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Alice Gerth: Strike action is not the answer

27 Nov, 15 | by BMJ

The strength of feeling of anger within the healthcare profession is so strong that those not planning to take industrial action are reluctant to speak out. I want the public and my colleagues to know that I will be at work, not because I support the new contract, but because I do not support striking at this point in time.

My reasons lie in the principles of “Just War” ethics. Industrial action is a form of conflict. I do not have space to go into the theory in full, but will highlight the areas I feel we contravene. more…

Latest spending review: Hail to the chiefs . . . but major challenges remain

27 Nov, 15 | by BMJ

chris_hopsonAs the details of the spending review were announced this week, the scale of the achievement by Jeremy Hunt and Simon Stevens in securing a frontloaded NHS settlement became clearer.

The spending review is, in the words of the Institute for Fiscal Studies, “one of the tightest in post-war history.” Unprotected departments will see cuts of 19% over the five year period. And 2016/17 was always going to be the most difficult of the five years covered by the review. more…

Tony Rao: Politics, persuasion, and pickets

26 Nov, 15 | by BMJ

tony_rao2“What makes the current dispute all the more remarkable is that in 1975, only 56% of junior doctors voted in favour of industrial action.”

Junior doctors accept their lot with unparalleled stoicism. Since the inception of the NHS in 1948, they have tolerated their long hours of work for one main reason: a sense of vocation.

Since the 1956 Guilleband Committee reduced medical representation on government bodies from a near majority to fewer than 25%, the role of doctors in senior decision making is perhaps echoed in the current dispute between junior doctors and the government over the proposed junior doctor contract. This is accompanied by a similar parallel in the emigration of doctors from the UK as a result of comparatively poorer terms and conditions. In 1975, the newspaper of the Junior Hospital Doctor’s Association remarked that 450 doctors per year were leaving the UK, this being equivalent to 1 in 5 of the total annual output of medical school graduates. more…

Henry Murphy: The Moderate Doctor

25 Nov, 15 | by BMJ

Jeremy Hunt recently told Twitter that “Moderate doctors must defeat the militants,” quoting the title of a Times article about the current war between the Department of Health and the BMA. My first response was to sit back and enjoy a flurry of hilarious responses (the reason I look at the @Jeremy_Hunt Twitter page so often). Comments included “Moderate doctors must defeat Jeremy Hunt,” ”If your definition of militant is standing up to protect the NHS against tyrants like you…,” and “So where are all these ‘moderate doctors’… I don’t know anyone who doesn’t think you are wrong and doesn’t support junior drs.” more…

Peter Killwick: Risks associated with conflicts of interest at CCGs

24 Nov, 15 | by BMJ

peter_killwickConflicts of interest are an inevitable part of the commissioning environment. There are obvious advantages to having local GPs at the heart of commissioning and in many areas they have made a very positive contribution. But the governance challenges associated with commissioning are enormous. In recent months, we have been working with a number of CCGs who have found those challenges difficult. At times they have fallen short of delivering in line with expected practice. From a number of recent investigations we have identified some key conflict of interest themes which contributed to the failure and are likely to be common issues for other CCGs. more…

Samir Dawlatly: Capacity insurance—not being missold

23 Nov, 15 | by BMJ

My wife and I have just booked a near extortionate holiday in the UK for the next major school holidays. As usual we were offered “cancellation insurance,” just in case something were to happen with either of us or our children that meant we couldn’t enjoy our rain drizzled fun in the Peak District. We didn’t take the holiday company up on the offer. In fact we rarely take out insurance or extend warranties on anything, apart from the washing machine, which we simply can’t do without as a consequence of having three children. more…

David Zigmond: Arguments about money are often about much else

18 Nov, 15 | by BMJ

david_zigmond2When partnerships break down, money is an expected battleground. One of the most public and fiercely destructive examples is in the disintegrated marriage. Charge and countercharge escalate; then these are translated into monetary forms.

Understanding this translation is crucial to any hope of understanding or containing the human agenda. For money is so often the exchange currency (literally) that expresses other—frequently unarticulated, even unconscious—forms of loss: those of being valued and in relationship. Anger becomes a frequent foil for sorrow: litigation is often obliquely obscured grief.

This process—the expression of degraded relationships in monetary or legal terms—is now commonplace in our NHS. more…

Jane Feinmann: Consumers co-design consumer friendly healthcare

17 Nov, 15 | by BMJ

jane_feinmannI am one of 50 or so attendees on a one day course organised by the Point of Care Foundation learning how patients like myself can work as partners with doctors and nurses to co-design a better healthcare system.

It’s not a new idea. Don Berwick, author of the NHS Patient Safety Review, pointed out ten years ago that “healthcare workers and leaders can often best find the gaps that matter by listening very carefully to the people they serve, patients and families.” While the NHS has so far picked up on the idea of “listening” with initiatives such as the Friends and Family test becoming ubiquitous in GP practices and hospitals, it’s arguable how careful this listening is. more…

Tony Rao: When doctors strike

12 Nov, 15 | by BMJ

tony_rao2To say that junior doctors are dissatisfied would probably be an understatement. It is now almost exactly 40 years since they turned to industrial strike action as a means of opposing a contract that failed to recognise their professional role. The 1975 strike emerged against the background of strike action from a number of other professions that also included nurses and ambulance crew (1). So what motivates a large number of highly respected individuals to turn into a collective political behemoth of the type that the public is now seeing loom large in the media on an almost daily basis? more…

Peter Sykes on the junior hospital doctor’s dispute—learning from previous experience

6 Nov, 15 | by BMJ

peter_sykesIn the next few days, Junior Hospital Doctors (JHDs) will be asked to vote either for or against industrial action. It is a situation that they will not have encountered previously, indeed one that some will wish they didn’t have to face. They have many factors to consider when casting their vote and will no doubt weigh the pros and cons carefully. They may be helped in coming to a decision by considering the lessons learned during the last major dispute with the government when, as now, a ballot of junior doctors was held. more…

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