Refreshing slice of medical student life

As promised when I last blogged on here last week, I said I would write about the next generation of Welsh medics, so here it is!

I went to our latest Medical Students Committee meeting a few days ago, and I have to say how refreshing it was to hear from young people, who are so enthusiastic and committed to their vocation. In general these days, youngsters get a fairly bad press, often seen as disinterested and disengaged. So I was really proud to see and hear this group wanting to improve standards and their overall educational experience, to make sure they become good doctors. It was somewhat unfortunate and disheartening to also hear how the training and resources, may not match the students’ dedication. It is worrying and disappointing that with members of this committee wanting to be good doctors, working to excellent standards, the system seems to be letting them down with poor educational experiences in some hospitals in Wales.

We all know medical students face an excessive financial burden, so it’s even more important that they are getting good training, to feel as if they are making a sound financial investment in their future. And the medical student experience looks likely to get ever more expensive as well in years to come with the WAG’s plans to refocus student finance in Wales (ie. scrapping the tuition fees grant), so what we need is a. for youngsters not to be put off a medical career because of excessive financial burdens and b. those who do undertake training, to ensure they are getting value for money and the best educational experience possible.

There are significant junior doctor vacancies in Wales already, which in the long term will affect patient care, so it is imperative we do all we can to support and provide high quality training to stay working in the NHS here.

Where are all our young GPs?

Glad to see that the issue of the very real prospect of a GP shortage in South Wales is getting some attention. Dr David Bailey, Chairman of our GP committee is highlighting the problem in the South Wales Echo as new figures show that most doctors here are now aged 60 or over, without younger ones coming through to replace them.

This seems to suggest that young medics are choosing not become a GP and perhaps some work needs to be undertaken to look at why this is. After all, it should be seen as a very attractive career option, what with being your own boss, being able to make decisions about patient care on the spot and having a direct and important link with the community you serve.

Perhaps what’s even more worrying still is the fact that, hearing from some medical students yesterday, it seems in years to come, this situation is likely to worsen, as many youngsters are being put off considering medicine as a viable career option at all, because of the increasing cost of training to be a doctor. But I think that’s a whole new topic for discussion on here in more detail another time! Or maybe some medical students reading this maybe might want to comment on here about how finance can be a barrier to entering the medical profession.

Getting tough on violence in the NHS

Myself and a GP member of BMA Cymru Wales gave evidence to the Assembly Audit Committee yesterday, on the back of the Auditor General’s latest report into violence and aggression against NHS staff. The committee’s holding an inquiry into the report findings, because the Auditor General has found that violence is still a big issue for NHS workers.

That’s despite the fact that the Auditor General first looked into this four years ago and uncovered serious concerns back then.

It would be unfair of me to say that the WAG hasn’t made any progress on this in that time, as some improvements have been made (for instance, the launch of the training passport scheme in 2005) but I’m afraid there is still along way to go. And what is worrying for doctors, is that the emphasis on tackling violence seems to be focussed on hospitals, when in actual fact, a big area of concern identified in the report is NHS employees working alone, such as GPs and their support staff. More investment needs to be made here with the introduction of safety measures such as panic buttons and CCTV being installed.

This inquiry is very timely, as it’s now, during the on-going NHS reorganisation that systems like the Primary Care Support Service could be given more scope for development, to help in areas like violence and aggression against doctors.

I generally got the impression yesterday that AMs sitting on the Audit Committee are extremely concerned about the issue and there is a strong will to change things. I just hope that happens sooner rather than later and that ways of tackling this growing problem feature heavily in the Health Minister’s NHS reorganisation plans.

Ways for BMA members to broaden their horizons

This post will hopefully be of interest to most of our members, but it may be of particular interest to junior doctors, who may find it a bit easier at the start of their careers and whilst still relatively ‘young’ (not that I want to in any way be ageist here!) to head off to another country. I just want to highlight some new guidance issued by the BMA about doctors working in developing countries.

’Broadening your horizons: a guide to taking time out and work and train in developing countries’ outlines national policies, as well as examples of best practice. It’s aimed at both doctors and those in medical education and employment. It supports doctors at all stages of their careers to take time to work in developing countries and make it a valuable part of their NHS careers.

The guidance is available on the BMA website at http://www.bma.org.uk/careers/working_abroad/broadeningyourhorizons.jsp

How much worse does binge drinking have to get before our politicians take action?

This article in the Wales on Sunday makes for disappointing reading for the BMA and its members, who deal on daily basis, with the very real consequences of alcohol misuse. The fact that many Assembly Members don’t think that raising the cost of drink won’t in any way help prevent binge-drinking, is quite staggering.
I hope this doesn’t stop the Welsh Assembly Government from continuing to support the idea of setting a minimum price on alcohol, with the Social Justice Minister, Dr Brian Gibbons saying he’d like to see a graded form of tax on drink, where a lower tax is placed on weaker alcohol and a higher tax is placed on stronger alcohol.
Last year the BMA published a report ‘Alcohol misuse: tackling the UK epidemic’, calling on governments in the UK to implement a full range of effective control policies that will reduce the burden of alcohol misuse.

It highlights how recent governments have worked too closely with the alcohol industry, pursuing policies of deregulation and liberalisation regarding alcohol control, contributing to the destruction of many people’s lives. It causes family breakdowns, is a major factor in domestic violence, ruins job prospects, is often related to crime and disorderly behaviour and it kills.

Alcohol misuse is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. The government approach has led to increased consumption levels and alcohol-related problems and demonstrates a failure in the political drive to improve public health and order.

As well as the human cost, it also costs the NHS millions every year, treating and dealing with alcohol problems and the criminal justice system also spends similarly large amounts dealing with alcohol-related and drink-driving offences.

Key recommendations from this report include:

• Higher taxes on alcoholic drinks and this increase should be proportionate to the amount of alcohol in the product.
• An end to irresponsible promotional activities like happy hours and two-for-one offers.
• Standard labels should be displayed on all alcoholic products that clearly state alcohol units, recommended guidelines for consumption and a warning message advising that exceeding these guidelines may cause the individual and others harm.
• The legal limit for the level of alcohol permitted while driving should be reduced from 80mg/100ml to 50mg/100ml throughout the UK.

Mass public awareness campaigns, which some AMs seem to be pointing to as a possible solution, may be politically attractive and increase knowledge about alcohol misuse, but they are very expensive and ultimately ineffective if unsupported by broad based policy. Targeted approaches are vital, including measures to reduce the availability of drink.

And we are not calling for minimum pricing of drink, to be killjoys, this is just part of it. The BMA also recognises that preventing alcohol-related harm requires accurately pin-pointing those who misuse alcohol. Yet, there is currently no system for routine screening and management of alcohol misuse in primary or secondary care settings in the UK. So, we would like to see a more comprehensive system of identifying patients at risk which could be done through screening questionnaires, when individuals visit their GP, or attend for a general hospital appointment, or when they go to A&E. So, if the WAG wants to continue with its plans for dealing with alcohol misuse, it has our full support.

Read the BMA’s report on this in detail http://www.bma.org.uk/ap.nsf/Content/tacklingalcoholmisuse

Reminder about the GMC’s Specialist Register and the restoration of the Existing Specialist Route

I blogged on a letter from the GMC about its Specialist Register and the restoration of the Existing Specialist Route back in January, but I think it’s probably just worth bringing it to members’ attention again.

The contents of a letter are as follows;

Eligibility for Inclusion on the GMC Specialist Register: restoration of the Existing Specialist Route

Since 1 January 1997 it has been a legal requirement that, in order to take up -as opposed to continuing to be employed in -a consultant post (other than a locum
consultant appointment) in a medical or surgical specialty in the UK health service, a doctor must be included in the GMC's Specialist Register.

When the legislation was introduced to create the Specialist Register, those who were already consultants were entitled to apply for specialist registration by virtue of their status as 'existing specialists'. However, later legislation introduced in 2003 prevented those who had not already applied as 'existing specialists' from doing so without being able to demonstrate that their past specialist training and/or qualifications met the present standards required for the award of a Certificate of Completion of Training (CCT).

This mechanism was never intended for established senior consultants who are already in post and quickly proved to be inappropriate for specialists whose training had been undertaken so long ago. These changes in legislation have left a small number of consultants in a position where they are either unable to move posts or with a straightforward means to have their names included in the Specialist Register.

Earlier this year the Government consulted on proposals to amend the relevant legislation which would enable the restoration of the existing specialist route; Parliament has now agreed this change and the GMC has consulted on a scheme for the registration of persons who were consultants before 1 January 1997.

The scheme will come into force on 2 March. If you are aware of any consultants (other than locums) who were appointed in the National Health Service or the Armed Forces on or before 1 January 1997, who are not currently included in the Specialist Register, we would be grateful if you could draw their attention to the scheme,

Expressions of interest in taking advantage of the scheme can be made by emailing the GMC at pre1997scheme@gmc-uk.org.

The wait goes on for hundreds of people in Wales on the organ donor register

Hard-hitting health campaigns can nowadays, seem to lack the very ‘shock’ factor they are trying to illicit. But I think the latest TV advert by Kidney Wales certainly should get across the point to viewers about just how important it is anyone considering signing up to the organ donor register does so, NOW. The fact that one person dies every 11 days waiting for a transplant really does illustrate how time is of the essence for anyone on the transplant list.

I also think this just goes to prove again how important it is that we move towards a system of presumed consent, as chairman of Kidney Wales Roy J Thomas says “We are in the grips of an organ donor crisis in Wales”. I still think the best way of tackling this crisis is to change the system as it stands now. And that’s why I welcome the private member’s bill on presumed consent being debated in the House of Commons tomorrow (put forward by Jeremy Browne, MP).

The BMA backs the idea of presumed consent, which would see all adults having the opportunity at every stage, to make it known if they do not want to donate their organs after death. Among the safeguards proposed - high profile publicity campaigns which would make everyone aware of the choices. Consent to donation would only be presumed, if individuals expressed no objection. Families would also be consulted and donation would not proceed if relatives would be seriously distressed. Doctors would consult with patients’ and their loved ones, every step of the way.

Some 90% of people say they would be willing to donate their organs. Unfortunately, this does not translate into people who actually sign the register - that stands at roughly 30%. And there lies the crux of the problem, it seems people want to be donors, but for whatever reason, they just don’t get round to signing the register. Of course, that wouldn’t be an issue with a presumed consent system and that is how a change to legislation, could make all the difference to anyone left waiting on the organ donor register.

Find out all about the BMA’s position on presumed consent by reading the BMA’s briefing paper on organ donation

Sign up to the organ donor register

National No Smoking Day is still needed

It’s that time of year again when smokers are urged to kick the habit. Some people may be surprised that we still have such National Days as, fortunately, many of us never come into contact with cigarettes and smoking since the introduction of the smoking ban in Wales. National No Smoking Day is still very much a necessary and worthwhile day however, with thousands of people continuing to smoke here.

Despite the fact we’ve had the ban on smoking in enclosed public places for almost two years now, thousands of people here are still dying each year from smoking-related illnesses. And it is our members, doctors that see first-hand the devastating consequences of developing such a deadly habit.

The planned legislation to ban the display of cigarettes at point of sale in Wales and England needs to happen sooner, rather than later, to try and help prevent the next generation here from starting to smoke. Children who do so face years of tobacco addiction that can lead to life-threatening diseases and premature death. So awareness-raising days will continue to serve a purpose, until we’ve convinced everyone of the dangers of smoking.

Patient safety has to be at the forefront of the Welsh NHS

This Western Mail article regarding NHS safety breaches is a cause for concern for anyone working in the NHS, as well as to patients.

Patient safety is paramount at all times in the Welsh NHS, but it would perhaps be naïve to think ALL risks can be removed. For instance, when the health service is running at full capacity, with staff under pressure to get patients in and out of hospital quickly, it is inevitable patient care will suffer at some point. It is also at times like this, with such a high turn over of patients, that cleanliness standards are likely to fall, which can lead to the spread of hospital acquired infections such as C. difficile. Just last week the Welsh Conservatives published figures showing the rate at which such infections are spreading in Wales.

Here are a few of the recommendations the BMA has made in the past in trying to prevent such incidents of hospital super bugs;
• Healthcare professionals must follow hygiene standards relating to hand washing. Effective hand hygiene is the single most important intervention in infection control.
• Hand hygiene needs better ward/clinic design and provision; hot water and liquid soaps play an important role.
• Health professionals are duty bound to ensure that they and their colleagues fulfil their responsibilities with regard to infection prevention and control. Senior staff should lead by example.
Health care settings must be kept clean and dust free. Clinical and non-clinical waste must be disposed of effectively and appropriately.

It’s easy for such basic hygiene measures to fall by the way side, when the pressure is on NHS staff for a quick turn around in treating and discharging patients.
It is also worth highlighting a recent report from the Welsh Liberal Democrats,which showed how unsafe actual NHS buildings are, for both staff and patients, because basic, yet essential maintenance work, isn’t being carried out.

It isn’t really until you start delving a bit deeper and really looking behind these figures that you can identify such issues and then start putting them right. And these statistics show just how important an initiative one like the Save 1,000 Lives Campaign really is, which was set up with the primary aim to reduce risks to patient safety.

BMA Cymru steps up calls for sunbeds to be regulated

BMA Cymru Wales is talking to young people at a school in Swansea today about the potential health risks of using sunbeds.

For at least five years now we have been calling on the UK Government to regulate sunbed use after research showed that some people are having more than 100 sunbed sessions in a single year.

Although the UK Government doesn’t recommend the use of sunbeds, there is currently no training or regulation associated with their use. The World Health Organisation has said that there is ‘an urgent need to reduce the health and environmental impact of increased ultra-violet exposure’ and has called for public education about this issue. And that is exactly what we are trying to do by organising for a consultant dermatologist and a skin cancer survivor to chat to school pupils about the dangers.

Recent cases like Kirsty’s just go to show how important it is that we have a public health campaign in Wales to highlight this.

A suntan is not a sign of good health; a tan, even when there is no burning, always means that the skin has been damaged. It’s ironic that people use sunbeds because they think they’ll look better and yet they will probably end up looking old prematurely and possibly even getting skin cancer. Just one session a month will double the average individual's annual dose of ultraviolet radiation.

Here are just some of the health risks that spring to mind when people use sunbeds:

• Developing certain types of skin cancer – the risks appear to be greatest for the young, with the chances of developing a tumour increasing by up to 20% per decade of sunbed use before the age of 56.
• Premature ageing – people tend to use sunbeds to look better but they could end up with leathery, wrinkled and sagging skin.
• The eyes (in particular the cornea) are very prone to damage from tanning equipment – it is recommended that sunbed users wear protective goggles, but research shows that people may not use them even if they are provided.
• The immune system – increasing evidence shows that sunbeds have an immunosuppressive effect.
BMA Cymru is urging government ministers again, to pass a bill that would compel local authorities to issue licences regulating cosmetic tanning salons.

The bill would require providers of cosmetic tanning facilities, or equipment, to obtain a licence to operate from the local authority. The licensing conditions would be set so that local authorities could:
• Prevent the use of sunbeds by children
• Protect adults from over-exposure
• Ensure that sunbed users are supervised
• End the use of coin-operated machines
• Ensure that sunbed sessions are monitored and limited
• Provide health risk information in sunbed parlours
• Inspect premises

The introduction of such a bill would hopefully mean adults can make informed choices about the risks of sunbed use. The conditions of licensing would require staff to be on premises, which would help to prevent over-exposure to ultraviolet light. It should also reduce the number of burns and accidents currently attributed to the misuse of unsupervised equipment and would drive up standards.

I wonder how many more unfortunate cases like Kirsty’s we will hear about, before any of the above actually happens?

Isn’t it about time England acted on bringing in free prescriptions?

England’s Department of Health is looking to extend the list of long-term conditions that are exempt from prescription charges. Instead of doing that, why not bring in free prescriptions, which is undoubtedly the fairest and simplest option, which the Welsh Assembly Government did nearly two years ago now?

It’s questionable as to the wisdom of just adding to the list of those who don’t have to pay when only 11% of prescriptions currently attract a charge across the boarder any way, and that will soon drop further, with the abolition of charges for cancer patients.

Scrapping prescription charges in Wales was seen by some as being a gimmick, when what it actually shows is a long term investment in managing chronic conditions and improving health and ultimately helping to reduce the cost and pressure on the NHS.

Since being introduced in Wales, the scheme has proved to be both popular and beneficial, particularly to those people with long-term conditions. Before the inception of free prescriptions, there was evidence that some patients didn’t take their medicines, simply because they couldn’t afford all those prescribed by their GPs. Now they can take their medications as advised, free of the worry of payment. Scotland and Northern Ireland have followed our lead, surely now it’s about time England bit the bullet and did the same.

New look for Careers Website

I just wanted to highlight the new Wales Deanery website, which is now taking shape, as part of the Cardiff University Uniweb upgrade. There has been a great deal of change in the shape and scope of medical career pathways over the past few years and the need for up-to-date information has grown.

Everyone from medical students, though to the later stages of training, needs information and signposts to relevant, career development resources. And consultants who support trainees as part of their educational supervisor role need to keep on top of best practice techniques to help trainees reflect on their career plans, options and strategies to deal with changes, to plan accordingly.

With this in mind, all previous content was abandoned and the Careers website section now has two parts containing:
- information and resources for doctors
- information and resources for those giving front line career support

Resources for doctors are organised to guide users through four key stages of career planning:
1. Self assessment (Taking a history)
2. Career Exploration (Examination)
3. Decision making (Diagnosis)
4. Plan implementation (Treatment plan)
Why not take a look for yourself!

Could the WAG be following it’s Celtic cousin’s lead in tackling binge drinking?

I think the front page of the Western Mail certainly makes for encouraging reading re. tackling the cheap prices of drink in Wales. In response to the Scottish Government deciding to draw up measures to stop sales of cut-price alcohol, it seems the Welsh Assembly Government wants to do something similar. Of course, the WAG can’t implement any licensing changes without approval from Westminster. But pressure will apparently now be put on the UK Government to make sure change does happen.

This can’t come a moment too soon either, with strong action needed NOW to tackle alcohol misuse in Wales. Doctors see first hand how heavy drinking destroys lives. The health consequences of binge drinking are serious and severe. It’s related to more than 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems.

The BMA has for some time now wanted to see licensing laws altered to take into account the points below;

• Higher taxes on alcoholic drinks and this increase should be proportionate to the amount of alcohol in the product.
• An end to irresponsible promotional activities like happy hours and two-for-one offers.
• Standard labels should be displayed on all alcoholic products that clearly state alcohol units, recommended guidelines for consumption and a warning message advising that exceeding these guidelines may cause the individual and others harm.
• The legal limit for the level of alcohol permitted while driving should be reduced from 80mg/100ml to 50mg/100ml throughout the UK.

One thing’s for sure, if radical action isn’t taken soon on this issue, then the many problems that go hand-in-hand with excessive drinking will get worse and the annual £70-85 million cost to the Welsh NHS of drink-related incidents and diseases will only increase.