Analysis of Talking Health contributions

Key themes and priorities

Talking Health collected 139 comments drawn from 47 individuals while it was ‘live’ between March and May 2012.

The section most populated with comments was ‘Education, training and workforce’, with 36 comments. ‘Pay and contracts’ was the second most populated, with 26 comments.

This paper outlines an analysis of the comments received, including the relative priority of each issue area. The comments are not necessarily representative of the profession or BMA policy. The paper will be shared for information with BMA policy making bodies and will help inform the development of the BMA’s membership engagement strategy, especially the role of digital in encouraging greater interaction.

Issues in order of priority
The nine issues have been prioritised based on how frequently individuals raised the same, or similar, points rather than simply by the number of comments received. So for example, although ‘Education, training and workforce’ attracted the most comments, ‘Pay and contracts’ is the top priority because a greater proportion of comments raised the same points.

1. Pay and contracts

2. Education, training and workforce

3. Professional regulation and professionalism

4. Health system reform

5. Improving public health

6. Funding and value for money

7. Quality, safety and patient experience

8. Service delivery

9. Ethics and human rights

Key themes under each issue

1. Pay and contracts (26 comments, 20 individuals)

Pensions
The BMA must defend doctors against the Government’s attack on NHS pensions. Meddling with the scheme is unacceptable.
Response rates to BMA surveys have been low because most doctors know the Government will win, public opinion is not behind doctors, and doctors still do better than most people who earn less.
A vote for IA will lose the respect of the public.
 

2. Education, training and workforce (36 comments, 28 individuals)

Oversupply of doctors in the future
Doctors in the future will face unemployment and worsening terms and conditions as employers are able to move away from national contracts due to oversupply. This will serve to drive down salaries.
There is a real danger of the sub-consultant post being introduced in the face of oversupply.
Many trainees will achieve their CCT but will not find a consultant post – these doctors may go to work in AQPs, driving the Government’s commercialisation agenda.
Training people to be doctors and then not having a job for them to do is a massive waste of taxpayers’ money.
Medical student numbers must be reduced.

EU and migration
EU graduates may be given F1 jobs at the expense of UK graduates who need them to register – BMA needs to think about how to best approach application and allocation of Foundation jobs.
Current UK graduates are leaving the UK to find employment elsewhere, especially the antipodes. This is a huge waste.
As EU students are valuable to UK universities for their tuition fees, potential UK medical students may find themselves unable to access a course or left without a job when they graduate. Overseas medical schools will only create more problems.

Student debt
Current arrangements saddle doctors with £70,000 of debt. This will incentivise them to work for less once they have graduated, simply to pay off the debt.
Medical students should have additional bursary arrangements.
Such a high level of debt is extremely damaging to widening access to medicine.
 

3. Professional regulation and professionalism (10 comments, 9 individuals)

Revalidation
Revalidation must not be introduced until it is properly ready. The GMC cannot answer crucial questions such as how revalidation will work for locums and doctors outside the mainstream NHS.
Doctors are not against demonstrating that they continue to be fit to practice, but revalidation cannot be launched until it, and the NHS, is ready.

4. Health system reform (19 comments, 15 individuals)

Implementation of NHS reforms in England
The passing of the Health and Social Care Bill should not be the end of BMA work on the issues. We should continue to highlight problems that arise as a result of these reforms and support doctors to provide good, safe, affordable, equitable healthcare.

Patient-centred care
Patients should be at the centre of healthcare, not efficiency, cost-cutting, competition and profit, which seem to be the current priorities.
 

5. Improving public health (11 comments, 11 individuals)

Position of public health doctors and services
Requiring Directors of Public Health to sign employment contracts with local authorities which prevent them expressing views on government health policies will be detrimental to public health and public health medicine.
Governments are not interested in public health. It does not produce instant results, is often up against wealthy companies and doesn’t have decent media representation. It will not be a surprise if the reorganisation proves disastrous for the specialty.
This extends to medical schools where students are taught about global health issues, which students struggle to engage with, rather than about relevant issues closer to home.

Alcohol 
The BMA should start to influence alcohol policy centrally and locally, through health and wellbeing boards. This should not be just about price, but also about education.

6. Funding and value for money (14 comments, 12 individuals)

Rewarding quality
Far from rewarding quality in general practice, the QOF has turned qualified GPs into glorified date inputters.
The quality premium, which will reward GPs for not referring patients, will further erode doctor-patient trust and undermine GPs’ integrity.

Rationing and prioritisation
Focus on NHS reforms has diverted attention away from thinking about rationing and the difficult decisions doctors are going to have to make.
Setting priorities based on who can shout loudest or evoke the most sympathy may happen more under CCGs if doctors do not recognise the danger.

Increases in doctors’ productivity
Senior doctors are unhappy at being asked to increase their ‘productivity’ with fewer resources, whilst facing attacks on pay and pensions.
 

7. Quality, safety and patient experience (8 comments, 8 individuals)

Quality and quantity
There is an inherent conflict between the need for quality care and the need to achieve targets. The drive to achieve targets drives down quality, patient experience and safety.

Whistleblowing
There is still a culture and fear among NHS organisations that prevents staff from speaking out where they see problems with patient care and safety. The BMA needs to support individual doctors to speak out.

8. Service delivery (9 comments, 9 individuals)

IT
More investment in IT in secondary and primary care is needed. The gap between IT aspirations and reality has never been bigger.
Shared data and systems can help with integration.

Clinical management
Consultants feel marginalised from decision-making partly due to unwillingness to apply for clinical management posts. These are unappealing due to the danger of being caught between the wishes of clinical colleagues and the instructions of management, while having insufficient time and resources to perform well in the role.
 

9. Ethics and human rights (6 comments, 6 individuals)

Advanced care planning
A properly organised system of advanced care funding and planning is needed to ensure the NHS is not overwhelmed as patients get older and live longer.
Decisions about resuscitation should be part of this advanced care planning.