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BMA research into end of life care: Consulting patients is a step in the right direction

19 Jan, 16 | by BMJ

Paul TeedThe BMA’s consultation with doctors and members of the public on their views and perceptions of end of life care and the assisted dying debate is a welcome step forward. A postcode lottery of care is unacceptable and no campaign group involved in the assisted dying debate disagrees with making end of life care a priority.

It is critical for policymakers and policy influencers, such as the BMA, to engage with the public and listen to their wishes on issues such as assisted dying. For too often this most important group has been sidelined in the debate. more…

John Hughes: Why dying should be everyone’s business

19 Jan, 16 | by BMJ

John HughesLike all non-specialist, palliative care healthcare professionals, doctors have varying degrees of willingness to broach difficult conversations with patients and families, particularly if it is a conversation that is about care as opposed to cure. But a new report from the British Medical Association (BMA) says that doctors need to be having these difficult conversations in order to ensure a good palliative and end of life care experience for all.

Good care is not only about planning how a patient can live, but also how a patient can die. A patient’s access to, and experience of, palliative and end of life care is influenced as much by a doctor’s communication skills as their clinical skills. more…

Sebastian Taylor et al: The junior doctors’ dispute: manufacturing bad faith

14 Jan, 16 | by BMJ

The rollercoaster ride of dispute talks between the British Medical Association representing “junior” doctors and the Secretary of State for Health points either to incompetent negotiations or to the political value of failure. Jeremy Hunt has claimed that 15 of 16 points were resolved, and that money was the only remaining issue. Junior doctors disagree. Now even the terms of disagreement are in dispute.

The government declares genuine support for a national health service, free at the point of delivery, populated by healthcare workers trained to the highest standards. It does so because evaluations of the NHS—by UK citizens and the World Health Organisation alike—are so positive. In 2013, the UK spent 8.5% of national income on health, below the USA (16.5%), Germany, and France (each 11%). NHS spending is set to stabilise at around 10.5% as projected (under the “fully engaged” model) for coming spending reviews, equivalent to Germany’s health budget for 2001. [1] Using the GDP yardstick, NHS spending is modest and excellent value. more…

Elizabeth Wortley: What the junior doctors’ strike taught me

13 Jan, 16 | by BMJ

Yesterday I came off the picket line having enjoyed some lively conversations with my colleagues. As passing drivers honked their horns in support, one of my colleagues observed that it’s a shame we don’t get together to provide more support for each other regularly. This started a discussion about our attitudes towards each other on a day-to-day basis. more…

Richard Smith: Does the NHS meet the needs of junior doctors?

12 Jan, 16 | by BMJ

richard_smith_2014Bain, the global consultancy, produces what it calls “a pyramid of employee needs,” and on the day when junior doctors are striking it’s instructive to see how well the NHS is doing in meeting their needs.

The bottom of the pyramid is “satisfied employees,” and the very fact that junior doctors are striking suggests that they don’t even reach this level. The first requirement for satified employees is to have a safe work environment. Hospitals are certainly not safe for patients in that they are famously riskier than bungee jumping, and they are not entirely safe for junior doctors in that the work is stressful and risky. The fear is not so much that junior doctors will be harmed themselves but that they will harm patients and suffer disciplinary, legal, and emotional consequences. I’m assured that it’s not like when I was a junior doctor and would be the first to arrive at a cardiac arrest without any training, but “safe” may be a bold claim. more…

Ian Forgacs: Will senior doctors and the public support junior doctor’s strike action?

5 Jan, 16 | by BMJ

ian_forgacsSupport for their junior colleagues from senior doctors has thus far been strong. What surely must have been almost the entire consultant body at the Royal Free Hospital (505 of them) wrote to The Guardian in their favour, the presidents of (almost) all the Royal Colleges were also behind them in their letter written not to a newspaper, but to the health secretary Jeremy Hunt.

Yet, the terms in which their support was phrased bears some attention. The Royal Free Hospital consultants said: “We regret, yet clearly understand, that public protest and possible industrial action by doctors has become necessary to safeguard these basic requirements.” The colleges wrote to the Jeremy Hunt to say…”We would urge the government to create the conditions where both NHS Employers and the BMA can reopen dialogue and constructively work towards a contract that supports staff to deliver the best care for patients.” In effect, they laid claim to the moral high ground—unqualified support for the junior doctors tempered by regret and urging a return to the negotiating table. more…

Jessamy Bagenal: Junior doctors strike action—frustration and mistrust

5 Jan, 16 | by BMJ

jessamy_bagenal2Junior doctors received a text on Monday 4 January informing them that the negotiations over the junior doctor’s contract had ended. Industrial action in England is going to proceed. It left one feeling somewhat flat.

The first day of industrial action will be on the 12 January when only emergency care will be provided for 24 hours. This will be followed by 48 hours of industrial action on 26 January. Finally on the 10 February there will be a full withdrawal of labour between 8am—5pm. The mandate to strike given by 98% of BMA voters runs out next week, so this seems a last minute attempt to gain some ground. more…

Samir Dawlatly: The countdown to the 2020 GP conundrum

31 Dec, 15 | by BMJ

There can be no doubt that the problems facing general practice are complex and interconnected, and that the answers have proved elusive for many. GPs and the organisations that represent them have been very vocal about the obstacles hampering the ability of grassroots GPs to do their jobs safely and effectively: from increasing workload from hospitals (due to increasing patient expectations and demands) to the strain of excessive regulation. These problems and, some would argue, the way that they are discussed openly are probably contributing to the decreased recruitment and retention of GPs.

In fact, some have gone so far as to say that the difficulty of holding onto and training new GPs is because of existing GPs moaning about their conditions of work. It is a chicken and egg situation. more…

Samir Dawlatly: What are the costs of the public sector’s tickbox culture?

22 Dec, 15 | by BMJ

One of the responses of the Department for Education to the problem of radicalisation of pupils in schools has been to increase the number of Ofsted inspectors. The issue of home schooled pupils raised the faintly ridiculous prospect of Ofsted inspections of family homes. It seems that the culture of regulation by inspection is pervasive in more than one public sector. As a GP working in England, my “Ofsted” is the Care Quality Commission (CQC).

A colleague of mine, who up until recently was of the view that the need to measure was important for the assurance of quality, recently visited Denmark and was told by the immediate past president of the Danish College of General Practitioners that the Danish are inherently a trusting people, and that this trust underpins a key difference between UK and Danish GPs. more…

Jessamy Bagenal and Rebecca Kenny: Turning up on the doorstep

21 Dec, 15 | by BMJ

jessamy_bagenalrebecca_kennyPoor Jeremy Hunt he can’t catch a break. As health secretary, one of the few things you could rely on was that your employees, sorry “colleagues” (the term Mr Hunt used when he recently wrote to all junior doctors about contracts), were so busy working that you could make politically expedient changes to the NHS without anyone really noticing. Lansley completely changed the foundations of the NHS and he didn’t get such a hard time. Suddenly, people keep turning up on the Department of Health (DOH) doorstep protesting about Mr Hunt’s vision for the NHS. No amount of calmly phrased euphemisms seems to settle them down. Presumably it’s all very worrying? more…

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