2010 for Consultants in Wales

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?

Chairman of Welsh Council Invites Questions

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.

Action needed now to stop NHS Wales becoming unsafe for staff and patients

Unless urgent action is taken to plug the gap in the shortage of middle grade doctors, the NHS in Wales could become unsafe both for staff and patients.

The problem‘s been highlighted this week within Hywel Dda NHS Trust, where 62 posts remain vacant.

But this situation is by no means isolated to Hywel Dda, with Abertawe Bro Morganwg Trust having had to move some specialist services because they were inadequately staffed. Similar problems are also affecting North Wales too.

We are facing unprecedented levels of a lack of middle grade and junior doctors right across Wales, which is clearly unacceptable to both our members and people needing hospital treatment and this does not look like changing in the immediate future.

There are a variety of reasons for this shortage, one being that Wales does not top the list of places where many junior doctors desire to work. Also, changes to the rules regarding immigration have caused problems with recruitment across the whole of the UK, not just Wales.

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. Inevitably, the rates of work being undertaken cannot be sustained with the current levels of staffing. Hospital managers really need to address this now, working with clinical colleagues.

These problems come as no surprise however to us at the BMA, having predicted that these shortages would happen at some point. That is why we have, for some time now been trying to meet with representatives from the Welsh Assembly Government, 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.

BMA Cymru Wales has also worked in partnership with the Wales Deanery for Postgraduate Medical and Dental Education, to produce a DVD for students, giving an invaluable insight into medical training here.

The aim of the video is to promote Wales as a primary destination to study medicine and to attract more junior doctors to apply, to complete their postgraduate training here. However, the positive effects of this will not be seen immediately.

The initiative to provide free accommodation for F1 doctors has been welcomed by BMA Cymru Wales and has had some impact. Yet, I think far more effort should have been put into anticipating and planning for the current shortages, especially the impact of the European Working Time Directive which has been known about for more than 13 years! Whilst it is very late in the day, I urge the Welsh Assembly Government and employers to focus on the actions we have been highlighting for some considerable time. I do not think sufficient, co-ordinated efforts to recruit and retain doctors to Wales has been made.

While in the short term, we have to have contingency plans put in place as soon as possible to ensure the safety of both NHS staff and patients, we need far more sustainable solutions if NHS Wales is to deliver and maintain the quality and capacity of services the people of Wales deserve.

Concern over readiness for EWTD in the Welsh NHS deepens

My concern about the effects from the implementation of the EWTD (European Working Time Directive) weren’t just confirmed at BMA Cymru Wales’ recent Policy day on the matter – they grew a whole lot deeper.

The Directive puts a limit on the working week of 48 hours for all employed doctors, including junior doctors, and it must be implemented by Trusts in full, no later than 1st August this year. Junior doctors were excluded from the original legislation because of the nature of their training, and the limit of 48 hours was to be phased in.

The deadline is fast approaching and despite the fact Trusts have had (literally) years to prepare for it, to say that we are still some way from being ready to move to a reduced working week, and thus ready to ensure essential protection for doctors and patients, is a massive understatement. This was highlighted by the Wales Audit Office just a few weeks ago.

A number of key messages came out of the Policy day, including drastic junior shortages, compounded by insufficient numbers of consultants to fulfill requirements of services to patients whilst at the same time trying to provide the dedicated and comprehensive training and support juniors need.

Also, members, with frontline-delivery experience, suggested a number of solutions in order for Wales to prepare and to cope with the implementation of EWTD. BMA Cymru, as the voice of doctors in Wales, will be taking these up with the Health Minister and with Welsh NHS Trusts in the next few weeks and as we approach the August deadline.

But with the situation already dire and morale amongst junior doctors at an all time low, without central support and adequate preparation from Trusts there is a significant threat to the current standard of medical training, to the delivery of healthcare provision, and to the quality of patient care as a result.