BMA Cymru Wales - the voice for doctors in Wales

BMA Cymru backs new GMC guidance on end of life care

2010-06-22T11:34:00.001+01:00

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.

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

2010-06-21T15:46:00.000+01:00

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

2010-06-21T14:52:00.001+01:00

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.

Letter from the Minister - Vaccination uptake in 2009-10

2010-06-18T16:14:00.001+01:00

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.

BMA Cymru welcomes call to lower drink-drive limit

2010-06-16T16:08:00.001+01:00

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.

Why Wales has to attract the best medical talent

2010-06-14T15:10:00.002+01:00

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

2010-06-14T15:08:00.002+01:00

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!

Time to tackle the affordability of alcohol

2010-06-02T10:52:00.002+01:00

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?

Why Wales has to persuade doctors to come home

2010-06-01T10:24:00.004+01:00

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.....

BMA Wales Social Media

2010-05-27T15:04:00.005+01:00

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

2010-05-27T10:12:00.003+01:00

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?

Survey on alcohol policy issues

2010-05-25T09:50:00.003+01:00

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.

Alcohol Abuse: An Integrated Approach Forward

2010-05-18T09:39:00.008+01:00

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

Welsh Cancer Standards

2010-05-10T10:37:00.005+01:00

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.

Alcohol Pricing

2010-04-27T16:28:00.000+01:00

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.

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

2010-04-26T11:01:00.001+01:00

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?

Mae hen wlad fy nhadau yn annwyl i mi

2010-04-23T10:30:00.003+01:00

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.

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

2010-04-21T16:24:00.003+01:00

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.

1,000 Lives Campaign

2010-04-19T11:27:00.003+01:00

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?

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

2010-04-14T09:22:00.002+01:00

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

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

2010-04-13T10:15:00.004+01:00

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

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

2010-04-12T11:05:00.003+01:00

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.

Sunbed ban to become law

2010-04-08T16:35:00.003+01:00

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.

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

2010-03-24T10:46:00.004Z

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.

400 doctors short in Wales

2010-03-22T12:25:00.000Z

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.

GMC consultation on the revalidation of doctors

2010-03-12T14:55:00.003Z

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

Welsh Medical Students Committee Update

2010-03-09T11:23:00.008Z

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.

Wales could lead the way…..

2010-03-04T11:11:00.001Z

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.

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

2010-03-01T11:31:00.006Z

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!

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

2010-02-26T10:29:00.007Z

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.

Homeopathy on the NHS

2010-02-23T11:59:00.001Z

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.

Q&A with CMO Dr Tony Jewell

2010-02-22T11:46:00.002Z

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?

2010 Welsh Conference of Representatives of Local Medical Committees

2010-02-18T16:38:00.001Z

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!

Drinks promotion taken off sale

2010-02-10T11:25:00.002Z

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

2010-02-10T11:20:00.002Z

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.

A tan to die for

2010-02-08T15:35:00.003Z

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!

Dr Andrew Dearden gives evidence to Assembly Health Committee on Sunbeds

2010-02-05T14:47:00.006Z

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.

Irresponsible drinks promotions in the capital

2010-02-04T10:39:00.003Z

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?

Sunbeds Bill through to the next stage!

2010-01-29T14:26:00.003Z

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.

Q&A with Wales Chief Medical Officer Dr Tony Jewell

2010-01-27T15:27:00.001Z

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

2010-01-27T10:02:00.001Z

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.

£25,000 for Health Projects in the Developing World

2010-01-26T15:23:00.003Z

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

2010 for Medical Students in Wales

2010-01-20T11:45:00.005Z

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

Putting an end to "all you can drink offers"

2010-01-19T16:20:00.004Z

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.

Another Government Strategy Launched…..

2010-01-14T16:44:00.002Z

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?

Julie Morgan’s Private Members Bill Receives Government Backing

2010-01-13T13:24:00.000Z

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.

Congratulations Dai!

2010-01-12T11:00:00.004Z

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.

2010 for the Public Health Committee

2010-01-11T14:41:00.005Z

Chair of the Public Health Committee Lika Nehaul (pictured)looks at the year ahead for the Committee.

"2010 will be another challenging year for the Public Health Committee. There are four main issues that we would like to focus on.

"Firstly, we will be working with the Board of the Public Health Wales NHS Trust (PHW) to make the new organisation function successfully, and to be the best Public Health Service in the UK.

"This will not be an easy task as public health capacity is slim. The Public Health Strategic Framework for Wales will need to be implemented and there are high expectations on the part of Local Health Boards of the newly appointed Directors of Public Health, and the support expected from PHW across all domains of public health practice.

"Local authorities and communities will look to the Public Health service to advise on, and support the health improvement agenda. These are substantial expectations in an increasingly difficult financial climate.

"The second issue relates to the ongoing development of BMA Cymru Wales policy. Our members want to work closely with Welsh Council and other crafts in regard to both health care and health policies.

"We would like more doctors specialising in public health to be actively engaged as BMA members, especially given the multiple challenges medics are likely to face in coming years.

"Finally, like other doctors we want the details of our specialty re-validation arrangements clarified at the earliest possible opportunity."

2010 for Junior Doctors in Wales

2010-01-07T11:23:00.005Z

My colleague and Chair of the Welsh Junior Doctors Committee Dr Dai Samuel (pictured) looks at the year ahead for junior doctors in Wales.

"2010 brings new and ongoing challenges for the Welsh Junior Doctors Committee. With the introduction of the EWTD back in August 2009, as a committee we are constantly reviewing the impact this is having on the working and training lives of Doctors in Wales. Being part of external groups such as the Junior Doctors Review Group offers the BMA a voice within the Welsh Assembly Government as well as the Wales Deanery and I hope our relationship with both these organisations continues to flourish in the new year.

"An exiting project which will come to fruition this year will be the development of an Ambassador role for junior doctors in Wales as well as working with the Deanery to nurture a network of doctors working on the front line to assess and discuss issues relating to Quality Assurance in medical education.

"Our committee grew and matured last year and I hope that conference 2010 will prove a successful one for the committee. Establishing equal voting rights for devolved nations on JDC have been a source of concern in recent times and this will be undoubtedly be debated at conference. Negotiating a new contract lies on the horizon for UK JDC and I relish the challenge of ensuring that doctors in Wales get a palatable and attractive offer to remain here to work and live. This issue never strays far from the top of the agenda with WJDC and we continue to look at what could and does make Wales a unique place to live and work as a doctor. Links with WMSC continue to mature and I hope I can help encourage students to become doctors in Wales, and members of WMSC members of WJDC!

"My hope is that the committee will attract new members, particularly from hospitals away from the capital city. Our roadshow tours to hospital messes are proving popular and hopefully planting the seeds of interest for new members to attend a committee meeting! Seeing how we can change things and interact with Chief Executives of Local Health Boards is an example of how grassroot members’ voices and opinions have channelled our work plan this year.

"WJDC looks forward to working BMA Cymru, Welsh Council and other professional colleagues in 2010."

Dai Samuel Chairperson WDJC 2009-2010

Are you a junior doctor in Wales? What are your thoughts on issues facing junior doctors for the year ahead?

New year message from the Chair of Welsh Council, Dr Andrew Dearden

2010-01-06T12:16:00.005Z

Well a New Year dawns and the snow has fallen again.

There are several big issues facing our profession in the coming year. Not least Revalidation and the preparations for its introduction.

I am pleased to say that due to the work of BMA Cymru Wales, our dedicated staff and Council members, we in Wales are well placed to agree an acceptable and GMC approved system that I think will be welcomed by the doctors in Wales. (see recent revalidation newsletter for details)

But we also face the worse financial situation the country and NHS has faced for many years, if not decades. We face real term funding / cash cuts to the NHS services. While we know who caused the problems we now face, as it was not us(!), it will fall to us to do what we can to protect the NHS and our patients from severe cuts to their medical services.

The new health boards desperately need our input, ideas and suggestions so we can adapt to the financial cuts without damaging cuts to healthcare provision in Wales. While NHS managers may not have listened to us (much) in the past, they really do need to take our advice and ideas now. Not to do so, would be a mistake.

Good Mental Health

2010-01-05T14:33:00.002Z

My colleagues in our public affairs department had an interesting meeting with mental health charity Gofal Cymru today, which got me thinking.

They discussed Conservative AM Jonathan Morgan’s Mental Health LCO - which will help change the way in which mental health services are structured and delivered in Wales, and we, alongside Gofal and others continue to support reform.

Their meeting however, soon moved onto the problems we face in Wales in relation to mental health.

The report published by the Healthcare Inspectorate Wales, the Wales Audit Office, Estyn and Care and Social Services Inspectorate Wales late last year which I blogged about certainly highlights that mental health services in Wales are still failing young people.

What I find exceptionally worrying though, is the issue of social stigma.

People find mental health an uncomfortable topic of conversation, and many people conceal their illness as a result of the social stigma surrounding it. But mental health problems are extremely common - it is estimated that one in four of us will develop mental ill health at some point in our lives.

The social stigma attached to mental illness, the need for better education and the lack of funding are at the forefront of discussions in this area.

Misconceptions and stereotypes of mental illness must be dispelled if we are to remove the social stigma which still exists. Education is the key to achieving this, partly through public health education, but also in the classroom.

Until society respects the rights of individuals facing mental health problems, we will not be able to provide an effective service.

Service users and carers should be treated with dignity and respect and should not be afraid to speak out about their problems.

There is a real need for a fundamental re-think of attitudes and responses to mental health.

Good mental health is a priority for us all, and the Government have a golden opportunity available now to reshape mental health services in Wales - which I hope they grasp with both hands because we still have a long way to go.

Have you been a victim of social stigma? Share your experience with us.

2010 for Consultants in Wales

2010-01-05T09:56:00.003Z

My Colleague and Chair of the Welsh Consultants Committee Dr Stefan Coghlan (pictured), has considered what 2010 will look like for Consultants in Wales.

"I expect this to be a difficult year for Consultants in Wales as we see the financial belt tightening further.

"With 7 to 10 % Cost Improvement programmes up and running in the new LHBs, the prospect of a further 10% cut in the budget allocation to Wales and demand ever increasing for specialist services, we can expect a tough year or two ahead.

"I have written before about the pressures on Consultants to fill gaps left by EWTD, and there is increasing evidence that poor planning by Trusts (and now LHBs) is leaving consultants to pick up the pieces.

"Is there any good news?

"Well, the Access targets are likely to be relaxed as the NHS simply can not afford to treat all patients within the 26 week timescale. The Minister herself has emphasised the need to treat patients on the basis of clinical priority as determined by Consultants.

"Revalidation may not be embraced quite so willingly by governments with stretched finances and little evidence of the benefit that this additional bureaucracy will bring.

"BMA Cymru Wales is exploring the possibility with partners of a Wales solution to revalidation.

"It may be a year or two before we see the benefits of integrating primary and secondary care, but there remains the real possibility of Consultants being able to lead the delivery of specialist care whether in the acute setting or in the community in partnership with GP colleagues."

Wishing you a happy new year.
Dr Stefan Coghlan
Chairman WCC

Do you agree with Stefan's predictions? Are you a Consultant in Wales? What are your predictions?

Welsh General Practice in 2010

2010-01-04T15:20:00.005Z

Happy New Year to members and regular readers.

My colleague and Chair of the Welsh GP Committee Dr David Bailey (pictured), looks at the year ahead for GPs in Wales.

"The financial downturn will limit innovation in practice and certainly new premises development and we will need to concentrate on maintaining and improving existing services.

"Whilst I’m conscious of the difficulties greater morbidity and deprivation brings to Welsh practices, one quick win would be organisational change to improve access. Many practices still use the “advanced access” templates which don’t deliver what patients need because of artificial phone barriers. A reasonable window to make quick appointments and keeping principle premises open throughout core hours would address many patient complaints at a stroke and should be our aim.

"The advent of new Health boards brings the potential for improving working relationships and new innovative services. It is to be hoped that this opportunity won’t be thrown away by them failing to engage GPs in designing service change and drowning us in unnecessary bureaucracy – time will tell.

"We can but hope that Doctors and Dentists Review Body does not listen to those in government who do not recognise the fantastic value we still provide.

"Through it all as usual General Practice will continue to be the one constant in patient’s experience of the NHS and the jewel in it’s crown."

Happy New Year!

David

Do you agree with David's predictions for the year ahead? Tell us what you predict.

Seasons Greetings

2009-12-23T15:41:00.000Z

I would like to wish all our members and regular observers of my blog a very merry Christmas and a happy new year.

2010 will inevitably bring with it huge challenges to the NHS in Wales, particularly in the light of financial uncertainty and real cuts in funding of public services. However, whatever the New Year brings you can rest assured that BMA Cymru will continue to be at the forefront of discussions, striving to improve the health of the people of Wales by representing the doctors who care for them. We believe doctors in Wales can provide the medical leadership needed to ensure NHS Wales delivers the services that will improve outcomes for our patients. While service delivery is important, so too is the training of the doctors of the future; one cannot be sacrificed for the other if we are truly to create sustainable excellence in healthcare attracting and retaining the very best doctors to Wales.

BMA Cymru looks forward to working hard on behalf of its members in 2010, and sends Seasons Greetings to all - especially those working for our patients over the holiday period.

Presumed consent: the debate

2009-12-22T14:54:00.004Z

Fervent debate has followed the announcement by Health Minister Edwina Hart last Friday that Wales could move to a system of presumed consent for organ donation.

Jonathan Morgan AM has voiced his concern over the announcement. This is what I said in response:

“We recognise that the introduction of an opt-out system would be a controversial decision, and as such those who do not want to donate their organs will sign up to opt out. A law on presumed consent would, at a single stroke, save lives whilst still giving the individual the right to have a choice.

“Given the very high level of support for organ donation expressed in repeated surveys it is reasonable to presume that those who die without making their views known are in the majority who want to donate, rather than the minority who do not.
“Presuming consent rather than presuming objection is more likely to achieve the aim of respecting the wishes of the deceased person.

“We believe that with further debate and information about the way such a system would operate, there will be widespread public and professional support for such a change.

“The gap between the number of organs available and those needed continues to grow, with around 1,000 people dying each year in the UK waiting for an organ.

“We must recognise that the current system is unable to meet the increasing demands placed upon it. Steps must be taken to increase the availability of organs for transplantation.

“Let’s show that we still care deeply about the health of our nation and that we are willing to lead with bold initiatives whilst other countries dither and waver.”

I’m looking forward to hearing Jonathan’s response.

We will continue our work with the Welsh Assembly Government and other partners over the next few months to raise public awareness of the urgent need for change and the rationale behind the presumed consent option. You can expect to hear a lot more from us on this important issue.

What are your views on the announcement?

Organ Donation in Wales

2009-12-18T12:22:00.003Z

BMA Cymru Wales is delighted with the announcement that the WAG will explore the possibility of introducing a soft opt out system for organ donation in Wales, and that a bid for a Legislative Competence Order will be submitted.

I hope that this brave decision by the Health Minister will mark a small step towards ending the tragedy of patients dying while waiting for a transplant.

Organ transplantation saves lives and it can transform the lives of people suffering disability and the tremendous burden of dialysis. There have been many high profile cases highlighted by the media over the last few years which touched us all.

As long ago as 2000, doctors voted for an opt-out/presumed consent scheme to be introduced in the UK following its success on the continent which increased the number of organs available for transplants and therefore reduced the number of patients who die waiting for a transplant. They also agreed that a public education campaign about the merits of organ donation should take place before introducing the scheme.

BMA Cymru Wales will continue to work with the Welsh Assembly Government, Kidney Wales, and other partners over the next few months to raise public awareness of the urgent need for change and the rationale behind the presumed consent option.

Tell us what you think of the announcement.

Responsible drinking

2009-12-18T10:31:00.003Z

As pubs and clubs are gearing up for one of the busiest nights of the year - widely known as “Black Friday”, BMA Cymru are urging party goers to drink responsibly tonight.

Black Friday has become one of the busiest nights of the year for those working in Hospitals and the emergency services in Wales. Hospitals are busy putting extensive contingency plans in place to cope with an influx of alcohol induced injuries.

The combination of the Friday before Christmas, pay-day and binge drinking will put an increased strain on services in Wales.

Anti-social behaviour, violence, and drink-driving will multiply this weekend across Wales due to an increased level of alcohol intake, and in many cases, binge drinking.

Alcohol can be an enjoyable part of social and cultural life especially over Christmas. I've said it before - we are not looking to restrict people from having a choice about consuming alcohol, we just want to encourage adults to drink in moderation, rather than drinking to get drunk.

Sometimes people may not even be aware that they are drinking too much – it is easy to do. It is important to keep track of how much you are drinking.

It is vital that people make alternative arrangements for getting home if they are drinking this weekend. Even driving the morning after can be dangerous as alcohol may still be in the system.

I met with Kate Edwards and Melanie Hamer of Pontypridd Women’s Aid recently who have considerable experience in supporting and dealing with victims of domestic violence. They were extremely concerned that the number of complaints about domestic violence would increase this weekend. Kate Edwards who is the Chair of Pontypridd Women’s Aid said:

“There will be a visible police presence out on the streets prompting some to take their anger out at home.

“It is particularly sad when such incidents occur at a time which is meant to be a happy one. Domestic violence can have a dreadful effect not just on the victim, but of course on the children and it can end up not just ruining their Christmas, but impacting adversely on the rest of their lives.”

So the message from us at BMA Cymru is – enjoy a drink, but don’t overdo it.

BMA Cymru support Julie Morgan MP's private members bill

2009-12-17T12:12:00.002Z

Julie Morgan, MP for Cardiff North has put down a private members bill which would ban under 18’s from using sunbeds, and ensure all sunbed use in England and Wales would be supervised.

BMA Cymru are delighted that Julie has chosen to use her bill to close a loophole in law to protect the public – particularly young people – from the dangers of sunbeds and from over-exposure to intense UV radiation.

This is something we have campaigned heavily on this year in Wales - calling for tighter regulation of the commercial sunbed industry; particularly for a ban on coin-operated / unsupervised salons and a ban on the use by under 18s.

The link between exposure to UV radiation and skin cancer is now 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.

Just one session a month on a sunbed doubles the average individual's annual dose of UV radiation and this is proven to greatly increase the risk of cancer, skin and eye problems in later life.

For us the essential point is that there is no such thing as a safe tan (unless it comes out of a bottle). The damage to your skin remains long after a tan has faded.

There are no formal guidelines about standards of private sector tanning salons, the ones which do exist are only advisory and providers are free to ignore them. Anyone can decide to set up a tanning salon, and they need no training or qualifications.

In 2009, there is no excuse for such lax regulation. When we gave evidence to the National Assembly for Wale’s Health Committee inquiry a few months ago that is exactly what we said – we are delighted that the Committee took our recommendations forward, and now we are even more delighted that Julie Morgan MPs Private Members Bill could close this gap in public protection on a UK level for good. We will do everything we can to support her.

The bill has it’s second reading on 29 January 2010 – we will be watching closely.

Tell us what you think of this private members bill.

Our booze culture

2009-12-16T12:00:00.002Z

The Western Mail has reported today that the number of people admitted to hospital with alcohol-related conditions has risen by 30% in five years.

These figures are unsettling. The population is drinking more and our society is awash with pro-alcohol messaging, marketing and behaviour.

Over the festive period, the admissions to A&E for alcohol misuse will put a huge strain on NHS resources. Intoxicated patients are dealt with by a variety of medical staff and even security guards if they are violent and abusive. Added to this are the costs of tests and treatment, and if the patient is then sent to a hospital bed on a ward, the costs mount up even further.

Supermarkets offering cut price deals and drinks promotions in pubs and clubs exacerbate the problem as people indulge over this period. All these promotional activities serve to normalise alcohol as an essential part of every day life. It is no surprise that young people are drawn to alcohol - when it is cheaper than bottled water, we have to worry about what message we are sending our children.

Alcohol misuse causes family breakdowns, is a major factor in domestic violence, is often related to crime and disorderly behaviour and it kills. It is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. The public should be made aware of the serious risks associated with drinking, so that they can make informed decisions about how much alcohol they are consuming.

Alcohol can be an enjoyable part of social and cultural life especially over Christmas. But the growing booze culture is creating serious problems for the future. Sometimes people may not even be aware that they are drinking too much – it is easy to do. It is important to keep track of how much you are drinking. We would like to see people enjoying alcohol sensibly without over doing it.

Are you a healthcare professional who has dealt with patients who have been admitted due to alcohol misuse? Share your experiences with us.

Action on aggressive behaviour in A&E

2009-12-15T12:07:00.002Z

I am pleased that the pilot to install CCTV in 4 A&E departments in Wales is being rolled out today and if successful, will be extended across Wales.

The Minister is clearly taking action on the violence and aggressive behaviour agenda.

BMA Cymru have repeatedly stated that there should be zero tolerance to violence of any sort in the NHS and the mechanisms must be there to minimise the likelihood of attacks, to support staff who experience them, and to ensure that anyone who commits an act of violence is dealt with appropriately.

Hopefully these cameras will make people think twice before attacking hospital staff who are trying to ensure the good health and well-being of patients.

Progress still needs to be made however, on protecting those working in primary and community care – especially the lone workers who are particularly vulnerable. I blogged earlier in the year on what BMA Cymru believe would be the most effective mechanisms to eradicate the problem.

I hope that this pilot will prove successful and demonstrate that violence against healthcare workers will not be tolerated.

Have you been subjected to violence and aggression in the workplace? Tell us about your experiences.

Room for improvement

2009-12-15T11:12:00.004Z

Auditor General Jeremy Colman, has today published a report entitled "Unscheduled care: developing a whole systems approach", which concludes that despite the strengths of the current system, there is work needed to improve the way which services work together.

The BMA has been calling for better service integration within the Welsh NHS for a long time - unscheduled care plays a key part in that agenda.

The report says that too many people who have urgent reasons to access the NHS or social services are encountering inefficiency, uncertainty and delays. Jeremy Colman says that a solution to this would be to show people how their needs can be met more effectively elsewhere.

It may sound obvious, but ensuring that patients are seen or treated in the right place at the right time will make a big difference to the efficiency of NHS services and so it is essential that we get that right.

The report recommends that the new LHB’s should take the lead in redesigning the structure of unscheduled care. I hope the Minister considers this and will take the appropriate action to address the issue. Of course, any changes must be backed by an effective channel of communication and better working practices.

In addition, universal targets for seeing patients in A & E Departments are skewing priorities – patients in more need should be prioritized and treated accordingly. That is just not happening at the moment. The use of smarter targets is a real solution to that and something we have been encouraging the Assembly Government to look into.

We must be careful not to undermine what we already have in Wales both in general practice and in secondary care. We need services that support and compliment each other – the danger which has become apparent is that unscheduled care has become a separate and isolated part of an already disjointed service.

At a time where NHS reorganisation is taking shape, it is crucial that the Minister acts now, so that the future benefits of the NHS in Wales can be fully realised. We would very much welcome the opportunity to work with the Assembly Government and the new LHBs on improving the service.

If you have any thoughts on the report, let me know.

Chief Medical Officer for Wales publishes Annual Report

2009-12-09T12:32:00.002Z

Wales’ Chief Medical Officer Dr Tony Jewell, has today published his annual report which looks at different methods of prevention to ensure the long-term health of the nation, including immunisation, screening and education.

He warns that preventing disease and illness is the key to a healthy future generation. I welcome this report and agree with the recommendations Dr Jewell sets out for improving the health of the nation. It is vital to focus on health promotion and illness prevention as well as illness itself.

Dr Jewell says that overall health in Wales is continuing to improve, but continued action is still needed to address issues like obesity, binge-drinking and smoking. These three issues are important for BMA Cymru members, and for years we have been trying to improve the health of the nation by campaigning for smoking bans, minimum pricing for alcohol and preventing childhood obesity.

The effect of the smoking ban is noted by Dr Jewell in the report. Findings from research commissioned by the Welsh Assembly Government show clear evidence of reduced exposure to environmental tobacco smoke, particularly in pubs, clubs, bars and at work. This means that the legislation has achieved its main objective to reduce environmental tobacco smoke. It is encouraging that the studies found no evidence of any shift of smoking to the home, or of increased exposure to children.

BMA Cymru would like to see further action taken by the Government in the long run, including banning advertising and displaying cigarettes at point of sale; as well as banning cigarette vending machines and scrapping the sale of ten packs.

Childhood obesity is a growing epidemic, and the soaring rates have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers. Teaching children at an early age about the advantages of a healthy lifestyle and introducing exercise into a daily routine may prevent them from chronic health conditions later on in life.

A sensible approach to alcohol is always important, but it is particularly pertinent at this time of the year. We want the public to be aware of the risks associated with drinking, and would like to see advertising for alcohol banned as well as minimum price levels for the sale of alcohol.

Health Minister Edwina Hart has welcomed the report and the recommendation that more focus should be placed on preventative measures. I look forward to seeing what action the Welsh Assembly Government takes. Let me know what you make of the report.

You say goodbye and I say hello…..

2009-12-08T12:03:00.003Z

Rhodri Morgan will formally step down as First Minister of Wales today, and I would like to wish him well for the future.

After 10 years as the Leader of Wales, Rhodri leaves a great legacy behind him. Under his leadership we have seen devolution take shape and flourish, and his commitment to Wales is admirable. Over the last 10 years Wales has remained loyal to the true values at the heart of the NHS. We have gained free prescriptions and free hospital parking, and maintained a clear rejection to the introduction of competition, choice and greater use of the private sector.

The approach to healthcare in Wales has been compared to England by Morgan, as “clear red water”. This rejection of the internal market has become part of Welsh identity. Instead of targets and choice, we invest in community and preventative measures, and in promoting public health.

During the rest of this Assembly I look forward to BMA Cymru working with Wales’ new leader Carwyn Jones, to ensure that Wales is the premier place for doctors to come and train and work.

The recruitment and retention of junior doctors must be high on the Government agenda moving forward. If we don’t have the quality and quantity of doctors, the health service will fail to function. This is a great concern to us and our members.

I hope that he and the Health Minister will work with us to build a health system that delivers better health for the people of Wales. We realise that we are in the middle of a recession, and difficult decisions will have to be made, but it is vital that health is properly funded.

So fare-well Rhodri, and welcome Carwyn, we look forward to working with you.

Less talk, more action!

2009-11-27T14:10:00.001Z

First Minister Rhodri Morgan, has voiced his fears for a “toxic generation” of children who play computer games and eat junk food.

I share his concerns, and fear that we are in danger of raising a generation of children burdened with long term chronic health conditions. Soaring rates in obesity have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers.

Small changes to a daily routine can make a real difference. Just getting children into the habit of walking to school has environmental benefits, and helps with the fight against childhood obesity. Teaching children at an early age about the advantages of a healthy lifestyle often means that they will continue this into adulthood. I’m not saying it’s easy, but it is vital that we act without further delay.

In order to achieve a real improvement for the future health of our children; parents, schools, health professionals, the media, food manufacturers, and the government all have an important role to play.

We need real action from the Welsh Assembly Government on what is going to be done to reverse this growing epidemic. What do you think?

Option 7 campaign extended

2009-11-26T15:25:00.002Z

BMA Cymru Wales has decided to extend the Option 7 campaign which is aimed at improving the lives of junior doctors in Wales.

We have taken this decision due to the increasingly alarming picture which has emerged since we launched the campaign in July this year.

Junior doctors have been afraid to voice concerns for fear of repercussions. I want to re-iterate the message that the option 7 phone line is completely confidential. If you are experiencing a problem with insufficient locum cover, intimidation, lack of training opportunities or anything else, please do contact us.

Together with BMA Welsh council chairman Dr Andrew Dearden, I have been meeting with the chairs and chief executives of the new NHS health boards in Wales where we have been offering support to employers to resolve the problems highlighted, and have been drawing up an action plans to resolve these problems. We have also met with many junior doctors to really get to grips with the issues that we are faced with.

The types of problems that have been reported to us will not be tolerated. It is vital that you come forward so we can put an end to what could be affecting careers and patient safety.

If you are a junior doctor and wish to raise a concern with a BMA adviser the hotline number is 0300 123 123 3, then select option 7.

You can also fill out a form on the BMA website.

To get involved and show you support for our campaign, join our facebook group.

And follow the campaign updates on Twitter.

The postcode lottery strikes again

2009-11-24T10:34:00.002Z

The Healthcare Inspectorate Wales, the Wales Audit Office, Estyn, and the Care and Social Services Inspectorate Wales have today published a worrying report on the state of Mental Health services for children and young people in Wales. This is the first time that all four bodies have come together for a service review, which highlights the seriousness of the failings in the service provision.

Although acknowledging recent improvements including the introduction of primary mental health workers who support professionals, such as GPs and school nurses working with children and young people, the report also brings to light those areas in dire need of improvement - especially stressing the variation across Wales in the availability and quality of services. Unfortunately we know all too well that a postcode lottery is a common problem across the board of service provision.

The report also found that Wales is the only place in the UK with no specialist mental health services for children under age five. Why is Wales lagging behind the rest of the UK again?

The Health Minister responded that the findings are "out of date" and "do not reflect wider improvements". However, despite the improvements already made, it is clear that there is a long way to go in improving services for children and young people suffering with mental health conditions. It is time that we stop failing and start helping the young vulnerable children whose lives could be dramatically improved by an early intervention. Let me know your thoughts on the findings.

Minimum price demand on alcohol –in the news again

2009-11-23T16:09:00.003Z

I'm pleased to hear that Social Justice and Local Government Minister Dr Brian Gibbons is in discussions with the Scottish Government regarding their plans to introduce legislation on the minimum pricing of alcohol, and has called for action in Wales saying we should follow Scotland’s example.

Although we do not have the powers in Wales to formulate similar legislation yet, I hope this is something that we will see progressing soon. The BMA in Wales has campaigned on alcohol issues for years, and we remain committed to finding practical solutions to the problems we are facing relating to alcohol.

We are not out to ban alcohol – we just want to ensure that the public are aware of the risks associated with drinking, and to promote a sensible approach to it’s intake.

Dr Gibbons has expressed his concern that a person can consume more than their desired daily intake of alcohol for less than £1. Cheap alcohol and marketing has led to a society in which the entire population is drinking more than ever, posing serious risks to health of the nation.

It is time that the Government in Wales took control of this situation. The population is drinking in increasingly harmful ways and the result is a mixture of avoidable medical, psychological and social harm, damaged lives and early deaths.

Earlier in the year we published a report examining the damaging effect of alcohol marketing on young people. To read the report in full click here: "Under the influence - the damaging effect of alcohol marketing on young people" and tell me what you think.

A clearing in the fog?

2009-11-18T16:04:00.003Z

The devolution settlement in Wales has often been referred to as a ”fog” , but today, the All Wales Convention has reported that the Assembly in Wales should be given full law making powers through a referendum, so there could be a clearing ahead.

The Convention, established by the Welsh Assembly Government, also said that a yes vote for further powers is attainable, that public support is out there, although it is not guaranteed.

For us, the transfer of full-law making power for Wales would be a welcome development on the current system.

BMA Wales gave evidence to the All Wales Convention earlier in the year, and I am pleased to see in the report that the evidence we submitted has been taken on board and cited on numerous pages.

We noted in our evidence that the current system by which the National Assembly can acquire legislative powers is cumbersome and thus not widely understood by the public in general - including BMA members.

In the context of a UK membership organisation, professional association and trade union that the BMA is, there is often central confusion about the extent to which the National Assembly for Wales can legislate in health matters. This can lead to Wales being left behind as it does not have the same tools available to implement BMA policy as is available to our counterparts in other nations. In contributing to debates on policy, in particular on a UK basis, it would be far more straightforward for members in Wales to be reassured that similar legislative change as is often proposed for Scotland and Northern Ireland could also be implemented in Wales by Welsh Ministers.

At the moment, the ability to develop and implement new policy via the legislation route is let down by the need to obtain ‘permission’ from Westminster, and the subsequent delay in that process. Using BMA Wales’ experience with the introduction of a ban on smoking in public places, we highlighted problems inherent within the present system. Although Wales were at the forefront in calling for a ban, ultimately the ban was only implemented marginally ahead of that in England, even though Wales had started the process much earlier. The delay in legislating in Wales caused by the lack of primary legislative powers can be argued to have led to many individuals health being damaged by exposure to environmental tobacco smoke in the interim period.

The report suggests that the Assembly should decide on whether to hold a referendum by June 2010, well in advance of the next Assembly elections. The timing of a referendum is clearly one for the politicians but the view of BMA Wales is that we support primary powers simply to allow effective, timely and consistent policy change in health (and the related portfolios) and to enable the Association work effectively with our members – on an equal footing as our colleagues across the UK.

I look forward to further developments – and to the statement by the First Minister next week.

WELCOMED: Proposals to Close Sunbed Regulation Loop-hole

2009-11-11T11:36:00.006Z

Today the National Assembly’s Health Committee publishes its report looking into the use and [serious lack of] regulation of the sunbed industry in Wales.

A clear message to discourage the use of sunbeds was sent out earlier this year following the success of our campaign to get local authorities in Wales to remove the sunbeds they operated in their local leisure centres.

Now the Welsh Assembly has the opportunity to develop on that, to steal a march and introduce adequate measures to regulate the commercial tanning industry and thereby protect public health in Wales.

The Health Committees report makes for very interesting reading, and while I would pick the Committee up on a few, very small, points in the document (as you would expect, you might say), BMA Cymru are absolutely delighted with its conclusions.

The report shows that the Committee has listened to the evidence it received – not just from us and the wider healthcare profession - but from a whole host of organisations and even from parents.

In line with our recommendations the Committee is asking the Welsh Government to “seek the legislative competence to introduce new laws to enable local authorities in Wales to regulate, license and, if necessary, impose liabilities and create offences in relation to sunbed facilities and their operators.”

Again, in line with our recommendations, (link) the Committee says that these new laws should be based around recommendations 1 and 2 of the thirteenth COMARE report on ‘The health effects and risks arising from exposure to ultraviolet radiation from tanning devices”.

As a minimum, the law should ensure that:
• use by under 18s is prohibited;
• use by other high risk groups is discouraged;
• facilities provide full-time supervision by well-trained staff;
• use of protective eyewear is compulsory;
• information setting out the potential health risks of using sunbeds is prominently displayed and provided to all users;
• information containing unproven health benefits of sunbed use should be prohibited from premises;
• written informed consent is obtained from all clients prior to use; and that
• facilities should not be allowed to use sunbeds that do not comply with both the British and European Standards on sunbed irradiance levels.

We will be urging the Health Minister and the Assembly Government to adopt and bring forward these proposals as soon as possible.

For us the essential point is that there is no such thing as a safe tan (unless it comes out of a bottle). The damage to your skin remains long after a tan has faded.

There is one area of regulation of the sunbed industry which we would like to see Wales go further on – that is advertising.

Although the report suggests that investment in the SunSmart campaign is needed on a UK level - bill-boards, posters and leaflets advertising commercial outlets continue to line most high streets in Wales. Although I’m not aware of any detailed study to date, I think it’s fair to say that these tend to be targeted towards our more deprived communities – and towards young people.

In our view a move to place tighter regulation on the commercial sunbed industry - including inspection and licensing, a restriction for under 18s and a ban on unsupervised salons - would be significantly more robust and complete, if it included some level of control on advertising and marketing.

HIV Related Discrimination by Healthcare Professionals

2009-11-03T15:01:00.004Z

I’ve just got back from the Assembly, where Dr Tony Calland and I gave evidence to the Equality of Opportunity Committee on discrimination against people living with HIV by healthcare professionals.

This by its very nature is a difficult issue.

But it’s compounded by the fact that there is no real evidence base in Wales from which to work from – at the moment the evidence of discrimination (by doctors and other health care professionals) is anecdotal.

And therein lays the problem. This lack of comprehensive evidence base is what the committee is working from; and as Jonathan Morgan AM points out they well struggle with this particular inquiry.

Advances in medicine and the ‘normalisation’ of how the HIV virus is treated have challenged much of the stigma previously found in healthcare settings.

That is not to say that discrimination is not occurring. I accept that unfortunately it may well be.

As we said in our paper, discrimination of people diagnosed with HIV by any healthcare professional is unacceptable, and is a breach of fundamental human rights – rights that are central to the practice of medicine.

Discrimination - whether actual or perceived - has a negative impact on health outcomes, and contributes to both a reduced use of prevention services and perhaps a higher rate of onward transmission. I suspect, however, that this point is obvious to most people.

Surprisingly perhaps, what’s less obvious to many people is what actually constitutes stigma and discrimination – and the effect that it can have.

Any drive to combat this should be directed at the whole healthcare team (managers, doctors, nurses, receptionists, social workers, clerks).

Non-HIV specialists may feel a lack of confidence in treating HIV patients – even if they present with common complaints. I would argue that for these clinicians, a tendency to refer HIV patients to specialist clinics or consultants arises from a lack of specialist knowledge and a desire to do right by the patient, to ensure they get the right care, rather than a reluctance to treat HIV patients on the basis of prejudice or discrimination.

This applies to many other conditions, such as diabetes and cancer, not just HIV.

It’s also important to remember that clinicians employ universal cross contamination measures for all patients (e.g. see 1000 lives campaign), because every patient could potentially have, for example, a blood borne virus or transmissible infection and are so far undiagnosed.

Precautionary measures which may seem to be over-the-top are often standard clinical practice.

A lack of knowledge about HIV, and misconceptions about onward transmission, fuels stigma and discrimination. As Dr Calland told the Committee this morning – ignorance may be the problem not prejudice.

I will follow the Committees inquiry with interest, and in the meantime we are planning to meet with the various organisations and representatives in Wales to see how we can improve on this agenda, jointly.

Some Good News on World Stroke Day

2009-10-29T16:16:00.004Z

You might have read elsewhere that today is World Stroke Day. And that to mark the day, its been announced that an NHS initiative to speed up the treatment of stroke victims is being rolled out across Wales.

A very welcome development.

BMA Cymru recently gave evidence to the National Assembly’s Health Committee on stroke services in Wales as part of the professions ongoing campaign to improve what is one of the worst performing areas of the NHS in Wales. In almost every aspect of stroke care Wales lags behind the rest of the UK.

The new NHS initiative, overseen by the All Wales Stroke Services Improvement Collaborative, has been created over the last twelve months. It is about creating new ways of working to ensure that all stroke patients in Wales have access to automatic emergency care, and receive faster relevant treatment.

In Wales 11,000 people have a stroke each year, it’s the leading cause of disability and the country’s third biggest killer - yet for some reason Stroke hasn’t quite hit the radar of Joe Public as a major health concern.

Perhaps it’s because traditionally stroke has been seen as something that only happens to older people. That’s no longer the case – stroke can and does affect anyone.

Or perhaps it’s because in the past stroke was not considered a medical emergency. But now it’s well established that stroke victims require urgent and prompt specialist assessment and treatment – and that this is the greatest determinant of both survival and recovery.

Either way, the theme of this years World Stroke Day ‘Stroke, What Can I Do ?’ gets to the heart of the issue: that Strokes are preventable, and there is a whole lot that we as individuals can do.

Like so many other health conditions, most strokes are related to overall health and wellbeing. Almost half of all strokes in Wales could be prevented by regular blood pressure checks and by taking steps to improve overall health. I noticed that Joyce Watson AM has done some work on this issue this summer and out of the 1000 people whose blood pressure was taken, a third returned high / borderline readings – a major risk factor for stroke.

Individuals can also do something important just by knowing the symptoms of stroke, how to recognise it and what to do about them – knowing that a stroke requires a 999 response.

Our clinicians and other healthcare partners are struggling to manage the volumes of stroke patients in Wales in an environment which has a severe lack of specialists, which has far from adequate acute care provision and where rehabilitation services, to put it very mildly, are patchy.

Whilst we welcome the news that the new scheme is making improvements in stroke care in Wales – there is much more that the Assembly Government needs to do if Wales is going to achieve the standards seen elsewhere in the UK and begin to provide even an adequate level of services for stroke patients.

To that end, we have made series of recommendations on the steps that should be taken – nationally and more locally - in order to improve the provision of stroke services across Wales. Some of these will need investment, and in the current climate we realise that tough choices have to be made – but money should be chasing need and this is one area of healthcare that Wales can no longer afford to lag so far behind on.

As a priority we need to attract more stroke specialists to Wales while promoting stroke as a speciality to medical students and Junior Doctors; we must improve overall staffing levels including the number of dedicated sessions consultants can allocate to stroke care; and everyone in Wales should have access to a dedicated stroke unit (with appropriate rehabilitation and support services attached) within 30 minutes travel distance from their home.

Significant investment is needed at the acute care level, but the focus needs to be on the whole stroke journey.

What Wales needs is a comprehensive action plan on stroke.

Out of Sight: Out of Mind

2009-10-13T16:50:00.003+01:00

Yesterday saw a historic victory in preventing children and young people from taking up the deadly habit of smoking as Members of Parliament voted to end the display of tobacco at the point of sale AND to ban the sale of tobacco in vending machines.

With most smokers becoming addicted before their mid-20s, it is essential that we try to prevent young people from taking up smoking in the first place. Making tobacco an ‘out of sight’ product is a huge step forward in protecting young people from a lifetime of smoking and will reinforce the increasing unacceptability of smoking.

The Health Bill 2009 will enable the Assembly Government to implement these measures and - as a Member of the Wales Tobacco Control Alliance - BMA Cymru is joining calls for this to be done as soon as possible. The Bill represents a brave move against a powerful international tobacco lobby which employs multimillion pound marketing tools aimed at recruiting new young smokers.

In July 2008, the BMA produced a report, Forever Cool: The effect of smoking imagery on young people. This report examined trends in smoking prevalence and initiation and it reviewed the different forms of pro-smoking imagery and the evidence for how they can affect behaviours and attitudes among young people.

The fact that the Health Bill was amended to include a ban on tobacco vending machines without the need for a vote shows the strength of feeling in the importance cutting off the supply of cigarettes to our young people, de-normalising the deadly habit and preventing the onset of smoking.

Reporting patient safety concerns will lead to better patient care

2009-10-08T15:33:00.009+01:00

Today the NHS National Patient Safety Agency published the latest incident report for NHS organisations in Wales. The information is compiled from reports from frontline NHS staff and is published twice a year.

Today’s publication shows that 90% of all patient safety incidents result in no (67.9%) or low (22.1%) harm to the patient. That leaves 10% of reported incidents which are classed as moderate (8.2%), severe (1.4%), and contributing to death (0.4%).

The figures include incidents that did not result in any harm but had staff not identified it, could have done so. Overall the proportion of serious incidents has remained stable as reporting rates have increased. The most commonly reported incident type were patient accidents (36.4%).

Patient safety is a top priority for anyone working on the frontline in the NHS in Wales. That’s why the BMA is such a strong a supporter of the 1000 Lives Campaign and has worked so hard to continually improve patient safety, and therefore improve patient care. For us, the safety and quality agendas go hand in hand.

There is a lot of good work being undertaken in Wales to improve patient safety, and in representing the medical profession we are keen to see that develop and expand in the new NHS Wales. Earlier this year we published the Speaking up for Patients report - based on survey responses from 565 doctors working in hospitals in England and Wales.

Almost three quarters (74 %) said they had had concerns about issues relating to patient safety, malpractice or bullying, over the course of their NHS careers. Within this group, 73 % said their concerns had related to standards of patient care.

Seven in ten doctors (70 %) who had had a concern raised it with the relevant authority at their trust. However, many said that their experiences of reporting issues had been negative, for example because they were unaware that anything had happened as a result, they were not approached for further information, or the information they provided was shared more widely than they were comfortable with.

A significant proportion (15.5 %) of doctors who reported concerns said that their trusts had indicated that by speaking up, their employment could be negatively affected. Despite these experiences, around three quarters (74.5 %) said they would be prepared to report concerns again in future.

In the minority of cases where doctors had not raised their concerns, this was most commonly because they were not confident that it would make a difference (81%).

I think we can conclude from this that organisational support is absolutely paramount to improving patient safety across the NHS.

The information published today will be vital to the new LHBs in Wales when setting local priorities and identifying areas for action. LHBs and healthcare professionals will be able to compare patient safety performance (in like-for-like service areas) across Wales. To improve that performance, they must provide an open culture of organisational learning by ensuring that patient safety is a high priority, and by encouraging and facilitating incident reporting.

Campaign Success – Every Welsh Council Leisure Centre soon to be Sunbed Free

2009-10-02T16:54:00.000+01:00

We are absolutely delighted that after our recent sunbeds campaign, the three remaining local authorities in Wales (Vale of Glamorgan, Flintshire and Wrexham) who continued to operate and profit from sunbeds are on the road to removing them.

That means by April next year, no local authority owned leisure centre will operate sunbeds.

Our campaign exposed the shocking profits the three Councils were making from sunbeds – a combined profit of around £46,000 annually.

After our success in securing a commitment from the Vale of Glamorgan to remove the five sunbeds it operated across the county we pledged to take the campaign to North Wales – to Wrexham and Flintshire – who were the only ones left operating sunbeds.

The fact that the Vale has already bowed to pressure and removed its sunbeds and Wrexham Council have agreed to remove the ones it operates by April next year, is a great result for local public health. Next week, Flintshire Council’s Executive is to consider the issue and is expected to announce the removal of all sunbeds before the end of the year – determined not to be the last authority in Wales to do so.

The link between exposure to UV radiation and skin cancer is now indisputable – shown by the recent decision by the International Agency for Research on Cancer to raise the sunbed classification to “carcinogenic to humans” and the fact that the sunbed industry is largely unregulated in the UK.

The removal of all sunbeds operated by local authorities sends a clear message to the public on the dangers of sunbed use.

We’ll continue fighting for tighter regulation of the Commercial sunbed industry – especially for a ban on coin-operated / unsupervised salons and use by under 18s, a move we understand the Assembly's Health Minister has asked her officials to look into.

Exposing Wrexham Council’s sunbed profits

2009-09-28T09:46:00.004+01:00

Our continuing campaign to highlight the dangers of sunbeds has revealed figures showing that over the last five years Wrexham Council has generated in excess of £83,000, by operating ten sunbeds in three of its leisure centres.

We were able to obtain the figures under a Freedom of Information request. And we are now calling for the immediate removal of all sunbeds from local authority-owned premises and for tighter regulation of the sunbed industry.

The figures are all the more shocking when you delve a bit deeper and see that the Council only began operating two of the sunbeds, at its Plas Madoc leisure and activity centre just last month.

Leaders on Wrexham Council have shown a blatant and reckless disregard for the health and well-being of the people they represent. They may well be making a lucrative profit from sunbeds, but you cannot put a price on good health. I’d go so far as to say that the Council’s conduct is unforgivably irresponsible.

The Council has told us that it is planning to remove all sunbeds by April next year, so why then have two more installed in the last few weeks? Such a move can only be put down to a last ditch attempt to make more money, putting profit before health.

The BMA’s recent criticism of the Vale of Glamorgan Council, who made an £15,000 annual profit from the five sunbeds it operated, led to that authority removing sunbeds from its leisure centres across the county. Since then we’ve pledged to continue in our fight to get Wrexham and Flintshire Councils, the last two in Wales to operate sunbeds, to remove them.

I don’t think the BMA is alone in believing that as a locally elected government Wrexham Council has an obligation to protect the health and welfare of local people. By ignoring the well-known and accepted scientific and medical evidence on the dangers of sunbed use, Wrexham Council has wilfully reneged on this duty of care.

Just one session a month on a sunbed doubles the average individual's annual dose of UV radiation and this is proven to greatly increase the risk of cancer, skin and eye problems in later life.

In 2009, there is no excuse for sunbeds to be operated by Local Authorities, especially in leisure centres which should be places of recreation, exercise and well-being. There is also no excuse for the current lax regulation of the commercial sunbed industry across the UK generally. When the BMA gives evidence to the National Assembly’s Health Committee inquiry in two day time, we’ll be highlighting all these issues.

NOTES –

WREXHAM COUNTY BOROUGH COUNCIL SUNBED ANALYSIS

FACILITY/LOCATION
Wrexham Waterworld
NUMBER OF BEDS SINCE 2002 - 2
NUMBER OF BEDS SINCE 2008 - 1
CHARGES - £3.20
MONITORING/BOOKING INCOME £
Maximum 20 sessions per year
04/05 - £7,765
05/06 - £5,909
06/07 - £4,772
07/08 - £5,168
08/09 - £3,590

FACILITY/LOCATION
Queensway Stadium
NUMBER OF BEDS SINCE 1996 - 2
CHARGES - £3.20
MONITORING/BOOKING INCOME £
Maximum 20 sessions per year
04/05 - £9,205
05/06 - £6,311
06/07 - £3,530
07/08 - £2,987
08/09 - £2,648

FACILITY/LOCATION
Plas Madoc
NUMBER OF BEDS SINCE 1990 - 3
NUMBER OF BEDS SINCE - August 2009
CHARGES - £2.50
MONITORING/BOOKING INCOME £
Maximum 20 sessions per year
05/06 - £6,702
06/07 - £11,091
07/08 - £8,764
08/09 - £5,190

ALL sunbeds will be removed by 1st April 2010.

ALL income generated would be offset against the departments deficit incurred in operating the Sports and Physical Activity service.

Action after inquiry needed on stroke services in Wales

2009-09-23T12:33:00.002+01:00

BMA representatives have given evidence this morning to the Assembly’s Health, Wellbeing and Local Government Committee inquiry into Stroke Services in Wales. Several other groups with an interest in this area have also given evidence, along similar lines to ours, so here’s hoping the committee listens and acts on the recommendations of the majority.

A stroke can be devastating condition and is the third most common cause of death in the UK; 11,000 people have a stroke in Wales each year.

Strokes leave one third of patients permanently dependent on the help of others and is the biggest cause of severe acquired disability in the UK.

The treatment and management of stroke is now supported by a good body of quality evidence and we have witnessed a number of medical advances in recent years. As a result acute stroke is increasingly becoming a treatable condition.

That’s one of the reasons why BMA Cymru Wales welcomes the Welsh Assembly Government’s decision to make improving stroke services a priority - as a result the last few years have seen improvement in stroke care across Wales. However so far, this has not gone far enough. In almost every area of stroke care Wales lags behind that of England and Northern Ireland. There are pockets of good practice but the patchy provision of services across the country indicates that much more needs to be done.

If we are to see real improvement in the treatment and services available to stroke patients across Wales, the WAG needs to take act on the points listed below;

• A Wales-wide doctor recruitment and retention strategy, with an emphasis on specialist stroke physicians and neurologists.

• Everyone in Wales should have access to a stroke unit within 30 minutes travelling time of their home and the units should;
* Offer round-the-clock care with access to thrombolysis and scanning equipment
* Be adequately staffed (doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, dieticians, psychologists, social workers)
* Have adequate bed capacity
* Have strong links with rehabilitation and support services

• The new LHBs should:
* Make it someone’s responsibility to lead the team and champion the improvements within their areas and offer local solutions;
* Greatly increase the number of whole time equivalent medical hours allocated to stroke treatment and management;
* Work closely with local authorities and others to create multi-disciplinary care partnerships ensuring joined up working and continuous care provision;
* Interpret national guidance into effective local delivery by considering what is best to meet the challenges of that particular area. In this way national guidance should be broad and flexible;
* Facilitate research and data gathering through, for example, local clinical research networks - working with other LHBs to take a Wales-wide view of stroke services;
* Utilise the new Professional Forums and Stakeholder Reference Group as a mechanism to highlight stroke issues.
* Facilitate public awareness and education campaigns.

• Given the importance in receiving treatment immediately after a stroke, people should be directed straight to hospital, ambulance staff should be specially trained in the early treatment of stroke victims, and information should be sent to GPs to support direct referral.

• A national public awareness campaign is needed to highlight the prevalence and severity of stroke, how to recognise the symptoms, and that it requires a 999 response. The FAST (Face, Arms, Speech, Time) campaign did some good work in relation to this but needs to be built on – for example, the ways to recognise transient ischaemic attacks (TIA), the risk factors such as high blood pressure and diabetes, high cholesterol, smoking, excess alcohol intake and recreational drug use should also be highlighted. Many people still do not realise that strokes are preventable, do not know the symptoms or risk factors, or how to manage them.

• A training programme should be developed for stroke treatment across the multi- disciplinary teams working within the primary and secondary care sector to ensure efficiency and confidence when treating or managing stroke. Training should also be extended to carers.

• The long-term impact of stroke on families and carers needs to be looked at and their views sought.

• Current policy on Stroke - the National Service Framework for Older People, the Stroke Improvement Programme and the Stroke Pathway – are useful but we also support the development of a Stroke Strategy for Wales accompanied by a solid and achievable Action Plan.

New fee scale for dispensing doctors

2009-09-23T12:31:00.001+01:00

The BMA’s General Practitioners Committee (GPC) and NHS Employers have agreed a new fee scale for dispensing doctors, which will come into effect next week, 1st October 2009.

The fee scale for dispensing doctors will be lowered by 8.7 per cent for the remaining six months of the financial year, representing a 4.9 per cent decrease across the whole year.

And, as of 1st April 2010, there will be an increase to produce a figure that is appropriate for the full new financial year.

Understandably this has left GPC disappointed. Many patients in rural areas rely on dispensing practices to obtain their medicine and the BMA’s very concerned that NHS Employers have underestimated the costs of providing dispensing services, which inevitably rise with increasing volume.

The ‘cost of service inquiry’ should help develop a fairer cost analysis and reimbursement structure in future, but the government needs to act urgently to deal with the unilateral withdrawal of discounts by many of the drug wholesalers, which could threaten the viability of some dispensing practices.

Surgeons’ overtime bill highlights more deep-rooted problems within the Welsh NHS

2009-09-22T15:33:00.004+01:00

The front page of the Western Mail today highlights an issue that has been of concern to BMA Cymru Wales for some time - the need to adequately staff the Welsh NHS.

The over-reliance on overtime and private hospitals to try and ensure waiting time targets are met, is merely using a sticking plaster to patch up what is a much more serious problem. There has been insufficient investment in the NHS in Wales over the last few years, with the default position becoming one of buying additional capacity through short-term schemes. Surgeons do not work on their own, they’re part of a team, including anaesthetists, nursing and other clinical staff. Extra resources are therefore needed to manage these issues long-term, with the employment of more surgeons, anaesthetists and nurses.

NHS staff are being pushed to the limit to deliver the 26-week access targets by December, set by the Welsh Assembly Government. Added to this is the impact of the European Working Time Directive, introduced in August, with many doctors being encouraged to work above the 48-hour limit set by this legislation.

It may not be what either politicians or patients want to hear, but if the current financial pressures do not allow for the NHS in Wales to be better resourced, then maybe it’s time for the WAG to scrap targets, as without extra resources, quality of care will undoubtedly suffer, which certainly isn’t in the best interests of patients or doctors.

Scrapping GP catchment areas – superficially attractive but not essentially practical

2009-09-17T15:53:00.002+01:00

Good to hear that this isn’t a priority for the Welsh Assembly Government as the BMA can see many drawbacks to the idea of scrapping GP catchment areas.

For a start, the rest of the health service and social services and county councils all work by boundary areas, and so to just suddenly take general practice out of that system, would be terribly complicated and actually very difficult to make work.

It would be hard for patients to access a doctor in more rural areas - how would they get home visits when they are ill, if they are registered miles away, near their place of employment?

Also what would happen to practices that are destabilised because some of the younger, healthier patients have gone elsewhere? Surgeries with a mix of patients, where some don’t visit their doctor that often, help general practice to be cost-effective. If younger people register near their workplaces, some practices could be left with patient lists mainly composed of those with long-term conditions and complex illnesses, severely disadvantaging some practices.

We do support boundaries being a little more flexible, so long as practice organisation isn't interfered with. We also support practices trying to make it as easy as they can for patients to see their regular doctor whenever possible. Our main concern though is not to disadvantage the most vulnerable, which these changes could possibly lead to.

So for the Department of Health to argue that the main reason for scrapping GP surgery boundaries is to increase patient choice, is in essence a false one, with many surgeries perhaps having to close as a result of these changes. This seems to be change for the sake of it.

Posted on behalf of Dr David Bailey, Chair of GPC Wales.

Swine flu vaccine agreement reached for Wales

2009-09-15T16:49:00.004+01:00

Agreement for a swine flu vaccination programme to be rolled out by GPs across Wales, I am pleased to say, has been reached.

General practice is an efficient and adaptable model that reaches into every community in Wales and is best placed to deliver the vaccination. GPs are used to delivering large scale vaccination programmes that target patients at highest risk and this agreement means that GPs and their teams will have the resources they need to take on the additional workload and run the vaccination programme smoothly and efficiently.

This agreement is testament to the cooperative work we have produced with the Welsh Assembly Government and our GP members look forward to delivering the protection for vulnerable groups that the people of Wales deserve.

A ban on violent patients doesn’t seem so "understanding"

2009-09-14T16:20:00.002+01:00

And just to add to my earlier blog post on violence and aggression, whilst we support the memorandum of understanding, we wouldn’t go as far as calling for people who are violent towards NHS workers to be banned from using frontline services, which is what Barbara Wilding, the Chief Constable of South Wales police seems to be advocating. A tougher approach is needed, we definitely agree with that, but to try and prevent people from accessing NHS services would be a potential violation of their human rights and goes against the very ethos of the NHS – health services accessible to all. Better surely that we focus on the points made in my earlier blog than to be so draconian?

More than just understanding is needed to tackle violence and aggression in the Welsh NHS

2009-09-14T13:39:00.002+01:00

This development is a step in the right direction and should help with the investigation and prosecution of alleged attacks against doctors and the wider medical profession.

Action to show people that violent behaviour will not be tolerated is long overdue with the problem becoming more widespread. More than 7,000 incidents were reported in the NHS in 2007-08. It is also an area that we have been calling for action for several years now, having been made aware of many incidents where our members have been victims of violence and aggression. As far as BMA Cymru Wales is concerned, it is totally unacceptable and inexcusable to attack a doctor, or any healthcare professional in the line of duty, when they are trying to ensure the good health and well being of patients.

There is still much to be done in completely stamping out this problem, which, to many of our members is sadly becoming part of the norm of their daily working lives.

To stand alongside this memorandum of understanding, BMA Cymru Wales is calling for the following;

• A register of violent patients - If a doctor, nurse or other healthcare personnel can be alerted in advance to the possibility of a patient becoming violent, s/he will be forewarned and no longer placed in a position of vulnerability, through a lack of relevant information.

• Training and Communication - Ensure that all staff are fully trained and are aware of the mechanisms to report physical or verbal abuse and that they are encouraged to report incidents.

• Staff Support - Ensure that all staff are supported at all times, and continuing support (counselling services for example) are available after the violent incident.

• Public Awareness - Patients and healthcare users need to know that they are not outside of the law while in contact with healthcare professionals and that those offenders will be brought to justice.

If these measures are brought in to force as well, then we really could be well on the way to eradicating this, unfortunately, growing issue.

The WAG could be storing up a whole heap of problems over a lack of GPs

2009-09-11T13:20:00.002+01:00

It seems as if nothing has changed yet then in terms of the future of the GP workforce in Wales, or if it has, it’s only a change for the worse. The latest round of “Workforce Statistics for General Practitioners in Wales, 1998 – 2008” just serve to highlight how much of a ticking time bomb Wales is sitting on when it comes to having enough GPs to serve the population. Put simply, the figures show how those GPs coming up to retirement age aren’t being replaced by younger doctors. I blogged on this particular issue earlier this year and so these stats just back up everything I said then.

There are several reasons as to why Wales may soon be facing a GP shortage, a key one being demographics, with lots of older, single-handed GPs coming up to retirement age in the valleys. Also in Wales, GP incomes are lower than their counterparts in England, but with a higher workload than England. There may also be less opportunity for surgery partnerships in Wales. Then of course, there has been the trend over recent years (and rightly so) for an increased emphasis on work/life balance, making it easier for more GPs to work part-time.

And just as there is no one reason, there probably isn’t one easy solution to what could be a very serious issue in the coming years. The reorganisation of the Welsh NHS is due to really come into effect over the next few weeks, which sees a greater emphasis on the role of GPs and primary care, so it really is about time that the Government here starts taking the recruitment and planning of the Welsh GP workforce seriously. Otherwise, as the old classic song goes "There may be trouble ahead..."

Life as a junior doctor isn’t car "crash" TV

2009-09-10T15:59:00.001+01:00

I was intrigued to hear about a new TV series, “Crash” which started on BBC1 last night, focussing on the lives of junior doctors, who’re just embarking on their medical careers and it is good to see this area of the medical profession being given such a prominent platform. I was curious though to find out how true to life it might actually try to be. However, as it’s been a while since I was a junior myself, this might be better coming from Dr David Samuel, chairman of the BMA’s Welsh Junior Doctors committee. So here’s his take on the show...

A hard-hitting, fast paced drama, which portrays the challenges and sometimes adverse conditions facing a junior doctor. The actors created a realistic portrayal of the nervous tension that flow through the veins of every new doctor, as well as giving some insight into some of the non-clinical issues facing hospitals across the country. Although some of the behaviours were not in keeping with good practice, the interactions between staff and patients were realistic - the use of dialect to communicate appropriately puts the more realistic dramas to shame where clinical jargon fills the ears of confused patients.

The only shame was that one of the show's stars was lost so early on but even this scene was skilfully executed.

I look forward to the next episode to see more flashbacks of my own year as an F1!

Calling time on alcohol promotion

2009-09-08T12:15:00.003+01:00

The BMA has launched a new report today looking at the effects of drinks promotions, particularly amongst young people.

We’re calling for a total ban on alcohol advertising, including sports events and music festival sponsorship as well as promotional deals like happy hours, two-for-one purchases and ladies’ free entry nights.

“Under the Influence”, also renews the call for other tough measures such as a minimum price on alcoholic drinks and for them to be taxed higher than the rate of inflation.

Over the centuries, alcohol has become established as the country’s favourite drug. But the reality is that young people are drinking more because the whole population is drinking more and we now see pro-alcohol messaging, marketing and behaviour everywhere. In treating the issues around drink, we need to look beyond just young people and at society as a whole.

According to the World Health Organisation, alcohol is the leading risk factor for premature death and disability in developed countries, after tobacco and blood pressure. It’s related to over 60 medical conditions, costs the NHS millions of pounds every year and is also linked to crime and domestic abuse.

Alcohol consumption in the UK has increased rapidly in recent years. Household expenditure on all alcoholic drinks increased by 81 per cent between 1992 and 2006. At the same, never before has it been so heavily promoted.

The drinks industry spends £800 million a year in promoting alcohol in the UK. So it’s little wonder that we see it everywhere – on TV, in magazines, on billboards, as part of music festival or football sponsorship deals, on internet pop-ups and social networking sites. Given that teens often don’t like the taste of alcohol, new products like alcopops and toffee vodka are developed and promoted because they have greater appeal to young people.

The BMA is not calling for a ban on alcohol. As doctors, our focus is to ensure that individuals drink sensibly, so they don’t put their health and lives in danger.

There was a time when it was regarded the norm to see cigarette adverts and people smoking on buses, trains, airplanes and in restaurants. When the BMA initially called for a ban on smoking in all enclosed public places, there was a general outcry about it. But I doubt most people would want to return to the days of smoky pubs now. There has been a cultural change for the better and this now needs to happen with alcohol.

As this report points out, it would seem that brand development and stakeholder marketing by the alcohol industry, including partnership working and industry funded health education, have served the needs of the alcohol industry, not public health.

We have a perverse situation where the alcohol industry is advising our governments about alcohol reduction policies. As with tobacco, putting the fox in charge of the chicken coop – or at least putting him on a par with the farmer – is a dangerous idea. Politicians showed courage before by not bowing to the tobacco industry, they need to do the same now and make tough decisions that will not please alcohol companies.

Key recommendations from the report include:

• There should be a ban on all alcohol marketing and promotion
• UK governments should establish minimum price levels for the sale of alcoholic products
• Tax increases on alcohol should be set above the rate of inflation and be linked to the alcoholic strength of products
• A reduction in licensing hours for on- and off-licensed premises should be introduced

Read the report in full - “Under the Influence – the damaging effect of alcohol marketing on young people”

New award to honour GPs and Consultants in Wales

2009-09-07T12:18:00.004+01:00

Just to highlight to our members - a new initiative by Cardiff University - to honour Wales’ best medical supervisor or trainer.

The Wales Deanery Best Educational Supervisor and Trainer (BEST) Awards 2009 have been launched by the University’s School of Postgraduate Medical and Dental Education. They have been set up to honour GPs and Consultants who have shown excellence in the role of Educational Supervisor of Postgraduate Medicine in Wales.

Any Welsh doctor in training has until mid September to nominate who they think are some of the best medical educational supervisors in Wales. They can nominate Welsh GPs or Consultants, who they believe have performed outstandingly either primary care or secondary care.

Such awards are a great idea, illustrating how medical educational supervisors and trainers play a vital role in delivering high quality training programmes for doctors entering the profession and encouraging more trainees to look to Wales to work and live.

More information about the awards is available from Cardiff University.

Schools in Wales have a key part to play in our obesity battle

2009-09-04T12:22:00.001+01:00

This campaign to get schools more involved in improving our health and fitness and in turn, hopefully helping to tackle obesity, really is a great idea.

Currently schools in Wales are perhaps something of an on under-used resource, with many closing their doors after 4pm on school days, not to mention being out of bounds on weekends and during school holidays.

One of the key factors stopping people from using leisure centres, particularly in more rural areas, is the cost and being able to access them. So it makes sense to utilise schools which are on the doorstep for most families. And with funding from the Welsh Assembly Government and the Sports Council for Wales, costs to the public are substantially reduced, or entry fees wavered completely.

This seems like a win-win situation to me. You have schools becoming the focal point of community activity, at the heart of where people live, being used in the evening and at weekends, meaning they’re less likely to be the targets of vandals and break-ins. As the same time they are providing a place for young people to go, occupying their time, so they don’t have to hang around on street corners. Plus, there is the added benefit that it encourages us all to get out of the house and get active. And this has never been more necessary, with more and more statistics these days to remind us how we’re piling on the pounds.

I really hope more schools in Wales now take the opportunity to open for longer and help to play a part in stemming what is fast becoming an obesity epidemic in the UK.

Vale of Glamorgan Council sees sunbeds sense

2009-09-03T09:42:00.005+01:00

Congratulations to the Vale of Glamorgan Council on making the right decision and removing the five sunbeds it operates in leisure centres across the county.

We have recently criticised the council for dragging its feet over the enforcement of a recommendation to remove the sunbeds, so it’s great that the Council Executive has finally seen sense and resolved to get rid of them.

The Vale Council was the last Local Authority in South Wales to operate sunbeds.

It should never have had sunbeds on its premises. The fact that an attractive £15,000 profit was made annually for the council might go some way to explain the delay in removing them.

This decision is an extremely important one in terms of promoting local public health and wellbeing and it also helps to spread the message about the dangers of sunbeds and UV exposure. A message which both Flintshire and Wrexham – who are the only local authorities left in Wales still to operate sunbeds in their leisure centres – would do well to listen to.

The BMA will continue to call for these two remaining Local Authorities in North Wales to remove the sunbeds they run. They should be leading on health protection; operating sunbeds is simply reckless and irresponsible.

Leisure centres should be places of health, recreation and well-being, not places which provide facilities that are so damaging to a person’s health. Just one session a month will double the average individual's annual dose of UV radiation and this has been proven to greatly increase the risk of cancer, skin and eye problems in later life.

The view of the BMA has always been that there is no such thing as a safe tan (unless it comes out of a bottle). When a tan fades the damage to your skin remains. We want to see tighter regulation of the sunbed industry and a ban on coin-operated, unmanned salons. When we give evidence to the National Assembly’s Health Committee later this month that’s exactly what we’ll be calling for.

Childhood obesity – prevention is better than cure

2009-08-27T14:46:00.002+01:00

I fully support this article by Sustrans Cymru.

To maintain good health and keep obesity at bay and other serious illnesses in later life, it is recommended that children have at least 60 minutes of moderate exercise every day, such as brisk walking, running, or cycling. But, research suggests that currently only around half of seven to 11 year olds manage to do this. So it's essential to get kids moving. And the journey to and from school is the perfect place to start. We know that, particularly in deprived areas, many parents are scared to let their children go outside because the roads are so busy. That is why we are in favour of 20mph zones in urban areas, and specifically around schools in Wales.

The number of children travelling to school by car has doubled over the last 20 years. Getting youngsters into the habit of cycling to school has obvious environmental benefits, and of course, helps with the fight against childhood obesity too. That’s why the Bike It project being trialled in three areas in Wales is such a good idea. It helps to establish cycling to school as part of a routine, not a one-off occurrence.

There is no precise figure of how much obesity costs the NHS, but every year the health service spends at least £2 billion on treating ill health caused by poor diet. Estimates indicate that, if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020. Therefore the cost to the health service is likely to increase unless measures are put in place to halt this growing problem.

We need now, more than ever, to be focussing on preventing childhood obesity. We know that parents want to do the best for their children and getting them out of the car more is certainly one way of doing so.

Revalidation in Wales

2009-08-26T12:19:00.003+01:00

Just to make you aware of a revalidation event which BMA Cymru Wales is organising, to be held in Cardiff on October 21st 2009.

Chairman of the General Medical Council, Professor Peter Rubin will be speaking at the event and wants to hear doctors' views about how revalidation should be implemented in Wales.

This event is open to ALL doctors (whether a BMA member or not)in Wales.

If you would like to attend please email BMA Cymru Wales CEO Sarah Miller - smiller@bma.org.uk

It would be good to get as many doctors there as possible, to get a wide range of views.

Chairman of Welsh Council Invites Questions

2009-08-24T11:56:00.004+01:00

The Welsh Secretary’s blog is part of a wide range of social media initiatives to ensure communication with our members is as accessible and wide-ranging as possible.

While trying to keep our members and anyone else who reads this blog up to date with current activities, hot topics and general policy position of BMA Cymru Wales, it is also an opportunity for YOU to put questions to the BMA.

Our Chairman of Welsh Council, Andrew Dearden, is particularly keen to receive feedback or questions from our members, whether it concerns junior doctor issues, our Option 7 Campaign, EWTD, etc. So if you have any questions for Andrew please post them here. In fact, if you have questions for any of the Chairs of our committees (GPs, Consultants, Public Health, Medical Students etc) I know they would be delighted to hear form you.

Local authority continues to put profit before health

2009-08-21T09:27:00.003+01:00

I have some serious concerns to share on here about the conduct of the Vale of Glamorgan Council, in particular, the way in which it appears to be dragging its feet over the removal of sunbeds in three of its leisure centres across the county.

Back in May, a Vale Scrutiny Committee recommended in a report to the Cabinet that the sunbeds should be removed. The Council have met three times since then and, in what can only be described as a “reckless failure to uphold their duty of care to the local population,” each time they have failed to consider the issue or take action.

The sunbeds are making a profit of around £15,000 a year for the Vale Council.

Now that the authority is in recess over the summer it will be September, at the earliest, that the recommendation to remove them can be put back on the agenda.

It is a step in the right direction that the dangers of using sunbeds have been recognised by the Scrutiny Committee, but it is difficult to see why the council have not yet taken action. I sincerely hope it simply isn't down to the finance the sunbeds generate. Surely local authorities have a duty of care to the people they represent and a duty to promote public health don’t they?

The Vale is not the only Council to have sunbeds in its leisure centres – Wrexham and Flintshire also do and we have called on them to take action too. Leisure centres, especially those owned by local authorities, should be places where people go for healthy exercise and recreation. Local Authorities should be leading on health protection. It’s absurd that sunbeds are even there. Just one session a month will double the average individual's annual dose of ultraviolet radiation and it’s well known that this increases the risk of cancer, skin and eye problems in later life.

The BMA has been a strong advocate for increasing community access to local leisure facilities and playing fields and has called for increased provision and investment to secure their future.

If leisure centres wish to diversify the facilities on offer, this should not be to the detriment of health and well-being. For instance, the beauty studio at Penarth Leisure Centre should offer fake tan sprays rather than the two sunbeds it currently hosts.

BMA Cymru Wales has campaigned for the tanning industry to be regulated for many years and when we give evidence to National Assembly’s Health Committee next month this is exactly what we’ll be calling for. Across the board we’ll be asking for tough action on sunbeds - including unmanned and coin-operated ones.

In the meantime we are calling on the Vale, and other Councils to act responsibly on behalf of the people they represent by removing the sunbeds at the earliest opportunity.

Juniors affected by exams mix up need our support

2009-08-20T14:46:00.002+01:00

This really is an awful situation that these four young people are currently faced with and it’s very difficult to imagine how they must be feeling right now. That’s why BMA Cymru Wales will be doing everything possible to offer as much help and support as we can to get them through this.

Rest assured too, we will be seeking answers as to how such a fundamental error occurred and what changes will be made to make sure such serious mistakes are not repeated. However, at this moment in time, the key focus of our efforts is to ensure that those involved receive all the support we can provide.

Don’t delay in getting children protected against measles

2009-08-20T09:50:00.002+01:00

I couldn’t agree more with this Western Mail article and the need to make sure children have been vaccinated against measles before the start of the new school year in Wales, in a few weeks time.

It’s only two counties in Wales which aren’t affected by measles, and with around 45,000 youngsters currently unprotected, this outbreak is only likely to get worse when schools go back after the summer holidays.

I have blogged on here before about the need for children to be vaccinated, particularly those who’re school-age and how damaging the unfounded allegations about the MMR jab from several years ago were, with the effects still it seems being felt today. So I think the need for a concerted drive to increase public awareness about the common misconceptions associated with the MMR jab has never been greater, as September approaches.

EWTD highlights the growing need for BMA Cymru Wales’ Option 7 Campaign

2009-08-18T09:54:00.002+01:00

This Sunday Times article just goes to show how important and timely BMA Cymru Wales’ Option 7 Campaign is. Although this article refers to Scotland, the situation is more than likely being replicated in other parts of the UK. The Option 7 Campaign (named after the option on the BMA hotline) was originally set up because we were hearing of instances of intimidation/harassment/bullying of junior doctors before the introduction of the European Working Time Directive (EWTD) and chances are this has just exacerbated things. EWTD stipulates that juniors must not work more than 48 hours a week, but there are of course easy ways to get around this legislation, such as juniors being told to under report the amount of hours they are clocking up in any given week.

The European Commission must do more than “threaten” to investigate these allegations highlighted in The Sunday Times, it has a duty to do so, for the safety of both patients and NHS staff.

Junior doctors in Wales can also report their concerns to the BMA and they don’t need be a member to do so. Any information given will be kept completely confidential. Help us to help juniors by ringing the BMA on 0300 123 123 3 and select option seven.

Show your support for the Option 7 Campaign on facebook too, by joining one of our groups, follow the links below.

BMA Cymru Wales Option 7 Campaign facebook group

BMA Cymru Wales Option 7 Campaign Supporters of junior doctors facebook group

Peter Black AM: The English disease

2009-08-13T10:05:00.000+01:00

Peter Black AM: The English disease

Tamiflu isn’t a wonder drug

2009-08-11T12:45:00.001+01:00

This piece of BMJ research certainly grabbed the attention of the media yesterday. Though at the moment, anything to do with flu seems to get picked up on and linked to swine flu in some way.

As the research itself actually details “it is difficult to know the extent to which the findings can be generalised to children in the current swine flu pandemic but, based on current evidence, the effects of antivirals on reducing the course of illness or preventing complications might be limited.”

This is not to say that all children should not be given anitvirals like tamiflu. What perhaps we need to bear in mind is that we are learning more about antivirals, the more we use them. And while we know they are safe, we also know that vomiting and diarrhoea can occur in some children and adults who take them.

GPs have always said that doctors need to balance the risk of major complications from swine flu and the risks of side-effects from antivirals.

The more we learn about these drugs the more we will know how to treat patients with the most up-to-date clinical evidence. Tamiflu has a place in dealing with and containing the spread of swine flu, but it’s not a “cure all”.

Boxing bouts are not what youngsters need

2009-08-10T16:34:00.001+01:00

This Daily Mail article made for uncomfortable weekend reading.

The BMA supports sports and hobbies aimed at improving children’s wellbeing and fitness, but not to the detriment of their long term health, which boxing can cause, such as potential brain damage.

It seems that it’s only schools in England who are looking at competing in these first inter-school boxing tournaments, which haven’t been around since the 1960s. Surely that’s where they should remain.

The BMA has campaigned for a ban on boxing since 1982 due to the physical dangers and harm it can cause. It can lead to brain damage, acute brain haemorrhage and eye, ear and nose damage. There is evidence that boxing not only causes acute brain injury but also chronic brain damage, which is sustained over a long period of time by those who survive a career in boxing. It may take many years before boxers and ex-boxers find out they are suffering from brain damage.

In 2005 the World Medical Association [WMA] stated that “Boxing is a dangerous sport. Unlike most other sports, its basic intent is to produce bodily harm in the opponent. Boxing can result in death and produce an alarming incidence of chronic brain injury. For this reason, the WMA recommends that boxing be banned.”

The re-introduction of boxing for youngsters leads to a bigger and more serious question for us as a society when, on the one hand, we’ve got repeated examples of young people attacking others on the streets and kicking them to death, which we seem to hear about far too often. It is then made difficult to explain to these youngsters who indulge in that kind of behaviour that they shouldn’t, when on the television they see adults punching each other, until one of them is knocked to the floor. It’s not really setting the best example now is it?

‘Boxing, an update from the Board of Science’ – the full report can be found on the BMA website at : http://www.bma.org.uk/ap.nsf/Content/boxing

Action not words now needed on organ donation

2009-08-06T10:24:00.004+01:00

Around 30* people will have died in Wales in the last year, waiting for a transplant on the organ donor register.

That's why BMA Cmyru Wales is calling for action to be taken by the Welsh Assembly Government with regard to possible changes to the organ donation system.

It’s also a year since the Assembly’s Health Committee rejected any ideas to change the organ donation system in Wales.

This led to the Welsh Assembly Government’s wider consultation on the matter, which has just closed.

We submitted a response to this consultation, reiterating calls for a “soft” system of presumed consent to be introduced and to do so sooner rather than later, before more lives are lost.

There are several reasons why the BMA believes that such a system would produce a far higher potential donor rate than at present and in turn, save more lives.

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 number of people on the organ donor register has doubled since 2001, from 8 million to more than 16 million. But the gap between the number of organs available and those needed continues to grow, with around 1,000 people dying each year in the UK waiting for an organ.

Presuming consent rather than presuming objection is also more likely to achieve the aim of respecting the wishes of the deceased person. Given the very high level of support for organ donation expressed in repeated surveys (up to 90%) it is reasonable to presume that those who die without making their views known are in the majority who want to donate, rather than the minority who do not. With such a shift towards making donation the default position this reflects a positive view of donation, demonstrating the very strong support for it within society. Therefore, over time donation would come to be seen as the norm, rather than the exception.

Added to this is the fact that there is significant and growing public and professional support for such a shift. Recent public opinion polls show around 60-70% support for a shift to an opt-out system of consent for organ donation. This is consistent with the views found in the Assembly’s own public engagement exercise.

The time really has come, before more people die waiting in vain, the Welsh Assembly Government needs to stop procrastinating and seek an LCO (Legislative Competence Order) from Westminster to bring in a soft system of presumed consent.

*The figure of 30 people dying in the past year in Wales is based on 150 people dying in Wales waiting on the organ donor register in the last 5 years.