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Junior doctors’ dispute: pause is welcome but fundamental problems remain

6 May, 16 | by BMJ

tom_moberlyA five day pause in work to introduce a new contract for junior doctors could be a welcome opportunity for both sides to engage meaningfully on the outstanding issues of disagreement. But it would do little to quell the anger that led junior doctors to the first all out strike in the history of the NHS.

Meaningful talks could undoubtedly go some way to closing the gap between the government and the BMA. The government says that the substantive areas of disagreement relate to pay, the most significant being around pay for Saturdays and antisocial hours. The BMA argues that there are at least seven areas of disagreement, including safeguards and protection against working excessive hours. more…

How do the healthcare systems in the UK compare with others internationally?

3 May, 16 | by BMJ

sarah-gregoryTwo years ago I wrote about how health systems in other countries were grappling with the problems of how to support an ageing population with high rates of comorbidities. I was interested in the fact that the same policy problem can generate different solutions depending on the context in which it sits—so while it may appear that there is a sort of “free will” in decisions about policy, in reality decisions will always depend on the limitations of funding and political structures. more…

Thomas Macaulay: Senior doctors’ opinions on the junior doctors’ strike

29 Apr, 16 | by BMJ

tom_maccauleyThe letters pages of British broadcasts last week were inundated with the views of doctors on the strike of their junior colleagues.

Most were united in their criticism of the misleading media coverage. Writing to The Guardian, Dr Michael Maier described the reporting as “sensational and inaccurate” with particular reproval reserved for the description of a 48 hour withdrawal of emergency care that was “actually between the hours of 8am and 5pm on 26 and 27 April.” more…

David Oliver: Are we recreating the conditions that led to the Mid Staffs scandal and Francis inquiries?

28 Apr, 16 | by BMJ

david_oliver_2015I am worried that we are heading right back to the very conditions that led to the Francis inquiries, losing any progress we have gained on the back of them. In health, as in many industries, it often takes a major incident or scandal to prevent more from occurring in the future. But let’s not go back to it.

It’s now six years since the report of the independent inquiry by Robert Francis QC into events at Mid Staffordshire NHS Foundation Trust from 2005-9. It’s still a powerful testimony of a hospital whose culture was broken. more…

Joseph O’Keeffe: The junior doctors’ strike—voices from the ward

28 Apr, 16 | by BMJ

joseph_okeeffeJunior doctors are arguing that the contract changes compromise patient safety. I agree. But do those we treat? It’s hard to tell. Social media appears dominated by the junior doctors, whereas the newspapers and the broadcasters merely present a succession of politicians and “experts.” The patient’s voice seems lost amidst the acrimony between the Department of Health and the BMA, especially that of some of our most poorly patients: the elderly. The official polls focus on getting nationally representative surveys, lumping our older patients into a “60+” category. As any healthcare worker knows, there’s a stark generational difference between patients in their 60s and those in their 80s. With the strikes raging all around me this week, I crossed lines and snuck back onto the wards to ask the patients what they have to say. more…

Duncan Steele: To strike or not to strike

27 Apr, 16 | by BMJ

duncan_steeleTo strike or not to strike, that is the question we have all asked ourselves over the last few months. To walk away from our patients, albeit to leave them in the care of some of the most qualified doctors in the world, is an incredibly difficult and tormenting decision. The contractual intricacies are complex. The reason why the message from doctors about why this contract is unfair and unsafe has sometimes felt jumbled is because for each of us a particular point of this contract is most important. The list is long: it openly discriminates against women, penalises trainees switching specialty or doing research, extends the week meaning what little social life we have will further be destroyed, pay will be as little as £1.50 to be on call out of hours, we will have shorter breaks and longer days, and there are practical implications for rota design and complex supplements for out of hours work. These are all valid reasons to throw this out. more…

Elizabeth Wortley: And strike I did

27 Apr, 16 | by BMJ

Yesterday I did not cross a picket line. I don’t yet know the figures for how many junior doctors did choose to work, aside from those who were unable to strike, but I would not blame anyone who chose to. I almost did.

I woke up at 5am and my heart was racing with moral indecision. This ultimate question of where my ethical and public service role as a doctor lies; with the individuals today, or the systems of the future, has had me on edge for days.

After the deliberation that went into my blog “should I strike” I realised yesterday morning that the question I was really battling was, “Do I need to answer this question for every junior doctor, or just for me, in my own context?” more…

Michelle Sinclair on the GP forward view

26 Apr, 16 | by BMJ

pounds_healthIt’s not about the money sings Jesse J.

Well yes, actually, it is.

The release this week of the General Practice Forward View sounds good, doesn’t it?

£2.4bn recurrent investment in general practice, £500m sustainability and transformation package to include a practice resilience programme, redesigning of services and support for collaborative work, a reduction in workload and bureaucracy, an expanded workforce, and a commitment to reduce the regulatory burden of CQC.

Sounds great in theory, except that as ever, the devil is in the detail. more…

Taryn Youngstein: “No doctor wants to strike”

26 Apr, 16 | by BMJ

junior_docs_strike26april

 

Ethical dilemmas are the essences of medicine. As doctors, we frequently have to act in our patient’s best interests; when they are confused, demented, or suicidal for example. We have to act fast, and make decisions they can’t, for their own good. At medical school great lengths are taken to prepare us for these situations and GMC guidance and the law are both very clear on this issue. This is our job, it is what we do and its preservation is what we are fighting for.

more…

Elizabeth Wortley: Should I strike?

26 Apr, 16 | by BMJ

junior_doctors_contractI am in a moral quandary, I am in a personal quandary, and I am in a professional quandary. I cannot answer the question “Should I strike?”

As a doctor, I’m very used to questioning, reviewing evidence, and coming to a conclusion. One of my favourite topics for discussion is bias and avoiding it every day. With regards to this contract, I don’t know what’s bias or not, I’m tired of thinking about it and I’m scared of getting the answer wrong. And I’m not alone. more…

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