Workforce, training and education
Yorkshire and Humber

News

News Editor : Richard Muirhead MBBS MSc DA FRCA

Retired Associate Specialist, rmuirhead@compuserve.com

Last edited 21 July 2020

IMPORTANT - PLEASE READ. 

This website is no longer edited as I retired from work over 6 years ago and have reached the age of 65.  It can be a very interesting role: are you interested? If so could you let myself or Mark know.

Writing and editing HTML is not really any more difficult than using a word processor. The tutorials that currently exist are detailed on the "resources" page, including my own "quickstart guide" for use by anyone interested. Further tutorials and help files will be listed there when available.


So you can quickly see what's new, the date alongside the category name shows the last edit.

 

The government has announce a pay rise of 2.8% for SAS and consultants, backdated to April.

Baroness Cumberlege’s NHS review has been published. Read about it at the official website.

Racism in medicine (14 February 2020). Read about it here.

There are new reports regarding Brexit ( 12 June 2020 ).

There is a new section for Coronavirus ( Covid-19 ) which has arrived in all its glory. There are a number of NHS and GP responses - see the appropriate section below. Emergency measures have been law, but are being relaxed. Testing is said to be being extended to health and care staff, but this seems largely of antigen presence: there are calls for antibody tests to be made widely available, but these are currently unreliable . Information about how it affects your contract may be found here.

The lack of PPE ( Personal Protective Equipment ) in the NHS remains dire. Current BMA advice will be in the Resources section. Medscape UK reports ( 07/04/2020 ) a Doctor's Association UK review.   Disposable coveralls are now being offered in place of gowns.  Should we all wear face masks all the time? There is some evidence of a protective effectSee also the recent( 18/04/2020 ) BMA survey and press release.  Read the  BMA advice regarding inadequate PPE.  There are reports of court action over PPE prevision. Evidence from China supports the view that adequate PPE prevents staff acquiring Covid-19 from patients. There are also reports that PPE is not designed to fit women.

Bullying and fatigue is reported and has led to an increase in burnout and other metal health problems. Government advice is being questioned.

Public Health England has published the 'missing' second part of its report on the impact of COVID-19 on BAME communities (16/06/2020). The delayed report is called  Beyond the data: Understanding the impact of COVID-19 on BAME groups and makes seven recommendations:

  • Improved data collection about ethnicity and religion, including on death certificates

  • More research with participation of BAME communities on risks and mitigation

  • Improving BAME groups' access, experiences, outcomes with NHS and other services

  • Developing 'culturally competent' occupational risk assessment tools

  • Developing culturally sensitive education and prevention campaigns

  • Targeted culturally sensitive health campaigns and disease prevention programmes

  • Ensuring that COVID-19 recovery strategies actively reduce inequalities for long-term, sustainable change.

The mental health of doctors continues to be an issue. See the results of the recent ( 01/06/2020 ) BMA survey.

Public Health England have published its review of susceptibility to Covid-19 and confirmed the increased risk to BAME persons.

Indications that the peak ( at least of the first phase ) of Covid-19 may be passed, but the BMA point out that there is still a need for PPE.

Lack of provision of childcare has been highlighted by Covid-19.

It is also time to consider salaries and pensions: I report links to the BMA summission to the DDRB and Chaand Nagpaul's recent letter.

After a paucity of news during December 2019, the New Year opened with Health and Safety problems. Read the report here.

The pension crisis continues to drag on. In the March 2020 budget the government has reduced substantially the burden upon senior doctors. See the BMA news report for full details

Occasionally blogs can be interesting: in particular "Who are SAS doctors anyway?".

If you are disabled please see the recent BMA Survey.

The new year also brings a flurry of activity regarding burnout and safety issues, including a GMC report "Caring for doctors - Caring for patients",   "GMC: specialty, associate specialist and locally employed doctors workplace experiences survey: initial findings report" and a September 2019 report from the MPS "Breaking the burnout cycle. Keeping doctors and patients safe" previously not known to me.

The BMA has issued a survey about disability: please read and respond. It is open to both BMA members and others

Negotiations for a new SAS contract are expected soon.

The DDRB report for 2019 has now been published ( read it here ). It appears we get 2.5% - hardly a fortune! Read the government response. It has been reported that a further 1% has been witheld pending a new contract.

 Health Education England and NHS Improvement have issued a review of SAS development: it is copyright free so please distribute as you see fit! The BMA has recently published a revision to the SAS Autonomous Practice guidance.

The Royal College of Surgeons has produced a guide to the expert witness role which includes a basic medic-legal tutorial. Possibly essential reading for all!

There is a recent section below entitled "Discrimination, bullying, fatigue and other work problems" which primarily relates to discrimination, bullying, fatigue, sexual harassment and burnout as none of the previous sections were relevant.  With the appointment of BMA president Dinesh Bhugra there is a new emphasis on mental health issues in doctors. Recently the Royal College of Physicians has issued a "code of conduct". There is also a new report on women in hospital medicine. There are also recent (11/01/19) reports on early retirement for consultants - are you following soon? Junior contract exception reporting is causing concern, as is the lack of  Foundation Year 2 doctors entering higher training posts. 2 years after it was first reported, a number of trusts still do not provide staff rest areas. A new ( April 2019 ) survey, commissioned by the BMA shows widespread concerns. There is also recent concern over the extent of female GP suicide: is this only a risk for GPs? The Royal College of Physicians have conducted recent surveys on workload; these make interesting reading! There is also an interesting personal view in the BMJ. Rota gaps are also being implicated. A recent update on burnout suggests organisational change. October 2019 sees a new report on the mental health of doctors, whilst a study published November 2019 indicates a high incidence in gynaecologists.

NHS pensions noe occupies its own page due to so much recent interest.

The  NHS Equality and Diversity Council has issued its 2018 WRES ( workforce race and equality standard ) data analysis report. Interesting reading! The 2020 report is expected soon: was this website!

25 June 2019 sees the publication of a GMC report that shows that BAME doctors are being referred more frequently to them. The full GMC report can be downloaded from their webpage.

The BMA has come under fire recently regarding sexual and other harassment. Their immediate response is to instigate an external investigation. This has also been reported by Medscape, whilst the GMC has instituted training in tackling sexist and bullying behaviour.   The BMA has now ( 19/06/2019 ) announced details of its investigation.

There is recent news of a change in regulation which may well affect HEE autonomy.  Anthea Mowat and Jeeves Wijesuriya discuss it here.

Of recent note is the Welsh government's commitment to a charter on fatigue. The  BMA has recently produced a study of fatigue, with a new report ( 24/09/2018 ). This was written primarily with junior doctors in mind but is also relevant to those of us who share out-of-hours rotas at any level. This is available for download from the "Resources" section of this website. as well as below. There are also recent entries on bullying. However, recent figures show an increase in voluntary and ill-health early retirement which not only reflects the changes in the working environment but removes experienced teachers from the workplace ( full BMJ article here ). Staffing problems are also relevant to CQC reporting. There are recent entries regarding mental health in doctors. Furthermore there is evidence of health and safety breaches due to a restricted maintenance budget. There is currently a vast number of vacancies in the NHS which is set to increase. Medscape UK Doctors' Burnout & Lifestyle Survey 2018  is also now published ( 22/12/2018 ): definitely a "must read", as is the BMA Fatigue and Facilities Charter.   See also Michael Fitzpatrick and Matthew Roycroft's discussion of the effect of poor staffing on training,  particularly as there is a reducing entry into core training following foundation posts. There is a further report regarding plummeting morale and a recent report on how the NHS can provide fulfilling, lifelong careers. The BMA has published a report on sexism.

Late September 2018 has seen the publication of a BMA survey - the results of which are shocking but  not surprising. See it here or see the story on the NHS Staff Surveys page. There is also recent evidence of a pay gap between ethnic groups.

There is news that the Associate Specialist grade may return. See the latest BMA report here. The Royal College of Paediatrics and Child Health currently considers that there is an unmet need for SAS doctors, especially in community paediatrics. Would restoring the grade improve supply and retention?

The GMC is due to release the long-awaited report on credentialing.

There are reports that Matt Hancock has retained his post as Secretary of State for Health and Social Care following the recent ( 13/02/2020 ) cabinet reshuffle.

June 2019 sees the publication of the Interim NHS People Plan, which covers all groups and Interim NHS People Plan: the future medical workforce.

A recent big news item is the publication of a CESR programme for A&E at Derby. Probably produced in response the the well-known recruitment and retention difficulties for A&E in the face of rising demand, it features an appropriate set of training modules with assessments. I wonder whether similar programmes will be rolled out in other specialties? The GMC have recently updated the CESR page and has stated tht it wil accept online evidence from November 2018.

Also in the last few months is the story that the Royal College of Physicians of London has misallocated the ST3 posts. Those of us who work alongside ST3 doctors should take care that this does not adversely affect their own job.

Dr Bawa-Garba has won her case and will shortly regain her license to practice! A ST6 paediatric registrar had been struck of by the GMC after a catalogue of failings by her Trust which led, in part, to the death of a 6-year old boy. I will not comment here other than to say that this event could easily happen to one of us, as we are also sub-consultant hospital doctors and should examine the case very carefully. The BMA considers that the GMC should not be able to appeal its own decisions and this is reported to be recommended in the Williams review.   April 2019 saw a further GMC hearing in which she regained her license to practice from July 2109, albeit with conditions attached ( see Medscape article ).  Read also the comments on the Doctors.net article: these are very pertinent! June 2019 sees a review which suggests that investigation of the employer should also occur in gross negligence manslaughter cases, which would result in relatively few doctors taken to court. See also the GMC page for further proposals. Dr. Bawa-Garba speaks here. The GMC has further admitted that legal advice it received was incorrect. A paediatric neurologist has won the right to claim unfair dismissal over whistleblowing at Leicester.

General Medical Council: Independent review of gross negligence manslaughter and culpable homicide. June 2019.  This report has recently been published ( 6 June 2019 ) and appears to make a very fair review of the current legislation. In particular, the following clauses seem particularly relevant to SAS doctors: More recently to MDU has called for an end to the unfair criminalising of doctors

Recommendation 10:   Where a doctor is being investigated for gross negligence manslaughter or culpable homicide, the appropriate external authority should scrutinise the systems within the department where the doctor worked. Where the doctor is a trainee, this should include scrutiny of  the education and training environment by bodies responsible for education and training.

Recommendation 15:   Improvements in patient safety are most likely to come through local investigations into patient safety incidents which are focused on learning not blame. We strongly endorse recent developments in the frameworks for investigations. These emphasize the need for the investigation team to have the time and the appropriate experience, skills and competence (including understanding of human factors) to undertake investigations, and the necessary degree of externality to command confidence in the process. We also stress the need to involve and support families and staff.

Recommendation 21:   We agree with the Williams review’s recommendation (at 6.1) to remove the GMC’s right of appeal of Medical Practitioners Tribunal Service (MPTS) decisions, as an important step towards rebuilding the profession’s relationship with its regulator. We urge the Government to introduce the legislative reform necessary to achieve this without delay.    We commend the GMC’s recent steps to review and reform its processes for decisions to appeal in the meantime.

Recommendation 26:   Doctors’ reflective practice is fundamental to their professionalism. We recommend that doctors use the Reflective Practitioner guidance and supporting toolkit to help them engage in reflective practice. This   will support doctors’ learning whilst limiting the possible relevance of any   recorded reflections in other proceedings. UK Parliament and the devolved governments should consider how  these reflections could be given legal protection.

Recommendation 28:   Healthcare service providers should provide induction and support for all doctors returning to clinical practice after a period of significant absence. These doctors should have a return to work meeting and appropriate supervision and support during the induction period tailored to the needs of the individual.

Of those recommendations, the two most pertinent to our employment are 28 ( return to work ) which is distinctly vague and in my view should be improved through the LNC. Recommendation  25 ( reflective practice ) requires government legislation which I cannot see happening soon. Whilst I was practicing I resisted attempts by my CD to write reflections as these could have been used against me, as Dr Bawa-Garbo found out!  Part of the case centered on the use of reflective practice and I have found a recent paper which may be of interest to you.

There have calls for  GMC chief executive Charlie Massey to resign, especially as the GMC are continuing to appeal MPTS determinations.  The government, in the form of the Commons Health and Social Care Committee, has started to reconsider the law on gross negligence manslaughter. Tbe BMJ has now published a review of the case and of the New Zealand experience.   The GMC chair has called for more "front-line" consultant prescence in hospitals.

The GMC has now published guidelines on reflective practice which is available form the Resources page.

Keeping silent at GMC hearings could draw “adverse inferences,” says High Court: the court has ruled for the first time that there is no “right to silence” at tribunals.

A bill preventing a no-deal Brexit has achieved Royal assent and requires the government to apply for a further extension should a deal not be approved before mid-October 2019. The "Brexit date" of 31 October 2019 is now postponed to 31 January 2019 and therre will be a 12 December general election. Recent papers on Brexit can be found on the page below. Brexit is, and will continue to be, a cause of concern for all sectors of the NHS. I will attempt to keep pertinent articles accessible here. However persistent underfunding is becoming dangerous and hospital deficits have now doubled.  There are frequent updates on the effects of Brexit, see the section below. Current staff shortages are also likely to be worsened by Brexit. EU citizens may now apply for settled status prior to Brexit. Please see the Brexit section for BMA advice. Drug shortages have already started and there is no guarantee that these will not continue. Furthermore staffing shortages are now apparent as EU staff continue to leave. The fate of many EU doctors is uncertain as information regarding applying for UK settled status remains poor, though a recent article from MedscapeUK sheds some light on this.  Should we be further worried that the NHS could be damaged as a result of a UK-USA trade deal after Brexit? This has since been refuted.

For budget news please see NHS staff surveys and financial news below. There have been recent calls for a 5% increase in NHS funding.

I am told that study leave budgets have stayed very poor in the Trent area with virtually all of the Trusts running at a deficit and that study leave is rarely approved. The results of the 2016 NHS Staff Survey have now been published; see below. Locum rates continue to be hammered: in there days of medical shortage there is even less incentive now to do locums!

Consequently we have to ensure that our CME is kept up-to-date. The GMC publish an app which may well help. I easily installed this on my Android tablet: it is also available for Apple IOS. I'm not able to make use of this myself ( retired ) but would like to hear from you about it. There is also a new GMC app for Good Medical Practice available from the same page. Could anyone write a review? The download link is now on the "Resources" page. The GMC is reported by "Hospital Doctor" to have issued new guidelines, but these, as yet,  do not appear to be available from their internet site. On Doctors.net are the eCME modules - see SAS development.

In great contrast is the SAS charter. This originated in 2004 but was recently revised.  It lists all the ways your employer  should be supporting you. The English version is also available on the "Resources" page. The Royal College of Physicians' recent survey has shown how poorly this has been implemented. There is a new BMA page regarding autonomy - see SAS Development.

Mental health provision for young people  is of a great concern nationally. A recent report shows the situation in Yorkshire. More recently severe bed shortages have been shown across all adult services.

October 1st 2018 pay increase is 3%!  Current pay scales are listed under SAS contracts.  I have also included links to NHS Employers below. April 2019 has seen the implementation of shared parental leave, thought concerns are evident that this has been done at the expense of other contract benefits, such as redundancy pay.

The GMC report:. "The state of medical education and practice in the uk 2019" has now been published.

The GMC has,come under a lot of criticism recently but at long last, revealed pending changes to revalidation, following Sir Keith Pearson’s report, as reported by the National Health Executive and pulse Magazine. There is an "Action Plan" on the same GMC webpage.The recent death of a junior anaesthetist has shown up serious failures in the GMC's processes. There is new initiative regarding exception reporting in an attempt to create and maintain safe working conditions. There is a recent report that  the GMC now considers medical training at risk.  The GMC has recently announced that it is reducing the number of fitness-to-practice investigations.  Finally the GMC is to survey SAS doctors, starting 1 May 2019.

This page is intended for news relating to SAS education and development: I intend to keep it there despite the ongoing political situation. Other news items will be gleaned from the internet largely from, I suspect, the BMA, Hospital Doctor and GMC sites. I will attempt to reference open access pages as much as possible. Please let me know if a page is restricted or non-existent! Doctors.Net and Medscape may need a login, but both are free! Those of you who work for the NHS will be able to log into BMA sites using Athens.

Yorkshire SAS on Twitter 12/03/2019
NHS, Staff Surveys and financial news 10/07/2020
Coronavirus & Covid-19 20/07/2020
NHS Pensions 15/06/2020
SAS Development 03/07/2020
SAS Contracts 21/07/2020
Brexit 13/06/2020
Discrimination, bullying, fatigue and other work problems 16/07/2020
GMC- CME, CESR, revalidation, credentialing 26/06/2020
Patient safety and gross negligence manslaughter 14/11/2019