The Doctor - issue 42, April 2022

The magazine for BMA members

thedoctor

Issue 42

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April 2022

Remember them The doctors lost to COVID, in their families’ words

Fighting back The campaign to rebuild general practice

Human rights New guidance for an uncertain world

Taxed out of a job Pensions rules drive senior doctors away

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In this issue 3 At a glance The BMA Scottish conference meets face to face to discuss health policy

4-7 Taxed out of a job Punitive pensions taxes continue to burden consultants, forcing some to reduce commitments or retire early

8-11 See one, do one, write one Three doctor authors explain why they write

12-17 Remembering them Families of doctors lost to COVID pay tribute to their loved ones

18-19 The fight back The campaign to rebuild general practice, and to give GPs the time and resources they need

20-21 Everyone’s rights,

everyone’s concern The sheer breadth of human rights, and the challenges faced by doctors across the world, are highlighted in a new BMA report

22 Your BMA Understand the process of the BMA annual representative meeting

23 On the ground A junior doctor was underpaid for six years and the BMA helped him recoup his earnings 02

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Welcome Chaand Nagpaul, BMA council chair I led a special and moving memorial service last month to reflect on the courage and bravery of colleagues who tragically lost their lives during the COVID-19 pandemic – lives which they dedicated to the pursuit of helping others.

A special stone memorial now resides in the central courtyard of BMA House, in London, and will serve as an enduring symbol of respect and remembrance to each and every one of those doctors.

At the event we were joined by some of the families of those who died, and in this issue of The Doctor we speak to them about their loved ones, their careers and legacies – including hearing about the patients whose lives they touched.

As I said at the memorial service, the deeds of these doctors will inspire generations long after this cruel pandemic has passed.

The NHS has a serious workforce crisis – we are short of some 110,000 staff in total.

The effects of this are brutal for doctors and patients with hospital rota gaps rife, general practices without the GPs to serve escalating demand, training and education compromised and the burden of mounting workload often leading to burnout and exhaustion.

This context makes it even more inexplicable that doctors with decades of experience are being forced to leave the health service owing to a punitive pension tax regime.

We have been writing about this issue for some time and the BMA has consistently lobbied the Government to take meaningful action.

Our feature shares the stories of doctors who are facing huge personal financial pain, essentially ‘borrowing’ from their future pensions to meet bills.

These sorts of situations will only lead to doctors retiring early and leaving the profession, further compounding this crisis.

In the April edition of the magazine we also cover the launch of a new campaign looking to rebuild general practice and discuss the BMA’s long involvement in human rights issues in the UK and around the world.

Read the latest news and features online at bma.org.uk/thedoctor Keep in touch with the BMA online at twitter.com/TheBMA

instagram.com/thebma

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WIKIMEDIA COMMONS

AT A GLANCE

Together again: doctors discuss COVID, workforce and global health Around 100 doctors and medical students gathered in Edinburgh for the first BMA Scottish conference to be held in-person since 2019.

Understandably, emotions were running high for some.

‘It’s absolutely brilliant to be in the same room with people,’ said Maeve McPhillips, who was wearing a mask decorated with caged birds. ‘But refraining from hugging people is very hard after two years.

‘I’m looking forward to the guest speakers, but really the big thing is seeing people again, and networking again. Zoom and Teams meetings are all very well, but it’s actually the human touch that makes the difference.’

Dr McPhillips, a retired consultant paediatric radiologist, probably spoke for most of the people there when she mentioned the joy of meeting people again (although maybe fewer agreed on the hugging).

Doctors and medical students from across Scotland who had made the journey to Pollock Halls on a beautiful early spring day were palpably bma.org.uk/thedoctor

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excited to be meeting up again after a spell where the pandemic had paused such face-to-face gatherings.

Not that COVID was ever far from delegates’ minds.

The Doctor spoke to several who had just recovered from Omicron – all were very keen to point out they had negative lateral flow tests before attending, and, as you would expect, COVID precautions such as mask-wearing and spaced chairs were in place.

The conference was labelled ‘What next for Scotland’s doctors?’ and it was clear that COVID was going to be part of life for some time to come. The effect of the pandemic was threaded through the day’s agenda, including talks directly and indirectly addressing it and its effects.

For example, one of the parallel sessions focused on long COVID and working with it and other chronic conditions, while an update on medical ethics addressed many of the ethical concerns flagged by the pandemic, such as vaccine mandates and moral distress.

The afternoon’s keynote speaker, BMA president Neena Modi, dealt with broad topics – and spoke about the importance of considering health as a part of each and every one of them. She discussed her BMA president’s project, which calls for human health to be recognised as a policy priority along with the environment and planetary health.

Although the conference dealt with global themes, there was a clear mood in the various rooms – and outside in the sunshine – that it was being together that was the most important aspect of the meeting for many.

‘It was great to meet up with everyone in person,’ said Jane Barraclough, a sessional GP in Portobello, near Edinburgh.

‘I’ve been to BMA conferences before and it’s important to keep abreast with things, but what was really good was that it was in-person [rather than online]. It’s harder to have that sort of informal chat when you’re not in a room with people.’

By Jennifer Trueland

MODI: Discussed president’s project

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GETTY

Taxed out of a job At the time when the health service needs all the talent it can get, punitive pensions taxes are forcing many senior doctors to reduce their commitments or leave their jobs. Jennifer Trueland reports

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hen Andrea Howes hit the top of the consultant pay scale – combined with a pay uplift for taking on clinical director responsibilities – she was ‘rewarded’ with a substantial pension tax bill.

Her new salary meant that her pension growth went well above the annual allowance of £40,000 and led to a five-figure tax penalty.

‘For something that I’ve essentially got no control over at all – short of reducing my hours or coming out of the pension – I’m liable for a significant tax bill,’ she says. ‘And it’s likely that I’ll have exactly the same problem again this year.’

Dr Howes is a consultant radiologist and clinical director in a busy trust in the northwest of England, leading on skin cancer. She works 10 PA (professional activity) sessions per week, which is technically full time, but less than some of her colleagues. She is very committed to her job and doesn’t want to go part-time – not least because she feels a strong moral and ethical responsibility to her patients.

‘I could probably afford to reduce sessions, financially,’ she says, explaining that some of her colleagues have already done so, specifically to avoid pension tax. ‘But there’s just too much work to be done in nuclear medicine. There are only two of us that do that subspecialty in our hospital, and there’s only two of us that cover the skin cancer service. So, if I cut sessions, we basically wouldn’t be able to continue to provide the services that we provide.’

Cutting sessions Punitive pension charges are having a severe effect across the country, on individuals like Dr Howes, who has taken a personal financial hit, but also on services. At a time when the NHS is struggling with an enormous treatment backlog, and a shortage of doctors in many specialties, individuals are looking at their options with many deciding to cut sessions or even retire early in an attempt to mitigate the pension tax issue.

Like many, Dr Howes elected to use ‘scheme pays’ – essentially borrowing from her pension to meet her bill, but she is aware this will affect her financially in future, particularly as she will have to pay interest on the sum borrowed.

This is a situation Professor Claire Hopkins knows only too well. It was in the financial year 2015-16 that she was landed with her first pension charge. She was hit by a ‘perfect storm’

when a bronze merit award coincided with the discovery that she had been underpaid in her first four years as an ENT consultant, and also a transition to the 2015 pension scheme.

‘It all came at once,’ she says. ‘That year I got a £78,000 charge against my pension for an increase in the annual allowance – and my salary that year was £96,000. In terms of the added value of my merit award over the five years it covered, I was charged more than the value of the award itself.’

Professor Hopkins, who is a consultant in ENT at Guy’s and St Thomas’ NHS Foundation Trust, and professor of rhinology at King’s College, London, used ‘scheme pays’ to meet the astounding bill, but the interest charged on that continues to deplete her pension pot.

‘At first I thought it must have been a mistake. It just didn’t seem possible that I could be having to pay back more than I’d paid in, even with the employer’s contribution. I did have it checked, but that’s part of the problem – because the NHS pension is so complex, it’s almost impossible to find someone who understands it and can give assistance.’

But that wasn’t the end of it. ‘The £78,000 was pretty shocking, but every year since then I’ve had a charge of about £15,000 to £20,000,’ she says. ‘I turn 50 this year, and I’m not going to be retiring for some time, and I now have a pension that already has £200,000 plus interest in debt against it. I’ve also had some periods of maternity leave and working less than full time, so my average earnings are going to be dented by that. And if this carries on growing in terms of what I’m charging against scheme pays, I’m really concerned that by the time I come to retire I will have completely depleted my pension and there will be nothing left.’

Penalised for extra work The charges are putting people off taking on additional responsibilities and work, she says.

‘I work until midnight most nights, and I am constantly exhausted,’ says Prof Hopkins, who conducts most of her research on a voluntary basis. ‘The NHS is a pretty tough environment to work in. It just doesn’t seem worth going over and above a 10-PA job when we’re being penalised for doing it.’

The ENT backlog is one of the worst, she adds, and while colleagues want to help, many feel they cannot take the financial risk. ‘We’re already working over and above a full-time

‘It didn’t seem possible that I could be having to pay back more than I’d paid in’

‘I have a pension that has £200,000 plus interest in debt against it’

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NEIL HODGE

ROBERTSON: ‘It becomes pointless to stay on’ HOWES: Cutting sessions would mean services could no longer be provided

‘I’d work at weekends to catch up but with such big penalties, I simply can’t’

contract, we’re already taking on things without pay. But when it comes to taking on extra sessions, there’s no incentive, partly because we’re all burned out and exhausted, and partly because we know it’s going to increase those charges against the pension.’

Doctors can take steps to mitigate exceeding the annual allowance and should take expert advice. Dr Howes has chosen that the remuneration for her clinical director responsibilities should be non-pensionable, for example, while Prof Hopkins has given notice that she intends to drop one session per week, taking her from 12 to 11. ‘I’m still working more than full-time, and I feel torn doing it because I know the pressure we’re under. But I want to try and pull myself out of this perpetual round of pension charges and get to a point where it doesn’t apply.’

Misconceptions

‘My manager knows now not to ask me to do extra because I can’t afford to earn more’

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The level of public misunderstanding about NHS pensions is also a problem, she adds, with many people making the assumption that if someone is being charged, for example, £40,000 in a year, they must be earning at least £500,000 (rather than it being based on the perceived annual growth of the pension pot).

It is these misconceptions that make some doctors reluctant to talk openly about the effect the charges have on them.

Nadja (name changed) is a case in point. She would only speak to The Doctor on condition of anonymity because she had already been criticised on social media for daring to complain that her ‘gold-plated’ public sector pension was being hit by charges.

She received a ‘shock’ £37,000 bill that

coincided with her hitting the top of the consultant pay scale and a clinical excellence award. She had also received some back pay because she had found out her male colleagues were being paid more than her, and had successfully challenged this.

‘As a result, my income that year went up quite substantially,’ she says. ‘I had no idea that it would have such an impact on my pension, and I’m sure lots of doctors are the same.

You get these pieces of recycled paper from the HMRC saying you might owe them some money because of your pension contribution, but it doesn’t tell you what, and says you have to work it out for yourself. So, I had just been thinking that if they actually wanted my money they’d tell me in more detail, so I put it to one side.’

A chat with a colleague made her realise she had to take it seriously, she adds, and she made contact with a pensions expert, who told her to go to the pensions agency to get the precise figures for each year.

‘I rang him and told them the numbers – reading them off like a child on the telephone – and he went very quiet, and said, “I’m sorry, I think you’re going to have a huge sum to pay”.

And, of course, I’d ignored these forms – there were no threatening letters or anything – so I had missed the opportunity to use scheme pays for that year.’

As the sole breadwinner in her family, she didn’t have that sort of money ‘lying around’, she says, so she took out a loan to cover it.

But the shock bill has had an effect on her willingness to take on additional work. ‘My manager knows now not to ask me to do extra because I can’t afford to earn more, when what it will mean is that I get another nasty surprise.’

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Earnings negated As a senior consultant, she worries that the pensions situation will drive those with the most experience out of the health service earlier than they otherwise would have retired.

She is also concerned about the effect this will have on junior colleagues. ‘What I’ve learned over the last ten to 15 years is how to impart knowledge to juniors and to my patients in a way they will understand. Obviously, I still do this with my patients, but I probably don’t teach my juniors as much as I potentially could because I’m not there as much.’

She also worries about the backlog, but simply can’t afford to be charged more than she earns. ‘If I had the option, I’d work at weekends to catch up and make sure that patients don’t suffer a backlog, but with such big penalties, I simply can’t.’

The BMA has been calling for a reform of the rules for some time. In March, BMA pensions committee chair Vishal Sharma warned the UK parliament’s health and social care committee that the ‘counterintuitive’ pension taxes were forcing doctors to retire early or reduce their hours.

Losing doctors Alan Robertson, a member of the pensions committee and joint deputy chair of the Scottish consultants committee, says that the health service is losing doctors with decades of experience because of the pension tax regime.

‘I’ve got colleagues in their mid-50s who would definitely have stayed until their 60s, but who are looking at going in the next couple of years – it becomes pretty pointless to stay on because you’re paying so much in tax that what you’re gaining for all that work is not that much. And that means the NHS is losing incredibly experiences people. It’s completely wrong.’

The BMA is encouraging members to write to their MPs and to elected members in the devolved parliaments to call for pension tax reform. It also runs regular webinars for members to keep them up to date – and advises doctors to be aware of their own particular pension situation and to do their best to mitigate the charges, such as timing applications for discretionary points or clinical excellence awards so that they don’t coincide with a pay increment. bma.org.uk/thedoctor

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DANGERFIELD: University scheme changes undermine pay parity with NHS

Think carefully Those mulling a move from the NHS to the university pension scheme need to consider the implications closely A senior medical academic is advising doctors to think carefully about their pension arrangements if they are moving to an academic post.

Peter Dangerfield, co-chair of the BMA medical academic staff committee, says changes to the USS (universities superannuation scheme) might make it less advantageous for doctors than it was previously. This is partly because the salary threshold in the USS is reducing from just under £60,000 to £40,000. Retirement income benefits will only be available on salary up to this point.

Contributions beyond that point will go into a separate investment scheme, which is a defined contribution rather than a defined benefit.

‘A majority of doctors earn a lot more than £40,000 so that’s a major problem because it will diminish the benefits to members and undermine the principle of pay parity [between the NHS and universities],’ says Dr Dangerfield. ‘The simple message is that if you are thinking of moving from the NHS scheme to the university scheme, think very carefully about it, and look at the implications.’

The BMA website has information about pensions and the organisation holds regular webinars on different pension-related topics.

Visit bma.org.uk/pay-and-contracts/pensions

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SEE ONE, DO ONE, WRITE ONE It can be a way to let off steam, make sense of things, capture a moment or even create alternative realities. Three doctorsturned-authors explain why they write. Interviews

by Seren Boyd

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Consultant anaesthetist and GP John Duncan published his first book at the tender age of 88. His memoir, The Best of Health, paints a vivid portrait of life as a medical student and junior doctor in Edinburgh in the 1950s and 60s – an extraordinary lost world

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t was an article in the BMJ that suggested medicine as an alternative career after the Suez Crisis forced the closure of the Duncan family pottery in Stoke-on-Trent. The dean of medicine at Edinburgh University was keen to recruit ‘from non-scientific backgrounds’. John Duncan applied and was accepted without an interview.

Dr Duncan’s descriptions of Edinburgh Royal Infirmary, a world-class teaching hospital, depict a cloistered world where juniors were treated like ‘prize poultry’. The residents’ mess served them three meals a day and had a butler. ‘The… belief was that well-fed young people work better than hungry ones,’ he writes. Laundry and shoepolishing were included.

These were optimistic days when the NHS was in its infancy and where men – mostly men – who had been schooled in the theatre of war were pushing at the boundaries of science and surgery. Anaesthesia for children undergoing openheart surgery at the time included lowering them into ice baths to slow their heart rate. One of his surgeons, James Sneddon Jeffrey, had been involved in the earliest trials of penicillin in war wounds in North Africa.

‘In Sir Derrick Dunlop’s introductory address to us in October 1957, he said, “I envy you young doctors the ability to prescribe for your patients the treatment they need, rather than what treatment they can afford”. His words have stayed with me ever since.’

Medicine was evolving fast and Dr Duncan witnessed

some difficult births. The first call out of Edinburgh’s surgical flying squad, precursors to paramedics, was to a window-cleaner impaled on railings. The ‘crash hamper’ of emergency care essentials was a giant laundry basket which proved too big for the ambulance, a converted bread van. The patient survived but the flying squad was mothballed for a decade.

Dr Duncan’s passion for writing was triggered six years ago when he wrote daily emails about their shared wartime childhood to his dying brother, Gregor.

‘Writing those emails became a daily discipline of memory, unlocking rooms in my mind that, once opened, seemed remarkably bright and free of dusty neglect,’ he says. The prospect of a medical school reunion gave added impetus.

Dr Duncan is keen to commit to memory what he calls the ‘golden age of the health service’ – as a marker of what was once possible and how far we’ve come.

The foreword to The Best of Health says it contains ‘a moral lesson’ too, about the need for transparency and openness. Without these, an unreported blood sample contaminated with Hepatitis B was able to infect medical staff and patients, with several fatalities.

By contrast, the monthly ‘death meetings’ in the surgical lecture theatre, where senior doctors discussed difficult cases for mutual learning, were key to a young doctor’s education. ‘The search for truth was more important than where to lay the blame,’ says Dr Duncan. ‘Medicine generally runs best on coordination and cooperation, not competition.’ thedoctor | April 2022

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GP Jo Cannon turned to creative writing as a way of helping her to process complex cases and better understand difficult patients. Her short-story collection, Insignificant Gestures, explores character, motivation – and alternative endings

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eing in general practice in multicultural Sheffield has meant a varied case load – and rich fodder for her fiction. In her professional life and her writing, Dr Cannon has tended to side with the outsider, the stranger, the struggler, and has sought to understand their backstory.

The three years she spent in west Malawi with VSO (Voluntary Service Overseas) in the late-80s fuelled this fascination. It was a tough training ground – and a window on an extraordinary world she’d spend years trying to make sense of, including through storytelling.

Newly qualified as a GP in the UK, she became ‘district health officer’ for Mchinji, near the Zambian border – responsible for everything from obstetrics to tropical diseases. Caesareans were memorably medieval, sometimes involving funnels and sieves, and her ‘clinical assistants’ had the most basic of training.

And a silent killer was on the loose: HIV. ‘It was spreading rapidly and the suffering was extreme,’ says Dr Cannon.

‘All the staff were dying: the dentist, the chemist, all the young people. When I raised this with the visiting minister of health, she said: “This is restricted information: you’re not to do anything with it.”’

This international perspective, and a love of the BBC World Service, has helped her connect with migrants and those on the margins. Many have traumatic backgrounds, some challenging behaviour.

‘GPs hear a lot of trauma but we don’t have any formal means of dealing with it – and a friend told me 10

about a reflective writing group for GPs that was for “increasing empathy with difficult patients”. I’ve been writing ever since.

‘I’ve had the most demanding patients, with unstable emotions and attachments, and it can take a long time to discover they were actually torture victims suffering posttraumatic stress.’

Insignificant Gestures explores difficult themes, from domestic violence to obsessive compulsive behaviour. But its stories also celebrate the healing power of love and acceptance. An account of a transgender woman’s smear test embraces both.

Where fictional characters are inspired by real patients, they are always composites.

One of the most helpful exercises Dr Cannon employs in her stories is to ‘try to write the consultation from their point-of-view’. ‘You ask yourself: What do they really want? Why are they endlessly seeking help and rejecting it?’

Over 30 years in general practice Dr Cannon has had the privilege of journeying with patients through dark periods – and seeing them emerge at the other end. The ‘decline of continuity of care’ these days, however, means she may no longer see ‘what happened next’.

Writing fiction allows her to administer a prescription, a solution – even if in reality situations remain unresolved.

‘Sometimes, after a surgery, you’re left sitting with emotions, even if your patient tells you they feel much better after seeing you. In writing you can always have things come right in the end.’

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Intensive care consultant Aoife Abbey has used her writing to help her reflect – and to open a window on a world most people rarely see. She wrote Seven Signs of Life while still a trainee

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or Dr Abbey, writing has been the headspace that has enabled her to navigate the uncertain, uncontrollable intensity of ICU. A difficult case while she was still a foundation doctor prompted her to submit a piece to the forerunner of The Doctor, which led on to a BMA blog under the guise of ‘The Secret Doctor’, which led on to her book.

Seven Signs of Life explores the maelstrom of emotions encircling staff, patients and families, and corrals them into key themes: grief, anger, joy, fear, distraction, disgust and hope.

It’s an honest and frank reflection of her wrestling to respond well to patients’ and families’ fears, to make sense of their suffering. She grapples with hope, refusing to dispense it blindly. ‘I can think of few responsibilities greater than handing somebody hope,’ Dr Abbey writes.

It charts her journey towards learning to sit with people’s fear without trying to ‘reshape it’, and accommodating herself with death, as a part of life. And she talks frankly about the things she can’t resolve, about mistakes. She writes, it seems, to refuse cynicism, to stay alert to her feelings.

‘I write to challenge myself and my understanding of things,’ she says. ‘I write to pay heed to the experiences I share with people.’

Dr Abbey writes for those who will probably never visit her workplace. ‘Before the pandemic, public awareness of what intensive care was and what happens when you walk through those doors was minimal. I felt

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there was some value in bringing people inside that, mainly to point out the people at the heart of it all and how much we all have in common.’

Understanding different perspectives is vital in a role that constantly demands ‘patient best interest’ decisions. It’s why Dr Abbey loves, and recommends, reading. And part of her aim in writing is to offer a different narrative and standpoint from the one that she feels medicine more typically presents.

That can make writing feel risky – especially as a relatively young woman in a male-dominated specialty.

‘I receive such wonderful support from the people I work with,’ says Dr Abbey.

‘But there is this cult of what it is to “be a doctor”, how we think a doctor should look or speak, and what we should value. Being who you really are – and being a doctor – shouldn’t be about “breaking a mould”.

‘Things are getting better, but I still have sleepless nights each time I write something. It can feel like we’re at risk of losing the currency of professional esteem at any minute.

‘Modern medicine is miles away from where it was 50 years ago, but we still have a way to go to foster a culture which is undeniably supportive for everyone and which makes space for individuals. Many of our systems continue to reward and make it most safe for those fitting specific norms to be at the fore, both internally and publicly. We don’t yet treat all doctors and future doctors equitably.’ thedoctor | April 2022

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SARAH TURTON

Ahmed Patel (left) and a photo of his late father Dr Yusuf Patel

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Remembering them Forty-nine UK doctors are known to have lost their lives to COVID, having toiled selflessly for their patients in the face of the pandemic. As a new memorial is unveiled at BMA House in London, Tim Tonkin speaks to the families of some of the departed

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amela Foley recalls well the ‘incredibly unlikely circumstances’ under which she and her future husband Amged El-Hawrani first met each other in June 1988.

Having missed their bus home, Pamela and a friend had decided to hitch-hike. The car that eventually picked them up was being driven

by Amged, then a medical student at the Royal College of Surgeons in Dublin, and a friend.

‘They were on their way to purchase frogs for dissection purposes,’ says Pamela.

‘They stopped to ask us directions and they ended up giving us a lift the whole way home many miles in the opposite direction of where they were actually going to, and that’s how we met.’

After marrying, travelling and living in different parts of the world together, Amged, Pamela and their son Ashraf settled and built their lives in Staffordshire, close to where Amged worked as a consultant in otolaryngology at the University Hospitals of Derby and Burton.

Then on 28 March 2020 Amged’s life, a life that had centred upon his family and the quiet acts of heroism in his career, tragically came to an end at just 55 years of age following a short battle against COVID-19.

One of 49 doctors across the UK to date known to have lost their lives to the virus, Amged’s name and life was among those honoured and commemorated by the BMA at a special memorial service in London on 16 March this year.

Attending the event with Ashraf and Amged’s brother Amal, Pamela says the memorial was deeply important to her, in large part because of the restrictions that had been

imposed on hospitals during the first lockdown.

‘Amged passed away in the very early stages of the pandemic, so we couldn’t be by his side through his time of illness,’ she says.

‘The restrictions also meant we couldn’t conduct an appropriate funeral. The absence of a funeral deprived Amged of the remembrance he deserved and denied our family the chance to communally honour his name.

‘I feel this memorial exists as a crucial opportunity for us to acknowledge the selfless nature of the health workers who lost their lives in the battle against COVID. These people died in the line of duty and should be forever admired as the heroes they are.

‘I also feel that this memorial allows me and my family to reclaim part of the experience we lost, when we were prohibited from a traditional funeral and memorial service.’

‘These people died in the line of duty and should be forever admired as the heroes they are’

Hardworking and adventurous Born in Khartoum, Sudan, Amged El-Hawrani’s family moved to the UK when he was a boy after his father, a doctor, landed a job in the NHS, with Amged ultimately deciding to follow in his father’s footsteps.

After completing his studies in Ireland, Amged trained in hospitals in Wales and the Midlands as well as spending five years training in Scotland and, in 2004, taking a fellowship at Stollery Children’s Hospital Edmonton in Canada.

While incredibly hardworking and dedicated to his professional life, Amged also had an adventurous side. In 2010 he took part in an expedition to Mount Everest in an effort to raise funds for a new CT scanner at Queen’s Hospital, Burton. thedoctor | April 2022

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NEIL TURNER

Zehra Zaidi and a photo of her late father Dr Syed Habib Haider Zaidi

‘He would always help people and was selfless in so many ways’

‘He would go out on Christmas Day and deliver someone’s baby’

In the months following Amged’s death, dozens of his former patients wrote to Pamela expressing their condolences.

One patient mentioned how Amged had once relayed to them the story of how he had met Pamela, and how he had told them that, on a day when he had been looking for frogs, he had ended up ‘finding his princess’.

‘I’m completely overwhelmed by some of the things that patients have said about him in letters, about how he has saved so many lives,’ explains Pamela.

‘To save a single life a is feat that will forever be respected. The requirement of Amged’s role led to saving lives on a consistent basis.

‘Amged lived his whole life treating everyone with kindness. He wanted to fix everything and everybody, whether it was physically or mentally. Praise and approval were meaningless to him, he was only gratified through witnessing the result his input had on the people he cared for, both professionally and as a husband, father, brother, son and friend.’

Loved and respected Syed Habib Haider Zaidi had been a GP in Leighon-Sea in Essex for more than 45 years having worked for the NHS for more than 50 years.

Although his original dream had been to 14

become a surgeon, he chose to pursue a career in general practice to focus on his growing family.

As such, he threw himself into becoming a GP, first working on a salaried basis before eventually partnering a three-site practice consisting of more than 17,000 patients along with his wife, Syeda Talat Zaidi.

Alongside running their practice, the pair also raised four children, all of whom ultimately went on to work as NHS doctors or dentists.

Dr Zaidi, who was 76, passed away in hospital after contracting COVID in March 2020.

His daughter Zehra, who is a GP herself, explains how she had grown up watching the respect in which her parents were held by their local community.

‘My dad was ultimately a really helpful person just in life in general, he would always help people and was selfless in so many ways,’ she says.

‘He would go out on Christmas Day in the middle of Christmas dinner, and deliver someone’s baby, or he would go and see a sick child.

‘People would stop him in a supermarket, or whilst out locally all the time. I can remember one old lady saying thank you for fixing my knee. He loved helping people [and] people

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SARAH TURTON

Dr Nagpaul addresses the memorial event at BMA House

SARAH TURTON

BMA president Neena Modi delivers a speech to the memorial event

genuinely loved him, he was a community person.’

Zehra explains how her father had used his business skills to fund the building of a primary care endoscopy unit, to allow surgeons from the hospital to come and do colonoscopies and gastroscopies on cancer patients, thus relieving pressure on existing NHS secondary care services in the area.

She says that, since his passing, she had sought to avoid feelings of anger or resentment about his death, on the grounds that she felt such emotions would stifle her and her family’s ability to heal.

She notes, however, that not being able to be with her dad in his last days because of the strict health restrictions in place during the first lockdown, has been very hard to take.

‘I couldn’t even travel to see him because the hospital wasn’t letting anyone in, even if you were on ITUs or were ventilated.

‘He worked really hard, probably to his detriment, because he was working till he died.

He never had a day off, he never retired [and] he never got to do any of the things they should have done [and] gave so much to the NHS. ‘He was a great man, a great family doctor and the most generous and loving individual I have ever known, constantly putting his own

needs beneath those of others and we all miss him immensely.’

Family man Yusuf Patel came to the UK from Malawi in the 1960s as a seven-year-old boy.

The son of Indian parents, he became the first doctor in his family, graduating from Sheffield medical school in 1984, before going on to forge a career in general practice in East London, where he founded the Woodgrange Medical Practice in Forest Gate.

Dr Patel’s hard work and dedication eventually saw his surgery receive an outstanding rating from the Care Quality Commission in 2017.

As well as being a full-time GP partner, he was also a committed family man who doted on his wife and three children, while also caring for his mother who suffered from dementia.

When news of COVID-19 first began to reach the UK in early 2020, Dr Patel tried to do everything he could to prepare for an uncertain and foreboding near future.

‘He was sending out messages to everyone and phoning friends and relatives, warning them to be cautious,’ says Dr Patel’s son Ahmed.

‘He was going into work “unarmoured”, but

‘In life he sacrificed a lot of himself for others, that was his nature... he didn’t have any airs or graces about him’

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SARAH TURTON

Dr Vish Rasiah on holiday in Tobago in 2004

LIZA HARRY

Dr Harry (left), her niece Alexandra Ramcharitar and daughter Katelyn (below) at the newly unveiled memorial at BMA House

‘I would like Vish to be remembered for his dedication and his humility and selflessness’

16

he still wanted to be part of the [response] plan and he was still there making plans about how they were going to react [to the virus].’

Falling ill shortly after the announcement of the first national lockdown, Yusuf immediately self-isolated before later being admitted to hospital.

He passed away on 20 April 2020, 10 days after having been placed on a ventilator.

The level of respect and gratitude felt towards him in his local community was demonstrated when a charitable fundraiser set up to continue his legacy saw more than £30,000 donated.

Describing his father as a pioneer within his family and community, Ahmed says that, as remarkable as his achievements were, his dad had been one of the most humble and downto-earth individuals he had ever known.

‘I think he always wanted to be a familyorientated doctor [and] he had always aspired to open up his own surgery and provide the best possible care for patients,’ says Ahmed.

‘He bought a property – it was literally a derelict bank – and he built it from scratch, starting from a small number of patients to over 16,000 patients as of today.

‘He was very business minded, very sharp, but also had a very generous heart. He always cared for his friends, his relatives and treated his staff like family. He gave opportunities to staff offering partnerships to people, who were 10 to 20 years younger than him which is pretty unheard of.

‘In life he sacrificed a lot of himself for others, that was his nature. He could talk to young people, old people, educated or uneducated, he didn’t have any airs or graces about him.’

Nature lover Consultant paediatrician Liza Harry describes how she met her future husband Shree Vishna Rasiah nearly 20 years ago while they were working at Jessop Wing, the maternity and neonatal hospital in Sheffield.

Known as ‘Vish’ to his family, friends and colleagues, Dr Rasiah had been born in Malaysia and after completing his primary medical qualification in Australia, had come to the UK to further his studies.

After completing his training at Sheffield, Vish went on to take a research role then a post as a consultant neonatologist in Birmingham.

As well as his consultant role, he became the clinical lead for the Southern West Midlands maternity and newborn network.

Vish and Liza married in 2005 and later settled together in Worcester where their daughter Katelyn was born.

Outside of medicine, Dr Harry says her husband was passionate about the natural world and was also a keen photographer.

He was the unofficial designated photographer at work and would take pictures of and for the team whenever there was a celebration or important event on the neonatal unit.

In early 2020, as the shadow of COVID lengthened across the globe, Dr Harry explains

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SARAH TURTON

Dr Abbas Zaidi, Dr Zehra Zaidi and Syeda Talat Zaidi

AHMED PATEL

that her husband seemed increasingly frustrated by the UK Government’s slow response to the looming crisis.

‘I remember when all the reports were coming out about what was happening in Italy, he was apprehensive that we would be in a similar position within a fortnight or less here in the UK,’ she says.

‘He was frustrated at the slowness of the response. I remember he said in early March that he didn’t understand why more wasn’t being done.’

After falling ill in mid-March 2020, Vish was admitted to hospital on the 25th of that month, before being transferred to the ICU two days later.

Dr Rasiah died on 23 April 2020. Dr Harry says her husband’s passing has left an ‘indescribable void’ in her and her daughter’s lives.

Having attended the special memorial event at BMA House last month, Dr Harry says that such remembrances are so important.

‘I would like Vish to be remembered for his dedication and his humility and selflessness.

And his commitment not only to always putting his patients first, but to training the junior doctors he came into contact with to work to the same high standard,’ she says.

‘It means very much for him to be remembered officially in the way that the ceremony [at BMA House] did, because it means that people are hearing his name and his memory is being kept alive.

‘Anytime that he is remembered and bma.org.uk/thedoctor

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honoured is painful but it is also comforting in a way to know that many others remember as well.’

Courage and bravery A stone memorial now resides in the central courtyard of BMA House, designed to serve as an enduring symbol of respect and remembrance in honour of every doctor who lost their lives during the pandemic.

The extent of their sacrifice was a source of solemn reflection for BMA council chair Chaand Nagpaul who, in his address to last month’s memorial event, emphasised that the courage and selflessness of every healthcare professional during the early days of the pandemic would be remembered for years to come.

He said: ‘It is important to reflect on those first few weeks to understand the depths of courage and bravery that our colleagues displayed.

‘There was no guarantee of personal safety, amidst shortages of protective equipment, with no vaccination or effective therapeutics.

For thousands of doctors, nurses, healthcare professionals and support staff there was only the front line.

‘It is a cruel tragedy that, in saving the lives of tens of thousands of patients, so many doctors lost their own. They dedicated their lives to the pursuit of helping others. Their deeds will inspire generations long after this pandemic has passed.’

Ahmed Patel’s family, Rumaysa Patel, Maariyah Patel and Nasima Patel at the National Covid Memorial Wall

‘Their deeds will inspire generations long after this pandemic has passed’

thedoctor | April 2022

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ALL PICTURES: REBUILD GENERAL PRACTICE

UNITED: (left to right) Dr Sharrock, Dr Ward, Mr Hunt, journalist Hannah Vaughan-Jones and Dr McGregor

THE FIGHT BACK General practice is stretched to breaking point, with doctors reporting burnout and depression. A new campaign seeks to give the country the GPs it needs, and GPs the time they need to deliver quality care.

Peter Blackburn reports from the launch

‘F

WARD: Can’t give care patients deserve

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irst of all, can I say it’s a bit of a surprise for me to find myself on the same panel as the BMA. ‘I can remember six years ago cycling down Whitehall and there was a demonstration outside number 10 [Downing Street]. As I got closer, I found my name was on some of the placards. I did a rapid u-turn and thankfully no one recognised me in my cycle helmet.’

Six years ago, at the height of the dispute over the junior doctors’ contract, it would have been incredibly hard to imagine former health secretary Jeremy Hunt and doctors leaders from the BMA sharing a stage. Fast forward those six years and, at the launch of a campaign to rebuild general practice, that is exactly what happened.

As Mr Hunt, now chair of the Commons’ health and social care committee, said speaking

at the event at the King’s Fund in central London, that this was the case is a recognition of the stark seriousness of the times.

He said: ‘I’m as surprised as I’m sure the BMA are that I’m here, but the reason is that I fundamentally agree … that there is a crisis. I always believed that general practice is the beating heart of the NHS, it is what makes it special for many patients as well as being an incredibly important part of the prevention agenda and all the things we need to change in healthcare.’

Staff shortages A new poll of nearly 1,400 GPs highlights exactly the crisis Mr Hunt mentions, with doctors’ concerns focusing heavily on staff shortages and a lack of time in appointments as the main factors affecting patient safety.

The poll reveals that 86 per cent

of GPs feel they do not have enough time in consultations with patients and 77 per cent of GPs feel GP shortages put patient safety at risk.

The poll revealed that 80 per cent of Welsh GPs and 86 per cent of Scottish GPs have felt anxiety, stress, or depression in the last year. And 79 per cent of Welsh GPs and 65 per cent of Scottish GPs do not think they have enough time with patients to allow for a comprehensive diagnosis for patient safety.

The BMA and the GPDF are funding the campaign which urges the Government to deliver on its commitment to deliver an additional 6,000 GPs in England by 2024. The campaign also demands ministers and health leaders tackle the factors driving GPs out of the profession, such as burnout, and create a plan to reduce GP workload and improve patient safety.

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HUNT: Agrees there is a GP crisis

SHARROCK: Not enough GPs

Speaking at the launch of the campaign, BMA GPs committee deputy chair Kieran Sharrock said: ‘Even before the pandemic, general practice was on the edge.

Now, we are facing the biggest public health crisis in a century.

‘COVID has been relentless.

Every day, colleagues around the country tell me about the challenges they face. Each has a unique story, but they are all united in one message: We are stretched to breaking point.’

Not coping Dr Sharrock added: ‘To say healthcare staff are overworked is a titanic understatement. One survey from last July found that 51 per cent of GPs are suffering from burnout, depression, or other mental strain. And over the last year, the equivalent of 279 fully qualified, full-time GPs have left the workforce altogether.

‘When I ask colleagues why they are reducing their hours, they tell me: “I cannot cope.

I am burning out”.

‘Doctors worked around the clock to vaccinate and now, a backlog of non-COVID cases is starting to catch up with us, breaking like a tsunami over general practice.’

Recent data shows that on average GPs are conducting 37 appointments every day – bma.org.uk/thedoctor

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almost 50 per cent more than the recommended number of 25. Last November, GPs in England conducted more than 19 million appointments face to face. Dr Sharrock said: ‘Despite this heroic effort, demand is at record levels and there simply aren’t enough GPs. The result is our current crisis: hospital waiting lists are longer than ever. People are living with undiagnosed illnesses. And families know the frustration of sitting on the phone, on hold calling up every day to try to book a doctor’s appointment.’

Decision fatigue The campaign aims to give GPs across the UK the time back to deliver the quality of care they want to be able to give patients while ensuring they are cared for by the right team member. It also aims to resolve the difficulties many patients face in getting timely GP appointments and to benefit the NHS as a whole by alleviating pressure on hospitals.

It is hoped the campaign can also help to tackle the backlog which existed before, but has been exacerbated by, the pandemic.

Appealing directly to the Government, Dr Sharrock said: ‘Ignoring the wellbeing of our people is at the NHS’s peril… All

that we are asking is that the Government trust GPs to lead.’

On the panel launching the campaign were Oxfordshire GP Rachel Ward and York GP Brian McGregor.

Dr Ward said: ‘I feel I can’t give them [patients] the care they deserve and the care I know they need and that’s because every day we are basically firefighting.’

And Dr McGregor added: ‘When you see 46 patients a day you get decision fatigue and then there is a risk to patient safety.’

The BMA has repeatedly warned that the workforce crisis in the NHS and general practice is ‘not sustainable’ with vacancies soaring and GP numbers declining.

Dr Sharrock said: ‘GPs are rushing headlong for the exit, and the UK Government is planning another review in England. This is fiddling while Rome burns.

‘I implore our political leaders as the cost-of-living crisis bites: if you raise taxes to pay for NHS improvements yet fail to stem the flow of GPs out of local surgeries, standards will drop, waiting times will rise, and you will face a wall of public anger. We must rebuild general practice, together, now.’

Visit www.rebuildgp.co.uk

MCGREGOR: GP fatigue a risk to patient safety

‘We are facing the biggest public health crisis in a century’

‘GPs are rushing headlong for the exit’

thedoctor | April 2022

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Everyone’s rights, everyone’s concern Conflict, climate change and the entreaties of anti-vaxxers all have implications for our human rights and the context in which doctors work. A new BMA report stresses the sheer breadth of human rights and illustrates the challenges doctors face around the world. Neil Hallows reports

T ‘An ambitious and wide-ranging report’

20

he BMA has had a long involvement in human rights. Thirty-five years ago, when it brought out a report on medical involvement in torture, some human rights groups were surprised that a national medical association would wish to be active in their field.

In 1992, under the memorable title Medicine Betrayed, the BMA again addressed the issue of doctors being involved in human rights abuses.

And in 2001, when it published The medical profession and human rights: a handbook for a changing agenda, a leading Harvard academic wrote in the BMJ that the tone was ‘expansive’, to move the profession from ‘its narrow normative niche in medical ethics into the globalised secular debate on suffering and human values’.

In its new report, the BMA continues this theme – to stress the breadth of the concept of human rights, and the role and responsibilities of doctors around the world in upholding these rights.

In six chapters, the provocatively titled report, Health and human rights in the new world (dis)order, is also a reflection of troubled times.

‘Alternative facts’ While there are some parallels with the previous report, the chapter about the information age would have been unimaginable 20 years ago. It gives an overview of the rise of ‘fake news’ and conspiracy theories, such as the anti-vaxx movement, which has dealt such an unnecessary, often mortal, blow to the health outcomes of so many people. A world where information is so abundant and shared so freely carries with it the risk that, to paraphrase a former Donald Trump aide, for every actual, demonstrable fact, there are multiple ‘alternative facts’ that are anything but factual. In this relativist world, populist politicians target scientific experts who speak inconvenient truths. The report calls for coordinated programmes to improve digital health literacy, and campaigns to target dangerous misinformation.

A chapter on migration, ethnicity and health considers the difficulties that people from ethnic minorities have found in accessing healthcare. These include migrants and indigenous people, as well as refugees. This can also involve threats to medical neutrality, such as in the UK where doctors have been pressurised to inform authorities of patients’ migration status, which the BMA has strongly opposed. The report says that states need to acknowledge barriers to healthcare and address racial equities in healthcare.

The report also builds on previous work in strongly demonstrating the links between climate change and human rights, such as

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GETTY GETTY

Domestic concerns There are still some who see human rights only as a branch of foreign policy – something to condemn and campaign about only in less fortunate societies than our own. But the report makes clear that human rights need to be defended in the UK as well, and that our own actions profoundly influence them. The NHS, bma.org.uk/thedoctor

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GETTY

GETTY

how it exacerbates mental health and acts as a ‘threat multiplier’ by increasing the risk of conflict and the displacement of peoples.

There is a grim circularity here as conflict – another major focus of the report – can further affect climate change.

The report points to the abundant evidence from recent conflicts of medical professionals and facilities being targeted, and calls for the clear recording of all human rights violations during war, and for a strengthening of the International Criminal Court.

Work on the report started before the Russian invasion of Ukraine, but that conflict gives an even greater impetus to this work.

with its vast estates and reliance on single-use plastics, has an effect on climate change that affects everyone. Political systems, which do not just create inequality, but seem to need it and thrive on it, have an inevitable effect on the rights of those ‘left behind’, particularly the right to health.

Human rights are universal, inalienable and indivisible, but the context in which they operate (or ‘history’ to put it more succinctly) is rapidly changing. That is why an update such as this is so important.

BMA medical ethics committee chair Zoe Greaves says: ‘This is an ambitious and wideranging report, which builds on decades of work by the association in articulating and defending human rights around the world.

‘It draws attention to and highlights the rapidly changing landscape in which we practise as clinicians and in which our patients live, and shines a light on the challenges this presents to us in upholding, defending and promoting the health and health rights of the most vulnerable; both at home and abroad.’

WIDE RANGING: Issues such as climate change, anti-vaxxer misinformation and migration all have human rights implications in which doctors have a role to play

‘It highlights the rapidly changing landscape in which we practise as clinicians’

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Your BMA Get to grips with the process for this year’s BMA annual representative meeting In three months’ time your BMA annual representative meeting for 2022 will take place – and preparations are moving ahead at pace.

When I stood as deputy chair of the representative body in 2019 I was elected on a manifesto of challenge, change and communication. For me, these were the three areas I needed to address to ensure your BMA is representing you as well as possible.

I have written in previous columns in this magazine about how I have sought to address the challenges of the pandemic and how we have changed your ARM to adapt to those challenges.

This year we will be holding a hybrid ARM which will take place across three days and we will welcome those taking part in person and virtually, with accessibility and inclusivity at the heart of every decision we have made.

When it comes to communication, my third priority, I would like to ensure the wider membership is informed about how policy is made and, most importantly, how you can influence it.

The deadline for submitting motions to this year’s ARM was earlier this month and the agenda committee, which is made up of eight doctors elected at last year’s meeting, will sift through the different motions to narrow them down to a number of around 45 (this was the number starred in 2019).

We usually receive up to 500. They are submitted from divisions, regional councils, branch of practice conferences, the BMA retired members conference, the junior members forum and the conference of honorary secretaries.

You may be wondering how some of those 500 submitted motions end up being debated at ARM. The agenda committee, of which I am chair but do not have a vote just as with the wider ARM, will prioritise the motions based on the information available, the types of motions submitted, the relevance to the past year and the gaps in our BMA policy book. All motions passed remain in the book while they are being actively pursued and until they have been achieved.

The committee will also look for common themes – and those motions which are particularly important and relevant to the association and the membership will be 22

@drlatifapatel prioritised. For example, without any intention to steer the committee, I would imagine there may be motions about the pandemic included this year. Our surveys have told us burnout and wellbeing are huge issues so I would expect motions about the workforce. And the Health and Social Care Bill is still going through Parliament so there may be some covering that process.

Each motion that comes to ARM has the potential of being in the BMA policy book for a decade or more so it is important we get it right first time. Spelling and grammatical errors matter a great deal and we have to make sure motions make sense not just in the moment but for the years ahead when people look back. Motions may be written with a stem – this meeting is concerned about… for example – and then come with a list of numbered parts. Each part therefore must be able to stand alone and make sense and be able to be debated as such.

Once the motions have been whittled down the agenda committee will go to the other branch of practice committee conferences and look at the motions passed there. It may be that something passed at the BMA junior doctors conference, for example, will be covering an issue which is of interest or importance across the association. These motions can be shared with ARM. Built into ARM is also the opportunity to vote for five chosen motions which aren’t prioritised for debate, giving our members direct control. For new business which occurred after the motion submission deadline we make time for emergency motions.

The creation of your ARM agenda is a detailed and lengthy process but it could hardly be more important, and I am committed to ensuring you are in touch and know how you can be involved.

We are a movement of 163,500 doctors. This is your association and I want you to have your voice heard within this movement.

Dr Latifa Patel is interim chair of the BMA representative body RBChair@bma.org.uk

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on the ground thedoctor

Highlighting practical help given to BMA members in difficulty

A doctor was underpaid for six years. Through patient work, the BMA helped him get back the money he was owed Even a stopped clock is right twice a day, but once the NHS makes a mistake with your pay, it can be the beginning of an unbroken series of errors that can carry on for years.

A junior doctor had been put on the wrong nodal point at the start of one of his jobs. With each new job that followed, the calculation of his pay was based largely on what he received in the previous one, so the errors compounded.

It was only a chance conversation six years later with a colleague, once he had achieved his certificate of completion of training, that led him to realise he had been underpaid for so long.

He queried it, but the demands of the job made it impossible for him to put in the necessary time to follow it up. This is where the persistence of a BMA employment adviser proved to be vital.

She went back to each previous employer. With the facts firmly on her side, they were cooperative, but it was a complicated task.

There were Review Body on Doctors’ and Dentists’ Remuneration pay rises to be taken into account, incremental increases, all the ‘extras’ for possibly two pay rates in one rotation, and the doctor had transferred from the 2002 juniors’ contract to the 2016 one during the six years which had been affected.

It took about a year and required just under 200 emails and phone calls. The adviser says: ‘To be fair to each employer, they all accepted the principle once they saw the data, then it was just a question of admin in getting the sums approved and for payroll to actually make the payments.

‘The member was very organised and had nearly all his payslips and contracts which made things very much simpler! Mainly my role was presenting the evidence, clarifying where there was error,

being persistent and following up when deadlines passed.’

Pay errors like this are all too common, although the period of time and number of rotations involved made this one particularly tricky. Once resolved, the member was in line for more than £8,000 in pay arrears.

He said the BMA had provided him with excellent advice, and had remained persistent and engaged.

He said to the adviser: ‘I have found NHS trust payrolls and human resources departments difficult to navigate and negotiate with in the past, but [the BMA’s] clarity of approach, and advice regarding tone of communications was key to making this endeavour successful.

‘At the start of this process in truth I held out little hope of achieving appropriate recompense.

Through [the BMA’s] wise counsel and attention to detail the claim has been successfully resolved.’

The adviser says the key in successfully pursuing the case was that the doctor had all the information that was required.

Doctors should download and keep their payslips, like he did. It can be easy to think that everything is available online if required, but access to the pay system is likely to be lost when doctors change post, and it can be hard to chase the information afterwards.

The same applies to contracts and work schedules. Pay issues can be pursued for up to six years in the courts.

Whether they’re in a neatly colour-coded file, or a shoebox in the attic, those little slips of paper are well worth hanging on to.

The Doctor

Editor: Neil Hallows (020) 7383 6321

To talk to a BMA adviser about a work-related issue, call 0300 123 1233 or email support@bma.org.uk

BMA House, Tavistock Square, London, WC1H 9JP. Tel: (020) 7387 4499

Chief sub-editor: Chris Patterson

Email thedoctor@bma.org.uk Call a BMA adviser 0300 123 1233

Senior staff writer: Peter Blackburn (020) 7874 7398

@TheDrMagazine @theBMA The Doctor is published by the British Medical Association. The views expressed in it are not necessarily those of the BMA. It is available on subscription at £160 (UK) or £225 (non-UK) a year from the subscriptions department. All rights reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical or otherwise without the written permission of the editor. Printed by William Gibbons. A copy may be obtained from the publishers on written request.

The Doctor is a supplement of The BMJ. Vol: 377 issue no: 8334 ISSN 2631-6412

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Staff writer: Tim Tonkin (020) 7383 6753 Scotland correspondent: Jennifer Trueland Feature writer: Seren Boyd Senior production editor: Lisa Bott-Hansson Design: BMA creative services Cover photograph: Neil Turner Read more from The Doctor online at bma.org.uk/thedoctor

11/04/2022 09:01

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