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BMA Scotland newsletter

February 2008

Dear Colleagues
Welcome to the first edition of the BMA Scotland newsletter for 2008. It provides a round up of news for all doctors in Scotland on what is happening in the medical community and in Scottish politics.

This edition includes a special feature on the Better Health, Better Care Action Plan, the Scottish Government’s five-year health strategy. Also included is an update on MMC, the SAS contract and the GP contract.

Last year was a difficult and challenging year for the profession, and this year looks to be equally challenging. I remain optimistic, however, that we will be able to work in partnership with the NHS and government to do what is best for the profession, patients and the NHS in Scotland.

Peter Terry
Chairman of BMA Scottish Council

Staff and Associate Specialist (SAS) Contract
Update: England, Wales & Northern Ireland
The contract proposals as set out in the summary agreement of November 2006 were finally ratified by the Government for England on 4 December 2007, subject to a ‘transitional pay award’ and implementation from 1 April 2008. The transitional implementation gives both groups of doctors – Associate Specialists and the new Specialty Doctor grade – half their expected pay increase in year one (1st April 2008) and half in year two (1st April 2009). Subsequently it has been confirmed that Wales and Northern Ireland will offer the same contract for SAS doctors as England.

Update: Scotland
In December 2007 the Scottish Cabinet Secretary for Health and Wellbeing gave a mandate to Scottish Government Health Directorate representatives to arrange meetings between the Employers’ Management Steering Group and the Scottish Staff and Associate Specialists Committee (SSASC) in January and early February 2008 to discuss the situation.

As a result, the contract offer for Scotland is as follows:

"Following discussions in relation to implementation of the new SAS contract in Scotland the Scottish Government Health Directorates and NHS Scotland employers have agreed that:

A) Any new contract will be implemented on an optional, not mandatory basis.
B) Eligible doctors who move on to the new contract on 1st April 2008 will be moved on to the pay point that they would have been on had the contract been implemented from April 2007.
C) Back pay will not apply to the period from 1 April 2007 – 31 March 2008."

The UK agreed TCS will apply for both the new Specialty Doctor and Associate Specialist contracts in Scotland, except where affected by the different assimilation arrangements in Scotland. The operative date of the contract will be 1 April 2008, the implementation date is 2 April 2007 and assimilation will be based on the seniority and salary level at 1 April 2007 (“the assimilation date”). Historical annual incremental dates will be retained for those transferring to the new contract. All staff transferring to the new TCS via this assimilation process will therefore already have achieved one year of incremental progression in accordance with Schedule 15 of the TCS by the operative date. There will be no detriment to anyone transferring to the new contracts either in financial or seniority terms and any pay protection will be applied at mark time of the value of payments at 31 March 2008 plus the value of any pay increase recommended by the DDRB and accepted in Scotland for 2008/09 only.

These assimilation arrangements mean that SAS doctors in Scotland who elect to transfer to the new contract within the timescale set out in the TCS will be one year ahead of equivalent SAS doctors in England, Wales and Northern Ireland in terms of seniority and progression.

Further information is available on the BMA website.

What happens next..?
Now that a contract offer has been received for all four nations, SASC UK will proceed to a vote of all SAS doctors on the proposed contract at the end of February. Events will take place across the UK to fully inform SAS doctors about the proposals. More information about these can be found on the BMA website.

The Scottish events are as follows:

Monday 18 February: Edinburgh (Royal Society of Edinburgh, 22-26 George Street)
Thursday 21 February Aberdeen (University of Aberdeen King’s College Conference Centre)
Monday 25 February Dundee (Apex Hotel)
Thursday 28 February Glasgow (Western Infirmary Lecture Theatre)

Session timings:

18.15 – Event opens with opportunity for informal discussions and use of the Ready Reckoner.
19.15 – Presentation on the details of the new contract
20.00 – Q&A session with a member of SASC UK’s negotiating core team
21.00 – Close

In the meantime all SAS grade doctors (including non-members) need to register with the BMA if they have not already done so or to ensure that their details are up to date in order to be able to vote. You can do this on the BMA website or by phoning the membership department on (020) 7383 6642. This is particularly important if you are a new entrant to the grade or if you have recently moved.

GP Contract Update
The Scottish Government has chosen to follow the Westminster approach to altering the GP contract for the coming year with regard to extended patient access to GP practices. This approach has also been taken in Wales however the government in Northern Ireland is discussing alternative contract changes as it has no wish to introduce extended hours.

At the end of last year negotiations came to an abrupt halt after interference from Westminster, which resulted in the NHS Employers making a final UK ‘offer’ which had not been agreed with the GPC. If the offer is not accepted by the profession, GPC has been warned that the alternative would be more draconian proposals, effectively a “take this or get something worse” situation. The GPC negotiators sought the view of the wider Committee which voted not to accept the offer under blackmail and decided to seek the views of the profession via a UK wide poll of GP opinion.

Initially, it appeared that the approach and proposals would be nearly identical in Scotland. However, whilst the approach is very similar, SGPC has been in discussions with the Scottish Government on the practical implementation of the offer, including additional funding of £9.5million. There does appear to be some degree of flexibility in Scotland which has not yet been evident in England. If the ‘offer’ is rejected the Cabinet Secretary for Health and Wellbeing has given SGPC assurances that she will enter into negotiations with the BMA on its alternative proposals.

Details of the Scottish offer and alternative proposals as they currently stand are outlined in a letter from Dean Marshall, Chairman of SGPC, to Scottish GPs. This can be viewed online.

GPC is currently polling all GPs in the UK for their opinion on the offer and the alternative proposal. The outcome of which will allow GPC and SGPC to progress discussions with their respective Governments. When completing the poll, GPs should take into account government health policy in the country in which they work.

SGPC is developing a document outlining the differences in Scotland and answering some frequently asked questions, which will be available on the BMA’s website. The Committee will also be working closely with Scottish LMCs in the next few weeks to ensure that Scottish GPs are kept well informed.

Dr Laurence Buckman, chairman of GPC UK has written to the profession to update GPs on the current situation. This letter includes information on the situation in all four nations and is available online.

GPC Resolution:
At a recent meeting of GPC, the committee passed the following resolution:
“The GPC has come to the conclusion that Option A is less damaging for general practice, because the alternative option will harm the underlying fabric of NHS general practice and patient care more quickly and more lastingly.”

Speaking after the meeting, Dr Laurence Buckman, Chairman of the BMA’s GPs Committee said:

“GPs have been put in an impossible position and will have to choose between two unacceptable alternatives. We have been asked which of these two is less bad and we have responded to GP demand that we do that. This is neither a climb down nor a U-turn but a recognition that between two bad alternatives, one is worse than the other.

Short term employment contracts: problems claiming travel and relocation expenses
The ongoing problems for junior doctors issued with short term employment contracts of just four or six months continues to be a major concern for SJDC. These short term contracts are leading to problems with mortgages, rental agreements and the reimbursement of removal and travel expenses.

In an attempt to resolve the situation, SJDC proposed an interim solution to employers in December last year which would allow Specialty Registrars, trainees in FTSTAs and Foundation Doctors to claim relocation and travel expenses. The employers rejected this proposal, which means the current unsatisfactory situation remains.

SJDC has raised this as a matter of urgency with the Cabinet Secretary for Health and Wellbeing, and made known the strength of feeling of its constituents. SJDC is planning to meet with Employers and the Scottish Government shortly to discuss this issue further.

Juniors affected by this issue are strongly encouraged to submit full claims for removal and travel expenses to their employer and contact askBMA (telephone: 0870 60 60 828) for advice and support in pursuing formal grievance procedures if they do not receive a satisfactory response.

Juniors are also encouraged to raise this issue with their MSP, either if they have been personally affected or if they feel strongly about this issue. You can find out more about contacting your MSP via the WriteToThem website. In order to help BMA Scotland with its continued lobbying of MSPs, if juniors are happy to do so, please email a copy of your correspondence to the BMA Scotland Public Affairs Office.

Doctors struck by Cupid’s arrow on Valentine’s Day
A Valentine’s survey has revealed that patients swoon at the feet of doctors.

The National Consumer Council asked 1000 consumers who they would most like to kiss on Valentine’s Day. Doctors proved to be the sweethearts of the survey, with 27 per cent of women saying they would give their GP a kiss.

MMC Update - Recruitment and Selection to Specialty Training in Scotland 2008
Interview offers and formats
Applications to specialty training in Scotland closed on 18 January 2008 and applications to GP training closed on 20 January 2008.

Interviews in Scotland will be held between 18 February and 17 March - the full interview schedule can be found online.

NHS Education for Scotland (NES) recruitment teams are currently issuing interview and selection centre invitations to short-listed applicants by email and advising candidates of their next steps. Please note that MMC Scotland has advised that candidates will have 72 hours in which to respond to the interview offer email. If you do not respond to the email within the time allowed, the interview offer will be withdrawn. Candidates who have applied to a specialty training programme in Scotland are therefore urged to regularly check their email. Candidates who are not offered an interview will be emailed by NES confirming this.

Details of the interview formats can be found online.

The Interview Expense Claim Form, Guidance Notes and list of HR contacts for further information have been published on the MMC Scotland website.

NES has advised that, while every effort will be made to avoid clashing dates in Scotland, it will not be possible to make alternative interview dates once they are fixed. Shortlisted candidates will need to decide which interviews they wish to attend.

The selection centre process for GP applicants is being handled by the National Recruitment Centre – details about the process can be found online.

If you are experiencing any problems please do not hesitate to email us so we can monitor and raise these with NES, if necessary.

Deanery preferences within Scotland and linked applications
Candidates shortlisted for interview(s) will be contacted by NES and invited to rank their specialty and deanery preferences in order (East, North, South East and West) and every effort will be made to match them to their first choice preference, depending on their interview score and number of training opportunities available.

At the same time as ranking specialty/deanery preferences, applicants will be invited to indicate the name of another applicant to whom they wish their own application to be linked. The geographical preferences of linked applicants must be the same and both applicants must indicate that they wish to be linked. Further details about deanery preferences and linked applications are available in the Applicants Guide.

Further GP training opportunities
If you have applied to GP training programmes in Scotland, please be aware that NES has made an important announcement regarding the potential for further GP training opportunities for August 2008.

JDC FAQs
The JDC has developed FAQs in response to queries it has been receiving, and includes advice for applicants applying to or already working in Scotland. The document also includes advice about seeking time off for interviews. More detailed information regarding the recruitment and selection process is available in the Scotland Applicant's Guide and numerous FAQs produced by the MMC Scotland team.

Offer process in Scotland
NHS Education for Scotland will offer successful applicants their ‘best possible preference’ offer based on their specialty and deanery preferences.

There will be three waves of offers, details of which are fully explained in the Applicants Guide. As this is a complicated process, we strongly recommend candidates read this information, and the information in their offer email, carefully. Candidates should also ensure they familiarise themselves with the offer deadlines – responses must be received on time, otherwise it will be interpreted as a rejection and the candidate will be excluded from any further recycling of offers.

Better Health, Better Care Action Plan
On 12 December 2007, the Scottish Government launched the publication of its new health strategy for the next five years. Better Health, Better Care Action Plan sets out the way forward for the development of a ‘mutual NHS’ in Scotland.

BMA Scotland is actively involved in the consultation process regarding a number of the proposals outlined in the plan and our finalised responses will be made available on the website.

A Mutual NHS
The Scottish Government is keen to promote and develop a new ethos within NHS Scotland, based on joint ownership and responsibility, with an emphasis on building on existing strengths and public sector values. The action plan expands on the Government’s concept of a “mutual NHS”, with a number of commitments to reinforce patients’ rights and responsibilities, including plans for a consultation on a Patient Bill of Rights, the introduction of independent scrutiny of major service change in the NHS and a Local Health Care Bill, with the possibility of direct elections to health boards.

The plan proposes to distribute an “ownership report” to every household in Scotland which would include information on how to access local services and become more involved in design and delivery of local health services. There is also the intention to “embed patient experience data” in NHS targets.

Workforce
The Action Plan expresses a commitment to working in partnership with staff and improving the NHS as a place to work. A staff satisfaction survey will be conducted in 2008 and the plan promises that results from this will be acted on at national and local level to improve working conditions for staff. There are also commitments to improve workforce planning nationally and locally and to support health boards to develop their workforce capabilities to ensure the delivery of services that are safe, affordable and sustainable.

Abolition of Prescription Charges
Prescription charges will be phased out with a gradual reduction in charges over the next three years, beginning in March 2008. This is similar to the approach which was taken in Wales, where prescription charges have now been fully abolished. The Scottish budget has allocated £97 million to achieve this.

Health Improvement
A new Smoking Prevention Action Plan will be published in 2008, supported by an additional £3 million per annum in funding. A new strategy for tackling alcohol misuse will also be published in 2008, with a commitment of £85.3 million in funding over 3 years. A new drug misuse strategy and delivery framework will be published this year although there is no explicit funding commitment.

A subsequent announcement in January committed £15 million to projects directly aimed at tackling obesity.

Access to Primary Care Services
There is an explicit commitment to address the issues outlined in the Audit Scotland report on primary care out-of-hours services and plans to establish local NHS24 services in every mainland health board area. The plan also raises the issue of access to GP appointments.

Waiting Times
The plan commits to developing an 18 week whole journey target from GP referral to treatment by the end of 2011. A national framework for achieving this will be published this spring and various interim targets have already been established.

To see the full copy of the Action Plan click here.

Elections to health boards not the solution to poor public engagement
The Scottish Government has launched a consultation on proposals for the introduction of a Local Healthcare Bill, which would introduce direct elections to Health Boards. It is the Government’s view that this approach would achieve greater patient and community involvement in planning and delivering local health services. The BMA does not support this move, and believes that there are better, more effective alternatives that should be considered, for example strengthening the public participation forums of Community Health Partnerships. It is estimated that direct elections would cost around £5m and would be resourced from existing funding. Commenting on the launch of the consultation Dr Peter Terry, chairman of the BMA in Scotland, said:

“Encouraging greater involvement and promoting effective governance are both laudable aims for the Scottish Government. The BMA supports greater public involvement but remains unconvinced that direct elections to NHS Boards will deliver the desired outcomes.

The consultation closes on 1 April 2008 and is available online.

Violence against doctors going unreported
One in three doctors in Great Britain has been a victim of physical or verbal attack in the past year, but most do not report it, according to the findings of a new BMA survey.

More than half (52 per cent) of doctors who suffered violence did not report the incident. This suggests both a degree of under-reporting and increasing acceptance of violence, the report states.

In the last six months alone, there have been two horrific cases of violence towards doctors in the Glasgow area and, unfortunately, this new research shows that these are not isolated incidents. In November, a GP was beaten up by a patient in his consulting room and, in August, another GP was stabbed by a patient in her practice.

Dr Dean Marshall, Chair of the Scottish General Practitioners Committee, said: “It is incredibly disturbing that more than half of the violent incidents against doctors are not being reported. Sadly, this means that official statistics are only the tip of the iceberg and do not reflect the true number of attacks against NHS workers in Scotland.

“It is encouraging that the Scottish Government has extended the Emergency Workers Act to include all doctors, including those who work in the community. The extension of this legislation sends out a powerful message that violence will not be tolerated and will not go unpunished. ”

The full report can be found online.

Hospital car parking charges
A review group set up to look at hospital parking charges has recommended a maximum charge, but said that further analysis was needed to determine what the maximum charge should be. As an interim measure, boards have been advised that they should cap charges at a maximum of £3 a day.

Revised guidance drawn up by the review group, states that boards must operate a presumption against charging and where charging is used, all reasonable steps must be taken to ensure that these are not excessive for people working at or visiting a hospital.

The guidance also states that boards must ensure that a reasonable allocation of spaces is made available for staff, reflecting the overall availability of car parking on the site.

GMC fees set to rise for the first time in six years
The General Medical Council (GMC) has confirmed that the annual retention fee for full registration on the medical register is to rise to £390 per year, with effect from April 2008.

The annual retention fee is the main source of income for the GMC, and is regularly reviewed. It has been frozen at £290 since 2002 and although the fee is set to rise, the GMC will continue to offer a 50% discount for doctors on lower incomes.

National clinical assessment service
A formal NCAS service in Scotland will be launched on 22 April 2008. The service will include all the existing components of the current NCAS service in England, Wales and Northern Ireland, but will be specific to the needs of Scotland.

The intention is that the service will operate from an office in Scotland with a local phone number; staffed by advisers and case managers recruited in Scotland, and trained specifically for the Scotland service with expert understanding and knowledge of the prevailing statutory, legal and NHS environment. BMA Scotland is clarifying how the service will fit with the existing disciplinary procedures.

Update on Scottish Council Elections 2008

Seats still available for Sessions 2008-2011
The majority of seats have now been filled, however, if you missed the first deadline, there may still be a chance to get involved.

Seats are still available for GPs, Consultants, Juniors, Medical Academics and Staff and Associate Specialist doctors. Full details are available on the BMA website.

A formal notice will follow in the BMJ in due course. In the meantime, for more information, please contact Claire Lang on 0131 247 3013 or by email.

Waiting times
The Scottish Government’s keynote policy of 18 week referral to treatment (RTT) from December 2011 has been launched. The 18 week standard is different from previous waiting time targets in that it does not focus on a single stage of treatment but addresses the whole patient pathway, from primary care consultation up to the point at which each patient is actually admitted to hospital for treatment.

Unvalidated management information on NHS performance on waiting times showed that on 31 December 2007:

• No patient had waited more than 18 weeks for a first outpatient consultation following a GP referral
• No patient had waited more than 18 weeks for inpatient/day case treatment
• It is estimated that NHSScotland delivered the standard waiting times target for key diagnostic tests
• Main hospital A&E Departments achieved the four hours target for admission, discharge or transfer during December 2007
• The cataract treatment whole journey target of 18 weeks was met
• The whole journey target of 16 weeks for cardiac intervention was met
• The target that no patient would wait more than 24 hours for hip surgery following admission to a specialist unit following fracture was met.

Official validated statistics will be published on 26 February.

NHS Scotland’s 18 week referral to treatment website can be accessed here.

Tooke Report in Scotland
Last month, the Scottish Government Health Directorates (SGHD) published a consultation on the Tooke recommendations. It recognises that some of the recommendations require further discussion on a UK basis and flags up specific actions which are being taken forward in Scotland around the following themes: MMC organisational structure; role of the doctor; undergraduate medical students; postgraduate medical training; control of staff grade and associate specialist posts; and GP training. BMA Scotland will be responding in due course.

One issue of particular interest and concern is the role of the doctor. The SGHD has set up a project to establish consensus within the Scottish medical profession and NHS on what a ‘trained doctor’ delivered service means. This addresses recommendation five in the Tooke report about developing an understanding of roles of the doctor in the contemporary healthcare team. Issues of affordability and sustainability will be addressed as well as the contribution to service expected from doctors in training and the role of the “registered specialist”. A national launch event will take place this month, followed by regional events focusing on acute and planned care in hospital and primary and community care. The intention is to have a consultation document on the roles and grades of trained doctors issued by June 2008.

The SGHD consultation document is available online.

Get involved locally with the BMA through your Regional Junior Doctors Committee (RJDC)
There are five RJDCs in Scotland: Highland, Grampian, Tayside, South East Scotland and West of Scotland.
The role of an RJDC is to:

• consider and act upon matters affecting junior doctors in the region.
• appoint or nominate junior doctor representatives to other committees.
• work with the BMA local offices in identifying and resolving employment issues.
• form part of the representative structure of the SJDC and wider BMA.
• represent the views of the region at SJDC.
• increase regional awareness of issues affecting junior doctors.

At this crucial time for the profession, we would urge you to get involved locally with the BMA through your RJDC to ensure your views are heard. Details of your RJDC, including contact information, can be found on the BMA website.

Pandemic Flu Guidance
The Scottish Government recently issued guidance on responding to an influenza pandemic, Pandemic Flu – Provisions of Healthcare in a Community Setting.

The purpose of this guidance is to provide a broad framework to help community health providers and NHS Boards develop plans to respond to an influenza pandemic. It was informed by a report and recommendations produced by a Royal College of General Practitioners Scotland led group, Front Line Community Health Services for Pandemic Influenza: Recommendations for Scotland.

The report drew on the expertise of an advisory group which included representation from the Scottish General Practitioners Committee. It defines some of the issues which need to be addressed when developing guidance for managing health services in the community in the event of a pandemic. Its focus is primarily on the general practice and community pharmacy elements of primary care, as core primary care services will bear a considerable burden of expectation from the community in the event of a pandemic.

GMC goes virtual - launch of interactive guidance
The GMC has launched an exciting new interactive web zone for doctors to bring its core guidance, Good Medical Practice (GMP), to life.
Good Medical Practice in Action invites the user to be the doctor in a series of ethical case studies which highlight some important issues addressed in the GMC’s guidance booklet.

The action starts with four patients in a waiting room. The user is able to click on one of the patients to watch and listen to their consultation with a doctor. As each ethical dilemma reveals itself, the user is called on to decide which option is the best match to the GMC’s guidance in Good Medical Practice. GMC Standards Committee member Dr Nicola Toynton gives feedback on the user’s decision, with links to the GMC’s website to view the guidance itself.

Each patient consultation presents dilemmas, which explore issues such as conscientious objection, communication skills, advertising, and reporting concerns about colleagues. For example, what should a doctor do when faced with the following situations?

Jason is well-informed about his mental-health condition. His usual medication has been withdrawn and he wants to try out a new drug that he’s researched on the internet. It is very expensive. What should Dr Williams do next?

Brian is allergic to penicillin, but has been prescribed it in error by Dr Hargreaves, who is currently not working due to his wife’s death. Should Brian receive an apology? Who from?

Dr John Jenkins, Chair of the GMC Standards and Ethics Committee said:

“Since publishing a revised version of Good Medical Practice in October 2006, we’ve been developing new ways to communicate its messages to doctors. GMP in Action is part of this ongoing work and is designed to bring the GMC’s guidance to life for doctors in a way that a traditional printed booklet can’t.”

To get interactive with Good Medical Practice, click here.
A full list of the GMC’s ethical guidance can be accessed online.

ARM 2008 motion deadline 4 March
Each year, Scottish Council submits motions to the Joint Agenda Committee for inclusion in the ARM or branch of practice conference agendas. Scottish Council welcomes proposed motions from any BMA member in Scotland and will consider which motions to send to the Joint Agenda Committee for the 2008 ARM at its meeting on 19 March. If you would like to put forward a motion via this route, please email clang@bma.org.uk by 4 March at the latest.

Campaign to increase public awareness of adverse drug reaction reporting in Scotland
Ensuring the safety of medicines is an important responsibility for both medicines regulatory agencies and the pharmaceutical industry. For many years health professionals have assisted in this process by reporting suspected adverse drug reactions via the Yellow Card Scheme to the Medicines and Healthcare products Regulatory Agency (MHRA) on Yellow Cards or electronically. The Scottish Yellow Card Centre (YCC Scotland) acts on behalf of the MHRA in Scotland to facilitate and promote this activity.

More recently it has become possible for patients to report their own suspected adverse reactions using the Yellow Card Scheme. Community pharmacists have an important role in advising patients on medicines use and on possible side effects of the medicines they dispense. They are also ideally placed to advise patients on their concerns regarding any possible side effects of medicines they might be having.

The Scottish Government, in partnership with the MHRA and YCC Scotland, is promoting a public awareness campaign with patients so that they can contribute to increasing the safety of medicines via the Yellow Card Scheme. A publicity campaign will be run from community pharmacies across Scotland over the period of 21^st February to 3^rd April 2008.

Patients will be able to obtain details from their community pharmacist on how to report suspected side effects via the Yellow Card Scheme, and what types of side effects to report. Patients are encouraged to speak to their pharmacists and/or to pick up an information leaflet from their pharmacy.

Events
Employment Law workshops 2008
BMA Scotland will be running another series of employment law workshops, starting in October 2008.

Employment Law is continually changing therefore it is our aim to provide GP members and practice managers with an opportunity to update their current knowledge or to learn something new.

Information on these workshops will be posted on the Scottish pages of the BMA website in early June. Scottish general practitioners will be sent a copy of the programme and further information will be placed in the next edition of this newsletter.

If you are not a Scottish GP and wish to receive a copy of the programme, please forward your email address with the title “Place on mailing list for 2008 employment law programme” to gfordyce@bma.org.uk.

If there are any aspects of employment law which you feel should be included in the next programme, please email gfordyce@bma.org.uk with your suggestions.

Coming Soon to Scotland: BMJ Masterclass for GPs: General Update
Monday and Tuesday 25-26 February 2008, Glasgow

A new two day general update is coming to Scotland for the first time this month. Leading experts bring you the latest evidence, guidelines, and best practice in an easy to understand and interactive format. You will also receive our popular course handbook covering new guidelines, practical management tips, and much more, currently exclusive to our delegates.

BMA member and other discounts are available.

To find out more and to register please visit our website.