Editors' Blog

April 2008 - Posts

• Is the Royal College of Nursing fit for purpose?

  While the nurses of the UK are debating and gyrating in the rain at Bournemouth, some of us observing from afar are asking the question: ‘Is the Royal College of Nursing fit for purpose?’ The somewhat meek acceptance of the latest disappointing pay deal has of course brought criticism from those in the profession who would like to see the RCN standing up to the government and demanding more. But the stance on the pay deal is just one symptom of the identity crisis that dogs the college. It was tellingly highlighted at a question and answer session last night with the general secretary Peter Carter. One of the delegates asked why he had recently added a second title to his job description – that of chief executive. His reply was essentially that one title was for his union role and one for his work running the college. This is where the problem lies. The RCN is split between two competing objectives: one to provide leadership and representation on pay and conditions for working nurses; the other to provide professional support and education as an academic body. Even the way its structured is divided between the politically active branches and educationally led forums. If you look at the picture in medical representation, the BMA takes the union role, while the colleges handle education. And the Royal Pharmaceutical Society is in the process of dissolution because it cannot reconcile the roles of academic college and professional regulator. Getting back to the identity crisis…Dr Carter is clearly more at home managing an institution than tub-thumping his way to Downing Street in the style of Beverly Malone. Perhaps the RCN needs both? Or do we need two RCNs? Posted Apr 30 2008, 03:50 AM by Colin Cooper with 3 comment(s)

• Muted start to Congress, despite the free apples

  New arrivals to RCN Congress 2008 yesterday were handed an apple as they walked through the doors of the Bournemouth International Centre, in keeping with the event's ‘Fit for Congress' theme. Free snacks are all well and good, but further into the centre's dizzying labyrinth of corridors, the campaign demanded a little more self-sacrifice. Enthusiastic nurses were to be found pedalling frantically on exercise bikes or gurning red-faced on one of a bank of rowing machines. The truly unfortunate found themselves gyrating desperately in search of long-forgotten hula hoop technique. All this exertion may have contributed to what seemed a rather muted first day at the event. RCN chief executive and general secretary Dr Peter Carter's lengthy speech received just three or four bursts of applause, and less than half the audience rose when he concluded – a standing ovation often seems a foregone conclusion at events such as this. One delegate was in rebellious mood, however. The conference chairman opened the debating sessions with a plea for nurses not to interrupt with points of order unless they were genuinely important. Within seconds, the rebel leapt to the microphone to complain passionately that council members – seated apart from the main audience to one side of the main stage – should have been facing the other way around so that ‘delegates could see their facial expressions' during debates. ‘Thank you,' the chairman muttered. Even a mention of health secretary Alan Johnson brought not a murmur from the ranks of nurses in the hall as Dr Carter spoke – no echoes yet of the fiery reception former health secretary Patricia Hewitt received in the same venue two years ago. Still, there's plenty of time yet for them to work up a head of steam for his visit – especially once they discover the chocolate fountain that one of the stallholders has smuggled in under the Fit for Congress radar.   Posted Apr 29 2008, 01:14 AM by Nick Bostock with 1 comment(s)

• Johnson to fight nurses on the beaches

  It’s all kicking off on the beaches of Bournemouth this week. The seaside conference centre will be hosting the annual RCN congress – a monumental gathering of nurses that two years ago saw hundreds of them barrack health secretary Patricia Hewitt until she was forced to end her speech early and retreat to the relative safety of a first class train seat back to London. Some people say she didn’t deserve that treatment. But sometimes politicians need to be confronted with the anger, frustration and misery that their ill-conceived policies are causing. And, anyway, it was probably no different from a bad day in the House of Commons. The RCN didn’t invite any health ministers last year. But this year Alan Johnson is on the agenda and the nurses would be unwise to mess with him. As a streetwise former trade union supremo he’ll no doubt strike a more empathic tone than Patronising Pat. But if there is any heckling, jeering or provocative t-shirt wearing, expect Alan’s Capello-esque management skills to come in to play. And remember, he used to be a ‘bit of a mod’. When the red mist comes down, he won’t see an audience of militant nurses waving their conference papers at him, but a gang of greasy rockers threatening to mangle his scooter. It will be Brighton beach in the 60s all over again. Alan will leap off the podium with a deckchair above his head and all hell will break loose. Not what you might expect from a minister of the crown (even in the House of Commons) but great television. Posted Apr 28 2008, 02:44 AM by Colin Cooper with 1 comment(s)

• Is GP access really improving?

  If you are a patient in need of a GP appointment, let's just hope you don't live in Torfaen, South Wales. According to Gwent Community Health Council, you could end up waiting over two weeks to see a doctor and in one alarming case over a month. The health council conducted a "mystery shopper" audit of almost 100 GP surgeries across Gwent, South Wales, with a caller pretending to be a patient phoning each surgery to try and get an appointment. Some of the results are quite disturbing - Specifically the review shows only four surgeries could arrange an appointment within two weeks. Surgeries in Torfaen seemed to be the "worst offenders" - out of 13 practices contacted, six close for a half day per week, despite not having to open on Saturday mornings. The longest wait for a routine appointment with any GP was over four weeks while most of the surgeries fell outside the two weeks GMS target. Moreover, the health council found that some practices offer GP appointments for less than 20 hours per week. It's not all that bad though. For instance, GP access in Monmouthshire was much more encouraging as only one practice failed to meet the two-week deadline. How representative is this survey of GP access in Wales? If  it reflects what is going on in the rest of the country, and with a deal on extended hours in Wales being negotiated, the main question is: Should in-hours services be improved before investing in out-of-hours? Posted Apr 25 2008, 12:05 PM by Emilie Reymond with no comments

• On my knees for some choice

  I hobbled into my GP’s surgery the other day with yet another knee injury. We discussed how this was becoming as bit of a habit and an examination quickly reproduced the acute symptoms resulting in me also leaping off the couch in an involuntary reaction. The conclusion was swiftly reached that this time I would have to see a surgeon. My GP suggested one at my nearest hospital. That seemed sensible to me, I’d had scans of my legs there in the past and been to orthopaedics and physio there as well – did I mention the habit regarding injuries? And so he embarked on Choose and Book, which unaccountably refused to work – a pity because I‘ve never seen it in action. So we reverted to the old-fashioned way, a letter was dictated and I was told the hospital would be in touch. And yesterday it was. I was provided with a number to call to arrange my outpatient appointment. Having read all that DoH propaganda about choice, I had this strange notion that there might be some flexibility in the system. ‘2pm on Tuesday,’ I was told. ‘Well,’ I explained. ‘That’s probably the most difficult time of the week for me to get away from work. Are there any other times?’ ‘3.10 on Tuesday.’ ‘What about other times?’ ‘Between 1.30pm and 3.30pm on the following Tuesday.’ ‘I was wondering about other times, because Tuesdays are difficult.’ I explained again, to learn that knees are apparently only between 1.30pm and 3.30pm on Tuesdays. So I chose 3.10pm on the following Tuesday. I haven’t really had any choice in this but how do I complain? My GP attempted to give me choice, we chose my referral together because of location, my history and because my GP thinks well of this consultant. But when it comes to the hospital the realities of choice are revealed. I notice the CBI has been having another dig at GPs this week, but as usual they have missed the point. I can arrange a GP appointment round my work to a certain extent but an outpatient appointment means disrupting not just my day but that of my colleagues when we will be very busy. Which do the GP-bashers actually think is more damaging to business (apart from the bit where I indulge in dangerous sports to need the appointment in the first place)? Posted Apr 24 2008, 10:33 AM by Bronagh Miskelly with no comments

• Breakfast is best for a boy

  At last we no longer have to rely on old wives’ tales when couples ask how they can determine the gender of their unborn child. Yesterday, and everyday before that, it was always a case of putting a wooden spoon under the bed for a boy, drinking coffee for a girl and standing on your head on Mondays to absolutely guarantee twins. Now anxious parents-to-be can be referred directly to a bowl of cereal. Unfortunately there was no indication in the research as to which brand of cereal was best, but whoever eats the most is more likely to have a baby boy, so just buy them all and eat the lot. If you really want a boy, then it’s best to do the wooden spoon stuff as well – or better still, eat the cereal with the wooden spoon before placing the utensil carefully under your bed. Unfortunately, this news has come just at the time that cereal prices around the world are rocketing, making it more expensive for all of us to determine the sex of our future children. Of course, the gender of a child can be a big issue for many couples, but I’ve never seen the point in worrying about it. Yes, boys and girls are different, and you really notice how much when you have one of each, but their individual qualities should be enjoyed and celebrated equally, not held up for judging. Having said that, my three-year-old son’s view on this debate is ‘I don’t like princesses’, while my six-year-old daughter offers: ‘Girls win, boys in the bin.’ Is that any help?   Posted Apr 23 2008, 10:37 AM by Colin Cooper with no comments

• Two weeks of twists and turns in nurse pay negotiations

  I know I wrote about the pay offer for NHS staff a couple of weeks ago, but things have moved on so much since then that I think its worth a revisit. As things currently stand there is a split between the unions on the three-year deal. On the one side we have Unison and the RCN, which negotiated the deal with NHS Employers and the DoH. On the other side, we have Unite (which incorporates the CPHVA) and the Royal College of Midwives (RCM). They think the offer represents a real-terms pay cut and are unhappy that the independent Pay Review Body will no longer recommend pay rises each year. The RCM seems particularly angry. It claims the offer shows a ‘clear bias' towards members of Unison and the RCN, which are overwhelmingly represented in bands 1, 2, 3 and 5. The RCM says that because of changes to incremental points in these bands in years two and three of the deal, these staff stand to gain the most. Staff in bands 6 and 7 (where lots of midwives are) will not benefit as much. Figures from the RCN seem to back this up. On Friday it sent out a press release showing that a nurse on band 5 spine point 20 with a salary of £21,494.00 this year will be on £24,553.29 by 2010/11. This is an increase of 14 per cent over the three years of the proposed deal. Considering the deal is supposed to be 8 per cent over three years this is a vast difference. My interpretation of the situation is that RCN and Unison were behind the offer because it was the best deal they could have possibly hoped for. It's not an inflation-busting pay rise, but it is certainly more than the award teachers are about to strike over. The RCM has already rejected the deal. Unison and the RCN are consulting members about whether to accept and Unite's health committee is meeting today to decide what its next step will be. In amongst all this, NHS chief executive David Nicholson has said that this year's pay rise could be staged or revised if unions don't back the three-year offer. It's certainly been an eventful two weeks. What happens next remains to be seen, but I'm fairly sure there will be a few more twists and turns before the final outcome of the negotiations are known.   Posted Apr 22 2008, 02:28 AM by Emma Bower with no comments

• Calories on menus, cloned meat, fig roll shortage

  If John Prescott’s tales of gorging weren’t enough to put you off your roast dinner this weekend, there was plenty of other dramatic food/health news to masticate. New Yorkers are being faced with the true awfulness of their eating habits, now that the city’s 2,000 chain restaurants are having to display calorie counts on their menus. This sounds like an excellent idea to me but I am fearful of the violence that erupted in New York when they banned smoking in bars. Staff were stabbed by frustrated smokers, and I can see the same horrible scenes when careful eaters realise that their favourite salad actually contains 900 calories a pop. We’re facing a similar situation in the UK with the shortage of fig rolls. It’s been caused by a freak coincidence of wasps in Turkey being too hot to pollinate the figs, at the same time as a fig ‘cancer scare’ (every food has one). Cups and saucers are going to be looking bare around tea time for several months to come, so expect to see incidents of what’s already being dubbed ‘fig fracas’ in supermarkets everywhere. I count myself lucky in that I am not a lover of figs. There is also a debate raging about the sale of meat from cloned farm animals. All around the world, barriers are coming down to allow us to eat meat from cows and sheep that look exactly the same (I thought all sheep looked the same anyway, until I visited the Seven Sisters Sheep Centre). This is a worry to many people for a variety of big scientific reasons, and there is also the fear that eating the meat will result in the growth of an extra head. Despite all of that, I think it will eventually come down to consumer preference. It will be like choosing organic over factory-farmed, local food over flown-in, real ale over lager. And mine, as usual, will be a pint of Harvey’s Best. Posted Apr 21 2008, 03:25 AM by Colin Cooper with no comments

• The pros and cons of polyclinics

  There seems to be an unnatural obsession with polyclinics in Whitehall at the moment. Among the policy bods and ministers at the DoH they are all the rage. The NHS Confederation also threw its weight behind them this week, publishing a report to ‘dispel misconceptions' about the clinics and calling for more ‘common sense' in the debate about their role. Leaving aside the argument that polyclinics are ‘privatisation by stealth', which I think is a real cause for concern, are they what patients want? Personally, I can see some of the positives. But I am relatively young and, touch wood, fairly healthy. I also have quite a hectic job and live in a city. Life would be much easier for me if I could get an appointment with a doctor or nurse in the evening or earlier in the morning - and get to see a specialist at the same time if I needed to, or even have a dental check up. I am an infrequent user of NHS services and, as such, I don't really mind if I don't see the same nurse or GP on every visit. Polyclinics, it seems, are perfect for me. However, if I was diagnosed with an illness or had a long-term condition I'm not so sure I would feel the same. Take my grandmother, for example. She's approaching 80 and has a number of medical conditions that require regular monitoring and she takes a lot of medicines. Continuity of care, both in her GP surgery and among the specialists she sees in the hospital, is hugely important to her and my grandfather. They don't want to have to explain her conditions and history every time they visit the surgery. They feel very nervous if they see someone new; they worry the doctor may miss something because he or she may not know a crucial piece of information. They highly value the relationships they have with the nurses and doctors they see on a pretty regular basis. I don't think my grandma would like a polyclinic very much. Yes, as the NHS Confederation points out, she may get to see the same GP on every visit, but I'm not sure  she would like waiting in a huge building with hundreds of people filing in and out, and I expect that she would miss the receptionists from her current surgery, who she knows and likes. I think I might feel the same if I was a regular user of health services. Of course, the NHS has to meet the needs of my grandma and myself. But, perhaps the needs of people like my grandmother are more important. Polyclinics do have many advantages, but I am yet to be convinced that they are what the NHS needs - or what patients really want.   Posted Apr 18 2008, 01:46 AM by Emma Bower with 2 comment(s)

• Happy talk

  I’m rather worried about the state of patient care over the last week or two. I’m even a little worried that GP and Healthcare Republic may have inadvertently contributed to any decline. After all we’ve been providing you with a lot of depressing information – the correction factor cut, no pay rises for 10 years, the polyclinic push. And now a report from the British Holistic Medical Association has landed on my desk, which tells me that patients believe unhappy doctors provide a lower standard of care than those filled with the joys of the world. Sorry. This does make sense, and GPs should be all to aware of it from their patients – mood affects performance. Of course there are some solutions at hand. Oldham’s Dr Anita Sharma offers her philosophy of five on this week's letters page. Among her suggestions are laughing for five minutes five times a week, eating dark chocolate five times a week and ‘just for five minutes forgetting about access’, five times a week. Really there is another answer, if the DoH is serious about improving patient care, then it needs to ease off on reforms and GP bashing so there are some happy doctors around. In the meantime we’ll try to bring you some good news and a little humour through our columnists and cartoons when we can. Keep smiling. Posted Apr 17 2008, 11:11 AM by Bronagh Miskelly with no comments

• Tongue twisters to be part of revalidation

  It’s now ten years since the GMC first mooted the idea of revalidation for doctors, and there must have been at least five years of arguing beforehand over what to call the process. Some thought ‘reaccreditation’, others wanted ‘revalidation’. The rest of us were still struggling with the difference between formative and summative assessment. Ten years on and at least we’re still happy with the name ‘revalidation’.  But the problem now is a whole host of new terms that came in to circulation with the CMO’s White Paper on medical regulation. First there’s the problem of two systems, called revalidation and recertification, that will supposedly be running at the same time – though nobody is yet sure exactly how they will be linked. Then we get on to the ‘licence’ that doctors on the GMC register will be issued with, and will need to revalidate every five years in order to continue practising. Unfortunately, some of the regulatory bodies have complicated things by using the term ‘relicensure’ to describe the relicensing (revalidation) process. Having said that, I heard at a conference yesterday that this term (relicensure) was now being dropped, partly because it sounds ‘very American’ and partly because it’s ‘too difficult to say’. Either way, it seems that the DoH is still struggling with the vocabulary. At the same conference we were addressed by none other than NHS medical director Professor Sir Bruce Keogh, who is responsible for revalidation and appraisal in the health service. Judging by his slide presentation, his backroom team are either very American or just finding all this academic stuff too difficult. According to them, doctors will be given a ‘license to practice’, and those ‘licenses will be issued by the GMC’. They obviously need some brushing up on the three Rs.   Posted Apr 16 2008, 03:58 AM by Colin Cooper with no comments

• GPs and pharmacists: make love, not war!

  There have been many concerns raised over the recent Pharmacy White Paper as the DoH is trying to push GPs and pharmacists to work together.  It plans for a transfer of traditional GP roles to pharmacists, where pharmacits will have the power to perform cardiovascular checks, manage long term conditions, give flu jabs and provide advice for minor conditions. Reactions from both camps are skeptical, as expected, with GPs raising concerns over the plans, despite the DoH claims they would save every GP the equivalent of around one hour per day. GPs seem to see the new proposals as a threat, and quite rightly. If the government gets its way, what will be the next step? Will GPs be allowed to dispense? Meanwhile, the pharmacists' camp supports an extended role for pharmacists, although RCGP chairman Professor Steve Field also raised concerns it could lead to fragmentation of care for long-term conditions. Another concern is liability in terms of patient safety. What happens if a pharmacist prescribes a drug and something goes wrong? Who will hold the patient's medical record and at the end of the day, who will be responsible for it?  For the pharmacist-GP 'partnership' to work efficiently, it will be crucial for any results of tests or checks carried out by a pharmacist to be communicated to the patient's GP. Finally, the issue of a potential conflict of interest needs to be dealt with as pharmacists will be giving advice while selling certain types of drugs. But if both parties make an effort, this strategy could work. As Health minister Ben Bradshaw summed it up: ‘These proposals are not about pharmacists taking over the work of GPs - it's about complementing them, taking pressure off GPs and enabling them to spend more time with those patients who really need it.' Can GPs and pharmacist get over their disagreements and work together? It's up to them. Posted Apr 15 2008, 11:52 AM by Emilie Reymond with no comments

• Healthy badgers mean healthy people

  ‘Healthy cattle, healthy badgers, healthy people’. This is the chorus of a song that the staff of the Welsh veterinary office link arms to sing, both before and after their weekly team meetings. Actually, they don’t. I made that bit up. But this was the phrase used by the chief veterinary officer of Wales when she announced a controversial cull of badgers to help prevent bovine TB. Look out soon for a poster campaign featuring a very healthy, cuddly, badger cartoon character. Apparently, only about 1 per cent of human TB cases come from the farmyard variety, but of course it’s worth mentioning, if not singing. The RSPCA opposed the cull as 'unscientific', while emphasising 'we are not a bunch of badger huggers'. But the only thing that seems clear in this debate is that nobody really knows whether a badger cull will make any difference to bovine TB levels, or in turn human health, but the government is proceeding on a ‘something must be done’ basis. Lots of emotion, lots of public relations, but very little evidence. It’s a bit like the DoH’s approach to dispensing practices. Come to think of it, there’s a poem by Roger McGough that describes how, long ago, the nasty badgers killed off all the nice goodgers in order to dominate the countryside. And that seems as good a reason as any for a cull – so let’s give them a taste of their own medicine. Doing nothing is not an option. Posted Apr 14 2008, 02:54 AM by Colin Cooper with 1 comment(s)

• Error on site - our servers are down

  As you may have noticed we experienced some problems with the site this week, in particular on Wednesday and yesterday afternoon. With error messages monopolising the screen it would have been easy to loose one's temper. But if you managed to stay composed despite this imposed inability to access the news, the clinical sections, and some much-needed drug information from MIMS online, your patience will be rewarded as the site is back to its old self this morning. This week's episode made me realise how the Internet is dramatically impacting many aspects of our lives and how frustrating it is when we cannot access the resources we need at the very second we need them. It's almost absurd how we now expect things to happen instantly and how vulnerable we become without immediate access to the web and its gigantic database of resources. Even when you leave your mobile phone at home it's like you're missing a vital organ. It would be interesting to get your feedback on how Healthcare Republic's technical difficulties on Wednesday affected your day. In fact we're so interested in finding out more about healthcare professionals' habits toward the Internet in general and how they use email and the web to source information that we've put together a survey... If you spare a few minutes to complete it you could win a iPod classic with Bose SoundDock. Ok we are not trying to bribe you here but a little incentive can't hurt, can it? I believe the results will be fascinating to say the least. Posted Apr 11 2008, 11:54 AM by Emilie Reymond with no comments

• Hair colour and socks - the better way of choosing a GP?

  I would like some funding for a study please. I wish to research whether doctors with red hair produce as many publications and contribute as much to medical education as those with other hair colour or indeed those with no hair. If they don't, then I will be making my recommendations about how this should affect medical school recruitment. A bit anti-ginger do you think? Potentially racist, as I might be singling out those of ‘celtic origin' from their colleagues? Perhaps my study should be on doctors who need glasses or those who prefer green socks? (At this point I should point out that I am of celtic origin, wear glasses, have plenty of ginger relatives and own at least one pair of green socks.) I'm also female which prompted my musings on this potential study, because it is possible to argue that the recent BMJ article on gender in medicine was prompted by an equally arbitrary division. But somehow it is one that is ‘acceptable' to use. Rather than saying that women's entry into medical school should be restricted because they are less likely to do out-of-hours, there should be some simple rules that should apply to medical students and doctors as much as anyone else. First, are the most suitable candidates being recruited in terms of their qualifications and measurable abilities? After that comes the question of performance in a role. Is the doctor, tall or short, of whatever ethnic origin, normal-sighted or not and regardless of sock colour, doing the job well? If not, why not? Is it because of problems that could be tackled or a lack of support - among which one problem might be with child care regardless of the doctor's gender. If so, then that is the issue to tackle. If they turn out to be unsuitable for the role or simply not putting in the effort then perhaps they should not be in the job. If we are to continue the out-dated practice of assuming someone won't be capable or suitable for a job in the future because of their reproductive organs, we may as well decide these matters on hair colour or footwear choice. Either way we will be missing out on talent and that is of no benefit to anyone. Posted Apr 10 2008, 03:02 AM by Bronagh Miskelly with no comments