20th November 2015
- Junior doctors vote overwhelmingly for industrial action
- RCS and RCP call for the spending review to front-load extra NHS funding
- Regulators report 'challenging' financial situation for NHS providers
- GMC releases annual report on the state of medical education and practice
- Monitor sets out proposals for specialised services top-up payments
- Whistleblowing consultations launched by regulators
- New CQC Chair announced
Junior doctors vote overwhelmingly for industrial action
The BMA announced yesterday that its junior doctor members have voted almost unanimously in favour of industrial action. 99.4% of ballots returned voted ‘yes’ on industrial action short of a strike, and 98% voted ‘yes’ to an all-out strike. 76% of junior doctors balloted took part in the vote. This gives the BMA the mandate to take industrial action on the 1st, 8th, and 16th December. The Academy of Medical Royal Colleges (AoMRC) of which the RCS is a member, released a statement following the announcement of the ballot result, calling on the BMA and the Government to re-enter negotiations and suggested a third party should mediate if necessary. The BMA and the Labour Party suggested this could be the Advisory, Conciliation and Arbitration Service (ACAS).
Ahead of the announcement on the ballot result, Health Secretary, Jeremy Hunt MP, wrote to the BMA emphasising that there are no pre-conditions attached to future contract negotiations, other than the ability to implement seven-day services. NHS England Medical Director, Professor Sir Bruce Keogh, also wrote to the BMA, outlining the need for contingency planning in the event of a strike, and making assurances that, if properly implemented, the proposed contract “will address the long hours and related safety issues which have been such a cause for concern”.
Today Shadow Health Secretary, Heidi Alexander MP, asked an urgent question in the House of Commons on future negotiations on the junior doctors’ contract. Health Minister, Alistair Burt MP, responded that conciliation is only needed when negotiations break down, and that negotiations have not started again. He reiterated comments made by the Health Secretary that there would be no pre-conditions to negotiations, other than the overall junior doctors’ pay packet, and that if negotiations do not reach an agreement conducive to implementing seven-day services, that the Government reserves the right to introduce a contract. The Minister called for an immediate return to direct negotiations.
RCS and RCP call for the spending review to front-load extra NHS funding
Clare Marx, President of the RCS, and Professor Jane Dacre, President of the Royal College of Physicians (RCP), wrote a joint letter to the Sunday Times last week highlighting the increasing pressures on the health service, including an ageing population, rising numbers of patients with complex conditions, and the increasing costs of new treatments. They echoed the view of Simon Stevens, Chief Executive of NHS England, that the Government must front-load the £8bn it has committed to the NHS this parliament, in the next two years.
On the same day, the Sunday Telegraph published a letter written by the Chief Executives of the Nuffield Trust, the King’s Fund and the Health Foundation, calling on the Government to honour the pledge of £8bn in the upcoming spending review but invest that funding now, not in 2020. They warned that the fall in healthcare spending as a share of GDP will contribute to an ‘inevitable’ winter crisis in the NHS.
The Government’s statement on the spending review is expected on 25th November.
Regulators report ‘challenging’ financial situation for NHS providers
Monitor and the NHS Trust Development Authority (TDA) published a joint financial report on the performance of NHS Foundation Trusts (FTs) and NHS Trusts today for the second quarter of 2015/16. NHS providers have recorded a half year (April-September 2015) deficit of £1.6 billion - £358 million worse than planned, and 190 out of the 241 NHS providers reported a deficit for Q2.
The regulators report that between July and September, many providers struggled to achieve several key national healthcare standards. They note that delayed transfers of care are having an impact on NHS organisations meeting other standards, particularly in A&E, and the financial burden of agency staffing continues, as it reached £1.8 billion in spending this year. Delayed transfers are estimated to have cost NHS providers £270 million over the first half of this financial year.
Monitor and NHS TDA have set out measures aiming to improve providers’ finances and performance issues, including a series of new hourly price caps to limit the amount of money agency staff can earn, and capping consultancy spend. The regulators expect the impact of these changes to ‘turn the tide on the worsening financial position and end the financial year closer to where they expected at the beginning of 2015/16’.
Jim Mackey, Chief Executive Designate of NHS Improvement, said: “NHS commissioners and local authorities need to work in partnership with local providers to help significantly improve how they tackle delayed transfers of care. However it is clear – especially as we see the majority of providers now struggling with their financial situation – that the national tariff for next year will need to be set at a level that will create the conditions where NHS trusts and FTs can begin to plan to bring themselves back into financial balance.”
GMC releases annual report on the state of medical education and practice
This week the GMC released its fifth annual report (mostly covering 2014) on the state of medical education and practice in the UK.
It found that strong anecdotal evidence across the profession that many doctors are frustrated and that there are signs of disengagement and disillusion, but there are increased levels of overall satisfaction among trainees, with 88% satisfied or very satisfied with their training.
Over 2010-14, the number of doctors has grown by 12 per cent, the number on the Specialist Register has grown by 22%, and the proportion of female doctors has continued to increase. The overall number of surgeons increased by 15% over 2010-14, and the proportion of surgeons over 50 is increasing. Women make of 19% of surgeons under 40, 13% of surgeons aged 40-49, and 6% of surgeons over 50, and the proportion of BME surgeons increased by 29% over 2010-14. In addition the number of non-UK graduates practising as surgeons in the UK is increasing at a rate of 20%.
The number of complaints made by members of the public increased by 51% over 2010-14, but this increase slowed sharply in 2013 and 2014, increasing by only 5% in 2013, and falling by 2% in 2014. The Joint GMC/NMC guidance on duty of candour has seen a positive reaction, but active steps by boards, managers and clinical leaders will be essential.
Bullying continues to be a matter of real concern, with nearly 1 in 10 trainee doctors reporting that they had been bullied, while nearly 1 in 7 had witnessed it in the workplace. Obstetrics and gynaecology and surgery have the most issues with bullying and undermining.
Language proficiency explains only a small part of differences in doctors’ performance. Higher scores on the IELTS test were only weakly associated with better results. Differences in IELTS scores accounted for 2.3% and 3% respectively of the variation in individuals’ applied knowledge test and clinical skills assessment results.
The GMC plans to develop a new unified assessment, the UK Medical Licensing Assessment (UKMLA), to provide a route for doctors seeking to practise in the UK. This would replace the current Professional and Linguistic Assessments Board (PLAB) test and would also be taken by UK graduates.
Monitor sets out proposals for specialised services top-up payments
As part of the preparation for the consultation on the 2016/17 national tariff, Monitor has published proposals for the future of top-up payments for specialised services. Changes to top-up payments are being proposed in the context of the potential currency design reforms, and the change in classification of specialised services, moving from the current Specialised Services National Definitions Set (SSNDS) to Prescribed Specialised Services (PSS) following the Health and Social Care Act.
Proposals would see a number of specialised services no longer receiving top-up payments, but Monitor expects the new currency design to better reflect the costs incurred in treating patients of different levels of complexity within national prices. Monitor sets out two options for transitioning to the new top-up arrangements for specialty areas that would lose top-ups on the new rates – spinal, orthopaedics and paediatrics. The two options proposed look at different rates of transition, in order to reduce the initial impact of changes.
Proposals are open to comment, and Monitor and NHS England are expected to make a final proposal in early 2016 within the statutory consultation notice on the 2016/17 national tariff.
Whistleblowing consultation launched by regulators
Monitor, the NHS Trust Development Authority (TDA) and NHS England this week published a consultation on a whistleblowing policy for the NHS. The regulators propose a national whistleblowing policy following recommendations made in Sir Robert Francis’s Freedom to Speak Up review. The policy details who within NHS organisations can raise concerns, and how organisations should respond. It will be expected to be adopted by all NHS organisations except primary care providers, and organisations should set up local processes that sit beneath the national policy.
The consultation welcomes responses from patients, staff and NHS organisations, and closes on 8th January 2016.
New CQC Chair announced
Peter Wyman has been named as the new CQC Chair, following Lord Prior’s appointment as a Peer and Health Minister, and subsequently stepping down from the position. Mr Wyman is currently the Chair of the Yeovil District Hospital Foundation Trust. He is an accountant by profession, was formerly a senior partner at consulting firm PwC, and was awarded a CBE for services to accountancy in 2006. His appointment will be subject to a hearing at the House of Commons Health Committee on 1st December.