Welsh Medical Students Committee Update

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2010 for the Public Health Committee

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."

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

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.

Seasons Greetings

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.

Our booze culture

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.

Room for improvement

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.

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.

Ways for BMA members to broaden their horizons

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

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

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

Headway being made on NHS reorganisation

Yesterday, BMA Cymru Wales held its second Policy day regarding the current plans for restructuring the Welsh NHS. The day was well attended by members and I really do think those able to make it, took away a great deal, including a large dose of reality from BMA Scotland’s Chair of GP committee, Dr Dean Marshall! I know it was extremely helpful for BMA Cymru Wales, as a whole, now providing us with a great deal more focus as to the shape of our consultation response. And it’s still not too late to feed into the process. Please feel free to post your views on here, before February 25th 2009.

Major breakthrough in fight against LCOitis

Wales is suffering from a major new epidemic - LCOitis.

The symptoms? Confusion, yawning and, in the most extreme cases, an inability to stay conscious. The source of this new and worrying epidemic - colleagues point to the appearance of the Government of Wales Act 2006 as the most possible source.

Let me explain...

Yesterday, I attended a major conference organised by the Bevan Foundation and Positif Politics. It brought together a whole host of speakers to explain how Wales is governed and how organisations like BMA Cymru Wales can make use of the Assembly's new powers. Under the Act, the Welsh Assembly Government and Assembly Members can now ask for Legislative Competence Orders (LCOs) from the UK Government -which basically means the power for the Assembly to change the law in the areas that are devolved.

Until yesterday, I was an extreme sufferer of LCOitis. Everytime an AM, MP, journalist or Welsh academic started talking about 'LCOs' my condition deteriorated.

Thankfully, I am happy to report - I'm getting better. The cure? Well, anyone who thinks they may be suffering should consult Daran Hill and Huw Edwards' excellent guide to the Government of Wales Act, available by contacting the Bevan Foundation.

So far, it's the only known cure.

Organ donor public debates test opinion on presumed consent

My Policy and Public Affairs Officers attended one of the many Welsh Assembly Government public debates this week, examining the question of 'presumed consent' for organ donation.

The BMA has long-argued the need for a fundamental shake-up in the way organs are donated. We have some 500 people in Wales waiting for a donation.

What I can't quite get my head around is the fact that if you ask people, the majority will say they support organ donation. In fact, some 90% say they would be willing to donate. Unfortunately, this does not translate into people who actually sign the register - it stands at roughly 30%.

So we have a problem. The BMA believes that we need to adopt a 'soft' system of 'opt-out' or 'presumed consent'. It's a subtle difference but an important one. People would still be able to opt-out if they have a moral or religious objection but it would help those people who for, whatever reasons, do not get round to registering.

Families would also have a final say. Which is why Kidney Wales' recent "Tell a Loved One" campaign, is so important. You can sign up to the organ donor register and carry a card, but if your nearest and dearest don't know your wishes, they'll be less inclined to follow them out if you haven't discussed organ donation with them first. And as next of kin would have the final say, they could go against your wishes, if you haven't bother to tell them.

Unfortunately, there's still a great deal of mistrust from the public and I still despair when I hear people saying that this is an attempt by the 'state' or 'politicians' to 'take my organs'. I really don't think that this is the case. Doctors just want what's best for their patients, and ensuring a supply of organs that will meet current and growing demand must remain our ultimate goal.

Anyone wanting to register to be an organ donor, can do so here

Rhodri backs BMA Cymru's calls for the NHS to continue for the next 60 years and beyond

I had the pleasure of presenting a giant birthday card to the First Minister this afternoon, as the 60th anniversary of the NHS draws to a close.

The card was signed by politicians from all parties and patients across Wales, showing the depth of support for the NHS to continue as it is, free, at the point of need. This is also the perfect opportunity for the Welsh Assembly Government to send a clear a message to keep the NHS public.

Here's what Rhodri Morgan had to say on receiving the card;

"The creation of the NHS, providing free healthcare for all, is arguably the greatest achievement of any government of the 20th Century. We all owe Nye Bevan a huge debt of gratitude for having the remarkable foresight and courage to introduce the NHS in 1948.

The NHS today is a lot different from the NHS of 10 years ago, and vastly different to the NHS that Bevan founded in 1948. It has adapted and modernised, as any public service must, to meet the challenges of today and it will have to do so again to meet those of the future. There’s no doubt that the continued hard work of staff, together with investment and reform, has made a huge difference to the quality of care that patients now receive. As we celebrate its 60th anniversary, we can be proud in Wales that the founding principles that Bevan established are as dear today as they were in 1948."

Shabby way to treat England's newly qualified junior doctors

I whole-heartedly support my English BMA colleagues attack on the Westminster Government's "shameful"refusal to even hold talks about the axing of accommodation support to newly qualified junior doctors. The BMA wrote to Anne Keen, England's Health Minister, back in July to request a meeting about the move to end the legal requirement for NHS trusts to provide free hospital accommodation to first year junior doctors. (At an estimated annual cost of £4,800).

Thousands of freshly qualified junior doctors who began work in August will just be starting to feel the effect of this, facing their first rent payments around now. That's on top of an average debt of £21,000.Even though the BMA has outlined the financial implications of this, Anne Keen refuses to meet with my English counterparts.

Thankfully, BMA Cymru Wales' campaign on this issue has already seen the Welsh Assembly Government guarantee free hospital accommodation for newly qualified junior doctors, until next Summer. Also, the Health Minister, Edwina Hart has established a working group to review staff accommodation across all hospitals in Wales - with respect to standards - which in some hospitals is appalling - to the extent that it should be freely provided.

I sincerely hope in coming up with recommendations, the group takes account of the fact Wales needs to do all it can to ensure junior doctors are attracted to work in Wales, and spend their future career here. While only one piece of the jigsaw in that issue - free accommodation will be one of the factors that influence whether the Health Service and the patients of Wales have the numbers of junior doctors we need, or will be running with disrupted and less than adequate services - as seen with the recent problems at Singleton Accident and Emergency Department.

As good as it is, free accommodation guaranteed until August 2009 is unlikely to be good enough to avoid these risks. And for any prospective junior doctor reading this, rest assured, BMA Cymru Wales will be doing all it can to try and get this message across and encourage the Welsh Assembly Government to continue to support junior doctors as it is doing now, and extend the agreement beyond next year.

We can't bury our heads in the sand over organ donation

I can understand where Denise Robertson is coming from here, after all, we Brits are well known for our stiff upper lip and not wanting to discuss such issues as death. But at the same time, is that a good enough excuse to stop us saving potentially hundreds of people's lives on the transplant waiting list?

Not so long ago this very issue was on the Welsh political agenda, with the Assembly's Health Committee rejection of the idea of introducing presumed consent for organ donation, in the near future. The reason for the rejection - the committee did not believe that it is currently the most urgent priority and would act as a “distraction”.

BMA Cymru Wales has campaigned for presumed consent for organ donation for some time now.
There is little doubt that a system of presumed consent would produce a far higher potential donor rate than at present, which is far too low at 22%. Experience of other European countries that have introduced presumed consent have demonstrated this. Some 400 people in Wales are still waiting for transplants and one person dies each day in the UK, waiting. The committee has missed an opportunity to shorten the delay for those people waiting desperately for a transplant.


As Denise Robertson herself points out "Every year almost 1,000 people die, either while on the waiting list, or having become so ill they are no longer able to withstand transplant surgery. Each one of us could save a life, maybe more than one, by signing a donor form now and giving away something that one day we will have no use for. We could discuss it with those we love and encourage them to see it as a renewal and not a loss. "

I couldn't have put it better myself, so let's start having a frank and open discussion with our loved ones about presumed consent, however difficult that maybe. Surely it can't be any more difficult than the long and anxious wait for people on the organ donor transplant list?

You can register online for organ donation and the UK Transplant website also gives a lot of useful information to help you decide and to use in discussions with loved ones. As I've already said, it is so important we involve our family, friends and loved ones in our decision - as they would be the ones left to ensure our wishes are met - which is never easy - so we all owe it to them to make sure they are involved in such an important decision.

Jenny Randerson responds...

This is an email I've received from Jenny Randerson, Cardiff Central, Liberal Democrat AM, re. my post on Monday.

"Thank you for giving me the opportunity to respond.

You will be aware I am sure, of how often small parts of much longer interviews are taken out of context, and this is exactly what David Williamson has done in this article. He phoned me about two separate issues and for some reason spliced the quotes together into one.

Let me get two things straight, firstly, I do not like the blanket PFI model, and secondly, I did not mention private finance in the context of any plans that I may or may not have to stand for the leadership. Instead, after that discussion, he asked me for my views on private finance and I pointed out to him the upcoming health committee report into PFI.

I told him that it would make some very interesting reading and stated that I believe that pragmatically speaking, because of the Westminster model for funding capital developments, we must find ways to unlock Private Finance in the NHS providing that it does not interfere with the fundamental principles of the NHS. All I said was that I am not in favour of the blanket ban on private money and believe that examples such as the mutual model can harness private sector money for use within the NHS.

In an Ideal world, I would like to say there should be no private money in the NHS but the fact of the matter is that Gordon Brown provides Wales with capital finance on the understanding that we use private sector money to top it up. As a result of the fact we are not doing this, capital projects in the NHS in Wales are falling further and further behind Scotland, England and Northern Ireland. We cannot allow this to continue.

I hope that this helps to clear up the situation and the misinterpretation which I blame on bad journalism rather than you."

Don’t be selfish by abusing free hospital parking

As mentioned in my blog here last month, BMA Cymru Wales fully supported the Welsh Assembly Government’s decision on scrapping hospital parking charges, something we felt for some time was merely a tax on the sick.

So I was very dismayed and concerned to read about how a minority of people are abusing the system. It seems some of us are parking in hospital grounds to go shopping for instance, instead of using an NCP, where you would have to pay. This of course is not what free hospital parking was intended for, to help those who’re ill and needing treatment.

The fact that hospitals feel the need to introduce fines means this abuse of the system is becoming more and more widespread. And is a sad indictment of the society we now live in, when those who GENUINELY need to park within hospital grounds can’t do so because of a selfish few. We need to make sure patients and relatives of those who are sick are the ones that actually gain from this, not someone going for a browse around the sales. Although the policing of hospital parking is necessary, surely it’s far better we weed out those who abuse the system, rather than penalising everyone and in particular, those people who can ill afford it?

The role of the doctor...

...seems to be being undermined once again.

This time the issue is being debated in the British Medical Journal.

Bonnie Sibbald, Professor of health services research at the University of Manchester argues that nurses can deliver as high quality care as GPs in most areas of general practice including preventive health care, the management of long term conditions, and first contact care for people with minor illness. And as such, should be the frontline providers of primary care, taking the place of GPs as the first point of patient contact.

But, thankfully, we do have, in Dr Rhona Knight, a GP from Leicester and who has first hand experience in a nurse led practice, someone to fight the corner of doctors. Dr Knight quite rightly points out that nurse led primary care would restrict patient choice and undermine the importance of nurses’ unique contribution to primary health care.

We must remember that GPs' shouldn't and can't be subsituted, with Dr Knight highlighting the difference in training for doctors and nurses. To become a general practioner, it takes 10 years and once qualified, they become hugely experienced in dealing with undifferentiated illness which enables them to be key deliverers and leaders of generalist healthcare. In contrast, she says, advanced nurse training is less developed and recommends a minimum of only 500 indirect or direct supervised hours and the competencies cover "just nine pages".

The erosion of the role of the doctor in some areas is something the BMA's annual meeting this year thoroughly condemned and must be resisted - let's get it straight, if someone wants to take on the role of a doctor - then bite the bullet and go and train as one.

Would the Welsh NHS be safe in the hands of the Lib Dems?

Having read this article , I feel Jenny Randerson needs to clarify her call for greater use of private finance in the NHS.

The Cardiff Central Liberal Democrat AM and party's Health spokesperson is quoted as saying that if she was to stand as the next leader of the Welsh Lib Dems, then her party should consider how best to use private sector finance to improve the NHS.

The One Wales government has many faults, but at least one positive thing that they've done is to rule out the use of the private sector in the NHS and the use of private finance through PFI projects.

To me, it seems Jenny Randerson's comments are at adds with this and appear to contradict her party's previous statements on the use of the private sector in the running of our NHS. You only have to look over the border to England to see the danger to the public service ethos of our NHS if we are to seek greater use of private sector funding.


If Jenny Randerson seeks to one day lead her party and potentially become the next First Minister, we need to know just what she has planned.

Where Wales leads, others follow?

So the government in Scotland has decided to fall in line with Wales, by scrapping hospital parking charges.

This is great news and should be commended. BMA Cymru Wales campaigned long and hard on the issue here, with the Welsh Health Minister eventually abolishing what we believe is simply a "tax on the sick". That came in to effect here in April (hospitals with private contracts have been told to gradually phase these out).

Why should people who're ill, or with relatives who are, have to indirectly pay for treatment, which is, under the founding principles of the NHS, meant to be "free at the point of delivery".

It will be interesting to see now what happens in England and Northern Ireland.