateb y cwestiwn; a yw’r swydd mor wael a’r rhaglen?  Heb os mae diwrnodau gwael ym mhob swydd a ‘dyw bod yn feddyg  ddim yn wahanol   Ond wedi dweud hynny mae’r diwrnodau da fel lluwch aur ac o’m cadair esmwyth gartre, mae adlewyrchiad y lluwch yn cuddio’r atgofion cas.

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Junior Doctors: Take a breather

By administrator at December 2nd, 2013

by

Dr Holly Kirk

Someone recently asked me about life as a junior doctor, “is it really as bad as the tv programme?” they said.

I suppose the question came at quite an opportune time for reflection; on a train on a Saturday afternoon minus work, minus stress, over two months into my F1 year.  I couldn’t in all honesty answer the question fully as I consciously chose not to watch any series of Junior Doctors: Your Life in Their Hands.  I had already created an image of what the 1st of August would look like – blood, sweat and tears – which terrorised my dreams for a good few balmy July nights.  No further encouragement needed thank you very much. 

Hindsight is a wonderful thing, and if that could be given to a new F1 along with a stethoscope and an ID badge on the first working day; it would be a lot easier!  There would be no mention of black Wednesday, no sleepless nights and be no tears in the corridor, but we live in reality. That’s one of the hardest things to grasp in the first few months.  The reality of real working life away from the student cocoon, where patients don’t present as textbook cases, the system doesn’t always run smoothly to the detriment of some people’s health and despite best care, some patients die.

Not only have the first few weeks proved to be an incredibly steep learning curve within my career but also as an individual. I’d probably be at one of my strongest positions to date to be confidently able to identify my strengths and weaknesses.  I would even say that my outlook has changed on life quite significantly and quite rightly so.  To be drawn into people’s worlds and to become snap shots within their life stories; it inevitably raises questions, nurtures intrigue and challenges thoughts and one’s own behaviour. 

I can’t honestly say that I’ve seen anything terribly gruesome yet, which is another  favourite question. ‘Yet’ is a fairly prominent notion in medicine truthfully…

“I haven’t seen one of those yet…”

“I haven’t done that yet…”

It is a continuum, there is a lot of unknown and anticipation but there is drive, commitment and hope and it is the latter which I have come to love about my profession. 

Maybe not gruesome, but sad, emotive cases I feel there have been a few.  This is one of the hardest lessons in medicine; to train an almost inherent emotion to behave and only perform on command.  I’ll often say to people that I have two heads; one for academic medicine and one for the normal person.  Obviously not strictly true but it gives me comfort and the patient comfort in dealing in stressful situations.  But as soon as I get back into my car and start my journey home the normal human person head is the one I’m inextricably left with and the emotion, reflection and thought left with that one is often painful and exhausting. 

When all is said and done, my job is incredibly rewarding, humbling and inspiring.  Every day is a challenge and every person is a new case and a new experience. 

So in answer to the question; is it really as bad as the tv programme? Every job has its bad days and being a doctor is no different, but the good days, the successes are like gold dust and where I am sat right now, the glare from that sparkle is blocking out most of those shadowy memories. 

 As seen in The Western Mail 02/12/13

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Negotiations are in progress….

By administrator at November 28th, 2013

Another really really busy few weeks both in and out of the surgery meaning lots that I could focus on. However, I think I should concentrate on the Welsh GMS contract negotiations as the announcement of the English negotiated agreement has led to me receiving a number of urgent texts, phone calls and emails asking what this means for us in Wales especially around seniority.

Firstly, I must emphasis that the English agreement does not apply to Wales – our negotiations with Welsh Government are in progress.

It is fair to say that GPs in England work in a very different environment than those in the devolved nations. GPC Wales has a good working relationship with Welsh Government who have listened to our concerns about workload demand in General Practice, practice anxieties about stability of funding, and the impending recruitment and retention problems within Wales.  This has led to us having a shared understanding of wanting to reduce bureaucracy, reduce inappropriate workload on GPs and move away from tick box medicine to enable GPs to return to the art of holistic General Practice.  We are looking at QOF (including mechanisms to revise QOF QP to focus on networks) and Enhanced Service commissioning. The details of negotiations are confidential at present but we hope that GPs in Wales will see a significant impact on workload if the changes we are negotiating are agreed.

Seniority has not been raised in Wales (nor in the other devolved nations to my knowledge). In England, the Treasury had made a commitment to remove pay progression awards. English dentists had this removed without any concessions etc some time ago. GPC UK has managed to ensure the seniority monies are not lost to GMS – it will be recycled into Global Sum over a 6 year period and not just taken away immediately. Will Welsh Government do the same I hear you ask? We shall have to wait & see. Welsh dentists still receive it and Welsh Government are very well sighted on the recruitment / retention issues!!!

Other important areas in brief:

  • Flu & shingle programme issues still ongoing and being highlighted to Public Health Wales, Welsh Government etc
  • Date extraction toolkit (currently Audit +) re-procurement – 1st part complete –practices will be advised of the outcome in due course.
  • First survey results in – interesting reading and fits with what we are working on – will send an overview of this soon.
  • Workforce solutions meeting to look at urgent solutions that can be put into place – Welsh Government are aware this is urgent.
  • We have agreed wording to protect practice QOF income in event of significant data loss in migration during system of choice change
  • We have agreed how Health Boards will manage adjusting QOF scores due to lack of availability of services / guidance on biopsychosocial assessments coming in mid way through year
  • We are chasing the indemnity issue for OOH doctors – a letter has gone from Welsh Government inviting the 3 main defense unions to engage in discussions about:

i) block contracts for GPs working OOH recognizing the rising costs

ii) looking for reasonable costs for those doing odd shift occasionally to help out the OOH service

iii) looking for reasonable costs for covering those that may consider coming out of retirement to assist in event of major pandemic.

It has now been confirmed that Welsh Risk Pool will cover all OOH GPs so each HB can offer this. Therefore, check with your OOH provider to see if this has been implemented – if so, then contact your defence organization to see if this will reduce your premiums. You will remember our concerns about just relying on Welsh Risk Pool as this only covers clinical issues and not professional issues so we need to ensure individual GP covered fully and not left vulnerable but also need to ensure GPs who are willing to work OOH can do so without it being prohibitively expensive. We shall update you once we know if the defence organisations are interested in block contracts but for the time being we advise you to have separate defense cover as well as Welsh risk pool cover.

  • Still uncertainty as to whether 4 year GP training will go ahead in Wales – GPC Wales, RCGP Wales & Deanery working hard to enable all involved to understand the risks of not having a 4 year training programme.
  • Planning on working with RCGP Wales to lobby for General Practice to receive a fair share of NHS Wales funding – it has dropped year on year yet ever more work and demands are placed on General Practice. This will inevitably mean some difficult conversations for Govt / Health Boards and Secondary Care but if the financial resources need shifting if we are to truly invest in, and develop, General Practice.
  • GPC UK recently launched their vision – “Developing General Practice Today: Providing Healthcare Solutions for the Future” – well worth a read. Our specific Welsh document coming soon.

Keep an eye for our workforce & sessional surveys coming in next few weeks. We appreciate your time in completing these – they are important & do make a difference.

We shall be holding a series of meetings across Wales in the New Year – we will obviously be talking about contract but want to hear your views / questions / concerns on any relevant issues so please do attend if you can. More details of dates and locations to follow.

I hope this update brings clarity on what is happening in Wales – now, if only organizing my daughter’s 14th birthday party and ensuring my son has done his homework were as straightforward.

Lastly, I just want to say how much I enjoy hearing from you so, please don’t hesitate to contact me at: info.gpcwales@bma.org.uk or tel: 02920 474614.

Yours,

Charlotte

@MadameGPWales

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Doctors from Wales who served in WWI

By administrator at November 27th, 2013

BMA Cymru Wales are trying to trace details of doctors from Wales who served in World War I.

If you can help, please contact John Jenkins at:

Address: BMA Cymru Wales, 5th floor, 2 Caspian Point, Caspian Way, Cardiff. CF10 4DQ

Email: jjenkins@bma.org.uk.

Telephone: 029 20 474646

Thank you! Please spread the word!

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One flu over the cuckoo’s nest

By drphilipbanfield at October 24th, 2013

Encouraging all NHS staff to have the seasonal flu jab – is a good idea, but making it mandatory – is not! There are examples from the USA of some health organisations “punishing” staff who do not have an influenza jab by making them wear a face mask - in my humble opinion, this is not the way to approach the issue of increasing levels of staff immunisation.

The BMA does not support compulsory immunisation of the public; so any proposal for compulsory immunisation of staff, when discussed both at Welsh Consultants Committee and Welsh Council – was also soundly rejected. BMA Cymru Wales is happy to work with employers and Welsh Government on strategies to increase staff uptake of influenza immunisation   – but punitive approaches or compulsion would NOT be part of it!

It didn’t take long during our discussions to agree on how miserable flu is – with a number of anecdotes reminding us how “proper flu” does have a mortality and significant morbidity rate. Vaccination is undoubtedly effective in preventing the overall personal risk of flu – and that is a very good thing. 

So BMA Cymru Wales is asking all our members who do not have a contraindication to step forward and have the flu-jab this year. If you have your flu jab outside work –  let your occupational health service know. 

Also let them know if you encounter obstacles and difficulties in getting your jab – and let us know too ! We have already made the observation that secondary care is more than a month behind general practice in starting its programmes and that occupational health in both sectors is severely under-resourced.

So if employers could do more to address the difficulties that staff encounter in easily accessing the flu jab we’ll try to do our bit, too please. If we are to make progress on a collaborative approach to professional engagement with changes in our NHS, let’s use evidence properly and not get side tracked by bad science – an unwanted cuckoo in the nest! 


Click here to watch Dr Richard Lewis in conversation with Dr Mark temple on this issue.

Philip Banfield
Chairman
BMA Welsh Council 


 

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The first of many regular blogs from GPC Wales Chair, Dr Charlotte Jones

By administrator at October 23rd, 2013

Have we had a lull in demand over the Summer / Autumn period? If we have our surgery must have missed it…..with Winter rapidly approaching (and I do wish radio and TV adverts would stop counting down to Xmas as that is causing me much stress not having thought of food orders / presents etc) then demand is only going to increase.

So do I have any good news? Sadly not yet but what I can tell you is that we are working on Welsh contract negotiations currently and have agreed with Welsh Government that the principles we both wish to work with are: reduced micromanagement, reduced bureaucracy, enabled individualized care to patients and some trust back in the profession. We also want to see significant reductions in QOF and in particular changes to QOF QP. There are other areas up for negotiation / discussion too including MPIG and again, please rest assured, we are extremely mindful of the concerns of individual GP practices as are Welsh Government and the Minister. More to follow…..

Some of you will have had a “lovely” letter which is definitely no early Xmas present and will have caused enormous anxiety at the prospect of an additional tax bill. The issue is extremely complicated – Dr David Bailey has written a briefing for GPC Wales and UK which will be available shortly – we will send you an email alert when you can access it. You should of course speak to your accountant too.

The flu and shingles vaccination programmes are causing concern at GP practice level for delivery of the programmes. There are reports of some patients getting the vaccine twice thus not just depleting NHS resources but also potential safety concerns for the individual, mixed messages on advice re: vaccinating children and immuno-compromised and also delays to delivery of shingles vaccine meaning that practices are going to end up with additional work to contact eligible patients when it should have been straightforward to give during flu campaign. These issues were raised locally and nationally both before the start of the campaign and since the programme has started to PHW and the CMO – we will be specifically speaking to the Minister about these issues next Tuesday.

So, is there light on the horizon? I firmly believe that we need to make significant changes to those elements of the contract we can to reinvigorate and re-energise our GP workforce to enable them to enjoy their job. The proposals we are working on with Welsh Government should be a good start in that direction. Am sure that if GPs are given flexibility of  frequency of when / how to review patients then they will masterfully rise to the confidence placed in them.

Additionally, we need to work on making general practice an attractive career prospect – that means getting it right for those of us working in the profession now and encouraging medical students, 6th form prospective med students and doctors in training to consider General Practice. I absolutely love my job, the patient contact I have, providing continuity of care where patients need it (or just simply being accessible when they need an acute problem sorting), the variety of roles that General Practice enables one to have and the autonomy. Just need to make some significant inroads on some of the inappropriate demands and expectations placed on us and think about what patients really need from General Practice – putting patients at the centre, and enabling GPs to support this is what will make NHS Wales and General Practice survive going forward.

We will be publishing our vision for General Practice shortly and I do hope you will take the time to consider its contents and give us your views!

Love, Charlotte

@MadameGPWales

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The draft budget

By Richard Lewis at October 8th, 2013

The details of the draft budget were announced this afternoon. We very much welcome the investment into a new Intermediate Care Fund as well as the enhancements to Health Technology funding which is long overdue and deserves even more attention. The Telemedicine Fund has also seen enhancement although significant benefits from this area are slow to realise. 

It is widely accepted by the profession that this will be a difficult year for health, and it has never been more important for resources to be targeted at frontline care. Doctors and healthcare staff need to know that our limited resources are being targeted at services that matter to patients and support their day to day work.

The Government need to be honest with the profession and the public about what can and cannot be delivered in these financially straightened times. There has to be a focus on clinical priorities and safe services there is no room for unnecessary bureaucracy and empty targets.

To secure the anticipated benefits of service change and reconfiguration planning must be realistic yet contain the detail necessary to secure professional and public confidence; robust workforce planning is essential. 

The funding made available must make the strategic intent of NHS Wales a reality, in order to deliver affordable quality healthcare to the patients of Wales.

It will require strong political leadership to inform the public of the challenges that lie ahead; and equally to put trust in health professionals to assist in overcoming those challenges.

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An unacceptable act

By Richard Lewis at September 26th, 2013

I felt incredibly angry this morning when I saw the news about the sale of “mental patient” fancy dress costumes at Tesco and Asda.

Campaigners and charities are working tirelessly to change attitudes towards mental health illness, and such thoughtless, stupid acts set us back years – and reinforce out of date attitudes – at a time when we think that progress is being made.

The imagery portrayed by these costumes promotes a picture of a person with a mental health illness which is just not true. It is totally unacceptable for such established household names to have made such an error of judgement.

The stigma surrounding mental health can inhibit many patients from telling anyone how they feel and sadly for some, it can be life threatening.

It remains vital that we tackle stigma so that people can feel able to access the available support, and know that when they ask for help that they will not be judged.

We battle on.

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