The BMA Cymru Wales blog has moved

You should be automatically redirected in 6 seconds. If not, visit
http://blogs.bma.org.uk/cymruwales
and update your bookmarks.

Tuesday, 22 June 2010

BMA Cymru backs new GMC guidance on end of life care

New guidance for doctors, “Treatment and care towards the end of life: good practice in decision making” has been published by the GMC.

The BMA has been involved with the development of this guidance and we support it. How best to care for individuals at the end of life is one of the most complex areas in medicine and it is essential that clear guidance is in place to assist doctors to act in the best interests of their patients.

The emphasis on advance care planning discussions with patients is to be welcomed, taking onboard their wishes and preferences and subsequently delivering quality care partnered with these choices.

The guidance highlights the importance of good communication, and is clear about the need to work with the patient or where appropriate their relatives or advocate to ensure that they are treated fairly, with dignity and without prejudice.

It will also be invaluable for patients and their relatives who need the reassurance of readily accessible information about what to expect in the very anxious period at the end of a person's life.

The guidance and supporting materials are available on the GMC website here.

Monday, 21 June 2010

All Wales telephone advice, information and support service on alcohol and drug abuse

The Primary Care Support Service has launched a range of services for those with alcohol or substance use concerns. This includes on-line screening tools as well as a confidential telephone information, advice support service.

View the services online here

This new Pilot project has been developed in response to primary care professionals’ concerns about their alcohol and substance use. It will run until March 31st 2011 and is subject to on-going evaluation. A Motivational Interviewing approach is used.

Drinking and Cooking related fires a burning issue for the fire and rescue service

This week the North Wales Fire and Rescue Service are guest blogging as part of our ongoing campaign to tackle alcohol abuse. This article by Richard Fairhead, Senior Fire Safety Manager highlights another dimension to the discussion.

North Wales Fire and Rescue Service has recently launched another campaign focussing on drinking and cooking, this time to coincide with the World Cup football tournament.

This initiative is the latest effort in the region to discourage residents from attempting to cook after drinking alcohol.

Statistics across the U.K. show that one in every three fire deaths is drink related, and the majority of accidental domestic fires begin in the kitchen.

In 2007, Sean Bowers, 24, from Penyffordd and Andrew Roberts, 39, from Ruthin, both died following separate fires in their homes both caused by chip pans. Both had been drinking, and had arrived home to cook themselves something to eat. Andrew had finished cooking and had fallen asleep on the couch but failed to turn off the gas. Sean also fell asleep with the chip pan left on the stove. The chip pans overheated and caught fire - Sean and Andrew never woke up.

Leaving cooking unattended is often a recipe for disaster and if you've been drinking you're even more vulnerable as you're at high risk of being distracted of falling asleep. Drink affects people mentally and physically, increasing their likelihood of having a fire and slowing their reaction times when one breaks out.

If you're asleep and a fire breaks out, you're in serious trouble. Just a couple of breaths of fire smoke can be enough to knock you completely unconscious. The smell of smoke doesn't wake up you up - the poisonous gases produced by a fire numb the senses and put you into a deeper sleep. This is why it is essential to have working smoke alarms in your home. Frighteningly, you are also putting the lives of your whole family at risk - a child can die from smoke inhalation in under a minute.

Despite the old proverb 'a watched pot never boils', keeping a close eye on your cooking really will save your life. Whether you've had a few drinks or not, our advice to cooks is quite simply to stand by your pan and get working smoke alarms.

Avoid your lives going up in smoke by following the tips listed below.

- Never cook after drinking - prepare a sandwich or get a takeaway instead.
- Don't leave cooking unattended -a small fire can quickly turn into a life threatening one. A household fire doubles in size every thirty seconds.
- Ensure you have a working smoke alarm in your home, and test them once a week.
- Formulate a fire escape plan to ensure that you and your family know how to escape safely in the event of a fire.

All three fire and rescue services in Wales fit alarms free of charge, and will give fire safety hints and tips as well as helping you design a fire escape plan for your home.

To take advantage of their friendly and informal home visits, residents can book a free Home Safety Check by calling the 24 hour hotline on 0800 1691234 or texting 88365, ensuring they prefix the message with the word HFSC.

Friday, 18 June 2010

Letter from the Minister - Vaccination uptake in 2009-10

I have received a letter from the Health Minister Edwina Hart regarding vaccination uptake in 09-10.

The Minister asks for her message of personal thanks to be shared with everyone involved in delivering vaccination services, and I would like to share her comments on this blog.

The letter reads:

I was very pleased to see the Public Health Wales annual report on the routine childhood vaccination programme. I noted particularly that, national uptake of all vaccinations by one year old is at the 95% target. Also that uptake of both MMR doses continues to increase towards target. This is all very good news.

There is still some way to go to reach target in the pneumococcal and Hib/MenC levels and uptake in the teenage booster is worryingly low. I am expecting to see improvements in these programmes during this year.

Vaccination is the best way of protecting children – and the wider community – against potentially very serious illnesses. We will achieve high uptake levels in all childhood programmes only through the efforts of local health professionals who support parents in making informed decisions about vaccination. I therefore want to thank everyone involved for their hard work last year when considerable challenges were faced during the swine flu pandemic.

I would appreciate this message of personal thanks being shared with everyone involved in delivering vaccination services.

Wednesday, 16 June 2010

BMA Cymru welcomes call to lower drink-drive limit

BMA Cymru Wales is very pleased that the North Review is calling for a reduction in the drink drive limit and we urge the UK government to act on the review’s findings.

We have lobbied for a reduction in the drink drive limit for over twenty years, and contributed to the North Review. We believe that such a move will help prevent deaths and reduce the number of lives ruined by drink-driving.

Scientific evidence from around the world has agreed that once a person’s alcohol level goes over 50mg their driving becomes impaired.

A reduction in the limit would also bring the UK in line with most other European countries, and would be in agreement with the best available evidence on the effects of alcohol on driving.

The introduction of the current limit, backed up by police enforcement and TV and media education campaigns, led to a dramatic fall in the number of deaths on the road, but the position has been stagnant since 1993. We need a new impetus to reduce the toll of injury and death.

The BMA is not suggesting a zero limit because there will be cases where an individual would register slightly above zero, even when they had not been drinking (diabetes and the use of mouthwash can both cause an above-zero level). The BMA doubts whether an absolute zero would be enforceable and acceptable to the public but argues that a 50mg level, would be effective and beneficial.

Scientific evidence from around the world has agreed that once a person’s alcohol level goes over 50mg their driving becomes impaired.

We would also like to see roadside random breath tests carried out. This measure is a vital element in deterring people from drinking and driving.

As a road accident doctor and a member of the British Association of Immediate Care (BASICS), I go to road accidents to provide advanced medical care with the emergency services, and I have seen at first hand the awful and devastating consequences of drink driving.

Monday, 14 June 2010

Why Wales has to attract the best medical talent


Our Public Affairs Officer Carla Mahoney has written a column for the Western Mail today. It looks at the inadequate staffing levels in the NHS in Wales.

Take a look here and leave a comment on this blog if you have something to share on this topic.

Diabetes Week 2010

This week is Diabetes week, an annual nationwide awareness week organised by Diabetes UK with the aim of raising awareness about diabetes and the issues people living with the condition face.

Diabetes Cymru UK are raising awareness this week about the key myths about diabetes, and have asked me to share some key facts and statistics with readers of this blog.

Diabetes costs the NHS in Wales £500m a year and is increasing rapidly.

According to the latest QOF statistics, released in September 2009, more than 146,000people in Wales – almost one in 20 people – have been diagnosed with diabetes. This figure had risen by more than 7,000 compared to the previous year’s statistics. The Welsh Assembly Government estimates that a further 50,000 people in Wales have undiagnosed diabetes.

Around 90 per cent of people diagnosed with diabetes have Type 2 diabetes. Usually diagnosed over the age of 40, the condition happens when the body stops making enough insulin or when it cannot use the insulin it produces. Eighty per cent of cases of the condition are associated with being overweight, but other risk factors for the condition are having a large waist and having a close family history of the condition. Being from a black or South Asian background makes people more likely to develop the condition and people from these communities are at risk of the condition from the age of 25. Type 2 diabetes can be treated with diet and exercise, tablets or insulin injections (30 per cent of people with the condition are treated with insulin injections). Many people with Type 2 diabetes assume that it is not as serious as Type 1. In fact, both conditions are serious.

Around 10 per cent of people diagnosed with diabetes have Type 1 diabetes. This condition happens when the body stops producing any insulin and is usually diagnosed in childhood and under the age of 40. It is not associated with lifestyle and cannot be prevented. Type 1 diabetes is always treated with insulin injections or an insulin pump, a device which constantly infuses fast-acting insulin into the body.

The complications of diabetes are heart disease, strokes, kidney disease, visual problems that can lead to blindness, and amputation. People with diabetes can reduce their risk of developing these complications by eating a healthy, balanced diet, maintaining a healthy weight, keeping active, taking their prescribed medications and keeping their blood glucose levels within the recommended levels.

People can live with diabetes for up to 10 years before it is diagnosed, which means half of these people already have developed the complications of diabetes. Many people can miss the symptoms of diabetes as they can often be mistaken for getting older and being stressed. The key symptoms of diabetes are going to the toilet more often to pass water (particularly at night), extreme tiredness, blurred vision, genital itching, regular episodes of thrush and slow-healing wounds.

People from deprived communities are up to twice as likely to develop diabetes. In Wales, there is a big variation of the percentage of the population diagnosed with the condition in different areas. According to the latest QOF statistics, Blaenau Gwent has the highest percentage of the population diagnosed with diabetes at 5.8 per cent. This is significantly higher than the area with the lowest percentage, Cardiff, which has 3.6 per cent of the population diagnosed with diabetes.

Diabetes UK Cymru provides advice, support and information for people with diabetes and their families and funds research into diabetes. The charity also does a series of talks for GPs every year and organises an annual conference for healthcare professionals in Wales.

For more information, contact 029 2066 8276, email wales@diabetes.org.uk or visit www.diabetes.org.uk/wales. The charity can also be found on Facebook and Twitter at http://twitter.com/DiabetesUKCymru.

I wish them the best of luck with raising awareness this week!

Wednesday, 2 June 2010

Time to tackle the affordability of alcohol

NICE have today published guidelines to tackle alcohol misuse.

BMA Cymru have been saying for some time that tough action is needed to tackle this issue. We are pleased that NICE is joining our call for a ban on alcohol advertising and the introduction of a minimum price per unit of alcohol.

Critics of minimum pricing should read the research by Dr Robin Purshouse on alcohol pricing - it makes for interesting reading. He estimates that a minimum price on every unit of 40 pence would result in about 1,000 fewer premature deaths a year, around 40,000 fewer hospital admissions a year, and about 10,000 fewer violent crimes and criminal damage incidents per year. Read his report here.

We are convinced that in order to tackle alcohol misuse a whole raft of measures is required, which include reducing availability, increasing taxes on drinks with the highest alcohol concentration, reducing the drink-driving limit and tackling advertising and minimum pricing.

We are not opposed to people drinking alcohol in moderation - what we want is to help people avoid using alcohol at levels which endanger their lives and those of others.

A few weeks ago we held a seminar on tackling alcohol abuse: an integrated approach forward. Watch it here.

What do you think about the recommendations from NICE?

Tuesday, 1 June 2010

Why Wales has to persuade doctors to come home


I was pleased to read this article in the Western Mail yesterday written by Conservative Assembly Member Andrew RT Davies, endorsing our We'll Keep A Welcome campaign.

BMA Cymru have consistently highlighted the problem of the shortage of doctors in Wales, which could lead to the NHS becoming unsafe for both staff and patients.

This campaign is the latest move by BMA Cymru to promote Wales as a desirable place to live and work.

We have contacted all schools in Wales to reach out to prospective medical students before they leave for university.

All students have been sent packs which include letters from me, as well as from Welsh postgraduate dean Derek Gallen, along with information about training in Wales and posters to put up in medical schools.

Whilst we are happy to initiate grass roots action here in Wales, the Government has a responsibility to ensure that safety standards in Wales are maintained, and that the citizens of Wales receive the quality healthcare they deserve.

Follow our campaign by joining our facebook group here to keep up-to-date with the latest developments.

Tell us why you think Wales is a great place to live and work.....

Thursday, 27 May 2010

BMA Wales Social Media

BMA Cymru Wales is embracing new media! We communicate with members and non members via a number of channels listed below.

Take a look and keep up-to-date with the latest news and developments.

Follow us on Twitter here

Join our Students Facebook group here

Join our Junior Doctors Facebook group here

Join our We'll Keep a Welcome Campaign Facebook group here

And finally watch our clips on YouTube here

The Welsh Health Survey

The new Welsh Health survey data makes for worrying reading. There has been a rise in the number of children classified as overweight or obese.

These soaring rates in obesity over recent years has lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers.

If current trends continue, the cost to the health service is likely to increase unless measures are put in place to halt this growing problem.

We need to prevent children from becoming overweight in the first place, and parents, schools, health professionals, the media, food manufacturers and the government all have an important role to play in this.

The other item which stood out from the data was the increase in smoking amongst men in Wales.

Although smoke-free legislation is making a huge difference to the health of patients, these figures reveal the serious reality of Wales’ smoking problem.

The damage caused by smoking is cumulative. Most people know that smoking causes heart disease and stroke. But they may not realise that if men smoke heavily during their teens and twenties, they risk developing erectile dysfunction in their thirties and forties.

There is no doubt that giving up smoking can be extremely difficult – like any addiction, kicking the habit is no easy task. When smokers decide to quit they are often advised to set a date, bin the cigarettes and then just do it. Support from a doctor or health professional during this time can be invaluable, and I would advise anyone thinking about quitting to contact their GP for advice and support.

What do you make of the data?

Tuesday, 25 May 2010

Survey on alcohol policy issues

Alcohol Concern Cymru are conducting a survey to gauge the views of those working in primary care on current alcohol policy issues in Wales.

45% of adults in Wales admit to drinking more than the recommended daily amount on at least one day in the past week, including 28% regularly binge drinking (drinking more than double the recommended daily amount over a short period). Alcohol now accounts for over 1,000 deaths in Wales each year.

If you are working in primary care take a minute to fill out this 7 question survey by clicking here.

Tuesday, 18 May 2010

Alcohol Abuse: An Integrated Approach Forward


Last week we brought together leading UK experts to speak at our seminar on alcohol abuse, and to debate an integrated approach forward in tackling Wales' growing drink problem.

Speakers included: myself; Dr Zul Mirza, President of the Emergency Medicine Section, Royal Society of Medicine; Simon O’Brien, Deputy Inspector of policing for Ireland; Professor Eileen Kaner, Chair, Alcohol Programme Development Group NICE; Wynford Ellis Owen, Chief Executive of The Welsh Council on Alcohol and other Drugs; Andy Tighe, Director, Brewing, Beer and the Pub Association.

You can watch the seminar here.

We know that Health Minister Edwina Hart would like to see action on alcohol pricing from her statement in Plenary last month, and we are urging the Minister to act sooner rather than later in seeking further powers to tackle alcohol abuse, to help improve the health of the people of Wales.

Recent years have seen an increase in the levels of alcohol misuse in Wales, and in particular the pattern of binge drinking and heavy drinking.

Alcohol consumption is associated with a wide range of medical conditions and is a significant cause of morbidity and premature death. It contributes to a range of acute and chronic health consequences, from alcohol poisoning and injuries resulting from traffic crashes to cancer and cardiovascular disease. The more an individual consumes, the greater the risk of harm.

Alcohol misuse is associated with crime, violence and anti-social behaviour, and can impact significantly on family and community life.

Below are our recommendations to tackle alcohol abuse which we intend to send to the Health Minister:

• Taxation on all alcoholic beverages should be increased at higher than inflation rates and this increase should be proportionate to the amount of alcohol in the product.

• Legislation should be introduced to:
-prohibit irresponsible promotional activities in licensed premises and by off-licenses
- set minimum price levels for the sale of alcoholic beverages

• It should be a legal requirement for alcohol labeling to include the following information:
- alcohol content in units
- recommended daily UK guidelines for alcohol consumption
- a warning message advising that exceeding these guidelines may cause the individual and others harm

• Licensing legislation should be strictly enforced, including the use of penalties for breach of license, suspension or removal of licenses, the use of test purchases to monitor underage sales, and restrictions on individuals with a history of alcohol-related crime or disorder. There should be adequate funding for enforcement agencies, with consideration given to the establishment of a dedicated alcohol licensing and inspection service.

• A statutory code of practice on the marketing of alcoholic beverages should be introduced and rigorously enforced. This should include a ban on:
-marketing of alcoholic soft drinks to young people
-alcohol industry sponsorship of sporting, music and other entertainment events aimed mainly at young people
-broadcasting of alcohol advertising at any time that is likely to be viewed by young people

• The legal limit for the level of alcohol permitted while driving should be reduced from 80mg/100ml to 50mg/100ml throughout the UK.

• Public and school-based alcohol educational programmes should only be used as part of a wider alcohol-related harm reduction strategy to support policies that have been shown to be effective at altering drinking behaviour, to raise awareness of the adverse effects of alcohol misuse, and to promote public support for comprehensive alcohol control measures.

• The detection and management of alcohol misuse should be an adequately funded and resourced component of primary and secondary care to include:
- formal screening for alcohol misuse
- referral for brief interventions and specialist alcohol treatment services as appropriate
- follow-up care and assessment at regular intervals

Monday, 10 May 2010

Welsh Cancer Standards

The Western Mail today reports on Wales falling short on meeting national cancer standards.

Health professionals throughout Wales are committed to providing the best possible services to patients, and welcome the Welsh Assembly Governments ambition to achieve 100 per cent compliance across this set of standards - unfortunately the reality falls woefully short of the ambition as this report highlights.

While acknowledging that much work has been done, this report highlights how much more there is to do.

Additional resources will be required to meet these standards - and even in these tight financial times, cancer services will remain a priority to doctors and patients in Wales.

The report highlights a shortage of specialists throughout multidisciplinary clinical teams. BMA Cymru have warned the Welsh Assembly Government repeatedly over the shortage of doctors in Wales, and this data adds wait to our argument.

The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas.

This is compromising consultants’ ability to deliver routine daily work, and there is no evidence that hospitals are adjusting services to take these shortfalls into account.

While BMA Cymru has been working with WAG and employing Local Health Boards around doctor shortages - many of our suggestions on how to address the current crisis we are facing have yet to be taken up.

Without doubt, the rates of work being undertaken cannot be sustained with the current levels of staffing.

The Welsh Assembly Government must ensure that training programmes are in place to provide future specialists.

Although the waiting times for radiotherapy have not improved, it is pleasing that the WAG identified the need for more resources in this area to ensure improvements were made. The recent investment into extended working hours and a national procurement programme for linear accelerators is to be welcomed.

The WAG must now ensure that sufficient resources are available in other areas to enable workers to implement recommendations.

Doctors are eager to drive forward efforts to improve the care cancer patients receive and are usually at the forefront of leading improvements and new initiatives; but sustainable solutions are needed to address the problems raised in this report if NHS Wales is to deliver and maintain the quality and capacity of cancer services that the people of Wales deserve.

Tuesday, 27 April 2010

Alcohol Pricing

This afternoon in Plenary Health Minister Edwina Hart AM set out the Welsh Assembly Government’s position on alcohol pricing.

I’m pleased that the Welsh Assembly Government are taking the issue of alcohol abuse seriously.

In recent years, the affordability of alcohol in the UK has been increasing, and this has played a significant role in the rise in alcohol consumption.

There is strong and consistent evidence that alcohol consumption and rates of alcohol-related problems are responsive to price.

It is clear that the relationship between the affordability of alcohol and the level of consumption provides an effective tool for controlling levels of consumption and reducing levels of alcohol related harm.

We believe it is essential that there is an increase in the level of excise paid on alcohol in the UK, and this should be relative to the number of units of alcohol. This increased taxation would not only reduce alcohol consumption and its related harms, but would also contribute to providing the necessary funding to meet the social and economic costs of these harms like police enforcement measures, healthcare service costs and treatment services.

We at BMA Cymru urge the Minister to act sooner rather than later in seeking further powers to tackle alcohol abuse, to help improve the health of the people of Wales.

Monday, 26 April 2010

WalesOnline - News - Health News - What do the big three political parties have to say about health in Wales?

BMA Members Jonathan Osborne, Sharon Blackford and Stefan Coghlan have been telling the Western Mail what they believe the priorities for the next government should be. Take a look here on page 3 and 4 of the article on health in Wales:

WalesOnline - News - Health News - What do the big three political parties have to say about health in Wales?

Do you agree with their opinions?

Friday, 23 April 2010

Mae hen wlad fy nhadau yn annwyl i mi


A line from the song which arouses passion in all who sing it. Hen Wlad Fy Nhadau, our national anthem.

It is precisely this type of gusto that BMA Cymru Wales would like to invoke in Welsh medical students currently studying elsewhere in the UK.

Our campaign “We’ll keep We'll Keep a Welcome / Pleidiol wyf i'm gwlad, intends to attract medical students back to Wales to train, and work as a doctor.

I’d like to thank all four Assembly Members who have contributed to my blog over the last two weeks in support of our campaign.

We really believe that Wales has it all. The standards of clinical training and career development opportunity are as good as can be found anywhere, with the added bonus of working in attractive surroundings offering excellent facilities and professional support.

With the added benefits of a quality lifestyle - reasonably priced housing, good schools and access to beautiful countryside - Wales is a clear winner when it comes to aligning career development with work-life balance.

Wednesday, 21 April 2010

“Wales has a tremendous amount to offer” - Shadow Minister for Health and Social Services, Andrew R.T. Davies A.M.


I am pleased to be given the opportunity to endorse the BMA Cymru campaign “We’ll keep a welcome”.

I have lived and worked in Wales all my life – I live with my family near Cowbridge in South Wales, situated in the rural Vale of Glamorgan but close to the Nation’s Capital City, Cardiff and we can therefore enjoy the best of both worlds – the beauty of the Welsh countryside and all that a bustling first city can offer.

We are never short of places to take our visitors - whatever their interests; the strikingly beautiful Welsh countryside boasts three National Parks and five regions designated as being of “Outstanding National Beauty”.

Wales has over 1200 Kilometres of coastline so you are never too far from the sea and the range of leisure activities that it provides, including surfing, sailing, fishing and swimming from some of the best beaches in the U.K. The temperate Welsh climate means that you can access the countryside throughout the year so if climbing the mountains of North Wales or the Beacons in the south are your bag or if you are into walking the coastal pathways or the picturesque valleys you will never be far from these areas.

Neither will you ever be far from civilisation – the cities and towns of Wales offer World – class theatres, museums and galleries – all evidence of the strong appreciation of music, literature and the Arts shared by Welsh people. Famous sons (and daughters) of Wales include Dylan Thomas, Richard Burton, Tom Jones and Shirley Bassey and throughout history many famous Welshmen and Welshwomen have helped shape the development of the Americas and emerging countries.

The Urban areas also have busy shopping centres that cater for all tastes and pockets and the night life – whether in the vast choice of restaurants of all culinary styles or in the friendly village pubs is there for all to enjoy and relax in.

In Wales we are also proud of the education that we provide for our children. We have a strong ethos of Life-long Learning and share our education facilities with many over-seas students. Our Universities are at the cutting edge of Research and Development, particularly in the Sciences and especially in Medicine.

Wales has its own unique culture and Celtic language, which although only spoken by 20% of the population, is enjoying a steady growth and is evident throughout Wales in the bi-lingual road signs and literature. This strong sense of culture helps the Welsh people to empathise with the cultures of other nations – illustrated by the International Eisteddfod held annually at Llangollen in North Wales since the Second World War to celebrate and promote understanding between nations of the World. Our Cities (Cardiff in particular) have a strong cosmopolitan flavour and are home to a myriad of ethnic cultures.

Did I mention Sport? The Welsh are renowned for their love of Rugby – but soccer also enjoys a wide following in Wales with highly enthusiastic teams representing their cities, towns, villages and schools. In fact, whatever your sporting interests you will not find it difficult to follow them in Wales.

Perhaps the thing that I love most about Wales is the people – the community spirit, the strong work ethic and the sense of “chwarae teg” (fair play) that is inherent in our culture makes me realise how lucky that I am to live and work in Wales, with the people’s sense of humour, willingness to communicate and their need to work as part of a cohesive team – working in Wales has much to recommend it – indeed, there has been an increasing inward trend for workers from outside Wales since the 1970s.

As a place to live and work I believe that Wales has a tremendous amount to offer – the beauty of its landscape, the entertainment in the towns and cities, the education and training opportunities available, the fascinating culture and history of the country and the warmth of its people make it a place that many want to come to but few want to leave.

Wales has a lot to offer everyone.

Monday, 19 April 2010

1,000 Lives Campaign

This week, the 1,000 Lives Campaign which was designed to improve patient saftey in the NHS in Wales comes to an end. Here is an article which I wrote for the Western Mail about the campaign.

Patient safety is the highest priority for anyone working on the frontline in NHS Wales and it’s making a real difference in primary care.

That’s why the British Medical Association strongly supports the 1000 Lives Campaign and works hard to highlight those areas of patient safety and care that are important to our members.

For doctors, safety and quality go hand in hand, and the Campaign has created a focus around which those can be considered every day, in every patient contact, by health professionals and managers alike.

As we come to the final months of this two year campaign, we are pleased to see how much progress has been made across Wales.

When the initiative was launched in April 2008, it was the first time that primary care had been included in a similar patient safety campaign anywhere in the world.

Wales has led the way and our members have contributed in many of the Campaign’s areas, including improving leadership, medicines management and general medical care.

We have seen the impact made by establishing patient safety WalkRounds and culture surveys which have empowered our members to talk about their concerns and hopes for improvement.

Again Wales has led the way in this area, becoming the first country to arrange a safety culture survey for its general medical primary care services at a national level.

And the response from our members have been extremely positive with over 60 per cent of GP practices taking part.

The results have been helpful in identifying aspects of care working well, but also raised areas where there is scope for improvement.

BMA Cymru supports a healthcare service that listens to the concerns of doctors, acts on those concerns to improve safety and quality of care, and in which health professionals are not afraid to speak out.

Last year we published the ‘Speaking up for Patients’ report based on survey responses from 565 doctors working in England and Wales.

Almost three quarters (74%) said they had concerns about issues relating to patient safety over the course of their career.

Within in this group, 73% said their concerns related to standards of care.

Seven in ten doctors said they had raised their concerns but were not always satisfied with the response.

Often they were not asked for further information or made aware if any action was taken to improve the issue.

WalkRounds and culture surveys have the potential to examine and improve patient safety issues across the whole patient pathway.

Other areas that have helped to improve patient care are in medicines management and work to improve the quality of life for chronic heart failure patients.

More than 80 GP practices are working with Health Boards to reduce, where possible, the number of unnecessary hospital admissions for patients with chronic heart failure.

The promotion of evidence-based procedures such as timely and accurate diagnosis, medication therapy, and lifestyle advice could make a significant impact on the disease process.

GPs are also currently carrying out detailed work to improve the reliability of instructions given to patients about their medication.

We have already seen the difference this has made for patients who take Warfarin and we are looking at other areas including diabetes.

The development of the primary care trigger tool to measure improvements is also being embraced by members.

We know that all our GP practices are continually making changes to ensure the care they deliver to their patients is the best possible.

But now, thanks to the trigger tool they will be able to actually measure those improvements, see how they are working and if they are making a difference.

One of the fundamental features of the new tool is looking at harm caused by failure to recognise or adequately manage a new presentation of an acute illness.

If a patient’s problem does not respond to treatment or they develop an adverse reaction, they are likely to make another appointment.

It is these unscheduled reattendances that can act as triggers of possible harm.

We are proud to see the progress made through the 1000 Lives Campaign, and that doctors across Wales are playing their full part in it.

BMA Cymru will continue to support the Campaign and to highlight those areas of healthcare over which our members have concerns – so that patients can look forward to even safer services in Wales.

What are your views on the 1,000 Lives Campaign?

Wednesday, 14 April 2010

“Wales may be a small country but it has a lot going for it” – Christine Chapman AM


How we get the next generation of Doctors to train in Wales continues to be a major issue and one which is not new for the BMA.

Representing an area which has traditionally suffered from high levels of health inequalities, over the last ten years I do think that we can talk up the achievements that have been made in Cynon Valley. We’ve got more salaried GP’s than ever which has helped to solve the recruitment problem we once had, new, modernised surgeries are clearly visible and in Spring 2011 the new Community Hospital in Mountain Ash will open its doors.

Across Wales, there is a choice of high quality facilities which provide first class training and education. But while clinical experience is very important, so too is the life experience.

I do think that what is attractive to those who have studied in England, particularly in the big cities such as London, is the quality of life on offer in Wales. Whether you are looking to continue with the city life or a more rural environment, Wales has much to offer. Generally house prices are lower and everyday living costs are more reasonable. In my own area, the Valleys have great opportunities for outdoor recreation, cycle trails, quad biking, mountain climbing and also its close proximity to Cardiff. Wales may be a small country but it has a lot going for it.

Christine Chapman AM Cynon Valley
Labour

Tuesday, 13 April 2010

“I am proud to work in the Welsh NHS” – Dai Lloyd AM


Croeso i Gymru! – Welcome to Wales! In Europe’s oldest living language, Welsh reflects the unique cultural and historical experience that is Wales. And, as a practising GP and a Member of The National Assembly for Wales, I am very well aware, naturally, that the National Health Service also, looms large in the National conscience of Wales.

From the history of the mining communities of the South Wales Valleys leading to the formation of the Tredegar medical Aid Society as a forerunner and template for the later NHS, the Welsh experience is not confined to the usual cultural issues, but extends to the Health Service too.

With the establishment of the NAFW in 1999, Health was devolved to Wales. Health Policy has developed differently here, and I am proud to work in the Welsh NHS.

Here in Wales, prescription charges were abolished in 2007. Patient care is thus not compromised by the cost of prescription items, people no longer have to choose themselves which item(s) in a multiple prescription to ditch. Northern Ireland and Scotland are following this proud example.

The internal market in Health has been dismantled with the latest NHS reorganisation in October 2009, Seven Health Boards now plan services – commissioning is a thing of the past.

In addition, no new PFI ventures are being undertaken in Wales, and the NHS in Wales remains a publicly-funded public service, with little private medicine. That is a reflection of the tremendous loyalty and trust that people still have for the NHS in Wales, a loyalty that is reflected in the esteem and respect accorded to the Nation’s Doctors and NHS Staff in general.

GPs here are not faced with the ubiquitous ‘Choose and Book” system and waiting lists have improved out of all recognition in recent years. Devolution brought more Medical Schools in Swansea and North Wales, and an exciting new, Postgraduate Medical School in Swansea.

The accent is rightly on Public Health in Wales, and history will record the first vote to ban smoking in enclosed public buildings in these Islands occurred in the National Assembly for Wales in January 2003. The absence of the relevant powers however, meant the ban had to wait until April 2007 to kick in.

For doctors certainly, Wales offers a different experience – yes, the fine scenery of mountains, beaches and breathtaking views – yes, the history and traditions – and yes, also an NHS still true to its founding principles.

Croeso i Gymru!
Dr Dai Lloyd AM South Wales West
Plaid Cymru

Monday, 12 April 2010

“What is important is that we do not become a net exporter of medical talent” – Peter Black AM

BMA Cymru have been concerned for some time about the shortage of doctors in Wales. It is a problem that we feel can no longer be ignored. For NHS Wales to maintain a high standard of delivery, sustainable solutions for the future need to be put in place now.

I have asked four Assembly Members for their take on this important issue. Today’s entry is from Welsh Liberal Democrat spokesperson Peter Black AM.



In March, the BBC reported that Wales is currently short of around 400 hospital doctors. Given that the total number of hospital doctors in Wales is only around 5,500, this is significant.

We have a significant problem with waiting lists in Wales. The latest statistics released by the Welsh Assembly Government show that there are 6,450 people who have currently been waiting for either an inpatient or outpatient appointment for over 22 weeks. The numbers of doctors available to treat them will not be the only factor in this, but it will be a significant one.

The need for new doctors in Wales is one that is not just confined to hospitals. The number of GPs under 45 has dropped considerably in the last ten years, from 951 to 743, while the number aged over 55 has increased from 272 to 450. This means we could expect roughly a quarter of our present GPs to be retiring within the next ten years or so.

Despite this, there has been no real increase in the number of GPs at the younger age of the scale during this period.

Many of those from Wales who choose to study medicine do so outside of Wales. Young people often do not want to stay in the area they have been brought up in and use their student years to explore the world by experiencing new places and people. This is natural and leads to well rounded individuals who are needed by every workforce.

However, what is important is that we do not become a net exporter of medical talent. When someone leaves Wales to study, we need to ensure that they are encouraged to return and that those who come from England to study in Wales are encouraged to remain.

As is often the case, the Welsh Assembly Government seem to have their heads in the sand over this issue. They claim that there are few vacancies and that there are good response rates to those vacancies that do appear. Even if they are correct and that is the case at present, we still have a potential looming crisis.

In healthcare, often the solution to short term problems is recruitment from abroad. However, if we have the talent, why should we have to poach professionals from other countries who have their own healthcare requirements?

The campaign currently underway by the BMA to encourage more Welsh medical students to return to Wales is a great idea and one which I very much back. Wales is a fantastic place to both live and work and we need to highlight this to students.

But this alone will not solve the problem. The government must ensure that the health boards have the funding they need to provide adequate coverage in all parts of the health service, so that the jobs are there for students to go into.

Putting off extra recruitment for later years will only make waiting lists longer, increase present GP workloads and make the problem more difficult to solve when our current medical professionals begin to retire.

The BMA are showing leadership on this issue, and now the Government need to back this up.

Thursday, 8 April 2010

Sunbed ban to become law

We are delighted that the Sunbeds Bill has passed through the Lords!

BMA Cymru would like to thank Julie Morgan MP for highlighting this important issue, and for the hard work which has gone into making this law.

Doctors have been concerned for some time about the effects that exposure to harmful UV rays can cause.

Younger skin is especially sensitive to ultraviolet light, and just one day of burning as a child increases the risk of getting skin cancer as an adult.

This legislation will protect vulnerable young people, and have a positive effect on the health of the people of Wales.

We will continue to work with the Welsh Assembly Government over the coming months as the regulations are drawn up.

Wednesday, 24 March 2010

BMA Cymru Wales supports the call for a ban on smoking in cars carrying children

You may have read this article in the news today.

BMA Cymru Wales fully supports the call for a ban on smoking in cars carrying children.

Anything that can be done to reduce exposure to environmental tobacco smoke and ill-health as a result of smoking must be given serious consideration.

Exposure of non-smokers to second hand smoke - known as passive smoking, consists primarily of non-inhaled sidestream smoke, together with exhaled smoke.

Almost 85% of second-hand smoke is invisible and odourless gases. Only the particulate matter, in the form of smoke, is visible. Tobacco smoke contains more than 4000 toxins, including over 50 that are known to cause cancer.

Passive smoking causes illness, including fatal illness. It also worsens existing health problems.

Smoking affects many parts of the body which are listed below – in the hope that any smokers reading this will seriously consider kicking the habit!

Smoking attacks the brain. The chemicals in smoke cause the lining of the arteries in the brain to become porous which allows cholesterol, white cells and blood clots to stick to them. Clogging arteries which supply blood to the brain leaves smokers at risk of a stroke.

Passive smoking is associated with a variety of health problems in children. It increases the prevalence of lower respiratory tract illness such as pneumonia, bronchitis, bronchiolitis, coughing and wheezing. Second-hand smoke can also cause asthma in children. It also exacerbates the condition in those who are already affected. Passive smoking is also associated with cot death (Sudden Infant Death Syndrome).

Smoking damages the eyes because it reduces the levels of plasma antioxidant – a substance in the bloodstream which protects retinal cells.

Smoking affects the nose. Smoking irritates the delicate membranes of the respiratory tract – including those inside the nose.

Smoking affects the mouth. The use of tobacco is connected to 90 per cent of oral cancers, including lip, tongue and palate. Many of the chemicals found in tobacco smoke are carcinogenic, and therefore, when the tissues of the mouth are bathed in toxic substances, this can lead to oral cancer.

Smoking affects the skin. Every in inhalation creates thousands of wrinkle-forming free radicals which attack collagen, cell membranes and the skin’s fatty layer. It is also thought that smoking impairs blood flow and lowers levels of Vitamin A which is vital for healthy skin, growth, so producing a dull, dry complexion.

Smoking affects the throat. The toxic content of smoke damages the delicate membranes of the larynx, making the smoker prone to laryngitis and in more severe cases – cancer of the larynx.

Smoking affects the lungs. Lungs are so vulnerable to damage because the tar that forms from burning tobacco and clogging the cillia – tiny hairs that protect the lungs from dirt and infection settles in them, damaging the surfaces.

Smoking damages the stomach. Chronic cigarette smoke may increase the amount of acid secreted by the stomach causing peptic ulcers – lesions in the lining of the stomach. Smoking is also linked to Crohn’s disease – an inflammation deep in the lining of the intestine.

Smoking affects the heart. Tobacco smoke produces carbon monoxide – a highly poisonous gas which combines with haemoglobin in the blood and makes breathing difficult. This reduces the body’s ability to carry oxygen – putting the heart under strain. Smokers also have a higher risk of hardening and narrowing of the arteries which can cause a wide range of cardiovascular problems.

Smoking affects the bones. Female smokers face an increased risk of developing osteoporosis – a condition that reduces bone substance and results in fragile bones that are liable to fracture.


We have a collective responsibility in society to protect children from the harms of second hand smoke. It is vital that we de-normalise the deadly habit and try to prevent the onset of smoking in young people.

What do you think of the call to ban smoking in cars carrying children? Join the debate and leave a comment.

Monday, 22 March 2010

400 doctors short in Wales

The BBC have reported today that Wales is short of almost 400 doctors.

These problems come as no surprise to us at the BMA, having predicted that these shortages would happen at some point.

For some time now we have been trying to meet with representatives from the WAG, to see how we can work together, drawing on the experience of front line doctors, especially juniors, to look for some solutions to the situation.

The levels of a lack of middle grade and junior doctors right across Wales is clearly unacceptable to both our members and people needing hospital treatment and this does not look like changing in the immediate future. The Health Minister should treat this situation with urgency.

The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas.

This is compromising consultants’ ability to deliver routine daily work, and there is no evidence that hospitals are adjusting services to take these shortfalls into account.

Without doubt, the rates of work being undertaken cannot be sustained with the current levels of staffing. Hospital managers must address this now, working with clinical colleagues.

The idea for our latest campaign "We'll Keep a Welcome", which aims to attract Welsh students who have left the country to study medicine to return to Wales to train as doctors, came about in an effort to tackle the problem of the severe shortage of doctors in Wales.

The safety of both NHS staff and patients is key, and we will need sustainable solutions for the future if NHS Wales is to deliver and maintain the quality and capacity of services that the people of Wales deserve.

Friday, 12 March 2010

GMC consultation on the revalidation of doctors

The GMC is consulting on its plans for the revalidation of doctors.

We asked Niall Dickson, the new Chief Executive of the GMC a few questions about the consultation when he visited Cardiff this week.

Take a look here:



To have your say or to find out more, please visit www.gmc-uk.org/thewayahead

Tuesday, 9 March 2010

Welsh Medical Students Committee Update



An update from Tom Combellack, Chair of the BMA Welsh Medical Students Committee.

The past three months have been very productive for the BMA Welsh medical students committee.

We have been focusing on finance, medical education, welfare and administration, as well as developing topics for debate at next month’s BMA annual medical students conference.

And we have successfully established a good working relationship with the new dean of medicine at Cardiff. At our regular meetings, it is clear that our opinions are being listened to and that our suggestions have been followed up and acted upon by the medical school.

These include having a clearer administrative structure, improving communication, addressing teaching inconsistency across Wales, and highlighting the importance of internet access for students on placements.

Throughout our exchanges the dean has been explicit about the issues leading to last year’s examination problems and the changes that have been made to ensure such a scenario does not happen again.

We are actively feeding into the Welsh healthcare funding review, and are working closely with the key stakeholders to ensure that medical students are not taken for granted and that any myths about medical student finances are dispelled.

The MSC’s Need for Change report on medical student finance and results from the focus groups for the English NHS bursary consultation have been instrumental in sending a clear message about our plight.

Medical student placements are currently financed through a funding stream known as the service increment for teaching. This helps the NHS meet the extra costs associated with teaching medical students. The WMSC believes it lacks accountability, and we intend to push for a more transparent system. In 2006, we used the Freedom of Information Act to ask trusts in Wales how the money was spent. Their answers showed it was not always spent the way it should be. We have now asked the same question. We will compare the results, and that analysis will influence our policy.

WMSC vice-chair Rob Seal, has been developing a finance questionnaire for graduate students.

Financially, these students form a very vulnerable group, and the results of the questionnaire will also shape our future work.

If you would like to raise any issues or enquire about our work, then please contact us via Lynn Steer by emailing LSteer@bma.org.uk.

Thursday, 4 March 2010

Wales could lead the way…..

Plaid Cymru MP Hywel Williams has laid an early day motion backing Wales’ decision to explore moving to a system of presumed consent. It says:

“That this House welcomes the announcement by the Welsh Assembly Government that Wales will move to a system of presumed consent, based on a soft opt-out system for organ donation; congratulates the patients and organisations, led by the Kidney Wales Foundation, on persuading the Welsh Assembly Government to take this step; recognises the overwhelming public support for such a move; and, following a free vote in the National Assembly for Wales, looks forward to supporting that move in this House, alongside a strengthened infrastructure to support the change.”

View the signatories here

This EDM has good cross-party support, and I hope to see more signatures added to the list over the next few weeks.

I’m glad that the Welsh Assembly Government are willing to take the lead, and send a clear message to the rest of the UK that a 'soft' system of presumed consent would increase donation rates and save Welsh lives.

BMA Cymru Wales believe that moving to a system of presumed consent, where it is assumed that people are willing to donate their organs after death unless they opt out, combined with other reforms to the transplant infrastructure, would play an important part in improving the organ donation system so that more lives can be saved.

The main difficulty with the current system is that where, as in the majority of cases, relatives do not know what their loved ones wishes are, they frequently, and understandably, opt for the default position, which is not to donate.

This would be addressed by the introduction of an opt-out system where the default position would change in favour of donation. We recognise this is a subject many people hold strong views about and as such, those who do not want to donate their organs will sign up to opt out.

The fact is, that people are dying while waiting for an organ transplant. It is vital therefore, that we increase the number of donors available, and we believe that a system of presumed consent with safeguards will do this.

A shift towards making donation the default position would reflect a positive view of donation, demonstrating the very strong support for it within society today. Therefore, over time donation would come to be seen as the norm, rather than the exception.

BMA Cymru Wales want what's best for patients, and ensuring a supply of organs that will meet current and growing demand must remain our ultimate goal.

Monday, 1 March 2010

We’ll Keep a Welcome/Pleidiol wyf i'm gwlad


Today we are launching a new campaign "We'll Keep a Welcome" to attract Welsh students who have left the country to study medicine, to return to Wales to train as doctors.

We felt that St. David’s day was the perfect day for our launch.

BMA Cymru Wales will be contacting all schools in Wales to reach out to those prospective medical students before they leave for university.

All students will be sent packs which will include letters from me, as well as from Welsh postgraduate dean Derek Gallen, along with information about training in Wales and posters to put up in medical schools.

The idea for the campaign came about in an effort to tackle the problem of the severe shortage of junior, staff-grade and associate specialist doctors in Wales.

We have a facebook group to accompany the campaign, which is a great resource for keeping in touch and receiving news on what’s going on in Wales - until it’s time for those students to come home.

Here is the link to our facebook group - join it and spread the word!

Friday, 26 February 2010

Annual Report from Dr. David Bailey, Chairman of GPC Wales


Last weekend we attended the Welsh Conference of Representatives of Local Medical Committees. Here is the annual report which Dr David Bailey, Chairman of GPC Wales delivered.

Since last year’s report the world has changed. We are now in the worst recession for decades – a situation not of our making but one which will have serious consequences for general practice.

The NHS will have to make significant cuts to overall spending, and this is likely to mean pitiful pay rises if any over the next 2-3 years. The only options for improving income will be private work or engaging in new cost efficient services. GPs in Wales will need to carefully consider how to engage the public in recognising the worth of General practice and will need to look carefully at the things that are important to their patients.

We will need to be pro active both with WAG, as we already are in regular meetings, and equally importantly with patients – through patient groups and patient charities the CHCs and our own Patient Liaison Groups.

We do have a clear idea of their likely concerns – Access, continuity and out of hours, though there may be others, and we need to consider how we could address them. We have already published guidance on opening for practices and we're enquiring from AMs how many actual complaints they get.

Following much anger in the profession, we have agreed to an alternative way of administering the Patient Experience questionnaire in Wales for this year which will involve practices administering the questionnaire to patients attending their practice with additional guidance from their local CHC. The results will be analysed as before by MORI for QOF payments but there is a golden opportunity to both engage patients and CHCs in discussion on practice access and to inform patients of the services you offer.

I’m confident that this deal will lead to better QOF scores in Wales by removing the confusion of the postal questionnaire, but we should view it as a positive opportunity to improve our services and our engagement with patients and not just negatively as a correction of last year’s unfairness.

Patients want to think well of their practices - we are still the most trusted profession and we should value and treasure that status. GPC has consistently supported the idea of patient liaison groups and they can be a way of improving both access and continuity if we listen to them. Practices should also try and design services to maximise the opportunity for patients when they wish to see the same doctor – continuity is still the unique selling point of UK general practice.

The Doctor Ubani case in England has put out of hours under the spotlight again and Welsh GPs need to have a view on what we want for OOH services. There is I'm sure absolutely no appetite in Wales for taking back OOH responsibility but many of us feel the LHBs have made a bad job of organising out of hours care for our patients.

There is currently an unacceptable variation in funding levels and the primary care strategy work again gives us the opportunity to press for an adequately funded and safely designed OOH service in our own areas. This would undoubtedly take pressure off hospitals, address many of the issues around patient frailty and allow more patients to be cared for in their own homes. In this particular area of the service the case for spend to save is absolutely crystal clear.

Currently the reason for many GPs disengaging from the OOH service is not money but intrusive micromanagement and understaffing leading to working conditions that many feel put both them and their patients at risk. So do we want to engage with the LHBs in redesigning better services? – I think we do but it’s an important question for this conference today.

Moving on now to contractual matters. We are awaiting the DDRB report. GPC were unable to reach agreement on any change to MPIG after the differential rise last year as we felt that the amount of money in the system would make this approach pointless. The governments however have suggested a rerun of the bizarre award from 2 years ago where all the rise – which will presumably mainly just reflect the higher expenses for all GPs - should be used to move GPs off MPIG – which roughly translated means no rise at all for all MPIG practices.

Strangely the negs (particularly me given there are more MPIG practices in Wales than anywhere else) were not much taken with this idea and GPC has submitted different and we feel much more sensible and fair evidence to the review body. We have asked to cover expenses in line with the mechanism in last year’s award and then just to be treated like every other doctor. What DDRB will actually do is anyone’s guess but any rise is likely to be tiny.

In an environment where jobs are being lost and wages cut we are fortunate to be in a job where rewards are good and job satisfaction high. Against that background as I've said Welsh GPs need to engage the Welsh public to demonstrate what fantastic value for money they still represent.

We’ve seen a massive health reorganisation in Wales this year – although the management faces seem eerily familiar - and there is still some confusion about how and whether the mantra of clinical engagement will get delivered. One thing is perfectly clear the only constant and proven avenues for all GPs to have their voices heard remain the LMCs and GPC.

Chris Jones' primary care strategic framework gained a lot of support in principle but we remain to be convinced that the resources both for infrastructure and GP engagement will be forthcoming. The principle of care closer to home delivered by a primary care led team is one we all support but the willingness of LHBs to reallocate resources to make it happen will be the main criterion against which most GPs will judge them.

And I have to say that LHB actions on enhanced services in Wales this year have not exactly increased the confidence of GPs. Despite a range of patient friendly services available to be commissioned and the support and commitment of the Minister for Health - Edwina Hart who allocated nearly £6.5 million to support extending services and sent it to the LHBs, enhanced service spending increased only £2.5 million in Wales last year. Our message to LHBs must be that GPs want to improve and enhance community services but, at least in some cases, they need to do their job much, much better.

Though the basket of enhanced services is the same as last year I (am happy to/hoped to) announce the finalising of an agreement to restructure the payments – though not the work - in the diabetic DES to better balance the reward for enhancing the process of diabetic care with that for achieving targets. (Sadly though it has gone through finance the papers are still with the minister for sign off) If approved I hope this will encourage the engagement of even more practices to further enhance the quality of diabetic care delivered in Wales in line with the strategy we want to support. In the light of evolving evidence on diabetic management we may look at revised criteria for 2010/11.

Talking of quality of care once again Welsh GPs increased their clinical QOF scores – matching the English despite 15% more workload. Unfortunately the patient experience survey meant that despite 80%+ satisfaction ratings overall Welsh practices lost QOF money last year. GPC Wales produced guidance on appeals and I wish all practices good luck in trying to recoup some of their losses.

We are also working to develop further improvements in clinical quality. We are seeing the benefits of the nursing home and diabetic DESs already, we are in advanced discussions about a palliative care DES and there has been positive patient feedback where the more holistic Welsh extended hours arrangements have been delivered.

The new First Minister Carwyn Jones has expressed a wish to see extended hours continue to be offered in Wales. He may however find it helpful to consider the fact that, despite a huge under spend in new enhanced services funding last year, less than half the old LHBs offered practices the opportunity to participate.

Rural doctors in Wales have long provided a fantastic service to their patients often across huge practice areas and the new rural health strategy may be evidence of some increased recognition of their contribution and their problems. On the downside however has been the 4.5% cut in the fee scale for the dispensing which keeps many rural GPs afloat and the ongoing difficulties in the market in terms of wholesaler charging and discounts. We are cooperating in a cost of service enquiry with the English Department and WAG is engaged as an observer with the aim of putting dispensing back on a fair economic footing.

GPC Wales produced the "Promoting Partnership" Document in 2009 and distributed it to all Welsh practices. The future of our craft depends on engaging the younger generation and a BMA Cymru survey last year confirmed that for 2/3 of sessional and trainee GPs in Wales their ultimate ambition is still partnership. The document sets out just why that's still a great option for existing GPs in Wales to offer and I hope every Welsh practice will take note.

Apart from the reorganisation and the recession the other main issue affecting GPs is revalidation. The timetable has moved back and back and the BMA is determined that the process will be properly funded. We in Wales have the skeleton of a process already with a first class appraisal system expertly managed and properly funded – even better Malcolm assures me that appraisal files can’t be googled as in some other countries I could name....

We also have the excellent work of Paul Myres and his team on the online clinical governance tool already in use for years with a decent evidence base and manageable workload, and we have the All Wales performance procedures and a nod here to Alison, Ian and Richard Quirke for their work on this.

Paul Williams head of NHS Wales has endorsed the continued use of the performance procedures in the new organisations. These three things - together with the sadly inescapable multisource feedback - should enable Welsh GPs to meet the criteria standards and evidence for revalidation as set by the RCGP in a proportionate system which doesn’t impact too much on our primary purpose – caring for our patients.

The end of my report as ever is an acknowledgement of many contributions to the work of GPC Wales. Thanks to Laurence Beth and Matthew from the UK team who join us today together with all my other friends in the smoke for their support. Thanks also to my current team Gruff Jones, Ian Millington, Charlotte Jones and Phil White and a special thank you to two ex members Kay Saunders and David Grant. To lose one deputy chairman in a year is unfortunate, to lose two looks like carelessness but the contributions of both Kay and David to the team were enormous. They will both be missed and we may perhaps see one or both of them back involved with the team in the future.

Lastly my thanks to the office – Richard Lewis, Andrew Dearden and Stephen Jones for their wise counsel, and John, Alison, Carla and Lucy for all their hard work. Most of all thanks to the incomparable Donna Martin (who’s out of the office) whose organisational skills are often the only thing standing between the Welsh neg team and chaos and disorder.

Ladies and Gentlemen enjoy the conference, Mr Chairman I have pleasure in presenting my 2010 report.

Tuesday, 23 February 2010

Homeopathy on the NHS

The House of Commons Science and Technology Committee has said that the NHS should stop funding homeopathy (read the BBC article here).

We at BMA Cymru believe that NHS provision should be confined to those areas of complementary medicine where formal regulatory systems exist.

We recognise the growing interest in complementary and alternative therapies, but it is important that patients are protected against unskilled or unscrupulous practitioners of health care. Standards of good practice should be set to help both referring doctors and their patients.

The current system needs to change where for most therapies - virtually anyone is free to practice irrespective of his or her training or experience.

It's very important that when a person goes to see a complementary therapist they know what sort of training they have had, and know they are bound by professional rules - because that gives them reassurance.

The key to enhancing scientific credibility for such therapies is through research into their safety and effectiveness. BMA Cymru Wales supports evidence based medicine, and feel strongly that all complementary therapies should be regulated to the same standards expected of the medical profession.

Monday, 22 February 2010

Q&A with CMO Dr Tony Jewell

Have a look at our new youtube clip – a Q&A session with CMO Dr Jewell and BMA members. Do you have any thoughts or comments on the answers given by the CMO?

Thursday, 18 February 2010

2010 Welsh Conference of Representatives of Local Medical Committees

This weekend we are heading north to Llandudno for the 2010 Welsh Conference of Representatives of Local Medical Committees.

We shall be live “tweeting” the fervent debates which are sure to be had, so if you want to find out what’s been happening, click here to view our twitter profile and take a look on Saturday!

Wednesday, 10 February 2010

Drinks promotion taken off sale

I was pleased to read this article in the South Wales Echo today.

I commented last week on a promotion that a club in Cardiff was running – 10 alcoholic drinks for £10. The concern that we have is that such deals encourage binge drinking which can have long term effects on health.

The club has now withdrawn the offer – hopefully taking on board our comments.

All these promotional activities serve to normalise alcohol as an essential part of every day life, so it is no surprise that young people are drawn to alcohol.

In a bid to tackle the soaring cost of alcohol-related harm, particularly in young people, we would like to see a total ban on all promotional deals like happy hours, two-for-one purchases and ladies’ free entry nights.

There can be no more softly, softly approach. The access and affordability of alcohol must be tackled head on.

BMA Cymru puts the focus on the dangers of tanning


This article in the South Wales Echo today explains a bit more about our short film “A tan to die for”.

I’m glad to see it getting coverage before the debate today – we have sent it to all Assembly members to remind them about the dangers that sunbeds can cause, giving expert views as well as the views of schoolchildren.

Thanks for all the positive feedback we have been receiving about the film clip – this is a public health campaign that we feel strongly about and it’s good to know the public are behind it too. If you haven't viewed it yet the link is below.

Monday, 8 February 2010

A tan to die for

This Wednesday a debate on the Health Committees report on the use and regulation of sunbeds in Wales takes place in the Plenary session.

BMA staff have produced a short information video and sent it to all Assembly Members ahead of the debate to remind them of the risks that sunbeds pose to the people of Wales.

We are hoping that they will support the recommendations of the committee.

In 2010 there is no excuse for the danger to public health posed by unregulated, unsupervised, coin-operated sunbeds.

The BMA Cymru production “A tan to die for” is on YouTube, and features Welsh schoolchildren giving their views on tanning, as well as consultant dermatologist Sharon Blackford and Cardiff North Labour MP Julie Morgan, who BMA Cymru Wales have work worked closely with in the campaign for UK legislation to ban children from using salons.

View the film (in two parts) here – and tell us what you think of it!




Friday, 5 February 2010

Dr Andrew Dearden gives evidence to Assembly Health Committee on Sunbeds

Ahead of next Tuesday’s Assembly debate on the Heath Committees report on the use and regulation of sunbeds in Wales – we thought readers might want to know what BMA Cymru Wales said in our evidence to the Committee inquiry - and what regulation we have called for.

In this video, Chairman of BMA Welsh Council Dr Andrew Dearden, gives evidence to the Committee.



Our written evidence, including our recommendations, is also available to view here.

Thursday, 4 February 2010

Irresponsible drinks promotions in the capital

Shocking article in the South Wales Echo today which reveals Cardiff clubs offering deals to lure people in like 10 drinks for £10.

It is no surprise that young people are drawn to alcohol as all these promotional activities serve to normalise alcohol as an essential part of every day life.

The truth is, there is nothing glamorous about drinking too much alcohol – it wrecks health, lives and families.

As a GP I see many families torn apart by alcohol problems. Alcohol often plays a major part in domestic violence and the breakdown of relationships.

I see many patients suffering ill effects because of alcohol. Many are disbelieving when I point out the effect of alcohol on their condition – “everyone I know drinks like I do, many drink more”, they say.

It is not infrequent to find patients with fatty liver in their 30s and 40s, and when asked about previous alcohol consumption often describe heavy or binge drinking when a student in their 20s.

The misuse of alcohol is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems – it costs the NHS millions of pounds every year and is linked to accidents and street violence.

In a bid to tackle the soaring cost of alcohol-related harm, particularly in young people, BMA Cymru Wales calls for a total ban on all promotional deals like happy hours, two-for-one purchases and ladies’ free entry nights.

There can be no more softly, softly approach. The affordability of alcohol must be tackled head on.

What do you think about drink promotions?

Friday, 29 January 2010

Sunbeds Bill through to the next stage!

I am delighted that Members of Parliament have voted Julie Morgan’s Private Members Bill on sunbed regulation to the next stage.

I hope that today's vote will encourage more MPs to get involved in the debate and begin to feed through into a commitment by Government for radical action to regulate sunbeds.

BMA Cymru Wales has campaigned for the tanning industry to be regulated for many years. We want to see tough action on sunbeds - including unmanned and coin-operated ones.

Doctors have been concerned for years about the rising incidences of skin cancer and the access that people have to sunbeds for cosmetic use.

We are particularly concerned by evidence that children are using sunbeds. Children are especially sensitive to ultraviolet light, and just one day of burning as a child increases the risk of getting skin cancer as an adult.

BMA Cymru strongly believe that there should be a thorough regulation of sunbed operators, and that tighter controls will have a positive impact on skin cancer prevention efforts.

I look forward to watching the further progress of this vitally important Bill.

Wednesday, 27 January 2010

Q&A with Wales Chief Medical Officer Dr Tony Jewell

BMA Cymru Wales will be filming a Q&A session with Dr Tony Jewell shortly, and we want to hear from YOU!

What would you like to know about Dr. Jewell? Perhaps what his day to day activities entail, or what he thinks the biggest challenges facing the health service are?

Whatever your question, we want to hear from you. Email cmahoney@bma.org.uk and we will try to ask as may questions as we can.

Calling for support for Julie Morgan MP

We are urging all Welsh MPs to support Julie Morgan’s Private Member’s Bill which would close a loophole in the law to protect the public from the dangers of sunbeds. The Bill is receiving its second reading in the House of Commons on Friday.

We are urging all Welsh MPs to remain in Westminster on Friday to support and vote for the Bill. It requires 100 votes to move to the committee stage as part of its route to the statute book. If it fails to attract this support, it will fall.

Doctors have been concerned for some time about the link between exposure to UV radiation and skin cancer which is indisputable – shown by the recent decision by the International Agency for Research on Cancer to raise the sunbed classification to “carcinogenic to humans” - the highest risk category.

We are particularly concerned by evidence in Wales that children are using sunbeds. Children are especially sensitive to ultraviolet light, and just one day of burning as a child increases the risk of getting skin cancer as an adult.

We must educate people about the dangers of sunbeds and counter the myths about tanning. A suntan is not a sign of good health; a tan means that the skin has been damaged.

A thorough regulation of sunbed operators, and tighter controls will have a positive impact on skin cancer prevention efforts.

This bill will protect vulnerable people. It will be good for the public health of Wales.

My colleague Dr Sharon Blackford, Consultant Dermatologist at Singleton Hospital has also been vocal about these issues:

“We are seeing more and more younger patients with skin cancer, particularly young women who are frequent sunbed users.

“In the past some types of skin cancer were only seen in elderly people, particularly outdoor workers, but now it is commonplace to see patients in their 40’s and even younger with these tumours.

“Dermatologists would never recommend sunbeds for tanning, it's much safer to stay pale and interesting or to use a false tan, or in other words fake it, don't bake it.”

The burns unit at Morriston Hospital has treated patients with burns caused by tanning sessions.

This legislation is vital to stop more young people being exposed to the risk of developing skin cancer.

BMA Cymru Wales is urging all Welsh Members of Parliament to rally behind this important cause and support Julie Morgan on Friday at the second reading.

Tuesday, 26 January 2010

£25,000 for Health Projects in the Developing World

NHS teams planning humanitarian work overseas can apply for grants of up to £3,000 from the BMA/RCN Humanitarian Fund from this week.

The total amount available for projects in 2010 will be £25,000 – comprising, £20,000from the BMA, and £5,000 from the Royal College of Nursing.

Last year, 29 grants were awarded from the Humanitarian Fund, which is administered by the BMA’s International Department.

Projects ranged from reducing infant deaths by training community health workers to deliver improved maternity care in Afghanistan to setting up a sustainable kidney transplant programme in Ghana.

Such projects can have lasting benefits. In Ghana, for example, a British team supported by the Humanitarian Fund have trained local surgeons and nephrologists with the aim of establishing a national kidney transplant service that will save many lives.

I am proud that the BMA funds such valuable work. I’m looking forward to reading about the next range of projects that will take place this year using the humanitarian fund.

NHS staff seeking funding for projects should apply to the BMA’s International Department at international.info@bma.org.uk

For more information, go to: http://www.bma.org.uk/international/international_development/humfund2010.jsp

Wednesday, 20 January 2010

2010 for Medical Students in Wales


In 2010, the Welsh Medical Schools Committee (WMSC) will be working hard to forge better standards for medical students across a broad range of tough issues. Our priorities include improving standards of education and reducing the financial burden on medical students.

In September 2009, Swansea medical school welcomed its first cohort that will complete all four years of the graduate entry programme at Swansea University. As the course evolves and grows, so too does the WMSC. We have one of the strongest committees I have had the fortune to be a part of so I have great optimism for a successful year.

Last year Cardiff University appointed a new Dean of Medicine. Over the course of the year we hope to build a strong working relationship with him with the goal of improving education and administration for medical students. The work we have done together so far has been very encouraging and we are very grateful for his frankness and willingness to discuss our concerns. The change in administration and exam mark processing protocols are of paramount importance, as we never want to see a repeat of last year's debacle.

Financial issues are a continuous cause for concern for medical students. The average debt upon graduating is approximately £37,000 and with the proposed lift of the cap on tuition fees as well as the reform of the NHS bursary system this could lead to student debt mounting even further. This not only penalises students across the board but will almost certainly disproportionally reduce applications from students of a lower socio-economic background. This is unacceptable. As the WMSC we are in the unique position to lobby for a fairer system that will benefit medical students across Wales. We also hope to implement initiatives to encourage Widening Participation.

We look forward to working with you and for you.

Tom Combellack
WMSC Chair 2009/2010

Tuesday, 19 January 2010

Putting an end to "all you can drink offers"

New UK Government proposals mean that the all you can drink promotions could be banned in England and Wales.

We welcome the crackdown on such promotions which can lead to excessive drinking.

The health consequences of binge drinking or regularly drinking over and above the recommended daily limits are serious and severe. The number of deaths in Wales as a result of the abuse of alcohol continues to rise, and doctors report an increase in the number of young people presenting to the NHS with serious illness resulting from alcohol misuse.

We are pleased that the UK Government are taking action, but if they are serious about tackling the UK binge drinking culture, even tougher action is necessary.

There is strong and consistent evidence that an increase in price will reduce consumption, and BMA Cymru believes that this should form a central plank of any strategy to deal with alcohol misuse.

Thursday, 14 January 2010

Another Government Strategy Launched…..

I have been reading the physical activity action plan which has been launched this week, with the aim to achieve an active, healthy and inclusive Wales.

We support the call for increased participation in physical activity in Wales and in particular it becoming part of a normal everyday routine.

I hope that the strategy will be successful, but the responsibility ultimately lies with the individual. We all need to be prepared to make small changes to our daily routine which can make a real difference.

Wales is a beautiful country, and what better way to appreciate our surroundings than swap the car journey to work, for walking or cycling. And I’m not just talking about adults. Children, where possible, should be encouraged to walk or cycle to school. The number of children travelling to school by car has doubled over the last 20 years - no wonder childhood obesity is a growing epidemic. We need to teach children from a young age about the advantages of a healthy lifestyle, and introducing exercise into a daily regime will help to protect them from chronic conditions later on in life.

The inequalities inherent within Wales have a profound influence on the health of children. I would like to see more investment in safe areas for children to play and exercise, as well as further investment for sport in schools. Deprivation limits access to safe play areas and safe physical activities.

In deprived areas many parents are too scared to let their children go outside because the roads are so busy, and in many communities there are the additional dangers of unsafe environments where play areas are littered with discarded syringes and broken glass. Until we address these fundamental barriers – nothing will change.

As doctors we have a vital role to play as well - in prescribing exercise for those who are overweight or obese.

Physical inactivity has so many different causes that it is impossible to be tackled by guidelines alone. I’ll be very keen to read the data that will be produced through the Welsh Health Survey and Health Behaviour in School-aged Children Study to see if the strategy has actually worked.

What are your thoughts on the strategy?

Wednesday, 13 January 2010

Julie Morgan’s Private Members Bill Receives Government Backing

BMA Cymru are delighted with the news that Julie Morgan MP’s private members bill which would ban under 18’s from using sunbeds, and ensure all sunbed use in England and Wales would be supervised has received Government backing.

Andy Burnham, Secretary of State for Health has stated he will take action to protect young people from the harm that sunbeds cause. He has noted the clear scientific evidence that sunbeds increase the risk of getting cancer and voiced his support for the bill.

I’m also glad to see celebrities such as Nicola Roberts from the popular band Girls Aloud, supporting the Bill and being a positive role model for young people.

Julie Morgan is hoping that the bill becomes law before the UK general election and we certainly hope so too.

BMA Cymru have campaigned heavily last year in Wales for tighter regulation of the sunbed industry, in particular for a ban on coin-operated / unsupervised salons and a ban on the use by under 18s. We were delighted last year when the National Assembly for Wales Health Committee took our recommendations from their inquiry forward, and await the debate in Plenary this term.

We will continue to do everything we can to support Julie Morgan. Our public affairs team are seeing Julie on Friday to discuss the Bill and what more can be done in Wales. They will be filming Julie for our Youtube channel. Tune in soon to find out more.

Tuesday, 12 January 2010

Congratulations Dai!


I would like to congratulate the Chair of the Junior Doctors Committee Dr David Samuel (pictured) who has won a Pfizer bursary. Dai will be talking to groups of up to 100 students from schools in Merthyr about teenage health.

Dai was raised in Merthyr, and now works at Prince Charles Hospital. As a local Doctor who is aware of the issues facing the residents, he hopes to break the cycle of ill health that runs in families from the area. He will be covering amongst other topics; drugs and alcohol, smoking and teenage pregnancy.

Merthyr has the highest rate of sexually transmitted diseases in Wales and the UK. The borough also has the highest proportion of smokers in Wales, as well as a high proportion of binge drinkers.

Collectively we need to work together to ensure a healthy future for our children and I am pleased that Dai is taking action.

BMA Cymru are extremely concerned about alcohol consumption among young people. It is shocking that in Europe, the UK’s teenagers are most likely to be heavy drinkers.

As doctors we see first hand how alcohol misuse destroys 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.

Alcohol misuse not only costs lives it also costs the country many millions of pounds. The NHS spends millions every year on treating and dealing with alcohol problems and the criminal justice system also spends similarly large amounts dealing with alcohol-related and drink-driving offences.

It is also vital that we break the cycle of young smokers who will become tomorrow’s parents who smoke, and continue the cycle of smoking-related ill-health. Every day doctors witness the death and despair caused by smoking.

It is essential that cigarettes are made less accessible to children. Banning point of sale displays and getting rid of tobacco vending machines will go some way to doing this.

We must also ensure that young people have access to adequate and appropriate contraception, as well as working together to educate and inform them of the risks of becoming sexually active too early.

We will be producing a youtube film of Dai in action at one of the interactive sessions – tune in to find out how he gets on.