Mae hen wlad fy nhadau yn annwyl i mi

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

Homeopathy on the NHS

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

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

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

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

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

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

Dr Andrew Dearden gives evidence to Assembly Health Committee on Sunbeds

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

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



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

A clearing in the fog?

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

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

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

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

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

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

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

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

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

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

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

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

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"

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

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

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..."