The BMA Special Representative Meeting(SRM)happened this week and for those of you that haven’t read the outcomes yet, here is a compilation of what motions did and didn’t get passed in BMA House this week. Also available is a live updated blog from Tuesday itself and a video recording of the day.
“Decisons made today will have a profound effect on your profession, your patients and the future shape of our NHS” says Dr Meldrum. “I do not support this bill. Two weeks ago we did achieve a modest but significant change to the legislation. We got rid of one of the worst features of the bill – the clauses that would have allowed price competition”. “GPs and their colleagues are being set up to fail; to take the blame when things go horribly wrong.”
Dr Meldrum closed his speech by challenging doctors to use today’s opportunity wisely.
What did get passed:
1. To robustly pursue amendments to the bill which will; reduce the inherent risks to patient care and promote safety and quality of medical and social care.
2. Increase publication and open opposition to damaging elements of the Health Bill.
This is instead of an outright opposition to the Bill where there were concerns about how professionals could be divided over the reforms.
- · Oppose relaxation of capping on private practice
- · 1st priority to provide NHS services to local population
- · Private work must not be subsidised by NHS resources/staff
- · Profits from private practice should be reinvested in the NHS
- · Private income should be capped
- · Sufficient time is needed for trusts to achieve FT status
- · Forcing NHS trusts to achieve FT status will impact negatively on patient care
- · Too great an emphasis on financial stability will be at expense of patient care
This was unanimously voted upon.
4. Doctors of public health should remain employed by the NHS to help improve health and health inequalities.
This is to safeguard the profession and to ensure its future as a specialty.
5. An equitable distribution of high-quality staff is important and there should be safeguards to prevent employers dismantling terms and conditions of service to detriment of consistent, high quality care.
6. Clinical effectiveness should be evidence based and that health outcomes are published and used to assess quality in care rather than process in care.
7. The Director of Public Health appointed within local authorities should be professionally independent and free to act as an advocate for the health of their population; should be registered specialists in public health or public health medicine and given appropriate authority and control over sufficient resources to deliver public health functions; responsible and accountable for the budget and able to influence all funding streams with public health impacts.
8. NHS commissioning board and Joint Strategic Needs Assessment are likely to conflict and clarification of the mechanisms for resolution are needed.
9. Calls for the creation of a single public health agency in England to prevent fragmentation of the specialist public health workforce.
10. There is no evidence to suggest that changing the medical education system including deaneries is needed.
Peter Bennie, a consultant psychiatrist said, “the deaneries are there to protect patient care as well as the quality of training”.
Motion was carried unanimously.
11. Government control of workforce planning is needed to prevent regional variations in quality of training.
12. Reorganisation of the health service poses a threat to training and calls upon evidence that patient care will not be harmed; commissioning should not impact on training; standards of training should be trained to consistently high standards and the medical profession should have a voice in the training of medical professionals.
13. Primary function of Monitor must be to maintain and extend a cooperative healthcare system and not promote commercial competition.
This motion was called for by Dr Mark Porter, BMA chair of consultants, and was carried overwhelmingly.
14. Secretary of State should remain fully accountable for the provision of services.
15. That the doctor-patient relationship may be damaged as a result of commissioning, rationing decisions and balancing commissioning budgets.
The option to completely reject the creation of GP consortia was rejected as focus is seen to be better placed elsewhere.
16. GP commissioning consortia must act transparently, take account of advice from all medical specialities and patients, take account of cost-effectiveness, clinical need and effect of research. Should also be able to work with local providers to assure continuity of care and commission a minimum set of core services to ensure appropriate care.
17. GP consortia should hold meetings in public and publish documentation, be aligned to local authority boundaries, commissioning roles should be elected, core functions should not be outsourced and practices should not be expelled without an independent internal evaluation.
18. It should be ensured that the NHS Commissioning Board does not centrally dominate over GP consortia; a robust appeal mechanism should be in place for the NHS Commissioning Board, all appointments to the board should be transparent and include a wide clinician representation.
19. Successful and effective commissioning can only occur through partnerships with GPs, hospital clinicians and public health practitioners.
20. Clinician-led commissioning could be achieved without the need for further legislation.
21. When changing the organisation and delivery of NHS care the government should involve public and patients as well as clinicians and managers.
22. Concern over the confidentiality issues that the data flow proposed will create.
23. There is no place for commercial confidentiality within the NHS and financial transactions within should be made public and this should be transparent and thus in the legislation as such.
24. Price competition in healthcare is damaging and the BMA’s input leading to the amendment removing price competition was crucial.
25. The NHS should be the preferred provider where it is accepted to be of good quality.
26. ‘Any willing provider’ will undermine the ability of health professionals to work together to benefit the patient, increases fragmentation of care pathways, could risk department and/or hospital closure.
27. It is the wrong time for reforms whilst trying to save £20bn.
28. PCTs are losing key staff and are at risk of collapse and undermining of PCTs should not occur until functions and responsibilities are appropriately relocated.
29. The Health Secretary should withdraw the health and social care bill, consider the criticisms and advice from the medical profession that were collected during consultation and that evolution not revolution is the way forward.
30. The reforms were not in the election manifestos of either coalition party and as such there is no electoral mandate for the introduction of the changes.
31. The government’s use of misleading and inaccurate information to denigrate the NHS and justify the reforms is not acceptable and the reforms are likely to worsen health outcomes.
Motions not passed:
1. To make a statement of ‘No confidence’ in the Health Secretary. Hamish Meldrum voiced concerns over the “voice of no confidence could make it difficult to engage with the government”.