My colleague and Chair of the Welsh Junior Doctors Committee Dr Dai Samuel (pictured) looks at the year ahead for junior doctors in Wales.

“2010 brings new and ongoing challenges for the Welsh Junior Doctors Committee. With the introduction of the EWTD back in August 2009, as a committee we are constantly reviewing the impact this is having on the working and training lives of Doctors in Wales. Being part of external groups such as the Junior Doctors Review Group offers the BMA a voice within the Welsh Assembly Government as well as the Wales Deanery and I hope our relationship with both these organisations continues to flourish in the new year.

“An exiting project which will come to fruition this year will be the development of an Ambassador role for junior doctors in Wales as well as working with the Deanery to nurture a network of doctors working on the front line to assess and discuss issues relating to Quality Assurance in medical education.

“Our committee grew and matured last year and I hope that conference 2010 will prove a successful one for the committee. Establishing equal voting rights for devolved nations on JDC have been a source of concern in recent times and this will be undoubtedly be debated at conference. Negotiating a new contract lies on the horizon for UK JDC and I relish the challenge of ensuring that doctors in Wales get a palatable and attractive offer to remain here to work and live. This issue never strays far from the top of the agenda with WJDC and we continue to look at what could and does make Wales a unique place to live and work as a doctor. Links with WMSC continue to mature and I hope I can help encourage students to become doctors in Wales, and members of WMSC members of WJDC!

“My hope is that the committee will attract new members, particularly from hospitals away from the capital city. Our roadshow tours to hospital messes are proving popular and hopefully planting the seeds of interest for new members to attend a committee meeting! Seeing how we can change things and interact with Chief Executives of Local Health Boards is an example of how grassroot members’ voices and opinions have channelled our work plan this year.

“WJDC looks forward to working BMA Cymru, Welsh Council and other professional colleagues in 2010.”

Dai Samuel Chairperson WDJC 2009-2010

Are you a junior doctor in Wales? What are your thoughts on issues facing junior doctors for the year ahead?

“I expect this to be a difficult year for Consultants in Wales as we see the financial belt tightening further.

“With 7 to 10 % Cost Improvement programmes up and running in the new LHBs, the prospect of a further 10% cut in the budget allocation to Wales and demand ever increasing for specialist services, we can expect a tough year or two ahead.

“I have written before about the pressures on Consultants to fill gaps left by EWTD, and there is increasing evidence that poor planning by Trusts (and now LHBs) is leaving consultants to pick up the pieces.

“Is there any good news?

“Well, the Access targets are likely to be relaxed as the NHS simply can not afford to treat all patients within the 26 week timescale. The Minister herself has emphasised the need to treat patients on the basis of clinical priority as determined by Consultants.

“Revalidation may not be embraced quite so willingly by governments with stretched finances and little evidence of the benefit that this additional bureaucracy will bring.

“BMA Cymru Wales is exploring the possibility with partners of a Wales solution to revalidation.

“It may be a year or two before we see the benefits of integrating primary and secondary care, but there remains the real possibility of Consultants being able to lead the delivery of specialist care whether in the acute setting or in the community in partnership with GP colleagues.”

Wishing you a happy new year.
Dr Stefan Coghlan
Chairman WCC

Do you agree with Stefan’s predictions? Are you a Consultant in Wales? What are your predictions?

The European Commission must do more than “threaten” to investigate these allegations highlighted in The Sunday Times, it has a duty to do so, for the safety of both patients and NHS staff.

Junior doctors in Wales can also report their concerns to the BMA and they don’t need be a member to do so. Any information given will be kept completely confidential. Help us to help juniors by ringing the BMA on 0300 123 123 3 and select option seven.

Show your support for the Option 7 Campaign on facebook too, by joining one of our groups, follow the links below.

BMA Cymru Wales Option 7 Campaign facebook group

BMA Cymru Wales Option 7 Campaign Supporters of junior doctors facebook group

The problem‘s been highlighted this week within Hywel Dda NHS Trust, where 62 posts remain vacant.

But this situation is by no means isolated to Hywel Dda, with Abertawe Bro Morganwg Trust having had to move some specialist services because they were inadequately staffed. Similar problems are also affecting North Wales too.

We are facing unprecedented levels of a lack of middle grade and junior doctors right across Wales, which is clearly unacceptable to both our members and people needing hospital treatment and this does not look like changing in the immediate future.

There are a variety of reasons for this shortage, one being that Wales does not top the list of places where many junior doctors desire to work. Also, changes to the rules regarding immigration have caused problems with recruitment across the whole of the UK, not just Wales.

The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas. This is compromising consultants’ ability to deliver routine daily work and there is no evidence that hospitals are adjusting services to take these shortfalls into account. Inevitably, the rates of work being undertaken cannot be sustained with the current levels of staffing. Hospital managers really need to address this now, working with clinical colleagues.

These problems come as no surprise however to us at the BMA, having predicted that these shortages would happen at some point. That is why we have, for some time now been trying to meet with representatives from the Welsh Assembly Government, to see how we can work together, drawing on the experience of front line doctors, especially juniors, to look for some solutions to the situation.

BMA Cymru Wales has also worked in partnership with the Wales Deanery for Postgraduate Medical and Dental Education, to produce a DVD for students, giving an invaluable insight into medical training here.

The aim of the video is to promote Wales as a primary destination to study medicine and to attract more junior doctors to apply, to complete their postgraduate training here. However, the positive effects of this will not be seen immediately.

The initiative to provide free accommodation for F1 doctors has been welcomed by BMA Cymru Wales and has had some impact. Yet, I think far more effort should have been put into anticipating and planning for the current shortages, especially the impact of the European Working Time Directive which has been known about for more than 13 years! Whilst it is very late in the day, I urge the Welsh Assembly Government and employers to focus on the actions we have been highlighting for some considerable time. I do not think sufficient, co-ordinated efforts to recruit and retain doctors to Wales has been made.

While in the short term, we have to have contingency plans put in place as soon as possible to ensure the safety of both NHS staff and patients, we need far more sustainable solutions if NHS Wales is to deliver and maintain the quality and capacity of services the people of Wales deserve.

We heard the reports from chairs of the following branch of practice committees: general practice; private practice; staff and associate specialists; medical students and junior doctors.

A number of issues within those professions were debated. Conference was treated to a notably lively and impassioned debate on student fees. This is something the Welsh Medical Student Committee (WMSC) has been working on in recent months following the Assembly Education Minister’s proposals to re-focus higher education in Wales.

I know that the Chair of WMSC, Elliott King, has spent many hours considering the implications of the proposals for medical students in Wales and along with the Committee has crafted BMA Cymru Wales’ response to this, at the same time as sitting his own final year exams. I’m looking forward to welcoming Elliott back as Dr King next term given his recent finals success. Congratulations to Elliott and all those who’ve passed their exams.

Conference heard from students who will be graduating with a crippling debt of more than £30,000.

The important area of medical education and training for Junior Doctors also delivered a lively debate. The mention of EWTD, working patterns, rota gaps and student/teacher ratios were met by jeers from fellow Juniors and other delegates. Again the issue of free accommodation for Junior Doctors was discussed. I wonder just how long it will take other nations to follow Wales lead and recognise the value of this important policy.

The surprise here actually comes in the estimate of how many junior doctors the Government predicts will soon be working on non-compliant rotas – 6% out of 600 in Wales. I’m not quite sure how that figure is arrived at, considering not so long ago, the Auditor General for Wales found that more than half of junior doctors in Wales were working more than 48 hours a week.

A real concern for us, and it should be a massive one for patients too, focuses on hospitals which may bring in rotas which meet EWTD compliance, but in practical terms, are unworkable and could jeopardise the safety of both NHS staff and patients.

In the longer term, it will also have a knock-on effect for the future doctor workforce of the Welsh NHS, with crucial training and educational activities being missed, just to provide the basic cover for patients.

We have been warning the Welsh Assembly Government about this for many years now, so it’s a shame that we’re in a position where we are just weeks away from EWTD coming into effect, yet the Welsh NHS seems to be light years away from being ready for it.

The effect of vacancies will be exacerbated in August with the introduction of the European Working Time Directive. The adverse consequences of unfilled junior doctor posts and its impact on the ability to deliver patient care cannot be overestimated.

I didn’t, however, appreciate just how bad the effects are being felt NOW, until I met with some junior doctors in South Wales, and heard some worrying concerns about many aspects of their training and development. They highlighted a range of issues, only some of which I’ll outline here:

A&E on-call rota
I was told of instances where F1 and F2 doctors are merely acting as clerking machines, which isn’t allowing for teaching on post take ward rounds. Rotas are also being used as a fast-track, in order to maintain the four hour A&E targets set by but this doesn’t provide opportunities for juniors to learn.

Rota gaps and lack of cover on wards
I also heard of how F1 doctors are being left without senior support on wards, for days at a time. Rota gaps are so widespread within the majority of specialities, there isn’t any advertising in advance for any known gaps and I was told that whilst medical rotas appear to be compliant on paper, that doesn’t actually translate into reality.

Locum cover
The meeting highlighted how there’s no real effort made when it comes to finding locums, instead juniors are being called back from annual leave to cover, with locum rates here being apparently half those in England; this is no way improve morale or make Wales the premium destination for junior doctors, especially when it is undertaken in a climate of bullying and intimidation.

Nurse Practitioner intimidation
Anecdotal evidence was also relayed to me about how Nurse Practitioners are prescribing medications and fluids and then demanding that doctors sign for them, even though the Nurse Practitioners are meant apparently to be independent prescribers. Junior doctors also felt that some working arrangements left them restricted and limited in their exposure to the range of clinical experience necessary for their training, especially when managing problematic patients.

I could go on, but I think this highlights the sort of issues facing junior doctors in Welsh hospitals. BMA Cymru Wales is so concerned about all of this, it is considering an initiative led by Welsh Council and the Welsh Junior Doctors Committee to take these matters up with the relevant employers.

Unless urgent action is taken to address these matters, our ability to attract the best to Wales will be thwarted. And that would be a shame as the direction of travel of the WAG and the Health Minister, Edwina Hart, to get back to the core values of the health service is something the BMA welcomes. It is a system that doctors should be queuing up to be a part of. Let’s all get on the case of the problems, have more ambitious aspirations and ensure the patients of Wales receive the high standard of services they deserve.

Expect to hear more about this over the coming weeks, this blog post won’t be the end of the matter!

If you have concerns as a doctor working in Wales, or a patient receiving care here, over any of the issues highlighted in this post, then please tell BMA Cymru Wales about them! You can do so just by leaving your comments on this blog post, anonymously.

The Directive puts a limit on the working week of 48 hours for all employed doctors, including junior doctors, and it must be implemented by Trusts in full, no later than 1st August this year. Junior doctors were excluded from the original legislation because of the nature of their training, and the limit of 48 hours was to be phased in.

The deadline is fast approaching and despite the fact Trusts have had (literally) years to prepare for it, to say that we are still some way from being ready to move to a reduced working week, and thus ready to ensure essential protection for doctors and patients, is a massive understatement. This was highlighted by the Wales Audit Office just a few weeks ago.

A number of key messages came out of the Policy day, including drastic junior shortages, compounded by insufficient numbers of consultants to fulfill requirements of services to patients whilst at the same time trying to provide the dedicated and comprehensive training and support juniors need.

Also, members, with frontline-delivery experience, suggested a number of solutions in order for Wales to prepare and to cope with the implementation of EWTD. BMA Cymru, as the voice of doctors in Wales, will be taking these up with the Health Minister and with Welsh NHS Trusts in the next few weeks and as we approach the August deadline.

But with the situation already dire and morale amongst junior doctors at an all time low, without central support and adequate preparation from Trusts there is a significant threat to the current standard of medical training, to the delivery of healthcare provision, and to the quality of patient care as a result.