Let's all move to Powys!

If yet more research is to be believed, Wales has one of the happiest areas to live in.

Powys is THE number one cheerful place in the whole of the UK based on a sense of wellbeing, adding in factors such as employment, health and educational qualifications.

So this got me thinking about the problems of attracting junior doctors to Wales and making sure that those who do train here, stay here.

Maybe we could set up a training facility for future medics in Powys? There has to be some mileage in selling this happiness story to potential junior doctor applicants to Wales. And maybe it's the answer to our rural health issues too. I can't wait to share this with the Dean when he returns from hols!

Wales is tipping the scales!

So Wales, according to research, is officially the fattest place in the UK.

The research is compiled using data from GP practices relating to the Quality and Outcomes Framework (QOF) for 2006/07. The QOF includes keeping a register of patients aged 16 and over with a body mass index (BMI) of 30 or over in the previous 15 months.

GPs are only too aware that the level of chronic disease in Wales is running at a higher level right across the board, than any other part of the UK.

Vascular diseases, like hypertension, heart disease and diabetes, and a range of other conditions, are all related to weight among other things.

While obesity and poverty are inextricably linked – with areas of Wales being the poorest in the UK, and Julian Tudor Hart's inverse care law alive and well in Wales, - improving health remains a massive challenge.

As much as we need to be trying to encourage people to exercise more, very often, those very people who need to, can't afford to join a gym. In supermarkets, the "buy one get one free" offers never seem to be on fruit and veg. Hardly enouraging a healthier lifestyle is it?

So is part of the solution having more exercise on prescription and more investment in sports in schools.

Ultimately, though cost is a contributing factor, we need to take personal responsibility for the amount of exercise we do and the type of food we eat. The buck stops with our burgeoning waistline.

Lucentis decision re-opens can of worms over NHS drug funding

The U-turn by NICE (the National Institute for Health and Clinical Excellence) this week regarding the sight-saving drug Lucentis, returns us once again to the debate about what the NHS should and shouldn't be funding.

Lucentis is used to treat wet age-related macular degeneration (AMD), the leading cause of sight loss in the UK.

But, in NICE's draft guidance last year it seemed to suggest a patient would need to lose their sight in one eye before the other could be treated with Lucentis. That has now changed, along with the introduction of a so-called "dose-capping system". The NHS will only fund 14 injections, with the cost of any more being met by the drug manufacturer.

It is still a costly course of treatment for the NHS. One Lucentis injection is £761.20, so the 14 injections being funded by the NHS equates to about £10,700.

This is money well spent, ensuring a loss of sight is avoided.

It has also ended the postcode lottery for patients in Wales, where some Local Health Boards were funding Lucentis and others weren't.

But where does that leave the NHS in terms of funding other "wonder" drugs?

How do you decide the cost "effectiveness" of such treatments?

We all know our health service doesn't have an endless pot of money, to be dipped into at a whim - which is why funding decisions must be transparent and clearly understood by clinicians and patients alike - based on evidence. It's also about the time the public is involved in the debate - after all it is our money!

But who has the guts to deny patients who've paid their National Insurance contributions all their lives, the treatment they need?

Perhaps none of our politicans have the appetite for that debate so soon after their summer holidays. But it is a debate they need to have.

For once - a pat on the back for GPs

At last, after all the GP bashing of late, with accusations of them get paid more, for working less hours, it's refreshing to come across a good news story about doctors.

And what makes this story all the more important, it's based on a survey of what you - the patient thinks.

BMA Cymru Wales on YouTube

The video team here in the office have been busy putting together various videos for our YouTube channel, BMAtv.

Here's a selection of their work.

BMA Cymru Wales at the National Eisteddfod



Find out how to join BMA Cymru Wales' junior doctors committee



Changes to the structure of NHS Wales



Reforms to Welsh Council



Experiences of junior doctors working in Wales

View more on our BMAtv channel on YouTube

Wales has lost a golden opportunity to take the lead on organ donation

The Assembly’s Health Committee has rejected the idea of introducing presumed consent for organ donation in the near future. They voted against a proposal to apply for a Legislative Competence Order (LCO), which would give the Assembly the power to bring in such a system in Wales, by six votes to three. And the reason they gave for doing so? They do not believe that it is currently the most urgent priority and would act as a “distraction”. So does that mean missing out on the chance to potentially save more lives is not a priority?

The committee also recommended that if any presumed consent system were to be introduced in the UK, it should be the "soft" version, where loved ones are consulted and their views taken into account. This is something BMA Cymru Wales wholeheartedly supports and I cannot see why this should not have been an option for consideration.

There is little doubt that a system of presumed consent would produce a far higher potential donor rate than at present, which is far too low at 22%. Experience of other European countries that have introduced presumed consent have demonstrated this. Some 400 people in Wales are still waiting for transplants and one person dies each day in the UK, waiting. The committee has missed an opportunity to shorten the delay for those people waiting desperately for a transplant. It is difficult to see how the decision will be explained to these patients and relatives as it does not stack up on the basis of the evidence.

We appreciate some people may feel that presumed consent means interference by the state and they will have no control over what happens to their organs after death. With a “soft” presumed consent system that certainly is NOT the case. A person’s organs would only be used to benefit others, IF the deceased’s family agreed to it and only if that individual had not removed themselves from the register and that option would be open at any time.

It would seem the committee did not even properly listen to and take into account the views of the general public they surveyed as part of this report. As many as 73% of those polled said when they die, they would like their organs to be taken automatically to save or improve someone’s life. And yet six of the health committee members voted AGAINST presumed consent. So what was the purpose here of consulting with the general public? The committee even reached the conclusion that, “presumed consent appears to have a positive effect on donation and transplantation rates.”

BMA Cymru Wales acknowledges that introducing a “soft” system of presumed consent would not necessarily, on its own, solve the shortage of donors, but it would go along way to doing so. And by making improvements to the transplant infrastructure as well, such as more training, increasing the availability of transplant co-ordinators, reviewing the health service’s capacity to cope and ensuring sufficient availability of intensive and critical care beds, then Wales would really be able to say it had made a significant contribution to saving the lives of those on transplant lists.

Junior doctors - Wales needs you!

The possible closure of Singleton Hospital’s casualty department
highlights the need to encourage more junior doctors to come and work in Wales.

BMA Cymru Wales and the Welsh Deanery have been working together on a joint video project to encourage more junior doctors to come and work in Wales.

Changes to NHS Wales

Edwina Hart is certainly a Minister willing to shake-up our NHS.

She's signed the death certificate for the much maligned internal market in NHS Wales – effectively ending the purchaser/provider split.

For our part, BMA Cymru Wales’ has consistently called for an end to the internal market which only serves to undermine the public service ethos and erodes the relationship between professional colleagues, wasting money on bureaucracy that can be put to better use on front line patient services.

Such a move should allow us to take a fresh look at managerial culture, which has distorted clinical priorities to the disadvantage of patients.

The Minister has announced the end of NHS Trusts and LHBs in their current form. These bodies will be reconstituted as one unified body, effectively creating a single local health organisation, responsible for delivering all healthcare services within a geographical area.

In principle, BMA Cymru Wales supports any plan to reduce the number of structures that detract from and absorb resources from the provision of front-line NHS services.

But if the Minister thinks that this is the end of the debate, then some time to pause and think again, would be advised, as there still appears to be some life in the structures argument yet.

For all the political rhetoric – the real work is yet to be done. Far from a done deal many have argued that rather than ending the internal market, NHS Wales could be sleep-walking from the existing internal market between commissioners and providers to a new competitive environment between primary and secondary care, as scarce resources are fought over.

This is causing concern amongst some parts of the medical profession – especially GPs. Understandably, they fear that any new unified bodies, particularly if the intention is to base them at Hospitals trusts, will simply see them continuing to focus on the acute/hospital-based activity. Unsurprisingly, most GPs remain in favour of a model which incorporates a distinct ‘community services’ provider as a counterbalance to the hospital focus that a unified Trust maybe persuaded to take.

GPs fear that the removal of a boundary between primary and secondary care equates to primary and community care being subsumed into a large unified body that will fail to give primary care adequate priority. Worse of all, rather than reverse the flow of resources from primary to secondary care, an Integrated Trust could actually accelerate and exacerbate existing problems.

BMA Cymru Wales will expect from the Minister significantly greater clarity and more detail for the next stage of the consultation process. In our initial response, we made it clear that any ‘integrated’ health body could only be supported if two essential criteria were met.

Firstly, that the new body must be designed as an entirely new entity – rather than one built purely around the NHS Trust model with its present focus on acute/secondary services; and secondly that it works in partnership with GPs, but not interfering with their independent contractor status, which allows them to exercise their patient advocacy role, so valued by patients.

The Minister’s commitment to take the time to do things right is to be welcomed but a ‘can-do’ Minister, perhaps with one eye on the top job – time may not be something that this Minister is willing to waste.

Reform of Welsh Council

The BMA's annual meeting in July approved changes to the rules, allowing Welsh Council's structure to be altered, to better meet our needs. The voting membership has been reduced to 24: nine ex-officio members recognising the principal branches of practice in Wales, plus fifteen directly-elected members. The "direct election" component is a first for us and we hope to encourage doctors who aren't otherwise active in the BMA, to stand. The election is now under way and I'm pleased that 25 doctors are standing as candidates for the 15 places - good luck to everyone involved.

The results will be announced on 12 September and I'll publish the results here. It's important that you know who the new members of Welsh Council are, as it's part of their job to keep in touch with doctors across their "patch" i.e. you! One of their first tasks will be to elect a new Chairman and Vice Chairman from among their number as Tony Calland, our current Chairman, has reached the end of his term of office.

I'll also publish the details of the new Chairman and Vice Chairman once the results are announced on 1 October.

The date of the first meeting of Welsh Council for this Session is Friday 3 October.

Don’t balls-up chance to address men’s health

WELSH rugby captain, Ryan Jones’ backing of the testicular cancer campaign is highly commendable and has the full support of BMA Cymru/Wales.

As the leading professional association for doctors, we’re not in the business of knocking attempts to raise awareness of such a serious condition – nor a Grand Slam winner, for that matter!

But, what it does highlight is the desperate need for decision makers to focus and develop specific policies that target men’s health.

For all the evidence shows that men are much more reluctant to admit to health problems than women. Men visit their family doctor less often than women and go to the pharmacist less. Just go into any GP's surgery or hospital ward and you will find it dominated by women. Then go to a Well Man clinic and you will probably find it empty.

All this might not matter, except for the fact that men are less healthier than women. Their life expectancy is less than women's and at every age up until 79 more men die than women.

A recent survey found that a third of men would risk their health by not going to the doctor's quickly enough. By contrast, women are more sophisticated in how they use health services because through necessities such as birth control, they familiarise themselves with the system earlier in life.

And it doesn’t take a rocket scientist to work out that if we can get men to see their GP sooner, then they can be treated more quickly and lives can be saved. Too often men present with symptoms late in the course of an illness.

That’s why at this year’s annual BMA meeting in Edinburgh doctors from across the UK and from all branches of medical practice expressed their concern over the late diagnosis of serious medical conditions as a result of men’s delayed presentation to health professionals and demanded greater research and action to address this issue.

This is where policy makers and the Welsh Assembly Government have a duty to act. Though they seem willing to tackle testicular cancer – and rightly so, they - like the men who don’t visit their GPs - are content to bury their heads in the sand to the bigger health picture.

And the danger? If we don’t do something soon then we could be guilty of one almighty balls-up!

Putting prescriptions in perspective

A five percent hike in the number of prescriptions dispensed in Wales, reported in official figures has led to the usual knee jerk response, that it obviously signifies a failure of the free prescription policy now benefiting patients in Wales. Why? Critics believe patients are exploiting the system to stockpile Bonjela and Calpol. Can this be true? What’s the evidence? Precious little, but let’s not allow the truth to get in the way of a good story!

There has been a five percent increase in the number of prescription items issued by GPs – during, at a conservative estimate, 12 million GP consultations annually – and rising – now that’s a fact! So what are the issues surrounding this?

Firstly, the notion that these figures are somehow out of the ordinary and a direct consequence of the free prescriptions policy is just not the case. In fact, if you look at the figures in detail for the last ten years or so, the rate of increase in prescription items issued has consistently grown by 3-4 percent for every year BEFORE the introduction of free prescriptions. Is there something else going on? Definitely.

Secondly, changes to GP contracts have resulted in more patients than ever being seen by their doctor – with a focus on early diagnosis of disease and much earlier treatment, with tighter control of chronic diseases through healthstyle advice and support, and where necessary drug treatment, based on sound clinical evidence. Patients with high blood pressure, heart disease, diabetes, to name a few, are seeing the health benefits being delivered through the new GP contract – inevitably this programme of early diagnosis and treatment will result in a rise in prescriptions – and long term health benefits for the individual.

Thirdly, we cannot escape the fact we have an ever increasing elderly population – with increasing health needs – and fortunately, increasing means by which to treat them.

Of course, there will always be a few who will seek to exploit the system. But on the whole, GPs are not reporting that they have been inundated with unreasonable demands.

Politicians would do well to focus their efforts on developing a full and frank debate with the public about what should and shouldn’t be funded on the NHS instead of the annual pre-occupation with free prescriptions. The issue of new drugs, and their affordability is one that seriously concerns patients and professionals alike.

So the next time a politician says that free prescriptions are a waste of money and are robbing vital resources from our NHS, perhaps it might just be worth asking the question whether a widescreen television, curtain rails, or even coat hangers are an expense that could also be better spent elsewhere.

NHS changes and the National Eisteddfod

This is my first attempt at a blog, so bear with me as I grasp the ins and outs of blogging! BMA Cymru Wales is trying to keep its members up-to-date with current events and issues as they happen. I would welcome any feedback and “constructive” interactive comments on what I post on my blog. I want members to see this as a useful way to directly get their point of view across to BMA Cymru Wales.

Current issues being worked on in the BMA Cymru Wales office at the moment include establishing the membership of the new Welsh Council. Proposals for reform of Welsh Council were successfully passed at this year’s Annual Representative’s Meeting in Edinburgh. The challenge for new members when elected soon, will be to elect a new chair and vice chair to lead Welsh Council over the next three years, at what promises to be an exciting time in our history.

As you are no doubt aware, the Assembly is currently in recess for the summer. There are quite a few important issues already under consideration. There was the Health Minister’s announcement just before recess about NHS reorganisation. This partly involves the end of NHS trusts and local health boards in their current form. These bodies will be reconstituted as one unified body, effectively creating a single local health organisation, responsible for delivering all healthcare services within a geographical area.

In principle, we support any plan to reduce the number of structures that detract from and absorb resources from the provision of frontline NHS services by hospitals, in community settings or in general practices, thereby reduce artificial funding boundaries.

The plans though are causing concern among some parts of the medical profession – especially GPs.Understandably, they fear that any new unified bodies, particularly if the intention is to base them at hospital trusts, will simply see them continuing to focus on hospital-based activity.
And running alongside the concerns of GPs, we have the place of Public Health services. Our Public Health Committee is significantly worried that the review of Public Health services underway in Wales is not aligned with the proposals for reconfiguration. The committee is very concerned that the role of local directors of Public Health medicine is not being factored into the future vision for the Welsh NHS.

On perhaps a somewhat lighter note, BMA Cymru Wales for the first time ever had a stand at the National Eisteddfod in Cardiff. This isn’t something we’ve done before and was the idea of our Senior Public Affairs Officer, John Jenkins. As it turned out, it was an excellent opportunity for BMA Cymru Wales and its staff to meet with the general public, as well as doctors from across Wales. The team from the office included John, Hayley Mellors, Chris Jones, Jill Beddoes, Nia Potter and Liz Howard.

They all mucked in to make sure the whole eight days were a success, despite some wind and heavy rain along the way. I know myself from past experience, just what hard work is involved in this type of event, having provided medical cover at various events in Wales. It can take it out of you, meeting and greeting people, for on average eight hours a day, for eight solid days. But judging from the feedback I’ve had from doctors and people in the office, it was more than worthwhile.

What really made the week, especially for John, was the fact that our stand won second prize in the best stand competition, out of dozens of others on the Maes. John, Hayley and Chris were rewarded with their moment in the limelight, going up on stage in the main pavilion, to collect their award!

The main reason for the BMA stand being singled out for praise was the element of interactive-ness and fun that it had, combined with educational aspects. For instance, we had a life-sized human torso, complete with removable body parts, which children had to put back together within a certain amount of time. We also used the stand to highlight key issues BMA Cymru Wales has been lobbying on in the last few years, including the effects of smoking, teaching people about their daily units of alcohol, how maggots and leeches are being used in modern medicine to treat wounds, and yes, we did indeed have live maggots and leeches on the stand too!

On average, 80 people visited the stand each day, including key politicians in Wales. I would just like to say a big thank you to all of you who popped in for a chat and a cup of tea. We will be looking at opportunities to repeat this whole experience again at future National Eisteddfods and other key events around Wales.

Dr Richard Lewis
Welsh Secretary
BMA Cymru Wales