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BMA Scotland newsletter

December 2007

Dear Colleagues,
2007 has been a difficult and challenging year for the profession and for the BMA: junior doctor training reforms have brought nothing but chaos and uncertainty for trainees; Staff and Associate Specialists remain in limbo after spending over a year waiting for the UK Treasury to release their contract and, now that it has, uncertainty remains over the revised contract; and GPs have endured a sustained media campaign against them, despite high levels of patient satisfaction.

But it’s not all doom and gloom. Plans to reduce student debt and abolish the graduate endowment are currently being considered by the Parliament, the Government has announced its intention to extend the Emergency Workers Act to give greater protection to GPs, and we are making progress towards holding a public consultation on moving to a system of presumed consent for organ donation.

I am sure that 2008 will bring with it more challenges for the profession but I also look forward to embracing forthcoming opportunities. I am deeply concerned that the next round of specialty training recruitment will be even worse than it was this year and I worry for the morale of junior doctors going through this process. However, we will endeavour to do everything we can to improve the recruitment and selection process for future applicants. We will also continue to work towards a new SAS contract that recognises and rewards this hidden group of NHS doctors.

I look forward to working with you all in 2008 and would like to take this opportunity to wish every one of you a very Merry Christmas and a Happy New Year.

Dr Peter Terry.

Tobacco licensing – a vital step forward in tackling underage smoking
Last month, Christine Grahame MSP, Convener of the Scottish Parliament’s Health and Sport Committee, published a consultation on her proposed Tobacco Sales Licensing Bill for Scotland. BMA Scotland has given its wholehearted support to the consultation and believes that a positive licensing scheme would represent a significant step forwards in tackling teen smoking. With over three quarters of regular smokers aged 15 and almost half of regular smokers aged 13 in Scotland reporting that they bought cigarettes from a shop in 2006, it is clear that the age restrictions are not being adhered to. Radical action is required to reduce school children’s access to tobacco.

A positive licensing scheme would bring the sale of tobacco into line with alcohol. Introducing a licence to sell cigarettes, which would be removed for persistent offenders, would discourage retailers from selling to underage children.

The consultation document is available at the following link:
www.scottish.parliament.uk/s3/bills/MembersBills/pdfs/TobaccoSalesConsultation.pdf

If you would like to contribute to the BMA’s response, please contact ggrant@bma.org.uk.

Make Scotland’s roads safer – reduce the drink driving limit
Dr Sally Winning of the BMA’s Scottish Council delivered a special Christmas card to Kenny MacAskill, Cabinet Secretary for Justice, and Dave Thompson MSP earlier this month.

The card marked the start of BMA Scotland’s campaign to reduce the drink driving limit from 80mg to 50mg per 100ml. As part of this campaign, BMA Scotland also hosted a parliamentary briefing event to call upon MSPs to exert pressure on the UK Government to reduce the blood alcohol concentration level and bring the UK into line with many other European countries.

SAS contract negotiations
Following the formal withdrawal from talks with the government over the contract, the UK Staff and Associate Specialists (SAS) Committee sought the views of SAS doctors and dentists to determine what course of action will now be pursued. A special conference was held on 1 December 2007 at BMA House to consider the contract stalemate and the possible way forward. The regional and national BMA centres hosted smaller meetings where attendees were able to watch the live webcast of the special conference in London and participate in local discussion groups. Comprehensive information on the contract package as it currently stands has been issued and a survey of all SAS doctors and dentists has been undertaken on the content of the proposals and options for future action.

Since the conference, the contract proposals have been released by the Department of Health with the proviso of two-year phasing from April 2008 in England. However, SASC has concerns with the phasing in aspects of the contract and will be seeking urgent clarification from the Department of Health about a number of points – including whether this contract is now only for England or whether it covers the devolved nations. The Scottish SASC is also seeking clarification from the Scottish government about how it intends to proceed. The matter is currently being considered by the Cabinet Secretary, Nicola Sturgeon. The SAS Committee has also agreed that when that clarification is obtained, it will start the process of putting the revised contract offer out to ballot.

Distinction awards and discretionary points
Further delays to the review of distinction awards and discretionary points mean that the 2008 rounds will take place under the existing systems. The anticipated introduction of an electronic system for the submission of nominations and citations for distinction awards has been delayed because of unexpected hardware problems. However, the electronic system will continue to be tested and trialled with the assistance of stakeholders in order to resolve the problems for future rounds.

Scottish Medical Students Committee (SMSC) survey
At the end of November, the Scottish Medical Students Committee sent out a survey to final year medical student members in Scotland seeking their views on applying to foundation programmes in Scotland and asking whether Scotland should be split into four foundation schools. The information gathered will be used by the Committee in its discussions with NHS Education for Scotland (NES) on ensuring the Scottish Foundation Allocation Scheme can best work for medical students.

If you have any queries about this research, or if you are a final year BMA medical student who has not received a copy of the survey, please contact Amanda Downing on 020 7383 6459 or e-mail adowning@bma.org.uk or Eleanor Gray on 020 7383 6262 or email egray@bma.org.uk.

Better Health, Better Care
BMA Scotland submitted its response to the Scottish Government’s consultation “Better Health, Better Care”. BMA Scotland welcomed many of the proposals outlined in the consultation document. For example, the focus on reducing health inequalities and tackling public health issues reflects the priorities of doctors across Scotland (as evidenced by the results of the survey of members carried out by BMA Scotland in 2006).

However, the consultation also presented a number of policies over which BMA Scotland raised concerns. These include the proposals for direct elections to health boards, extended GP opening
hours and enforced patient waiting time guarantees. The lack of evidence for proposals to set targets for anti-depressant prescribing and the introduction of generic health checks have also warranted concern.

A copy of BMA Scotland’s response is available at:
www.bma.org.uk/ap.nsf/Content/BHBCresponse

The consultation informed the development of the Government’s Health and Wellbeing Action Plan, which was published on 12 December. The action plan is available here:
www.scotland.gov.uk/Publications/2007/12/11103453/0

BMA Scotland is currently considering the plan in detail.

BMA Scotland at SNP party conference
In October, BMA Scotland sponsored a Health Reception at the SNP’s Annual Conference. Dr Mary Anderson, a GP from Kingussie and a member of the Highland Local Medical Committee, came along to speak with the Minister for Public Health, Shona Robison MSP, and Bruce Crawford, the Minister for Parliamentary Business.

Engaging with members in the West of Scotland
West of Scotland Regional Junior Doctors Committee is making use of old and new technologies to maximise involvement and engagement of training grade doctors in the area.

The committee has established a ‘google’ group so that they can have ‘virtual’ discussions online, inspired by a similar one running in South East Scotland, and recent publicity in their newsletter has seen its membership increase by 25.

Dr Gordon Lehany, an ST4 in Psychiatry, said: “This is an important time for junior doctors and, in the West of Scotland, we’re trying to get as many doctors as possible involved with our local committee. Attending evening RJDC meetings is not always easy or possible because of work or family commitments so a ‘virtual’ group is probably the best way for us to keep members informed and to give them the opportunity to contribute to online debates.

“Our membership has gone from zero in August to 40. The combination of electronic communication and paper newsletters has been particularly effective and I would recommend this approach to other local committees who are trying to engage with members.”

Any junior doctor in the West of Scotland wishing to join can simply go to: http://groups.google.co.uk/group/west-of-scotland-juniors or email Gordon on: glehany@mac.com.

New registration framework for doctors
October saw the introduction of the GMC’s new registration framework for doctors. Key features of the framework include the abolition of limited registration for international medical graduates and the introduction of GMC approved practice settings for all doctors new to full registration. The overall aim is to assure both public protection and equality of treatment for doctors, and to make the registration system clearer for patients and employers.

More information is available on the GMC’s website: www.gmcuk.org. This includes a full description of the new system, frequently asked questions, and a list of approved practice settings. All Scottish health boards - and the appropriate special health boards – have been confirmed as approved practice settings.

Immigration Regulations
Last month the Court of Appeal upheld an appeal by the British Association of Physicians of Indian Origin (BAPIO) and ruled that the Department of Health had acted unlawfully by instructing employers not to consider doctors on the Highly Skilled Migrant Programme as equal to UK/EEA applicants for specialty training posts. The judgment did not uphold a second claim by the BAPIO over the lawfulness of changes to the immigration laws that abolished permit-free training for overseas doctors. The ruling means that the proposed Department of Health guidance, which the Scottish Government consulted on implementing, cannot be put into effect on the grounds that this would be unlawful as it affects immigration law and, as a point of principle, the Secretary of State for Health cannot issue such guidance. The Department of Health and the Home Office intend to challenge the ruling.

Consultation on Consultant Recruitment
Earlier this year, the Scottish Government Health Directorates commissioned independent research into best practice in senior medical recruitment with a view to establishing sound principles on which consultant appointments should be made. Last month the Cabinet Secretary for Health and Wellbeing announced a consultation on the options for improving the consultant recruitment process, which were identified by the SGHD as a result of the research. The consultation is available online at www.scotland.gov.uk/Consultations/Current and the full research report can be accessed at:www.scotland.gov.uk/Publications/2007/11/19142654/10

Responding to the launch of the consultation, Dr Charles Saunders, Chairman of the BMA’s Scottish Consultants Committee, expressed concern that the consultation was the result of a flawed review process that did not reflect the views of key stakeholders.

Hepatitis C Campaign Stepped Up
An information campaign aimed at improving health professionals’ knowledge of Hepatitis C is being stepped up and widened to target other professionals likely to come into contact with people with Hep C such as prison officers, local authority staff, midwives and students in the health field. Health Protection Scotland is currently developing Phase 2 of its Hepatitis C Action Plan which will seek to build significantly on the work already taken forward. Its proposals will be presented to Ministers early next year for consideration.

Professionals can access the website www.hepcscotland.co.uk to view the nationally managed clinical guidelines which include information on testing, referral and treatment of the virus. For further information contact Kim Munro on 0141 333 9585 (office), 07967 328004 (mobile) or kim.munro@bigpartnership.co.uk or Elaine Robson on 0141 333 9585 (office), 07795 435484 (mobile) or Elaine.robson@bigpartnership.co.uk.

Modernising Medical Careers update
Scottish Junior Doctors Committee survey on specialty training
In August, the Scottish Junior Doctors Committee (SJDC) surveyed junior doctors in Scotland to gather their views on the future recruitment and selection process for specialty training. The results of the survey are available on the BMA Scotland website:
www.bma.org.uk/ap.nsf/Content/SJDCsurvey07

The results were presented at the NHS Education for Scotland (NES) Modernising Medical Careers workshop in October, which was held to evaluate this year’s recruitment and selection to Foundation and Specialty Training in Scotland, look at the lessons learned and discuss future arrangements. A summary report of the workshop and each of the speakers’ presentations have been put on the MMC Scotland website and can be found at the following link: www.mmc.scot.nhs.uk/news_article_01.htm

Based on the survey results, SJDC has been lobbying for the following measures for the 2008 application process:

• Improved communication.
• A common UK application and offer timetable that is fixed and will not change.
• Two application rounds.
• A commitment that there will be an expansion in ST2, 3 and 4 programme opportunities to absorb FTSTAs, existing SHOs, SAS grades and trainees currently in research.
• Transferable competencies.
• No restrictions on the number of applications.
• A CV based application with published scoring criteria.
• No knowledge tests.
• Structured CV based interviews.
• Competitive entry for 'higher training' within a programme at Deanery level and Scotland/UK level where appropriate.

The Scottish Government Health Directorates have now set up a new Specialty Training Programme Board and new Selection and Recruitment Delivery Board for 2008. BMA Scotland is pleased to have representation on both Boards.

Support for unplaced junior doctors in Scotland has been a priority for SJDC and the Committee is pleased that the Cabinet Secretary for Health and Wellbeing announced that the contract extensions for unplaced junior doctors in Scotland would continue for a further three months. This will take the total extension period to six months from 1 August 2007 to 31 January 2008.

Applications for 2008
Applications for the 2008 specialty training programmes in Scotland (which will start in August) will open on 4 January and close on 18 January. The new MMC Scotland website, which will contain the information applicants require to help them through the application and recruitment process, was launched on 10 December. Following this, doctors who wish to apply for specialty training programmes in Scotland must register their interest in applying via the facility on the home page.

The Structured Application Forms for each specialty are now available on the MMC Scotland website so that applicants can familiarise themselves with the format and types of questions that will be asked. However, it will not be possible to download or complete the forms at this stage.

From 4 January 2008, registered applicants will be able to use their unique reference number to complete the application form relevant to the specialty and level they wish to apply to. The form will enable applicants to capture all relevant information from their CV.

If you wish to receive email alerts and newsletters from the MMC Scotland communications team, you will be able to sign up for these on the new site. This will keep you informed about developments related to the application process as well as new information added to the site.

Tooke report
Last month, the BMA published its response, including a BMA Scotland appendix, to Professor Sir John Tooke’s interim report on Modernising Medical Careers (‘Aspiring to Excellence’). The BMA described the report as “excellent” but argued that a new grade below the level of consultant is unnecessary, would not improve the quality of care, nor save the NHS money. Other key points in the BMA’s response included:

• Support for the concept of a three-year core training programme followed by higher specialist training, although recognition that this will not necessarily be the best model for every specialty.
• Support for multiple recruitment rounds so doctors have more than one opportunity a year to get into training.
• That there are problems with the second foundation year that need to be addressed but it would be opposed to the idea of the two year foundation programme at the start of training being broken up.
• Support for GP training to be extended to five years as long as the focus is on the GP curriculum and the training is relevant to doctors’ future careers in general practice.
• That there should be early exposure to opportunities for medical academic careers.
• Support for the idea of a single body to regulate undergraduate and postgraduate medical education, as long as it has appropriate medical representation and does not penalise doctors financially.
• That there is a need to make non-training staff and associate specialist (SAS) grades more attractive to doctors, for example through better training and continuing professional development delivered through a new contract and reward structure.

The full BMA response, including the BMA Scotland annex, can be found at the following link: www.bma.org.uk/ap.nsf/Content/Tookeresponse. The inquiry is expected to publish its final report on 21 December.

Who’s who in BMA Scotland
Scottish Council Elections
If you are interested in getting involved in the Scottish Council of the BMA, nomination forms are now available to apply for a seat on Scottish Council for the 2008-2011 sessions. Scottish Council is the cross- branch of practice committee which deals with matters relevant to the whole medical profession in Scotland and meets three times a year in Edinburgh. For more information or to access a nomination form, please see
www.bma.org.uk/ap.nsf/Content/ScottishCouncilElections2008 or contact Claire Lang on 0131 247 3013 or email clang@bma.org.uk.

Scottish Council
Dr Peter Terry, a Consultant in Obstetrics and Gynaecology in Aberdeen, is now in his fourth year as Chair of Scottish Council following his re-election in 2007. Dr Terry was previously the Chairman of the Scottish Consultants Committee and led the negotiations of the new consultant contract.

He sits on BMA UK Council and is also an elected member of the GMC. He graduated from Edinburgh University Medical School in 1976.

Dr Brian Keighley, a GP from Stirlingshire, holds the post of Deputy Chair. Dr Keighley graduated from Glasgow medical school in 1972 and has worked in General Practice for 33 years. He is a former chairman of the BMA’s Scottish General Practitioners Committee, sits on BMA UK Council and is also an elected member of the GMC. He is also the Treasurer for the GP Defence Fund.

Scottish Council continues to focus on issues which affect the whole medical profession in Scotland, including changes to professional regulation, MMC, Scottish health policy, medical workforce planning and national staff partnership issues.

Scottish Consultants Committee
Dr Charles Saunders, a consultant in Public Health Medicine in NHS Fife, is Chair of the Scottish Consultants Committee. Dr Saunders served as a deputy chairman to the committee for the last three years. Dr Saunders graduated in 1981 and was previously a GP in East Anglia before undertaking further training in public health medicine in Yorkshire.

Dr Saunders was the former chairman of the BMA’s Scottish Committee for Public Health Medicine and Community Health and is a member of the BMA’s Scottish Council and the BMA’s UK Consultants Committee.

Dr Jane Lolley, a consultant psychiatrist in Aberdeen, serves as joint Deputy Chairman of the Scottish Consultants Committee. She is also Chairman of the SCC’s Policy and Finance Sub Committee.

Dr Lewis Morrison, a consultant in General & Geriatric Medicine in Lothian, also serves as Deputy Chairman of the SCC as well as Chairman of the SCC’s Negotiating Subcommittee.

Last session the SCC dealt with issues such as consultant productivity, consultant accountability, and the impact of MMC on service provision. New business will include outcomes of the review of distinction awards and discretionary points and from the review of best practice in consultant recruitment, and changes to professional regulation.

Scottish Staff and Associate Specialists Committee
Dr Sally Winning, a Staff Grade psychiatrist at the Macrobin Centre at the Royal Cornhill Hospital in Aberdeen, is the Chair of the Scottish Staff and Associate Specialists Committee. Dr Winning was previously the Deputy Chairman of the Committee.

Dr Christine Robison, an Associate Specialist in Anaesthetics at the Edinburgh Royal Infirmary, is the Deputy Chairman of the Committee.

This session the Committee will continue to focus its attention on securing a ballot of all SAS doctors on the new contract, while ensuring that existing terms and conditions are upheld. The
Committee will continue to seek improvements to the training and educational opportunities available to SAS grades, and work to secure the future of the SAS grades.

Scottish General Practitioners Committee
The Scottish General Practitioners Committee is currently chaired by Dr Dean Marshall. Dr Marshall graduated from Aberdeen medical school in 1988 and currently practises as a GP in Dalkeith, Midlothian. He previously served as the Secretary of Lothian’s Local Medical Committee.

Dr Stuart Scott serves as Joint Deputy Chairman of SGPC. He graduated from Aberdeen University in 1984 and has been a partner at the Holborn Medical Group, a city centre practice in Aberdeen, since 1992. Dr Scott also leads on information technology issues.

Dr Andrew Buist also serves as Joint Deputy Chairman of SGPC. Dr Buist graduated from Edinburgh University in 1987. He has been a partner at the Ardblair Medical Practice in Blairgowrie for 13 years. Dr Buist also leads on rural issues.

Key issues and challenges for Scottish general practice include an unfunded rise in GP patient populations; two consecutive zero percent Doctors’ and Dentists’ Review Body awards; SNP manifesto pledges on flexible access to GP services; and the Scottish Government’s Better Health, Better Care strategy.

Scottish Junior Doctors Committee
Dr Alan Robertson, a Specialty Registrar in General Medicine at Edinburgh’s Royal Infirmary, is currently Chair of the SJDC. Dr Robertson graduated from Glasgow University Medical School in 2003 and during his time as a medical student, chaired the BMA’s Scottish Medical Students Committee.

Dr Katie MacLaren, a GP Specialty Registrar from Tayside, serves as Joint Deputy Chair of the SJDC.

Dr Colum Slorach, a Specialty Registrar in Anaesthetics in Edinburgh, is also a Joint Deputy Chair.

The last year was challenging for SJDC given the catalogue of problems that arose with the MTAS recruitment process. Recruitment and selection to specialty training for 2008 in Scotland will be the focus of SJDC’s work over this session and the Committee will continue to work hard to protect the interests of junior doctors. Other key issues will include: the implications of the Tooke inquiry; and discussions with employers to clarify the issue of relocation and travel expenses for junior doctors and agree Host Health Board arrangements.

Scottish Medical Students Committee
Anna Riemen, a fifth year medical student at Dundee University, is currently Chair of the SMSC.

Mori Mansouri, a third year medical student at Edinburgh University, is Deputy Chair of the Committee.

The SMSC will continue to work on behalf of medical students discuss issues surrounding applications to foundation programmes and seek improvements to the Scottish Foundation Allocation Scheme. Issues concerning student finance, in particular the proposed abolition of the graduate endowment fee and graduate up-front fees, will also be discussed.

Scottish Medical Academic Staff Committee
Mr Philip Belcher, a Consultant in Cardiothoracic Surgery at Glasgow University, is Chair of SMASC.

Dr Richard Weller, a consultant in the department of dermatology at the University of Edinburgh, is Deputy Chair.

During the last session the SMASC agreed a new contract for senior academic GPs; submitted evidence to the Review of Distinction Awards and Discretionary Points schemes; raised concerns about the reduction in the number of clinical academic staff; and met with the Chief Scientist to discuss the implications of the Cooksey Report for health research funding in Scotland.

The key issues concerning SMASC over the next session will be: academic career pathways under MMC – the development of the Scottish Clinical Research Excellence Development Scheme; and
seeking formal trade union recognition with the individual universities.