The Doctor – issue 60, October 2023

the doctor

For our future, for our patients

Doctors’ united call for fair pay

Knife violence

Tackling an epidemic at source

‘Natural campaigner’ GPs elect a new leader

Lack of support

‘Patchy’ occupational health services

At a glance

A new podcast series with a focus on communication

4-7

Stop it at source

The ‘public health approach’ to tackling knife violence

8-9

‘I’m a natural campaigner’

The new GP leader, and her ‘bruised’ profession

10-13

‘We shall fight on’ Doctors unite in support of pay restoration

14-15

Taking the strain Pressure on doctors is intense, but access to occupational health services is ‘patchy’

16-19

A precious time

A chronic lack of investment in paediatric palliative care is causing unnecessary anguish

20-21

Supporting each other Thousands of doctors have already benefi ted from the BMA strike fund

22

On the ground The BMA helps a member secure a vital career break

23 Your BMA

Doctors unconvinced by the Government’s workforce plan

Welcome

Phil Banfield, BMA council chair

It gives me great pleasure to welcome Katie Bramall-Stainer to her role as chair of the BMA GPs England committee – and for us to introduce her to you in more detail in this issue of The Doctor. Katie has been a tireless campaigner for, and leader of, GPs for many years and will no doubt bring her great strengths to the BMA’s fi ght for fair pay, better terms and conditions and safe working environments for all doctors.

The dispute has an opportunity to make progress. Although Mr Sunak refuses to discuss pay in a pay dispute, there are increasing and multiple calls demanding he meets with us. We will not stop until your voices are heard. In this issue of the magazine we reveal thousands of doctors have been supported to take industrial action by the BMA’s strike fund. We speak to doctors who have benefi ted – who would not have been able to join our collective action without fi nancial assistance – and to others who have contributed to the fund to ensure our industrial action can continue for as long as is necessary. Whether this dispute runs for days, weeks, months or years, we will continue to fi ght and we will continue to advocate for our profession and our patients.

Also in this issue of the magazine we hear from frontline doctors about the traumas and tragedies of knife crime – and what positive eff ects treating the issue as a public health problem can make to the health service and communities. Among the heartbreaking stories about lives lost there is also, thankfully, cause for optimism thanks to the brilliant work of doctors and other health workers who are taking action to try to intervene in these senseless cycles of violence and suff ering.

Elsewhere, we analyse the eff ects of workplace pressure and a mounting backlog on doctors, and hear about eff orts to improve occupational health services for staff. We also visit Chestnut Tree House in Sussex as part of a piece about children’s palliative care. This hospice is a ‘life-affi rming’ place where the short lives of terminally ill children are lived to the full.

It is absolutely inspiring to read about the tireless work of staff and the bravery of patients – but also eye-opening to uncover the struggles families face navigating the system and the desperate need for investment in paediatric palliative care.

Keep in touch with the BMA online at instagram.com/thebma twitter.com/TheBMA

‘There is something magical about the confluence of medicine and communication. It is an alchemy which can produce genuine inspiration.’

So observes former BMA president Martin McKee in his introduction to the association’s Inspiring Doctors podcast, a series dedicated to exploring the contributions of doctors and scientists noted for their achievements in effectively communicating the complexities of medicine to the public.

Despite having only launched in June this year, the podcast has already showcased more than a dozen luminaries from the medical world, all of whom have made a name for themselves as exceptional communicators in one medium or another.

These include Private Eye’s Medicine Balls columnist and Edinburgh fringe comedian Phil Hammond with whom Prof McKee discussed the Bristol heart scandal and the importance of protecting whistle-blowers in the NHS.

Others to have appeared on the series include Trisha Greenhalgh who, like Prof McKee, is a member of Independent SAGE – a group that played a pivotal role during the pandemic in broadening the public’s understanding of COVID-19.

Prof McKee has also enjoyed audiences with Bad Science author and long-time Guardian columnist Ben Goldacre and Alice Roberts, who along with having presented numerous BBC shows including Time Team, The Incredible Human Journey and Origins of Us, also serves as Professor of Public Engagement in Science at the University of Birmingham.

Prof McKee notes that, while communication is an essential and everyday aspect in medicine, from doctors consulting with their patients to their referrals to other clinicians, the ability to speak to

AT

those beyond medical and scientific audiences is not a skill possessed by everyone in medicine.

Dr Goldacre, who features in the ninth episode of the series, reflects that while a large part of his media career focused on communicating medical and scientific information to a generalist audience, this skill is a fundamental requirement to any practitioner.

‘When you’re making a diagnosis, you know, patients don’t come in and say, “I’ve got central crushing chest pain that radiates up my neck”,’ he tells Prof McKee.

‘They come in and describe their bodily experiences in their own language, and you’ve got to negotiate the mapping of all of that on to the sort of body of technical medical knowledge. So, I think it’s [good communication] at the core of everything that everyone does all of the time.’

The importance of good communication was perhaps most brought home by the late Kate Granger, a geriatrician who, following her own experiences as a cancer patient, launched an NHS-wide campaign # hellomynameis aimed at encouraging doctors to introduce themselves on first-name terms to those they were caring for.

Indeed, kindness and good communication are arguably integral to one another, something that Dr Hammond touches on in episode three of the series.

‘I’ve worked with chronic fatigue, ME/CFS, long COVID, for 11 years, and there’s loads of stuff we don’t understand about that,’ he says.

‘But what we do understand is that you have to acknowledge people’s stories. You may not have the solution, but you acknowledge their stories and their suffering, and you legitimise it.’

A new episode from the series is planned for later this autumn. To listen to the series and to find out more visit bma.org.uk/inspiringdoctors

MCKEE: Effective communication can be magical

GREENHALGH: Member of Independent SAGE

Doctors want to do more for knife-crime victims than just ‘stitch them up and send them back’. Going into communities with a strong educational message, and using the best available data, they tell Tim Tonkin about the ‘public health approach’ to the violence epidemic

STOP IT AT SOURCE

As an experienced trauma surgeon, Nikhil Misra is used to seeing patients in life-or-death conditions and in desperate need being suddenly thrust before him.

While his patients come from all ages and backgrounds, many of those he has encountered on the operating table are young people who have been the victims of severe and violent injury resulting from knife violence.

One such incident five years ago, however, proved so catalytic for Liverpool-based Mr Misra that he decided he had to do more than simply treat the physical wounds wrought by knife crime, and instead work with others inside and outside of the health service to promote prevention.

‘We had had a really bad summer for fatalities from knife wounds in young people that culminated in a case where a young lad taking part in an organised fight in a field near his school ended up with a single stab injury to his groin,’ he reflects.

‘He exsanguinated. Ran across the field and came into the trauma centre with cardiac arrest. We did incredibly aggressive resuscitative surgery on him and the whole trauma team were brilliant that day, but we couldn’t save his life – I couldn’t save his life.

‘The immediate few minutes after that [losing his patient] of having to pause and then go and speak to his dad and break the shattering, horrible news. I went back home that night, spent time with my family and thought, “This needs to get better, this can’t be right”.’

Knife violence, particularly among young people, is a

long-standing and tragic social phenomenon that blights communities in all parts of the UK, with the latest figures released by the ONS (Office for National Statistics) painting a grim picture.

Incidents doubled While the number of assaults with injury or with intent to cause serious harm involving knives fell from 22,097 at the end of March last year to 21,555 during the same period in 2023, this figure is almost twice as high as that recorded a decade earlier in March 2013.

ONS data specifically related to homicide, meanwhile, reveals that of the 69 murders involving victims aged 13 to 19 years old recorded at the end of March 2022, 74 per cent of these killings were as the result of a knife or sharp instrument, compared with just 41 per cent of all victims of homicide.

Mr Misra’s experience back in 2018 ultimately led him to found KnifeSavers, a charity which primarily seeks to educate young people about the dangers of knife violence as well as provide basic clinical skills to help save lives in the event of someone being stabbed.

The charity has also sought

to improve victims’ chances of survival by caching 1,500 bleeding control packs in different parts of Liverpool and Merseyside, with the locations of these potentially lifesaving resources plotted and accessible via an app.

KnifeSavers’ work, however, is just one component complementing a broader, ‘public health’ response to knife violence in communities within Liverpool and Merseyside.

Determining what exactly a public health approach to knife violence equates to can vary, but one vital aspect is that of different institutions such as health services and the police sharing data in line with the precepts set out in the Cardiff violence prevention model.

Devised by Professor Jonathan Shepherd, the Cardiff model prescribes collecting data on location, nature and scale of violence, determining the factors which influence the risk for violence and then using this analysis to devise and implement interventions at a local level which can later be scaled up if required.

This approach was used in the UK back in 2005 with the launch of the first VRU (Violence Reduction Unit) by Strathclyde Police in Glasgow,

‘I thought, “This needs to get better, this can’t be right”’

WALL OF RESOLVE: KnifeSavers volunteers prepare to educate young people

OLIVIA VILLEGAS

a city that at that time had one of the highest murder rates in Europe.

Data-driven

Underpinned by the belief that violence is a preventable not inevitable outcome in society, the VRU used pooled data to help direct and target resources, as well as seeking to identify and address the factors deemed likely to increase an individual or community’s vulnerability to violence.

It was an approach credited with delivering a 35 per cent reduction in Scotland’s murder rate between 2010 and 2020, and a success story that ultimately saw the UK Government provide a total of £70m to establish VRUs across 18 English police-force regions in 2019. Alongside his role with KnifeSavers, Mr Misra now serves as the health lead for the MVRP (Merseyside Violence Reduction Partnership) and says that sharing data has been critical to enhancing his charity’s work.

‘When I first started off [with the bleeding-control packs] it was essentially a scattergun approach, putting them in areas where we thought they would be needed,’ he explains.

‘Since then, we’ve made

some incredibly strong connections with Merseyside police and work with their intelligence analysts who have helped us to identify areas that may benefit more from bleeding control packs.

‘We then look at data from the violence-reduction partnership in terms of where the incidents occur as well as data provided by North West Ambulance Service and emergency departments via the MVRP so that we know where patients [of knife violence] are coming to us from and who they are in terms of demographics.

‘This approach has made me totally rethink my way of how I deliver healthcare on the wards in the hospital, how we can effect change as clinicians. I think we could play a massive role in that, which as doctors we may not fully realise. Just pausing, taking a beat, and taking time to listen to the person we are delivering healthcare to could make such a huge difference.’

Data sharing between emergency departments and other bodies took place prior to the roll-out of VRUs via Information Sharing to Tackle Violence, which sees the sharing of anonymised

data of patients who have been the victim of violence with the police and with local community safety partnerships.

Looking at data to develop a better understanding of where knife violence may be happening is, however, only one part of a public health response.

While numbers can provide a better sense of the bigger picture, being able to understand and relate to those most likely to be affected by knife violence and trying to provide guidance and support beyond just repairing their physical wounds, is something final year medical student Vishal Chahwala firmly believes. Having written a dissertation examining hospital-based violence intervention programmes while studying medicine at Barts and The London, Mr Chahwala has for five years volunteered for the charity StreetDoctors.

As a national organisation, it trains young people affected by violence with emergency lifesaving skills and increases their understanding of its medical and psychological consequences.

The training is delivered by a network of healthcare volunteers, including student doctors, nurses and paramedics to a range of youth partners across the country including youth and sports providers, educational settings and criminal justice services.

He says interacting with young people, many of whom have been directly or indirectly affected by knife crime, had given him a much greater appreciation and understanding of the societal causes and risk-factors around

‘There’s not that much appreciation of the risk factors of violence’

PEER SUPPORT: A StreetDoctors volunteer teaches first-aid skills

the phenomenon.

‘I think as medical professionals we are slowly getting better at viewing people with diseases rather than just the disease on its own,’ he says.

‘We’re beginning to move away from a system where we stitch people back up and then send them back to the same environment that victimised them in the first place. However, there still needs to be a greater appreciation of the risk factors of violence and what makes young people more vulnerable to violence.

‘I think a lot of the pushback to a public health approach is that mentality of “I need to fix their [patients’] diabetes and heart disease, I don’t have the time to worry about their social issues”,’ says Mr Chahwala.

‘I understand and agree with the argument that medical professionals can’t fix everything on their own, but we have a responsibility to know how we can refer patients to the right services and refer them to the right people.’

Mr Chahwala says training young people in clinical lifesaving skills not only serves a practical purpose, but also

bma.org.uk/thedoctor

provides a mutually beneficial opportunity for both sides to learn from each other.

‘It’s allowed me to have a real understanding of violence as an issue,’ he says.

‘One of the really dangerous and worrying misconceptions that some young people have is that there are safe places in the body to be stabbed. I’ve heard a few times young people talk about knowing peers who have stabbed someone in their thigh because they thought it was safe [and] they’ve ended up with a murder charge instead.

‘StreetDoctors sessions go beyond just teaching “this is how you save a life”, it gives these young people an opportunity to have some time with a mentor, with a role model. It’s a safe space for them to ask questions and talk about issues that are important to them.’

Engaging with those affected by knife violence in ‘reachable’ rather than ‘teachable’ fashion, is something Mr Misra also recognises the value of, having welcomed non-clinical youth workers known as youth navigators into his own ward.

These navigators, who are

deployed by the MVRP, aim to engage with the young victims of violence and attempt to gain a better understanding of their lives and social circumstances, and what interventions might reduce their risk factors of knife crime in the future.

‘The first thing we [as doctors] have to do is to understand why this person, who has been stabbed, in front of me – what brought them to that point in their life and how can I make a difference?’ says Mr Misra.

‘I’m a lifelong Liverpool fan so when I go in to see a patient I initially talk about football. That breaks the ice and allows them to see me in a different light, and for us to communicate at a different level, as someone they can talk to as a person, not just a doctor.’

The KnifeSavers training team, as well as the senior leadership team of Kristian Tattam and Nicole Russell, are all volunteers who run the campaign and deliver the training in their spare time.

The number of clinical volunteers has grown from a group of four to almost 80 people currently, and the campaign is being started in a number of other locations around the country.

‘We have a responsibility to know how we can refer patients to the right services’

‘This approach has made me totally rethink my way of how I deliver healthcare’

CHAHWALA: ‘It’s allowed me to have a real understanding of violence as an issue’

MISRA: Uses data to learn more about knife-crime hot spots

OLIVIA VILLEGAS

Katie Bramall-Stainer, recently elected as chair of the BMA GPs committee, takes on the leadership of a ‘bruised’ profession with a strong determination to rebuild general practice.

Interview by Peter Blackburn

Maxims about the best leaders being people who don’t actively seek out power are abundant.

It is in this tradition that Katie Bramall-Stainer finds herself chair of the BMA GPs committee – giving up a job role she loved and taking responsibility for leading the profession during arguably the most challenging period in the history of the NHS.

It is a change which comes not out of a desire for decision-making and being in charge, but because of an empathy for colleagues and patients and, frankly, an overwhelming number of appeals for her to ‘step up’

from friends and supporters.

Dr Bramall-Stainer was local medical committees UK conference chair and thriving in the role – not least in securing a passionate keynote defence of general practice from Brass Eye creator Chris Morris at the 2023 conference – until taking on the leadership of GPC in August. The speech, in which Mr Morris quipped that 100 per cent of patients would rather see their GP than (then health secretary) Thérèse Coffey, went viral, with more than 350,000 views on YouTube.

‘It’s a bit of a surprise – not least to myself. If you had told

me six months ago I would probably have laughed. I was asked by a considerable number of people to take on this role just under a couple of years ago but I had only just become chair of the UK conference so I felt it would be wholly inappropriate. Conference, if I’m truly honest, is where my heart lies, and it’s been difficult to walk away from that role. It’s a tremendous privilege.’

‘Rock bottom’

Dr Bramall-Stainer’s analysis, however, is that the profession and the NHS are at ‘rock bottom’. And she may be as well placed as anyone

‘I’m a natural campaigner’

SARAH TURTON

BRAMALL- STAINER: ‘I’m probably in my happy place carrying a placard and shouting’

to try to enact change. Detractors of general practice have grown in number and voice in recent months and years despite all the remarkable achievements during the pandemic and relentless increases in demand. The country, she says, cannot afford to lose expert generalists in the gatekeeper role – a ‘unique feature recommended and replicated worldwide’.

GP practices across the country are experiencing significant and growing strain with declining GP numbers, rising demand, and difficulties recruiting and retaining staff all having knock-on effects on the wellbeing and morale of the workforce and access and care for patients.

These are pressures Dr Bramall-Stainer has felt keenly – and, as a result, GPs are likely to feel they have an ally in their new representative. In 2010, Dr Bramall-Stainer – a notably charismatic, and convincing, public speaker –was diagnosed with MS which became so overwhelming she couldn’t even speak in consultations. Dr BramallStainer attributes regular partnership days of 12 or 14 hours and sometimes more with creating the ‘perfect storm’ of conditions for the aggressive early phases of her chronic illness. Different roles as a salaried GP, as well as a variety of leadership positions, have helped but Dr Bramall-Stainer will always look to protect and advocate for a workforce too often pushed to burnout and illness.

‘We feel very bruised as a profession – particularly

bma.org.uk/thedoctor

through the pandemic when we were instructed to change everything overnight and we did that.

‘We need to think really carefully about protecting and sustaining general practitioners at the heart of primary care and the NHS and I’m going to be unashamedly protectionist about our workforce in that way.’

In Dr Bramall-Stainer, GPs have a representative unafraid to speak truth to power – even when doing so might become painful and problematic personally.

In 2019 Dr Bramall-Stainer and then GPC colleague Zoe Norris called out sexism and sexual harassment within the BMA and committee, leading to an independent inquiry, and subsequent report, by Daphne Romney KC and a following programme of cultural reform within the association.

‘It was difficult,’ Dr BramallStainer says, reflecting on the decision to speak out and the fall-out following the revelations. ‘But a lot has changed since then. It was painful but it was important for the BMA. We’ve changed and our demographic is quite different – but we still have a long way to go.’

Key proposals

Among Dr Bramall-Stainer’s immediate ideas and priorities – a catalogue of potential solutions to crises are being drawn up constantly – are a sharp focus on the retaining of newly qualified GPs, continuity of care as a core principle, and a removal of overburdening bureaucracy and regulation.

There are detailed proposals and projects too.

Dr Bramall-Stainer gives examples such as the planned introduction of easy patient access to medical records. Her team – which includes newly elected deputies David Wrigley, Samira Anane and Julius Parker – will call for a suspension on publicity for patient access to medical records to give doctors and other staff time to adjust and urge action to redact parts of files which may put people in abusive relationships at greater risk, such as information about abortions and contraception. Many other areas of work continue.

Dr Bramall-Stainer is keen to build on positive early relations with goodnatured negotiations – ‘the department is listening to us’ at the moment, she says –aimed at rebuilding general practice and protecting the workforce. But she does not shy away from action should that relationship become unhealthy once again.

‘I think we want the same things. And I think that’s a really good place to start. But no one is under any illusion. If conversations become increasingly difficult, if we find ourselves with a record third contract imposition –a historic position – we then ourselves would have to consider unique, historic consequences.’

She adds: ‘There’s a lot of frustration out there. And goodness knows I share that. I’m a natural campaigner, I’m probably in my happy place carrying a placard and shouting… I’m not discounting action. In fact, I think action might well be necessary. And I am prepared to take it.’

‘We feel very bruised as a profession’

‘We need to think really carefully about protecting and sustaining general practitioners’

‘WE SHALL FIGHT ON’

Doctors have sent the strongest warning yet to the Government that they intend to continue striking up to the next general election as the fight for fair pay intensifies.

Thousands of doctors gathered in Manchester as the Conservative Party conference took place in the city this month, with consultants and junior doctors travelling from all corners of England on buses provided by the BMA.

Health secretary Steve Barclay made no mention of plans to resolve the strikes in his speech to his party’s conference on the same day and has not met with either consultants or junior doctors for months.

BMA consultants committee chair Vish Sharma wrote to prime minister Rishi Sunak to say no new

strike dates would be announced for four weeks from the latest three-day joint action, which took place from 2 to 5 October, because the Government has refused talks as long as strike dates have been called. Dr Sharma also urged the involvement of arbitration service ACAS.

‘Scapegoats’

Doctors remain defiant despite the Government digging in on its ‘final’ pay offer of a 6 per cent uplift for consultants, and 6 per cent plus a lump sum of £1,250 for junior doctors in England.

And as the action being taken by junior doctors and consultants progresses, specialist, associate specialist and specialty doctors and colleagues in Wales and

Consultants and junior doctors came together to show their commitment to pay restoration and to urge the Government to resume talks. Ben Ireland reports

SOLIDARITY: Doctors protest in Manchester earlier this month

Northern Ireland are taking steps towards their own industrial action.

Speaking at the lively Manchester rally, BMA council chair Phil Banfield said: ‘We will strike until the next general election and beyond if that is what it takes.

‘But our patients need the PM to meet with us now; restore the value of pay, now; make a credible offer, now; end these disputes, now.’

He said the dispute was: ‘For our future, for our patients, and the future and health of the people of this country.’

Junior doctors have been striking since March, and consultants since July. Prof Banfield praised BMA members for being ‘unflinching in the face of a Government scandalously trying to scapegoat doctors for 13 years of their failures’.

Vivek Trivedi, co-chair of the BMA junior doctors committee, reflected this sentiment in his speech, reiterating that – until a credible offer is made – doctors ‘are not going anywhere’ because ‘we deserve fair pay’.

‘The Government is fighting for its survival, and we have the public on our side,’ he said.

Results of a September survey of 1,765 adults in England confirm that 42 per cent of the public blame the Government for record waiting lists, while only 15 per cent blame striking doctors.

Mr Barclay used his conference speech to lay out plans to update the NHS constitution, to ban trans patients from being seen in female-only or maleonly wards – and announce funding for technology.

‘Cruel’ approach

Prof Banfield said Mr Barclay’s speech was ‘a distraction from serious NHS problems’, adding: ‘Mr Barclay claims to be focused on outcomes all while refusing to speak with those who deliver care.’

BMA consultants committee deputy chair Mike Henley told the rally: ‘The Government may tell itself that avoiding compromise shows strength. But it is clear to the eight million voters awaiting care that this

‘For our future, for our patients, and the future and health of the people’

is no more than cruelty and abandonment.’

Doctors descended on Manchester from all over England to attend the rally.

The Doctor joined a group on a coach departing BMA House in London. Leeds foundation year 4 Rachel Southern-Thomas criticised the Government’s ‘convenient amnesia’, contrasting its attitude towards striking doctors now and healthcare professionals at the peak of the pandemic – adding that workload pressures have not eased.

London foundation year

2 Robert Gittings agreed, saying: ‘It’s as if we’ve gone from heroes to enemies of the state. It’s really hypocritical.’

London consultant anaesthetist Rachel Freedman said the sheer number of doctors travelling to Manchester showed how serious the profession was about securing the NHS’s future.

‘This is not a minority of doctors, as government spin might suggest,’ she said. ‘We are a large group of cohesive doctors who have said enough is enough.’

DDRB reform call

Dr Freedman reiterated the importance of reform of the Review Body on Doctors’ and Dentists’ Remuneration , which a Conservative back-bencher has said is ‘basically rigged’. She insisted it must be fully independent to help restore trust among doctors who are leaving the

NHS in increasing numbers.

As many consultants do, she also sees the strike as a battle for the future of the NHS as a free-at-thepoint-of-care service.

‘It won’t be sustainable with continual underfunding and staff who aren’t remunerated properly,’ said Dr Freedman.

Gloucestershire psychiatry trainee Amir Palermo feared the UK’s healthcare system could fall into a ‘two-tier service’ comparable with that in his home country Malaysia if the pay issue was not resolved.

Having consultants join industrial action in recent weeks has created a greater sense of ‘camaraderie’, he added.

‘We’d rather work’

That camaraderie was also clear from picket lines in London during the September strikes, the first joint consultant and junior doctor strikes in NHS history.

Emergency medicine consultant Simon Walsh, BMA consultants committee deputy chair, was picketing outside the Royal London.

He said: ‘We’d all rather be at work. If the Government hadn’t entrenched themselves in a ludicrous position where they won’t talk to us, perhaps we wouldn’t be here.’

Margarita Kousteni, a specialty trainee 2 in psychiatry at Maudsley Hospital in London, said it was

‘This is not a minority of doctors’

BANFIELD: Prepared to take action until general election

ON THEIR WAY: Doctors on board a bus heading for Manchester

reassuring to picket alongside consultants.

‘It’s encouraging that doctors who have gone through what we’ve gone through and reached the grades we’re aspiring to, are supporting us,’ she said.

‘They know the hardship we go through and have seen better days in the NHS so can recognise how things are getting worse.’

More ballots

SAS doctors in England have opened an indicative ballot, which runs until 16 October.

Committee chair Ujjwala Mohite said: ‘All we want to do is care for our patients, but that’s put at risk when doctors feel undervalued and end up wondering whether they even want to stay in the NHS.’

Consultants in Northern Ireland are to ballot for industrial action, after the Department of Health – which has essentially been left to run the health service since the collapse of devolution in February 2022 – said it would not offer any pay uplift for doctors, despite DDRB recommendations.

Of consultants polled in Northern Ireland, 77 per cent said they were willing to take industrial action.

Junior doctors in Northern Ireland are also preparing to ballot. Respondents to a recent survey reported how workload pressures meant they are unable to continue with training, and that low pay meant they are now more likely to leave.

bma.org.uk/thedoctor

In Wales, junior doctors are to be balloted for industrial action from 6 November to 18 December. Consultants and SAS doctors in Wales will also be balloted. All groups of doctors were offered a pay uplift of 5 per cent, not just below inflation but below that offered to colleagues in England.

It is only in Scotland where there has been any resolution. Junior doctors in Scotland accepted a 17.5 per cent pay uplift over two years, which included a ‘key’ commitment from the Scottish Government to work towards full pay restoration in the future.

BMA Scotland, however, continues to warn that the devolved Government must take ‘real action’ to stem low morale among consultants who were handed the same 6 per cent offer as in England, and have not ruled out balloting for industrial action.

With various different groups of doctors coming together in a collective fight for fair pay, there is a sense that doctors are growing in confidence that they are on the right side of the dispute and will find a way through.

The message from the BMA, as speakers at the Manchester rally reiterated, is: ‘Stick together, strike together, win together.’

To donate to the BMA strike fund, go to bmastrikefund.raisely.com and see the feature on pages 20-21.

‘Doctors end up wondering whether they want to stay in the NHS’

TRIVEDI: ‘We deserve fair pay’

SHARMA: Negotiate with us and end dispute

TAKING THE STRAIN

It is not without a certain degree of irony that, while doctors dedicate much of their lives to providing care to their patients, this devotion often comes with the cost of neglecting their own health.

Making sure doctors’ health needs and wellbeing in the workplace are being met is of critical importance, not just for the clinicians affected by ill health but also for helping to minimise staff absences and to ensure safe and effective care is delivered to patients.

In this respect, occupational health units can play an indispensable role, one that since COVID has become more visible and increasingly sought after.

While traditionally viewed by health professionals as merely a one-stop-shop for routine health clearances and booster vaccinations when starting in a new workplace, occupational health departments are charged with a range of roles concerning staff health.

These responsibilities include undertaking health assessments and providing rehabilitation to staff returning to work following illness or injury or advising employers about suitable alternative positions for staff temporarily or permanently unable to perform their existing roles.

Occupational health also assists in the development of workplace policies and practices designed to promote and safeguard the physical and mental wellbeing of the staff working there and can serve as a conduit sign-posting those with health issues to more specialised forms of support.

A recent example of this collaborative approach is the SMHS (Staff Mental Health Service) at Cambridgeshire and Peterborough NHS Foundation Trust.

Pressures on doctors and other NHS staff have never been greater, and yet occupational health services can be ‘patchy’, and specialist care hard to access. Tim Tonkin hears the urgent need for a comprehensive and high-quality service

Launched in September 2020, the service provides rapid access to psychological assessments and treatment and is available to 25,000 clinical and non-clinical staff based across five trusts.

Reasonable adjustments

Consultant psychiatrist Muzaffer Kaser is part of the service’s multidisciplinary team, which includes psychiatrists, psychologists, mental health nurses and an occupational health nurse.

He says that, while referrals come from a number of sources, including general practice, more than 85 per cent of those he and his colleagues see come from the trust’s occupational health service.

He says a particular innovative aspect of the scheme is having occupational health embedded and part of the conversation when it comes to determining reasonable adjustments and supporting staff engaged with the service in remaining or returning to work.

‘Universally healthcare workers have higher mental health needs than the general population; [at the same time] the healthcare they get is usually quite patchy and there are many barriers towards them accessing help,’ he says.

‘In the current provision in the NHS, there are lots of people who fall into the cracks of the mental health system [and] what we have seen in the last couple of years is healthcare workers tend to fall into those gaps quite easily and then experiencing delays in their assessments and treatments.’

The success of programmes such as the SMHS is a good practice example of what can be achieved for health service staff when occupational health services are effectively utilised.

The wider picture concerning the state of occupational health in the NHS, however, is a complex one with highly variable standards of and access to care between secondary and primary care, and with specialist staff qualified in occupational health in short supply.

A review of occupational health in the NHS conducted by Steven Boorman in early 2021 concluded that an increasingly restrictive financial climate over the previous decade had seen occupational health taking a more reactive approach to staff wellbeing resulting in it being perceived as a ‘breakdown service’.

Dr Boorman’s report, Growing a Healthier Tomorrow, further highlights the diminishing

bma.org.uk/thedoctor

numbers of specialist staff employed in the NHS with just 98 occupational health physicians working in the NHS in England in 2021 compared with 172 in 2009.

BMA occupational medicine committee co-chair Kathryn McKinnon, who is a consultant in occupational medicine and education, acknowledges these limitations and the need to remedy them.

Accessing services

With levels of burnout among NHS staff higher now than perhaps they have ever been, Dr McKinnon says that, while universal access to well-staffed occupational health has never been more important, huge structural deficiencies need to be addressed if these services are to reach their full potential.

‘While there is [universal] access in secondary care, the access isn’t always what we would like it to be,’ she says.

‘There isn’t always a doctor present on the team, although they may have access to a doctor. And that doctor may not be an accredited specialist.’

Occupational health service provision within general practice is an even more complex situation, in large part because GPs are their own employer making the commissioning of services unclear.

This year’s BMA annual representative meeting saw doctors successfully endorse a motion calling for a primary care-wide policy on occupational health to assist GP practices in managing long-term sickness and return to work provision for their staff, while Dr McKinnon’s committee is engaged in work towards creating a national occupational health service for all primary care workers.

Dr McKinnon says that, while engaging with occupational health often results in highly detailed information being gathered on an individual, much of this data is for the purpose of assisting the occupational health team to make appropriate recommendations, and not to be passed wholesale to an employer.

‘I always explain to people that we [occupational health] are like Switzerland,’ she says.

‘We’re neutral and we try and make both parties better informed about the medical circumstances and make recommendations that we think will be beneficial from a medical perspective.’

‘There are lots of people who fall into the cracks of the mental health system’

KASER:

Healthcare workers can face barriers in accessing

help

‘Healthcare workers have higher mental health needs than the general population’

LIFE-AFFIRMING: Here, and on following pages, some of the opportunities for children at Chestnut Tree House

A PRECIOUS TIME

At Chestnut Tree House, short lives are lived to the full. The team does its utmost to make memories and grant wishes, whether it’s zip wiring in a wheelchair or being dunked in spaghetti.

This children’s hospice is a life-affirming, colourful place with beautiful grounds, wonderful amenities and the gracious air of a Sussex country home.

The nurse-led team here can provide the very best of care on site to a child with a life-limiting or life-threatening condition and their family.

However, they struggle

to offer the same highquality care to other families, especially those whose children want to die at home. Because Sussex, like many areas in the UK, does not have its own specialist paediatric palliative care team.

Consequently, many children needing palliative care have little choice in where they die – and deaths can be more distressing than necessary for their loved ones.

Families are struggling to navigate a complex care system alone and often come late to palliative care when their children are

the

child and the impact a treatment might have on them’

nearing the end of life.

Anna Jones, director of children’s services at Chestnut Tree House, is tireless in her advocacy, fundraising and passion. But she is tired of ‘living in the gap’ between what she and her team want to provide, especially in end-oflife care at home, and what they can offer in practice.

‘I have the most wonderful team here but there’s only so much you can achieve as a nurse-led unit,’ says Anna.

‘It’s distressing when you can’t give the specialist medical provision that children and young people

Immense kindness and an inspiring attitude to life are abundant features of paediatric palliative care. So too, sadly, is a chronic lack of investment and specialists.

Seren Boyd reports

‘We think about

whole

deserve and need.’

What makes things harder is knowing the care children receive depends on their postcodes. Nationally, the picture is patchy and wholly unfair.

ICBs (integrated care boards) have been required to commission appropriate palliative care for people in their area since the Health and Care Act 2022.

Yet, because of chronic underfunding for paediatric palliative care, there are not enough specialists, training places or commissioned services (see box, ‘Challenges faced’), let alone community children’s nurses who do the lion’s share of children’s palliative care.

Only a fifth of ICBs in the UK are meeting National Institute for Health and Care Excellence guidelines in children’s palliative care. Chestnut Tree House’s ICB does not commission paediatric palliative care.

Compounding this injustice is the fact that a child’s condition often determines whether they receive timely palliative care.

Oncology is relatively well funded: every child with cancer comes under the care of a central treatment centre and its palliative care team. But children with neurodisabilities, for example, rarely receive support from specialist palliative care teams at regional centres. Their deaths are hard to predict; they may come close to death many times before dying.

And what of the 15 per cent of Chestnut Tree House’s patient group with life-limiting conditions that have no diagnosis? ‘How do you put a

trajectory on that?’ asks Anna. Meanwhile, demand is rising for palliative care, which is about supporting children and families to live well, managing symptoms as much as endof-life care. Medical advances mean children with life-limiting or life-threatening conditions are living longer: in England, their number has more than doubled since 2001 to about 86,600.

Holistic care

Hannah Linford – ‘Dr Hannah’ as her patients know her – was a general paediatric consultant. Now, she works in a specialist paediatric palliative care team, one of very few in the UK. The SPACE team is a partnership between Shooting Star Children’s Hospice in Guildford and the Royal Marsden NHS Foundation Trust.

The team Dr Linford works with at Shooting Star comprises a consultant in paediatric palliative medicine, other doctors, a nurse consultant and specialist nurses, supported by other services. Dr Linford also works within a separate team of specialists based at the Trust, focusing on palliative care and symptom management in children with cancer.

‘Even the briefest tour confirms Anna’s mantra: it’s all about living’

So, she’s well placed to assess the difference that such a team could make to Sussex. She’s visiting Chestnut Tree House today to help Anna ‘scope a model’ to propose to the ICB.

It was the death of two terminally ill babies in her care when she was a general paediatrician that prompted her career shift. ‘I didn’t have enough knowledge and experience to be able to make it better for the families,’ she says.

‘We start from: how can we make this as good as we can for as long as we can?’

Far from withdrawing care, palliative care is all about creating a protective support structure. The families whom the SPACE team supports can have 24/7 access to specialist advice, whether they need a hospice stay for symptom management or a medical handover for paramedics.

Palliative care’s priorities are different: even the briefest tour of Chestnut Tree House, from its gaming hub to its dressingup costumes, confirms Anna’s mantra, ‘it’s all about living’.

‘We start from: how can we make this as good as we can for as long as we can?’ says Dr Linford.

‘Some of our children are managed by lots of different teams and tertiary hospitals.

HELP AT HAND: Anna Jones (left) and Hannah Linford

Specialists can tend to think in silos; we think about the whole child and the impact a treatment might have on them. We want to work out what symptoms are adversely affecting the child and their family the most, and manage them so that they can enjoy the lives that they have.’

Giving the family choices and working in partnership with them is paramount. So too is preparing families practically and emotionally for different scenarios through what’s called parallel planning.

‘Whatever course the child’s illness takes, we’re ready so the child doesn’t have to suffer,’ says Dr Linford. ‘When they fall, we’ve got them.’

The team works closely with other professionals to ensure the family’s wishes are respected and to spare them the agony of having to explain everything repeatedly. This might involve sending a directive to the ambulance service about a child’s resuscitation plan – or a specialist nurse to accompany the family to appointments as an advocate.

Ultimately, it’s about ensuring that death, when it comes, is as smooth and calm as possible.

‘If we’re expecting a child to die at home, we make sure they’re seen by a GP regularly to avoid it being an “unexpected death” so there’s no need for a post-mortem, the police don’t have to be called. If we can help minimise a family’s trauma on the worst day of their lives, that’s a privilege.’

Stuck in the system

Without the equivalent of a SPACE team who can join up the dots for them, families are left to find their own way through the acute sector, especially those whose child has a non-oncology condition.

One parent told Anna, ‘It’s not my son’s condition that upsets me most, it’s navigating the system.’ The boy was known to 27 different agencies.

It means families referred to Chestnut Tree House often arrive without the benefit of parallel planning. Many have stayed in the care of acute general paediatricians for too long because of the lack of this specialist support, Anna believes.

‘How do families say, “Stop”? If they’re having ventilation for their child’s breathing, why would they say no to TPN (total parenteral

nutrition)? These families are on a hamster wheel. It takes a skilled professional to discuss ceilings of treatment.’

And sometimes there are delays in children accessing hospice care because of misconceptions – held by parents and professionals – that hospices are ‘just for dying’.

‘Parents so often say, “We wish we’d known. This is nothing like what we thought”. It takes the right people to be having those conversations with parents, because some would hear the word “hospice” and think, “You’re telling me my child’s going to die?”’

Most heart-breaking of all for Anna are the families left to navigate a child’s death at home alone – often teenagers who want to be ‘around all their stuff’. If the family calls an ambulance, and the crew don’t have the benefit of a hospice’s support, the paramedics may not know if the death is ‘expected’ or not.

‘You need people who know what they’re doing, otherwise that parent’s memory is: It

‘Whatever course the child’s illness takes, we’re ready so the child doesn’t have to suffer’

HOUSE CHESTNUT TREE HOUSE

was chaos. The professionals looked terrified.’

The mother of a child who died in hospital told Chestnut Tree House: ‘The hardest thing was having to leave him in the mortuary. I was so scared of him being alone in the dark.’ Baby Rupert was later transferred to Chestnut’s bereavement suite – where the lights were left on.

Brave conversations

If families had 24/7 support at home such as SPACE offers, hospital admissions and hospital stays would be reduced, Dr Linford and Anna believe.

‘Acute paediatric wards can house children with complex needs during an episode of illness often for weeks and weeks,’ says Dr Linford. ‘It’s very challenging for the ward teams: they can feel like they aren’t doing very much medically but the child is not yet safe to discharge.

‘If there’s a team that can help navigate that time-consuming patientmanagement journey and help arrange stepdown care, it’s massively beneficial for the paediatric team, and the child –and it saves resource.’

It all starts with a referral to the palliative care team –which means initiating difficult conversations. Dr Linford understands why these can be hard for her colleagues.

‘There can be a reluctance with acute paediatricians to have these conversations because they worry, “Have I missed something? Would someone else know the diagnosis and I don’t?”

‘You’ve built a relationship with this family and then you feel like you’re taking away

bma.org.uk/thedoctor

their hope and letting them down. As a child’s paediatrician, making that shift is really challenging: I haven’t had to go on that journey with them, so it’s more straightforward for me. I can offer support to my colleagues and be a friend in the room for those conversations.’

What makes Anna and Dr Linford’s work so rewarding, despite the sadnesses, is helping a child have a ‘good death’.

The sooner those brave conversations begin, the earlier families access proper support, the greater the chances that a death will be ‘good’.

These discussions have to be euphemism-free. Talking about a child ‘going to sleep’ can leave young siblings waiting for the child to wake up again or afraid of going to bed, says Dr Linford.

‘If no one’s said to you, “Your child is dying,” you won’t hear it as a parent.

‘No parent ever wants to be the person who calls time but there will come a point when the child doesn’t need a transfusion or to have their bloods taken because the benefit isn’t worth the distress.

‘If you’ve signposted these things in advance, the parents feel able to say, “I think it’s time.” And you can affirm them: “You’re doing the right thing. This is what we spoke about.”

‘And when what should have been a really sad day ends with the child being with their family, with their dogs, in their front room, where everything is sorted and smooth, it can be beautiful.’

Or as Anna puts it, ‘when a child dies, you have one chance to get it right’.

Challenges faced

– Together for Short Lives estimates a £300m gap in NHS funding for children’s palliative care to meet NICE standards in the UK

– NHS England said it would end the £25m Children’s Hospice Grant this year – but recently renewed it for 2024/25

– Chestnut Tree House receives 17 per cent of its £5.5m annual care costs from government funding. The rest comes from donations and fundraising

– England has only 18 specialist children’s palliative care consultants.

CHESTNUT TREE HOUSE

Supporting each other

Doctors are taking industrial action because they are not paid what they deserve. And every time they strike, they lose out on pay for that shift. For doctors who face mandatory professional costs, and often have to make costly repayments on eye-watering student loans and fund their own specialty training exams, this adds to their existing financial burdens.

The theory is short-term pain for long-term gain. But with the Government having imposed another real-terms pay cut this year and saying that is final, the dispute appears to be at something of a stalemate.

Amid a cost-of-living crisis, with some doctors facing outgoings such as childcare fees and rising rent or mortgage repayments, continuing to strike for your future could be hampered without a safety net.

In March, the BMA launched its first ever strike fund. Six months, 22 junior doctor strike days and six consultant strike days later, it has now supported more than 3,000 people. The vast majority of recipients have

been junior doctors, but dozens of consultants under financial pressure have also been supported.

By helping doctors meet obligatory payments, such as their rent or utility bills, the strike fund has taken the pressure away from many who may have otherwise had to consider crossing picket lines despite agreeing with the reasons for industrial action.

GP trainee Iain Bolton moved to less than full-time hours before the industrial action ballot.

‘I felt like I was getting quite close to burnout,’ he says of switching to 60 per cent of a 46-hour full-time week (including on-calls).

Robust support

Dr Bolton backs industrial action but, already on a reduced wage, says he would struggle to cover essential bills with strike deductions. He has spent the money he has received, which is less than the value of his deductions, on essentials such as his weekly shop.

‘Without the strike fund it would make me think whether or not I can afford to strike,’ he says. ‘It will

MARK HARVEY

‘Without the strike fund it would make me think whether or not I can afford to strike’

Thousands of doctors put under financial strain by taking part in industrial action have already benefited from the BMA strike fund. Ben Ireland speaks to recipients and donors

DOLPHIN: Donations strengthen strike action

RUNSWICK: ‘If we all take part, we can all win together’

definitely be helping quite a lot of doctors.’

Newcastle-based specialty trainee 1 Dr Bolton has mandatory GMC fees and medical indemnity costs to pay, as well as student-loan repayments and car-parking fees at his workplace. He also has his AKT (Applied Knowledge Test), which costs £470 and is essential to career progression, on the horizon.

The strike fund is evidence ‘the BMA is looking out for you’, adds Dr Bolton. ‘It’s looking after its members’ interests in quite a robust way.’

He says: ‘The strike fund will definitely have contributed to more people striking, and more people being able to get involved in picketing, showing support and doing what they need to do to look after themselves.’

Sherie George, a foundation year 2 in West Yorkshire, was recently married, which depleted her and her husband’s savings. They also send money to support family members in Singapore.

Dr George says she would have had to work on strike days had the fund not been available. And she believes support is more important now than at the start of action, as financial pressures grow.

‘More people are feeling the hit,’ adds Dr George. ‘People who are scheduled to work all of the strike days in one month are facing huge deductions. It’s very difficult. At first I was very nervous [about going on strike] as an IMG (international medical graduate) but I’ve had a lot of encouragement from colleagues and advice from the BMA. It’s made me more confident to strike. For IMGs particularly, it gives you reassurance.’

While payments have been made to doctors who need financial support to keep striking, the fund – as it stands – relies on generous contributions.

Many of these have come from senior doctors and consultants, and from junior doctors based overseas who support the pay restoration cause. There have also been large contributions from organisations such as the Hospital Medical Staffs Defence Trust.

Stronger together

Tom Dolphin, a consultant anaesthetist and BMA council member, has made regular donations to the strike fund, including voluntarily donating his honoraria payments from BMA meetings as well as the pay he has received, after tax, for night shifts he has taken on to cover junior doctors while they are on strike. For a 12-and-a-half-hour shift, that equates to about £1,880.

He says: ‘It’s important to remember this isn’t an act of charity. Donating to the strike fund strengthens the action we are taking, helps more doctors participate and

bma.org.uk/thedoctor

makes it more likely that we will win overall.

‘I don’t expect everybody who has covered night shifts to give their income to the strike fund, because it’s hard work and money well earned, but I want to set an example. If everyone donated the income from just the first hour of their strike cover shift, that would be a huge boost to the strike fund.

‘The Government thinks it can wait us out and pick off the least well-off doctors who have less discretionary income to draw on to weather that deduction they face on strike days. The strike fund is a way of preventing the Government from undermining our action.

‘We want to be able to make the strike fund as strong as possible so the union is as strong as possible and we can win as much as we can for our members.’

Emma Runswick, deputy chair of BMA council, has – for the second year in a row – arranged for the amount she is entitled to from her honorarium for union duties that is above what she would have been paid as a full-time junior doctor to go to the strike fund. This is approximately £22,000.

She says: ‘As we take more strike action, more people find it difficult financially. So having a strike fund is important. If we all take part, we can win together. If we help each other maintain our action, the action will help us all.’ Recalling the 2016 junior doctor strikes, when there was no strike fund, Dr Runswick says some members began to feel under financial strain when the strikes progressed. ‘It’s vital to be telling members that we know this is hard, and we are going to help,’ she tells The Doctor. ‘By sharing among ourselves, people feel backed up and feel able to take action now and in the future.

‘The word “solidarity” is not just a word. It’s a common understanding that we will back each other up when we need it.’ Dr Runswick reiterated that the BMA is pushing for a resolution to the dispute with the Government but accepts industrial action could still continue for many months. ‘Whether this dispute runs for two weeks further, or months and years further, we are trying to put ourselves in a position where members will continue to be able to take the action required,’ she says.

Going forward, the BMA hopes to raise funds for the strike fund through regular contributions taken from member subscriptions. Proposals are being worked on.

The money banked would be able to support doctors in the future, be it a major national dispute such as the continuing pay restoration campaign or localised issues.

One-off donations to the strike fund can be made via its dedicated website bmastrikefund.raisely.com and doctors can submit a pre-approval claim online at surveymonkey.co.uk/r/Strike_Fund_pre-application

‘The word “solidarity” is not just a word. It’s a common understanding that we will back each other up’

on the ground

Time off work was vitally important

John Lennon said: ‘Life is what happens while you are busy making other plans.’

This is rarely more apposite than when it comes to caring responsibilities. However hard we try to plan for them, there is always a hefty element of unpredictability.

A consultant had been granted six months’ unpaid leave by her NHS employer to help her parents relocate, to reinstate support workers, to clear their house, and to ensure their healthcare needs continued to be met. All while being a single parent herself.

The six months were vital, but she needed longer. She had an off-the-record conversation with her departmental lead but was told it would not be possible because of service needs and locum cover coming to an end.

The consultant could understand the situation from her managers’ point of view, but they needed to understand it from hers.

So, she involved the BMA and, with an employment adviser, attended a meeting with her clinical lead and a senior HR representative.

In the member’s words, the adviser’s ‘empathy,

confidence, knowledge base and sheer diplomacy meant that I was able to de-escalate a tense situation despite having brought the big guns! Everyone in the room felt better for having met him’.

The result was a six-month extension to her career break, in which she not only settled her parents but arranged a new school for her daughter and supported her sister through a difficult pregnancy. She also used the time to think about her work-life balance. She then returned to a job plan of approximately 85 per cent rather than full time.

She reflects: ‘Workload is manageable, colleagues are really supportive. I feel lucky to have had the opportunity to get the break, to stand back and reassess everything. It really changed my life.’

This column is about the cases the BMA wins for its members, but in this case it’s a win for everyone. So many doctors are needlessly burnt out by the impossible balancing act between their demanding jobs and their wider commitments. In this case, the doctor says: ‘I actually enjoy coming to work again.’

With Age Co comes making the most of later life

That’s because the products and services we offer help people over fifty to live life on their own terms – now and in the future. Plus, we’re 100% owned by Age UK so our profits go to the charity to support older people most in need.

www.ageco.co.uk

Highlighting practical help given to BMA members in difficulty

Your BMA

NHS England’s long-term plan has not convinced doctors the crisis in care will be tackled

Winter will soon be upon us, and with it a period during which NHS staff will face increased pressure and demand on services – that is on top of the distressed baseline service they are already working in.

While seasonal illnesses do affect the health service, chronic staffing shortages, underfunding and a lack of resources have, in reality, made it increasingly difficult to distinguish ‘winter pressures’ from those experienced throughout the rest of the year.

Doctors and other healthcare professionals know, however, that this winter is likely to be exceptionally tough, for a number of reasons.

It hardly needs saying the NHS is still recovering from COVID-19, a crisis which stretched and tested the healthcare workforce to breaking point, and which greatly exacerbated a backlog in unmet patient care.

Indeed, the number of patients waiting for consultantled elective care services rose from an already daunting figure of 4.4m at the start of the pandemic, to 7.7m recorded in July this year just in England alone.

Meanwhile the health service is desperately contending with a workforce shortfall, estimated at around 150,000 full-time equivalent staff.

Improving recruitment and retention rates of all staff is clearly essential if we are to prevent this black hole in staffing from expanding let alone improving.

NHS England’s Government-approved Long Term Workforce Plan launched in June this year was meant to allay fears and address the crisis, yet analysis by the BMA has concluded the plan ‘is silent’ when it comes to elaborating on how it will retain staff, by addressing doctors’ and others’ demands regarding pay and workplace terms and conditions.

There was a clear consensus at this year’s BMA annual representative meeting that the plan is not fit for purpose and, as doctors, we cannot afford to be dependent on a strategy we know is set to fail.

The failure to understand and adequately address the needs of the NHS and its staff are in large part the catalyst which has this year seen doctors and their consultant colleagues take the difficult decision to engage in independent and joint industrial action.

I know full well how painful the decision to strike has been for our profession, with tens of thousands of you having bravely sustained your action over many months in the face of an obstinate Government and often hostile national press. On top of this, specialist, associate specialist and specialty doctors in England are conducting an indicative ballot on strike action, which could ultimately see them joining their doctor and consultant colleagues on picket lines up and down the country.

Fortunately, the majority of our patients recognise our cause and continue to support our struggle, knowing the crisis in their NHS is not the result of doctors’ striking, but the culmination of persistent underinvestment in funding, resources and staffing for the NHS.

If you would like to learn more about how you can get involved with your BMA, please write to me at RBChair@bma.org.uk or @DrLatifaPatel

Dr Latifa Patel is chair of the BMA representative body

The full version of the column will appear online at bma.org.uk/news

Editor: Neil Hallows (020) 7383 6321

Chief sub-editor: Chris Patterson

Senior staff writer: Peter Blackburn (020) 7874 7398

Staff writers: Tim Tonkin (020) 7383 6753 and Ben Ireland (020) 7383 6066

Scotland correspondent: Jennifer Trueland

Feature writer: Seren Boyd

Senior production editor: Lisa Bott-Hansson

Design: BMA creative services

Cover: Sarah Turton

Read more from The Doctor online at bma.org.uk/thedoctor

@drlatifapatel