Thursday 4 July 2002
Doctors not to blame for systems failures, ARM told
Doctors should not be blamed for systems failures, the ARM was told.
Hertfordshire GP John Sterland said the NHS system in which doctors operated must recognise that doctors were human and would develop by learning from mistakes. He said: ‘Doctors are part of an ergonomic system and the time for scapegoating is past.’
Sheffield specialist registrar in obs and gynae Meenakshi Dass called for a culture change, adding: ‘We must shift away from demonising individual doctors to looking at underlying systems that may cause error.’
Act now on locum pensions, doctors tell government
Doctors have called on the government to act now to address its failure to include all GP non-principals in the NHS pension scheme.
GP leaders understood last year, after difficult negotiations, that they had a deal that all locum income would be superannuable from April 2001.
But when the BMA received draft regulations in January, doctors found they excluded locum income where a doctor also worked as an assistant or principal practitioner, although they included any locum who also had a hospital post.
Cleveland GP John Canning said the government had reneged on its promise and this time ministers must deliver. ‘It’s local medical committees conference policy that if pensions issues are not managed properly the new contract will not be acceptable.’
BMA superannuation committee chairman Simon Fradd said doctors doing locum work should keep the necessary records because it was his firm intention that changes should be introduced before the end of the financial year.
Implement occupational health schemes now, doctors tell PCOs
Primary care organisations must put in place occupational health schemes they are required to implement as soon as possible, doctors said today.
Harrogate GP John Givans said PCOs had been given significant government funding to provide schemes but large amounts had vanished into a ‘black and mysterious’ hole.
He said PCO management had prioritised other issues, such as paying off inherited deficits, for which they could face disciplinary action or even dismissal, but that failure to implement occupational health schemes carried no such threat.
Dr Givans said many schemes were paying lip service to the government agreement and in many PCOs there was still no provision. ‘We need a service provided by competent, appropriately qualified and trained staff. We demand PCOs honour their obligations to provide a comprehensive service now.’
Doctors reject CCST downgrading
Doctors have opposed any move to reduce the standing of the UK certificate of completion of specialist training and the introduction of a subconsultant grade.
They have said there should be no backdoor route of post-CCST specialist training following a shortened period of specialist training.
Some of the UK’s royal colleges have already worked out models of how the CCST could be changed.
The Royal College of Paediatrics and Child Health has said the CCST would indicate the ‘completion of a period of formal training as a specialist . . . rather than being equivalent to the competence expected of an NHS consultant’.
Southampton GP Alex Freeman told the ARM she regretted that ten years after implementation of the Calman reforms the positive changes were threatened.
Joint Consultants Committee chairman James Johnson said neither the BMA nor the JCC would support the introduction of a subconsultant grade.
Lancashire consultant in obs and gynae Alan Russell said obstetricians had been leading the rush towards a consultant delivered service, which would require round-the-clock consultant care.
He said: ‘People taking the posts need to be consultants, not some sub-consultant grade.’ He added that they should have consultants’ pay, security of tenure and the benefits of the new consultants’ contract.
Tax-funded NHS is best, doctors say
Doctors have reaffirmed their commitment to a tax-funded NHS and rejected fresh calls for patient charges.
Birmingham specialist registrar in public health Richard Brighton told this week’s ARM: ‘It is quite clear that the most equitable form of funding the NHS is central taxation. Systems of insurance are based on those at the least risk paying the least. We must see the NHS as being for those in greatest need.’
Pointing to the report earlier this year by former NatWest Bank chief executive Derek Wanless, which said the NHS should continue to be funded by central taxation, Leeds consultant anaesthetist Ian Wilson said: ‘I don’t have any doubts about the ability of the country to pay for a tax funded system.’
East Yorkshire GP Andrew Green said it would be more difficult for GPs to give frank advice and refuse inappropriate prescription requests if they had to collect charges. And Cardiff GP Andrew Dearden said charges would mean patients facing the choice of paying for household essentials or visiting the doctor.
Doctors reject assisted suicide calls
Doctors have rejected calls for the 1961 Suicide Act to be amended to give physically incapable individuals help to take their own lives.
Southampton GP Alex Freeman argued that the proposals were not sanctioning physician-assisted suicide, which the BMA has consistently rejected, but was extending patient autonomy in a very small minority of cases.
She referred to the case of motor neurone disease sufferer Diane Pretty, who took her plea for her husband to be immune from prosecution if he helped her die to the European Court of Human Rights and lost.
As the law stands, people who attempt suicide are not prosecuted, but it remains an offence to assist a suicide and is punishable by up to 14 years’ imprisonment.
Dr Freeman told the ARM: ‘The current legislation is outdated. This is not about whether suicide is morally wrong. This is about allowing patient autonomy for a very, very small minority.’
But Kent GP Hugh Robertson-Ritchie said doctors would inevitably be drawn into helping patients commit suicide, which would be unethical.
BMA medical ethics committee chairman Michael Wilks said there was an ‘unhelpful’ gap between what the law said and what the law did. He said very few people who assisted a family member to commit suicide were dealt with harshly by the courts.
He suggested there could be a case for creating a lesser offence or reducing the maximum sentence imposed, without decriminalisation.
Doctors raise human cloning concerns
The government should take the lead in negotiating an international ban on human cloning for reproduction purposes, doctors said today.
Worcestershire consultant paediatrican Anthony Cole said most doctors opposed cloning humans, but some would exploit the lack of international legislation.
Doctors at the ARM reaffirmed their support for well-regulated research using human embryos because of its potential for saving lives and transforming treatments, despite calls for it to be halted. They also backed calls for more research involving adult stem cells.
Birmingham GP Gregory Gardner said embryos created by cell nuclear transfer were undoubtedly embryonic human life and there were concerns over whether other human beings should be used for research whatever their stage of biological existence.
But BMA medical ethics chairman Michael Wilks said: ‘The BMA strongly supports stem cell research because we believe it has enormous potential to save and transform life.’
Doctors call for rethink on sperm donor anonymity
Doctors leaders will have to re-examine BMA policy on sperm donor anonymity after the ARM backed calls for anonymity to remain.
The BMA medical ethics committee has supported possible government moves to insist the names and details of sperm donors can be made available to any children that resulted from fertility treatment. Their views were backed by BMA council earlier this year and sent to the Health Department in response to a consultation paper.
But doctors at the ARM called on council to look again at the issue.
Retired Berkshire community paediatrician Joan Black said removing donor anonymity could have ‘very serious consequences for fertility treatment’, particularly when one in six couples were now seeking medical assistance to have children.
She said there was a moral dilemma between balancing a child’s right to know their biological father and the sperm donor’s right to remain anonymous.
BMA medical academic staff committee joint deputy chairman and medical ethics committee member Peter Dangerfield said the arguments for and against donor anonymity were finely balanced, and the committee had reached its decision in the interests of ‘fairness and equity’.