The RememberingQueen a royalAhealingdaily struggle Medical students facing poverty and huge debts Junior doctors The fight for pay restoration New council chair Willing to make a stand Issue 47 | September 2022
When the Queen came to the aid of a distressed doctormentally
Many of you will have come across the writings of neurosurgeon Henry Marsh. As his new book is published, he gives us an interview in which his wit, humility and zest for life light the page. We can all learn from his perspective of recently being an NHS patient, an experience he rightly acknowledges that some find frightening.
Medical students forced to live in poverty and rack up thousands in debt
In14-17allhonesty
Your22BMA
02 the doctor | September 2022
In this issue
Lead18-21theway
10-13
The8-9Queen, the surgeon, and a box of dog biscuits
SAYWELLMATT
Welcome
How not to treat a student on a clinical placement
Boosting the diversity of leadership at the BMA
Left out
Henry Marsh, author and retired ponders mortalityneurosurgeon,
Junior doctors draw a line in the sand
Thousands of doctors have no guaranteed access to pay scales or training
On the ground
Throughout her 70-year reign she was a dedicated public servant and muchrespected figure with an immense sense of duty. During her stewardship of the nation, there has been substantial social and political change, and her role in enabling this will never be Juniorforgotten.doctorsin England have told the Government they will ballot for industrial action if pay is not fully restored to levels equivalent to 2008/09 by the end of this month. The pressures from staff shortages and overwhelming workloads are taking their toll.
would first like to acknowledge the great sadness and sense of loss felt by many across the profession at the death of Her Majesty, Queen Elizabeth II. The BMA also offers its deepest and most sincere condolences to the Royal Family. The Queen was a patron of many medical organisations, visited countless hospitals and GP surgeries, and has been a constant in an ever-changing world.
In this issue of The Doctor, I make clear my willingness to make a stand for the profession, and for a health service in which doctors are paid fairly so that declines in recruitment and retention are reversed for the sake of our patients.
Phil Banfield, BMA council chair
He is just the kind of highly skilled future doctor the Government says it wants to make the profession more diverse, and yet huge obstacles are put in his way. A BMA survey last month found almost half of students expected to run out of money by the end of the year, while more than half were working paid jobs during term time.
Another group of doctors facing challenges are those who lack the protection of nationally agreed terms and conditions. LEDs, or locally employed doctors, make the same contribution as their colleagues in tackling the immense NHS backlog, but they have no agreed pay scale, no guaranteed access to training and often have uncertainty as to how long they will stay in post.
23
Keep in touch with the BMA online at instagram.com/thebma twitter.com/TheBMA
At3a glance
Joe Tonge, one of the students interviewed in our feature on student debt, is juggling three jobs with his sixth year at medical school and still expects to be £100,000 in debt when he qualifies.
The new council chair and the battle for fair pay
They can often feel forgotten, which is why the BMA and other organisations are making positive steps to recognise their plight and do much more to defend them against some shockingly poor HR practices.
Debt4-7and despair
I
Sarah Hallett and Mike Kemp, BMA underpaidoverworked,ofhaddoctorssaid:co-chairs,committeedoctorsjunior‘Juniorhaveenoughbeingand
take industrial action if the Government does not commit to full pay restoration.
‘The Government’s failure to include junior doctors in the wider – though still derisory – pay uplift for NHS workers or make any comment on pay restoration has only restorationonfutureworriedwerestoreGovernmentactionwithoutrockour resolve.strengthened‘Moraleisatbottomandrapidfromtoourpay,aredeeplyfortheoftheprofession.’MoreinformationJDC actionswithpaycanbefound at bma.org.uk/juniorspay
the doctor | September 2022 03JUNIORbma.org.uk/thedoctorATAGLANCEDOCTORS in England are being urged to prepare for industrial action if the Government does not commit to full restoration of pay to 2008/09 levels by the end of September.TheBMAis calling on junior doctor members to write to their MPs, update their details, encourage colleagues to join and share the campaign on social media using hashtag #BMABallotReady.Fullrestoration of junior doctor pay has been demanded by the BMA junior doctors committee after a real-terms cut to salaries of more than a quarter since 2008/09 while colleagues face a record backlog and spiralling cost-of-living crisis. The BMA has continually highlighted to Government that junior doctors are endifballotaction,withnowilltop priorities.hasministerfeelsignificantlydemoralised,burntout,andundervalued.NewprimeLizTrusssaysshemadetheNHSoneofherInactionfromGovernmentleavejuniordoctorswithchoicebuttopressaheadpreparationsforindustrialtheBMAsays.ItistojuniordoctormembersdemandsarenotmetbytheofSeptember.
HALLETT: Junior undervalueddoctors
As many as 83% of more than 13,000 junior doctors who completed a recent BMA survey said this year’s 2% pay award is ‘completely unacceptable’ while 72% said they would be prepared to
KEMP: Morale at rock bottom
INDUSTRIALACTIONDEADLINELOOMS
SAYWELLMATT
undervalued, and will not tolerate these cuts any longer.
A trade union ballot requires a turnout of 50% of those eligible to vote to be considered to have support for industrial action. All BMA junior doctor members employed by NHS organisations will be eligible to vote. Non-BMA members cannot vote. Membership remains free for junior doctors until 1 TheOctober.JDCisalso looking for activists to become junior doctor pay campaigners and is encouraging junior doctors to put themselves forward for upcoming regional elections.
In the meantime, members have been urged to send template letters to their MPs asking them to lobby new health secretary Thérèse Coffey to restore junior doctor pay.TheBMA has also stressed the importance for junior doctor members to update their contact and rotation details, which is crucial as any legal industrial ballot must be conducted via post.
STAND FIRM: Junior oftheprotestdoctorsoutsideDepartmentHealthinJuly
‘I love going into placement and I absolutely love my degree,’ he says. ‘And I’ve never felt like pulling out. But this is not what I imagined life would be; I get quite choked up thinking about it.’
J
despairand
OE TONGE ticks all the boxes for the kind of student doctor the NHS is keen to recruit. Working-class background, low-performing state school, first in the family to go to university.
Mr Tonge, now in his sixth year, has applied for several hardship grants – and been awarded £32. When he graduates in two years’ time, he expects to be £100,000 in debt for the privilege.
04 the doctor | September 2022
But, predictably, he’s also the kind of student who cannot count on financial support from home. And so, predictably, he is struggling to pay his way through medical school, like so many others.Forayearnow,
Mr Tonge has barely been able to cope, despite having three jobs, because of the medical student funding model in much of the UK.
Some days this summer, when he was doing placements, he couldn’t afford to travel. On others, he couldn’t afford not to take paid work instead. He had harboured an ambition to do an elective in Canada; instead, he has had to do shifts at a clothing retailer, tutoring and working for his university, just to pay his rent.
No one wants medical schools to be the sole preserve of the rich, but the Government is forcing students from ordinary backgrounds to live in poverty and rack up tens of thousands in debt. Seren Boyd meets the students tackling nearimpossible odds Debt
SUCHARITKUL: Not enough money to pay for food
Pushed to the brink Eilidh Garrett co-founded the Liveable NHS Bursary campaign, with other students, in April – because she couldn’t see a way out of her financial difficulties.
When Ms Garrett shared her frustrations on Twitter, others opened up too and the Liveable NHS Bursary campaign took off.
She’sa month.calculated she would need to work 20 hours a week just to make ends meet. Given the demands of her course, that’s not possible, although she works all the hours she can. As she points out, some medical schools ban or heavily restrict students from termtimeSheworking.bitesher tongue when consultants at her placement have questioned her commitment to medicine because she can’t stay on for ‘important learning opportunities’. And she says nothing when frustrated supervisors at university ask why she’s not revised.
The situation gets more challenging from the fifth year of study onwards. In most of the UK, undergraduate medical students are funded like all other students for the first four years of their degrees – but the funding model shifts in year five.
‘I couldn’t even go into becauseAsda I’d be atworryingthe checkout’
At this point, their access to Student Finance loans for their living costs is reduced, and they have to apply for the NHS Bursary. For most, this results in a sharp drop in overall funding – just as their costs increase, during clinical placements.
the doctor | September 2022 05bma.org.uk/thedoctor
For a student in England living away from home outside London, for example, the maximum funding falls from £9,706 to £6,458 (see box on page 7). The BMA has been calling for retention of and improvements to the NHS Bursary for years. But for many medical students, the funding allocation letter for year five comes as a huge shock.
The rising cost of living – with no commensurate
increase in funding – has brought many students to a crisis point this year and prompted some to speak out.
Her recent application for hardship funds was rejected because she had not ‘maxed out her credit cards’.
Conspiracy of silence
Funding crisis exposed Mr Tonge isn’t the only one. The latest BMA student finance survey, published on 23 August, makes for grim reading.Ofthemore than 1,000 respondents across all years of UK medical schools, 44.3 per cent expected to run out of money before the end of the academic year. One in seven respondents had applied for hardship funding and one in 25 is using food banks.Morethanhalf of respondents (53.6 per cent) work during term-time, and 73.1 per cent of them say this has a negative effect on their studies.
‘I can’t say, “I’ve been
They’ve met with the Medical Schools Council and the senior leadership of several medical schools, and held briefings for MPs. Even some medical schools
GARRETT: heavyhavefinancialOverwhelmingpressurestakenatollon her health
working every spare minute since we were taught this,” because I risk being told off for working too much. It’s really hard to tell them the truth, while trying to be professional and also trying not to cry out of frustration.’
It’s calling for full maintenance funding for all medical students for the full duration of their degree. Specifically, it is calling for them to be given access to the NHS Learning Support Fund, available to other healthcare students such as midwives and nurses. The fund provides a £5,000 non-means-tested grant: only the first £1,000 of the NHS Bursary allocation is non-means-tested.
Her credit card debt had reached £8,000, and the pressure had taken a heavy toll on her physical and mental health, landing her in hospital.
‘I just couldn’t cope with normal life,’ she says. ‘I couldn’t even go into Asda because I’d be worrying at the checkout, “What if my card gets declined?” It was just overwhelming.’AsMsGarrett is a graduateentry medical student, her funding has been reduced for two years already and will be again in this, her final year. She is estranged from her parents and so receives the maximum funding of about £540
But even as a carer from a single-parent family with no income, Ms Sucharitkul is not eligible for some hardship funds because she has a car. One of her placements this summer would have required her to take three buses.
The explicit requirement for a means-tested ‘parental contribution’ to dependent medical students’ NHS Bursary funding in England and Wales is telling.
Yet the funding model hasn’t changed, leaving disadvantaged students highly exposed. The BMA student finance survey found that less than a third (32.6 per cent) of students who had had free school meals received financial help from parents.
Why this situation has been allowed to persist is uncertain. But it’s hard to dispute Ms Garrett’s theory: ‘The only feasible reason that medical students get less than all other healthcare professions is because medicine is seen as a degree that traditionally only the sons and daughters of wealthy people take.’
The Department of Health and Social Care has consistently pointed out that students can apply for hardship funds.
The average student rent in Manchester is £6,815, which is £357 more than the maximum funding allocation in England for living costs.
When Ms Akinnawonu, with her committee co-chair Khadija Meghrawi, gave evidence to the Health and Social Care Select Committee in May, they urged reform of medical student finance generally – and especially for the most disadvantaged.
financial situations don’t have the time to raise the issue, or the capital or the voice. A lot of them, unfortunately, are the ones who drop out, so the issue gets swept under the carpet.’
But medical student demographics are changing with the NHS’s drive to widen participation. The Medical Schools Council found that the percentage of medical students from the most deprived areas increased by 46 per cent in 2014-2019.
levels of funding for medical students through the NHS Bursary, particularly for students from low-income backgrounds, and for the bursary application process to be streamlined. The student finance survey results show that, for many, the bursary covers only 30 per cent of their living costs.
have been unaware of the funding shortfall.
MEGHRAWI: Bursaries must be improved
06 the doctor | September 2022
Changing demographic
AKINNAWONU: sufferingstudentsWorst-affectedoftenin silence
Lara Akinnawonu, cochair of the BMA medical students committee, echoes Ms Garrett’s concern that the worst-affected students are suffering in silence. ‘A lot of the students who are in dire
‘We’re pressureimmenseunder to finish our becausedegree we’ve earned this school’medicalplacemagicalin
They called for higher
Penny Sucharitkul, a fifthyear student at Leeds, is a good example of why reform is needed.Shewill receive funding of £6,710 this year – a combination of NHS Bursary and Student Finance loan –but it’s about half what she received previously. After she’s paid her rent, she has £3 a day for everything else, including food and bills.
Lack of support
Lack of awareness of the funding gap has helped perpetuate a dangerous conspiracy of silence. Ms Garrett says it was only when she did the maths and realised her funding didn’t cover her basic living costs that she stopped blaming herself for her financial problems.
Ms Sucharitkul, a Liveable NHS Bursary campaign cofounder, is a remote carer for her dad and she sends him money when she can. She’s had extra financial support from her university but even before her funding was reduced this year, she had two jobs – as a martial arts instructor and healthcare assistant. She funded her intercalation year largely by working 12-hour night shifts on COVID wards.
‘We have a massive drive to admit into medical school people from these special backgrounds,’ she says. ‘But then we don’t support them in the later years of medical school. We’re under immense pressure to finish our degree because we’ve earned this magical place in medical school. But we don’t even have enough money to pay for food.’
Final-years funding gap in figures
‘Medical students feel left by the wayside, especially compared with other healthcare students,’ she says. ‘They’re graduating burnt out, and then they’re expected to work in an underfunded foundation year. Of course they’re going to Australia. Retention starts at medical school.’
There are some glimmers of hope. It’s largely through Ms Sucharitkul’s lobbying that Leeds School of Medicine has committed to provide a £500 grant per year to supplement the NHS Bursary through alumni giving, and to pay GMC fees for ‘wideningaccess’ students.
In February, the Government announced that from September 2023 it would cut the earnings threshold for student loan repayments to £25,000 and extend the repayment period from 30 to 40 years. With interest, higher-paid doctors could expect to pay back their loan three times over, according to some analysts.
SUJI: affectedemploymentPaidherexam performance
Being from a low-income background has taught Trisha Suji to plan her finances carefully. So even before medical school, she was aware of the final years’ funding shortfall, and made provision from the start.
Total £9,706 £6,458
NHS Bursary non-means-tested £1,000
She has paid a price for her prescience. Work in a pharmacy warehouse one Christmas affected her performance in exams the following term.
In England, Wales and Northern Ireland, the maintenance loan is lower in final bursary-funded years. By contrast, Scottish undergraduate medical students studying in Scotland receive the same funding for living costs throughout their degree: a maximum of £8,100, a combination of bursary and loan from Student Awards Agency Scotland.
the doctor | September 2022 07
Maximum possible funding for a student from England living away from home outside London
Student Finance loan £9,706 £1,975
She chose a medical school in her city so that she could commute from home, and has worked and saved throughout the first three years of her degree.
bma.org.uk/thedoctor
NHS Bursary means-tested £2,643
The funding gap has ramifications far beyond the ability of individual students to survive their degree.
Ms Suji mentions a phrase circulating in medical schools: ‘Graduate and evacuate.’
Years 1-4 Year onwards5
Planning ahead
lots of people who haven’t known this was coming are really struggling. For them, it feels like everyone is laughing at them. “Ha! You really thought you could do medicine?”’MsSuji,who’s spoken on the subject at BMA conferences, urges students to raise the issue with their medical schools, to meet with supervisors and welfare officers in person and explain their situation. Her hope is that universities will join forces to lobby the Government to make up the funding shortfall.
NHS Bursary Extra Weeks Allowance (for courses of 30 weeks +) £840
‘I think I will survive because my mindset is to constantly plan,’ says Ms Suji, a campaign co-founder. ‘But
David Nott returned from volunteering in war-torn Aleppo mentally stricken by his experiences. Invited to lunch at Buckingham Palace, he describes how the Queen did something rather wonderful to help him
08 the doctor | September 2022 IMAGESGETTY
THE QUEEN, THE SURGEON, AND A BOX OF DOG BISCUITS
She asked me where I had come from. I suppose she was expecting me to say, ‘From Hammersmith,’ or something like that, but I told her I had recently returned from Aleppo.
the doctor | September 2022 09bma.org.uk/thedoctorELIZABETH
II:
lip started to go and all I wanted to do was burst into tears, but I held myself together as best I could. I hoped she wouldn’t ask me another question about Aleppo. I knew if she did, I would completely lose control.
What was it like? What could I say? My mind filled instantly with images of toxic dust, of crushed school desks, of bloodied and limbless children. And of Alan Henning and those other Westerners whose lives had ended in the most appalling fashion.
‘There,’ the Queen said. ‘That’s so much better than talking isn’t it?’
I
The contrast between those gilded walls and the ravaged streets of Aleppo began doing weird things to my head. I walked along the red carpet into one of the reception rooms and stood awkwardly with the other guests. I felt a fraud, guilty – I should not be here enjoying this splendour and warm hospitality while my friends in Aleppo are suffering. I looked at the seating plan and found that I was sitting on the Queen’s left, which I knew was an honour. But I was perilously close to a panic attack.
I stood dumbly with the other guests making small talk with Prince Philip. God knows what he must have thought. Finally, we were taken through to the dining room and one of the courtiers showed me to my seat next to the Queen. Etiquette dictates that the Queen will speak to the person on her right for half the lunch and will then turn to the person on her left for the second half. I realise now that I should have been speaking first to the person on my left, but I cannot recall doing so and whoever it was must have thought me extremely rude. I could feel myself staring into space.
The dessert arrived and the Queen turned to me. At first I couldn’t hear what she was saying, as my hearing had been damaged by a bomb blast near the hospital in Aleppo. I tried to speak, but nothing would come out of my mouth. It wasn’t that I didn’t want to speak to her; I couldn’t. I simply did not know what to say.
She looked at me quizzically and touched my hand. She then had a quiet word with one of the courtiers, who pointed to a silver box in front of her. I watched as she opened the box, which was full of biscuits.
IMAGESGETTY
‘These are for the dogs,’ she said, breaking one of the biscuits in two and giving me half. We fed the biscuits to the corgis under the table, and for the rest of the lunch she took the lead and chatted about the dogs, how many she had, what their names were, how old they were. All the while we were stroking and petting them, and my anxiety and distress drained away.
This extract is reprinted with the kind permission of Pan Macmillan from David Nott’s book, War Doctor: Surgery on the Front Line. More details are at authors/david-nott/war-doctor/9781509841622www.panmacmillan.com/
was not in a good place. My diminishing ability to cope was rather spectacularly exposed quite soon after my return, when I was invited to a private lunch with the Queen at Buckingham Palace. I am not sure how this came about; I knew the broadcast of my Eddie Mair interview had touched a lot of people, so perhaps someone in the Royal household had also tuned in. In any event, one day not long after I got back I put on my one and only suit and waved goodbye to Elly as I passed through the gates of the Palace.
‘Oh,’ she said. ‘And what was that like?’
NOTT: tobottom‘Mylipstartedgo’
I don’t know why it happened then, or why it should have been the Queen who breached the dam. Perhaps it was because she is the mother of the nation, and I had lost my ownMymother.bottom
‘She looked at me quizzically and touched my hand’
Then imagine that this same doctor does all of this despite not having the protections of a nationally recognised contract or agreed pay scale, despite not having guaranteed access to training and professional development and all the while having to cope with uncertainty over the security of their post.
Left out
Each day, this doctor works long hours helping to cover rotas, dedicatedly caring for patients and diligently supporting their healthcare colleagues in a health service battling against a pandemic and a mountainous backlog of elective care.
magine for a moment a highly talented and experienced doctor eager to make a difference to the NHS.
I
10 the doctor | SeptemberThousands2022
of doctors have no guaranteed access to pay scales, job security or training. Tim Tonkin speaks to doctors who lack a national contract, and considers the options for improving their working lives
While such a set of circumstances might at first seem unthinkable, they are in fact
JIBRIL: ‘ Trustgrade doctors can be moved from ward to ward’
The dearth of awareness of LEDs is perhaps in part owing to the variety of job titles assigned to doctors working in these roles, which can include clinical or teaching fellow, trust-grade doctor, trust registrar or even foundation year 3.
Lack of training
‘Some trusts give inductions to new trustgrade doctors and some don’t. Sometimes they are just thrown into the rota and many of us are IMGs so it’s difficult to start on day one without proper
Indeed, with staffing shortages across the whole of the NHS, there is even greater pressure on LEDs to cover gaps in rotas created
Employed directly by trusts usually for nonpermanent roles, the terms and conditions of employment experienced by LEDs vary hugely and can, in a very literal sense, be a postcode lottery.Notconsidered to be a trainee role, employers are not obligated to provide LEDs with access to specialty training, while the doctors are still subject to yearly appraisals and revalidation every five years.
know that that’s not the story for a lot of other trust-grade or locally employed doctors,’ says Dr Jibril.
Rotas and pay
the doctor | September 2022 11
‘Trust-gradeinduction.doctors
She says that, while her own experience as a trust-grade doctor has been a positive one, she knows of many other doctors at other trusts where this is not the case.
Ihsan Jibril came to the UK last year having completed medical school in her home country of Nigeria 13 years ago.
While the backgrounds of doctors in this group are also varied, with UK and international medical graduates occupying these roles, LEDs are predominantly men from minority ethnic backgrounds who gained their primary medical qualification overseas.
Having previously worked at the level of specialist registrar in infectious diseases and dermatology back in Nigeria, Dr Jibril is now employed as a ‘locum appointment for service’ at a trust in Sheffield, where she also works as the representative for LEDs in her trust division.
the day-to-day reality for many of the LEDs (locally employed doctors) working in today’s health service.
‘I’ve been able to speak with doctors from my own trust as well as other trust-grade doctors in other trusts all over the UK and most of the feedback I’ve gotten were [concerns] around rotas, education and pay protection.’
trust’employingofdiscretionundertheybecausevary‘Contractsalot,arethethe
She adds that, unfortunately, the inconsistency in what conditions and support doctors receive means not all LEDs are able to benefit from their posts.
Limited access to training and opportunities for professional development are frequently reported as one of the main concerns of doctors working on a locally employed basis.
‘I’m lucky because the trust and the department I am in are quite supportive of LEDs so that has been positive for me, but I
Despite being overlooked almost to the point of invisibility, LEDs form a significant minority of the health service workforce, with data gathered by local negotiating committees estimating that there could be up to 20,000 working across the NHS.
‘The problem is contracts vary a lot, because they are under the discretion of the employing trust,’ Dr Jibril explains.
‘Some trusts are very, very good and they basically give you almost the same treatment as they would give their own trainees but for some trusts it’s different.
Dr Jibril says, for many IMG (international medical graduate) doctors, the prospect of working in the NHS, even if only for a few years, is an attractive proposition in terms of professional development and gaining experience, and that, to this end, non-permanent LED roles can seem like a logical choice.
are employed for service so they may not have a specific ward where they can work every time so it’s very unpredictable. They can be moved from ward to ward depending on where there is a service gap. For the doctor [experiencing this] they will not get the professional development because they wouldn’t have experience in just one ward.’
HODGENEIL bma.org.uk/thedoctor
‘Often opportunities’andprogrammesfromoroverlookedomittedteachingtraining
‘We’ve got a huge cohort here of very, very talented, very, very bright doctors who for whatever reason aren’t trainees but do not have any national protection or local protection and who have no job permanency,’ explains Mr Surash.
12 the doctor | September 2022
‘Many are undergoing a period of uncertainty; some of these doctors have not undertaken medical education within the UK, and few have seen the UK healthcare system up close before they join its workforce, and that can place a lot of pressure on them personally if they are not supported or supervised adequately.’
SURASH: Set up LED hisprogrammesupportattrust
when junior doctor colleagues are required to take time out for training.
‘With LEDs there are no nationally agreed terms and conditions and no agreed training opportunities, which means LEDs are treated very differently across the country depending on which trust they are working in,’ Dr Nageswaran explains.
‘We have to question whether keeping LEDs stagnant and not providing these training opportunities plays any benefit at all. Ultimately, it leads to a widening attainment gap between those in formal training and those who aren’t, which also disproportionately affects certain groups such as IMGs who make up a large proportion of LEDs.’
With many LEDs hailing from overseas, the effect of unfamiliarity with the UK and NHS often compounds the challenges they face in the workplace. This is something the BAPIO SAS and LED forum hopes to address, among other issues, as they host the very first conference for LEDs on 24 September in Leicester.
The difficulties faced by LEDs in maintaining continuing professional development is something that clinical teaching fellow and the acting vice-chair of BAPIO’s (the British Association of Physicians of Indian Origin) LED forum Priyanka Nageswaran knows all too well.
LED is the umbrella term for a variety of titles that doctors are given at different trusts, ranging from ‘trust grades’, ‘trust doctors’, ‘clinical fellows’, and ‘FY3 doctors’ among others.
‘There is a lot of support that these doctors need,’ she says.
potentially puts patients at risk.
‘A huge cohort’ Newcastle-based consultant neurosurgeon Surash Surash is a long-standing advocate for LEDs and was responsible for setting up a LED support programme at his trust, the first of its kind in WithEngland.LEDsnow accounting for tens of thousands of doctors in the NHS, he says there is a greater need than ever to give these staff the recognition and support they deserve.
‘There are some trusts that do this very well. However, there are also a large number of trusts that don’t do this well, and this is something that needs to be addressed as a matter of importance given the current workforce pressures.‘LEDsareoftenoverlooked or omitted from teaching programmes or training opportunities that take place in hospital trusts, and therefore it feels like doctors that are working in these roles are merely present to plug the needs of trusts at the expense of their own professional development.’DrNageswaransaysthat, regardless of whether in formal training or not, the GMC requires all doctors to maintain their knowledge and skills to practise safely, adding that limiting access to training is not only detrimental to LEDs’ progression but also
a theirhappengoingforarefamiliesgotpeopleof‘Somearen’t’thosetrainingformalthosegapattainmentwideningbetweeninandwhothesehaveyoungwhowaitingwhat’stowithjobs’ bma.org.uk/thedoctor
‘As a trainee, you have eight years from specialty trainee 1 to ST8 guaranteed placement. If you speak to LEDs many of them are waiting for their job contract renewals every six months or every year [so] there’s no certainty. Some of these people have got young families with young kids with husbands and wives who are hanging around waiting for what’s going to happen with their jobs.’
the doctor | September 2022 13
For Mr Surash, achieving greater equity for LEDs cannot be brought about through a single measure, but requires employers and other doctors to begin to start questioning the way their LED colleagues are treated.
BMA staff, associate specialist and specialty doctors committee deputy chair Amit Kochhar has long sought to highlight and champion the work of LEDs, saying that he knows only too well what it is like to belong to an overlooked and often exploited branch of practice within medicine.Headdsthat,with growing awareness of the unfair plight faced by many of these doctors, he hopes even more can be done to support them.Hesays:‘Iam passionate about representing them as I do not want to see the creation of another forgotten tribe of doctors just as we were in the past.
In a move that has the potential to improve the level of support available to LEDs, the BMA last month launched an affiliate membership package designed to support overseas doctors planning on working in the health service before they even arrive in the UK.
While the law provides a legal right to a permanent contract after four years of continuous service, data gathered by local negotiating committees through the LED toolkit developed last year by the BMA found 530 doctors, still in LED roles, who had accrued four to 10 years’ service, with 100 having worked for more than a decade.
‘For me, it’s about breaking down the hierarchy and levelling the field and you’re only going to really do that by first of all
‘You can’t have one single policy because there are doctors who will do [LED roles] for six months to a year, other doctors who will do this for their whole career, so we’ve got to respect the fact that there are people doing this for various different reasons and there’s no onesize-fits-all,’ he says.
Supporting LEDs can take many forms and is largely dependent on what an individual doctor wishes to achieve in his or her career.
Some trusts enable LEDs to gain consultancy through the CESR programme, with Mr Surash having personally aided one doctor in doing just that.
‘These doctors deserve to be valued and welcomed and their challenges addressed especially as regards their induction and mentoring to further their career progression. It is vital we support them or as one of the doctors said to me, they will become the “locally exploited doctors”.
‘The NHS depends on these individuals for its continued functioning, and yet they are often taken for granted. Standardised terms and conditions of service should be offered with educational learning and supervision during their placements.’
At this year’s BMA staff, associate specialist and specialty doctors conference, doctors endorsed calls to introduce an agreed framework and timeframe where LEDs wishing to transition to an SAS contract be empowered by their employer to do so.
Contractual agreement
‘It
treating people in your department the same, regardless of their employment status.’
KOCHHAR: Does not want to see creation of ‘another forgotten tribe of doctors’ leads to
Henry Marsh has a reputation for frankness –with patients, colleagues, and about his neurosurgeon.shortcomingsownasaNow he is a patient with a serious illness, he has become more honest with himself. Seren Boyd reports
MARSH: ‘Being a patient is humiliating and demeaning’
14 the doctor | September 2022
IN HONESTYALL
SHERLOCKPATRICK
Dr Marsh, senior consultant neurosurgeon at St George’s Hospital in London till 2015, has retired from clinical work in the UK. He suspects his experiences of the last two years would make it ‘very difficult’ for him to do the job now.
‘Self-deception’
H
enry Marsh has just had a five-mile run and is in the thick of wall papering. Even before he retired from neurosurgery, he had always enjoyed DIY. He is, in his own words, leading a normal life, but for the hormone therapy.
Working in Ukraine
Last month, on a visit to Ukraine, where he’s worked for 30 years, he had to tell a young man that his brain tumour would be fatal. It is a thankless task he has had to perform endlessly in a nation where the most desperate cases find their way to his clinic. This time, however, it was different.
But he embraces the indignity of it all, discussing urine flow and rectal clinics with brutal honesty and wry humour. He’s furious with himself for the self-
‘It’s only when doctors become old enough to become patients themselves or their family become patients that you get a sort of insight into just how detached we become as doctors,’ he says. ‘We have to be detached: we couldn’t do the work if we didn’t.
‘I think I could have been more sympathetic with patients than I was, but I don’t know if that would have made operating more difficult.
His self-deprecating memoir, And finally, recounts his abrupt fall in the hospital hierarchy from eminent brain surgeon to patient ‘Marsh: five, three, nineteen-fifty’.
‘Much to my surprise, I now feel a more complete human being’
He describes sorting through old case notes during lockdown – and being ambushed by memories and emotion.
‘I was incredibly lucky to have had the career I had and the NHS at its best, which was probably 15 years ago or so. But I don’t miss it: I’m relieved not to. Much to my surprise, I now feel a more complete human being. I no longer feel split down the middle, having to divide humans into us and them, patients and the medical profession.’
‘I could talk to him man to man about what it’s like to have an uncertain life expectancy,’ he says, ‘although at my age it’s profoundly different from being in your early 30s. Being a patient is frightening and humiliating and demeaning… and I think doctors often underestimate, and don’t really understand, what it’s like.’
the doctor | September 2022 15bma.org.uk/thedoctor
In Ukraine, by contrast, Dr Marsh’s work is not over –and it’s been profoundly upsetting for him to watch the conflict unfold since February.
In his words, he’s lost the capacity for ‘self-deception’, the necessary confidence to wave aside self-doubt and disengage emotionally in the face of complex medical challenges. Empathy, an unexpected side effect of his close encounter with death, has undermined all that.
Among the London hospitals he attended as a patient was one he used to visit weekly for conferences with neuro-oncological colleagues about brain tumour cases. ‘I could feel myself lose height as I walked along the corridor,’ he writes.
In March, he worked with renowned war surgeon David Nott to deliver online surgical training to hundreds of healthcare professionals in Ukraine. But he’s at pains to point out that Ukrainian clinicians are experienced in
In the interim, he’s wrestled ‘with philosophical and scientific questions that suddenly seem very important’ and come to terms with the idea of dying. ‘At 72, the future’s uncertain anyway,’ he says cheerily. These are some of the themes explored in his new book, And finally: matters of life and death
Two years ago, he was diagnosed with advanced prostate cancer and his life expectancy dwindled to a few years. Today, after treatment, he’s in remission.
denial that made him put off seeking advice prostatic symptoms.about
Dr Marsh may no longer work in the NHS as a clinician but he is still passionate and outspoken about it. He insists that doctors need supportive colleagues and a collaborative culture if they are to learn to sit with failure and not be damaged by it.
‘In a big general teaching hospital, it is very difficult to create that sort of “family firm” atmosphere which my generation had, and which helped you cope with what is a deeply stressful job.
‘Medicine is all about feelings, communication, dealing with colleagues and patients, decision-making and all that leads up to an operation. That’s the difficult bit. The actual technical operating side of surgery is, in one sense, easy.’
The past two years have been tough, as he has observed his own physical decline, and his ‘lifelong obsession with death and suffering’ has become personal.
The need for honesty
battlefield medicine: the current conflict began with the Russian annexation of Crimea in 2014.
He has been rocked before, when his son William was
‘I sat in my favourite café in the old market square in Lviv and it’s unchanged,’ he says. ‘Very strange. There are the occasional air-raid sirens and they are very distressing, but the chances of being hit by random missile strikes there are fairly small.’
‘I went into the profession keen, ambitious, individualist, egocentric and egotistic’
‘The generation who trained me were like lonely gods and I think, in neurosurgery, many of them were a bit damaged as a result. Real teamwork means discussing difficult cases. Multidisciplinary team meetings are a step in the right direction. But the art of conducting a good clinical meeting is incredibly important and it is not really taught at all. It is vital to a happy, successful department.’
He worries especially for junior doctors who don’t feel they have the support of their seniors. He cites psychiatrist Simon Wessely’s finding that one of the factors that makes post-traumatic stress disorder in soldiers more likely is poor leadership.
Dr Marsh has, for example, been an outspoken advocate of assisted dying and writes bluntly about having a ‘suicide kit – a few drugs legally obtained’. He’s no longer afraid of death, but he won’t countenance dying with dementia, his father’s fate.
he says. ‘There’s nothing special about success. I think it’s terribly important we are honest and realistic about what the work is really like, although there’s nothing more frightening for a patient than a frightened doctor. That’s a very difficult balance we have to strike.
‘We need good leadership in consultants. They are the longest-serving people in hospitals but consultants have in a sense been emasculated in the NHS. Chief executives come and go and make no impact.’
‘I went into the profession keen, ambitious, individualist, egocentric, egotistic, as I think most surgeons are, and I’m leaving it a passionate believer in team working,’ he says. ‘If you’ve really good colleagues, your decision-making will be better. And it is vital for your mental health.
‘The generation who trained me were like lonely gods’
He devotes his time to supporting younger surgeons whom he describes as unhindered by Soviet-era thinking. And he has good relationships now with the senior professors who used to regard him as ‘the devil incarnate’ for his pioneering work there.
He remains in regular contact with his many friends and colleagues in Ukraine. As recently as August, he visited Lviv, ‘saw a few patients to help a colleague out’, and met with the minister of health.
He’s also written and spoken extensively about the need to be honest with patients about their prospects, and having the courage not to operate when surgery won’t repercussionsThehelp.heart-rendingofthisfor the many Ukrainian patients he sees with inoperable tumours are played out in the BBC’s 2007 documentary about him, The English Surgeon.
Team working
‘Pathetic, crying’
16 the doctor | September 2022
It’s been a painful time which has caused him to reassess his legacy in Ukraine – but also reinforced the importance of honesty, a ‘compulsion’ and recurring theme of his.
One reason he gives for the breakdown in relationship with his Ukrainian former colleague was a lack of honesty about his success rates. Post-surgery complications, even deaths, were being hidden from him.
As And finally recounts with blistering frankness, his working relationship with Ukraine has changed since his 20-year collaboration with a colleague ended abruptly.
Living with failure – whether unsuccessful surgery or declining to treat – is ‘what makes medicine special’, he writes. His openness about his own mistakes is partly what has made him famous.
He fears that the culture of litigation and criticism means it is sometimes difficult for doctors to be fully honest with patients, colleagues, even themselves.
‘The real test of a doctor is when things don’t go well,’
Dr Marsh (left), in Kyiv, Ukraine, with an personallyandboughtmicroscopeoperatinghehadsecondhandtransported
MARSHHENRY
‘If only more people were better at saying, “I don’t know but let’s try to find out”’
Surrounded by mysteries
‘We are surrounded by mysteries and that’s wonderful. It’s like opening a door and facing a room with a lot more doors.’
He believes, for example, the NHS is ‘perfectly solvable with a different government, properly looked at, properly funded’.
He’s increasingly speaking out on climate change too and his belief that we each have a duty to try to reduce our carbon footprint. More DIY home improvements, maybe new plumbing to enable grey-water harvesting, will undoubtedly follow – although his book suggests strongly he’s a better brain surgeon than builder.
And finally is full of ellipses, as forays into scientific explanation are mingled with moments of star-gazing, where the metaphysical defies human intellect and understanding.
treated (successfully) for a brain tumour as a baby – and his wife, anthropologist Kate Fox, suffers from Crohn’s disease. But he admits he was completely thrown when his initial ‘sky-high’ PSA (prostate specific antigen) of 127 suggested that he had metastatic disease. ‘I was panic-struck, pathetic, crying, everything else,’ he says.
His long fascination with philosophy – a subject he studied, and dropped, in his first degree at Oxford – has resurfaced too.
‘But also I felt very strongly I’d had a fantastic life. I need to live longer for my wife, for my children, my family. But for myself, I’ve had my cake and eaten it. I’m pretty privileged and lucky: in my parents, my upbringing, my education, my experiences. I’ve been quite successful. And I’ve no bucket list whatsoever.’
For much of the book, however, he’s staring death in the face. In the final paragraph, he considers what physicists call ‘block time’, where past, present and future are equally real, as if his life is flashing before him.
‘I love the not knowing,’ he says. ‘The really important things I don’t know. If only more people were better at saying, “I don’t know but let’s try to find out.”
For now, he’s well and determinedly optimistic.
His cancer proved only locally invasive. After radiotherapy and hormone treatment his PSA is now low – an update given in postscript – although his original PSA puts him at high risk of recurrence within five years.
As in his first book, Do no harm, he’s still exercised by the question of consciousness – whether it arises from physical processes or ‘something we cannot know’. But he can accommodate mystery and unanswered questions these days. Almost.
the doctor | September 2022 17
He even plans to write a children’s book about Olesya, the hero of the stories he told his granddaughters over video calls for two years during COVID.
LEAD THE WAY
Describing himself as an ‘ordinary bloke’, the BMA’s new council chair Phil Banfield is focused on achieving fair pay, fighting for a better health service and ensuring the BMA reflects its membership. Interview by Peter Blackburn
That is the message to doctors from Phil Banfield, the new BMA council chair, as he outlines his central ambition to force the Government to take responsibility for the plight of the profession and the state of the NHS.
Just two months into the job Professor Banfield is putting an action plan into place to ensure the BMA is ready to take whatever action is required to hold employers, politicians and policy makers to account and to drive positive change – including laying the foundations for serious and effective collective and industrial action.
18 the doctor | September 2022
‘If you’re serious about having an NHS that is world leading, then you’ve got to accept that the cost of your medical experts is the cost,’ he says. ‘We look forward to discussing what that cost is, and how you are going to meet those costs.’
Almost all parts of the profession have seen their pay drop, their working conditions worsen and demand on their services rocketing. Junior doctors, for example, have suffered real-terms pay cuts of 26.8 per cent since 2008/09 and BMA members in England will be balloted for industrial action if the Government does not commit to full restoration by the end of September.
‘S
people’motivatedandintelligenthighlyskilled,areall.doctorsaboutjuniornothing‘There’stheseatThesehighlyhighly
tart to believe that your future is in your own hands. The BMA is here to help you achieve what you thought was unachievable.’
‘I’ve tried to opennessandkindnessapply I’veeverythingtodone’
Professor Banfield also has a message to ministers in Westminster. Doctors, who have kept the NHS running through years of crises, demand fair pay and will no longer tolerate the erosion of their terms and conditions.
Speaking about junior doctors, Professor Banfield, who grew up in Crawley, studied medicine in London and has since worked in hospitals across the
BANFIELD: ‘If we lose a generation of junior doctors from the NHS we are all stuffed’
SAYWELLMATT
bma.org.uk/thedoctor the doctor | September 2022 19
In 2012 he was elected chair of council for BMA Cymru Wales and has since been chair of the BMA Welsh consultants committee. During his years representing doctors in Wales, Professor Banfield successfully led a campaign against the closure of hospital services in the north of the country, made a clear case for the parlous state of the NHS (most particularly during a striking interview with journalist Eddie Mair), raised awareness of the bullying of staff, associate specialist and specialty doctors and worked with ministers to bring about NHS Wales’ core principles which enshrined the valuing of staff.
For Professor Banfield, a largely productive relationship with political counterparts was brought about through being willing to listen – but most importantly showing strength wherever necessary.‘TheWelshGovernment got terribly upset
about some of the things I said,’ Professor Banfield says. ‘I said I don’t mind you being upset but I am going to give you examples outlining the state of the NHS every week until you finally cotton on that we are in trouble. About a month later we were having meetings regularly with the minister and started having sensible conversations.’
20 the doctor | September 2022
And while Professor Banfield plans to fight for doctors, he is clear he is also fighting for patients. ‘It is ultimately about patients and patient care,’ he says. ‘If you don’t sort these problems out for doctors it will impact
country from East Anglia to North Wales, adds: ‘There’s nothing junior about these doctors at all. These are highly skilled, highly intelligent and highly motivated people. If we lose a generation of junior doctors from the NHS we are all stuffed.’
Experience
While never aspiring to be a political leader, Professor Banfield – a keen gardener and nature lover away from medicine – is not new to a role like this. He has significant experience in elected positions and holding politicians’ feet to the fire.
EYE TO EYE: (From left) former Welsh minister for health Vaughan Gething, Professor Banfield and former first minister Carwyn Jones meet in 2017
Professor Banfield takes the post at a time of unprecedented challenge: austerity politics have been brutal across society and the health and care system has felt the effects keenly. The COVID-19 pandemic laid bare many of the inequalities that exist in our society and has left the NHS with an unprecedented backlog. The inequalities highlighted and exacerbated in recent months and years – particularly issues such as homelessness – are areas of personal passion for Professor Banfield and priorities for action in the future. But most immediately, the concern is that doctors are leaving the health service in droves while those who remain are often running on fumes.
‘I said I am going to give oftheoutliningexamplesyoustatethe NHS every week until you finally cotton on that we are in trouble’
Patients first
‘If we don’t make a stand there won’t be an NHS. I’ve committed my life to this. We’ve all committed our lives to this. We don’t plan to stop that commitment now.’
‘I’ve always thought of myself as a relatively ordinary bloke. I don’t seek political power for the sake of the title – but I am ready to do the job that comes with that title. I want to surround myself with extraordinary people and direct their talent.
‘I feel like everything in my career has led to this. That does give me a great sense of purpose. My vocation was to serve patients and I feel I can serve patients best now by reestablishing the much-needed professional voice and the authority of doctors.’
It was a lesson learned in early life. At school Professor Banfield wrote to David Attenborough for help when struggling to find books about Borneo, one of the settings for a story he was writing.
Just two months into the job Professor Banfield clearly already has great clarity about the required sense of direction and the job that needs doing. His mission is already very much under way. As he says: ‘Start to believe that your future is in your own hands. The BMA is here to help you achieve what you thought was unachievable.’
Professor Banfield, who wanted to be a doctor from the age of eight, intends to place kindness and an investment in people at the heart of everything he does.
patients even more. The harsh reality is the health service is deteriorating rapidly and it is going to be doctors that make a stand at this point. Pay is just one aspect of this.’
the doctor | September 2022 21
During his three-year period as chair Professor Banfield intends to also deliver on the work to improve the culture of the BMA, to overhaul and massively expand and improve local organising and to drive a radical membership recruitment campaign – committing to the association being a strong trade union and an expert professional association representing members as well as possible.Hesays:
bma.org.uk/thedoctor
Support is central
The letter was written more in hope than expectation, but to the then 15-year-old’s surprise Mr Attenborough’s wife responded informing him that her husband was away
filming for television but that he would respond on his return. Just weeks later he did so, suggesting a number of options for reading – but not including any of his own published works.
‘I can bestpatientsservenow by reestablishing the muchdoctors’authorityvoiceprofessionalneededandof
‘My role is to change the face of the BMA. I’ve got to create a BMA that has an inclusive culture and which reflects the membership better. I want to get the best out of everyone. If, one day when I’m gone, I’m known as Phil Banfield the obstetrician and trade unionist that would be job done for me.’
These are memories that still strike a chord to this day. ‘For me it has always been about people – and I’ve tried to apply that kindness and that openness to everything I’ve done,’ Professor Banfield says.
MEDIA SPOTLIGHT: Professor Banfield gives media interviews in his role as chair of BMA Cymru Wales, with BBC Wales health correspondent Owain Clarke (left)
‘I’m one of those people who takes pleasure in helping others to achieve,’ he adds.
Dr Latifa Patel is chair of the BMA representative body
Despite the few ignorant comments I received when I stood for election, the experience I have had of leadership at the BMA as a mum who requires flexibility and the ability to prioritise my daughter has been brilliant. Most importantly, I have been supported to work differently – I am able to work from home when I need to, I am given childcare support when required and I have even chaired meetings lasting up to nine hours with my baby in a sling. I have been able to arrange my diary around breastfeeding my daughter, taking her to play groups or putting her down for naps.
Our chief officer group is now 50% women and we have more women than ever before in leadership. We still need to do more – we must reflect the workforce and the membership as best we can and we are still some way from that given the NHS workforce is around 75% female.
It is crucial our leadership is as diverse as possible so we can advocate for our profession and our patients as comprehensively as we can. If you have any questions about taking up leadership roles, contact me on Twitter or email RBChair@bma.org.uk
My experience of being a woman in medicine is that it often feels – for good reason – like huge decisions are made about our working, and personal, lives without people like us in the room. Decisions are made about our careers without women being involved in consultation and evaluation. The BMA has been guilty of this like many organisations and institutions but there is no doubt change is under way in the association.
I would also like to say to my male colleagues that if you are the sort of person who makes those comments that I received – questioning the commitment of women, intruding on their privacy by demanding future life plans or suggesting they may not have enough experience –then you are not welcome in the BMA.
The BMA needs more women in leadership positions to boost diversity and inclusion
Your BMA
I had stood for many roles before and not been asked these questions. However, those comments were perhaps not hugely surprising – I, like many women and people from minority groups, have heard the lazy stereotypes and the language of discrimination all before. They are inappropriate and unacceptable.
I am now your RB chair, a chief officer and have fulfilled all of my duties in this role and my previous role while pregnant, while on maternity leave, and while raising a newborn baby during lockdown and without any child care. I have also become a flexible worker and have taken time out of training during my time as a senior leader.
We need more women. I know that may seem daunting for some of you but I can tell you, from first-hand experience, these are positions in which you can thrive and in which you can make a difference because your BMA will work around your personal requirements.
complicated your life circumstances might be – please consider standing for election. We need your voice to represent our profession better.
22 the doctor | September 2022
@drlatifapatel
My experiences show that leadership – and senior leadership – at an organisation such as the BMA are possible for people from under-represented backgrounds, or for people who need flexibility, like me. If you have ever thought your ambitions for leadership should be tempered because you don’t have the privileges that come with being a straight, middle-aged, white, man or because your life circumstances might require adaptations around you, then think again. I want to tell you that there are no obstacles to you taking a leadership role – there are no requests for support that we will not consider. Whatever specialty you work in, whatever grade you are, whatever your experience is, however
There will be elections for leadership positions at the BMA running throughout the year and I would urge you to get involved. We need those of you whose voices haven’t already been heard, whose voices often aren’t heard, to come forward and take on these roles.
I was asked by some BMA members what my intentions were for the future: did I really want to take this commitment on? Should I be doing it so young and as a junior doctor? Would I be thinking about marriage and having children and would that affect the role?
When I stood for election for the position of deputy representative body chair I was in a field of candidates with six men.
The medical student said the BMA employment adviser had been ‘very supportive’ with ‘frequent communication’ and ‘lots of advice’.
The Doctor is a supplement of The BMJ. Vol: 378 issue no: 8352 ISSN 2631-6412
BMA House, Tavistock Square, London, WC1H 9JP. Tel: (020) 7387 4499
She was not happy with the occupational health report and did not think it was accurate. It alluded to attendance problems, and how these would affect her ability to achieve her competencies. However, her attendance had never been an issue.
It was this the medical school focused on as she began a clinical placement. It insisted that, when undertaking it, she sign in every day at the undergraduate office at the hospital.
Call a BMA adviser 0300 123 1233
Nothing about this was right. It singled her out unfairly. It clearly was not needed for the purpose of confirming attendance or others would have had to do the same – and it’s usually pretty obvious if a student isn’t present on a placement. And, perhaps worst of all, it involved a considerable extra walk, thus increasing the risk of exacerbating her condition. She was told that this was to fulfil the requirements of the GMC and her future foundation application – which was not true.
Email thedoctor@bma.org.uk
Of all the organisations that should have insight into people’s health conditions, you might think a medical school would be fairly near the top.
Showing considerable courage, the student raised the matter with her medical school. She took a fellow student with her to the meeting. The medical school’s response to the BMA member’s concerns about her feeling singled
out was… to say to her peer that he would have his attendance monitored too. It was a response which seems harsh and peevish. Students are taught that as doctors they have a duty to raise concerns, and yet here they were being shown that by raising concerns they would be subject to less favourable treatment.
The Doctor
Read more from The Doctor online at bma.org.uk/thedoctor
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 £170 (UK) or £235 (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.
groundtheon
A compromise was reached, where it was agreed that this was the last placement at which she would be monitored, and her friend would not be monitored at all.
Feature writer: Seren Boyd
Staff writers: Tim Tonkin (020) 7383 6753
membersgivenpracticalHighlightinghelptoBMAin difficulty
Chief sub-editor: Chris Patterson
The student got the BMA involved. The BMA employment adviser wrote to the school requesting a formal meeting, with her present, to discuss what support the student needed (and which she clearly was not getting). She said the conditions being put on the student and her peer were potentially discriminatory and requested a second occupational health opinion. The school raised her supposed attendance problems, but had to retract these claims when it turned out that they simply were not true.
For employment advice, call 0300 123 1233 or email support@bma.org.uk
Editor: Neil Hallows (020) 7383 6321
@theBMA@TheDrMagazine
and Ben Ireland (020) 7383 6066
Design: BMA creative services
The student has a health condition where she is prone to fainting or collapsing episodes which can be exacerbated by excessive walking and exercise. Following a spell in hospital, her medical school referred her to occupational health.
But one of them subjected a medical student to unnecessary and discriminatory measures while she was on a placement.
Cover photograph: Matt Saywell
Senior staff writer: Peter Blackburn (020) 7874 7398
doctorthe
Scotland correspondent: Jennifer Trueland
Senior production editor: Lisa Bott-Hansson
A student was singled out unfairly – and a friend who spoke up for her was targeted too
As a professional association as well as a trade union, the BMA is able to offer more than just workplace support, and so the employment adviser was also able to refer her to the BMA’s equality and diversity team, who gave advice about possible forms of future support and the chance to contact doctors who had overcome similar obstacles.
–
Make sure your details are up to date
Update your details today myaccount.bma.org.uk
ADVERTISEMENT
With the correct details on your account you can: access essential products and services vote in BMA local and national elections attend events and network with peers receive the communications relevant to you.
–
–
For information on all your member benefits, or any other queries, please call us on 0300 123 1233 or email support@bma.org.uk
Ensure you make the most of your benefits by keeping your details updated, including contact preference, place of work, and primary grades.
BMA membership is here to give you the support you need when you need it most.
