Cowper’s Cut 306: Be GMC-ing you

I’ve been touching on the controversy over the introduction and expansion of medical associate practitioners (MAPs) over recent columns.

The basic idea of creating additional, new roles to maximise the potential of the most highly trained and most expensive medical staff remains a good one. Unfortunately, its national implementation has struggled to rise to the level of incompetence.

It is clear that the effort to bring the majority of the medical professions along on board with these changes to their working patterns and practices have been deeply inadequate. A significant number of medical professionals do not support these changes, because they simply do not trust that this has been done with fairness; nor with openness; nor with positive motives.

One of the best things to read on trust is Baroness Oonora O’Neill’s 2002 Reith Lectures. She opened with Confucius’ advice that a leader needs three things for government: weapons, food and trust; and that in extremis, the last thing without which a leader can survive is trust: “without trust, we cannot stand”.

Well, quite. And a freedom of information request recently shared with me demonstrates that on this major issue, the General Medical Council has yet again conducted itself with the balletic poise of an elephant on ketamine.

The FOI request asked, “Regarding the public consultation around the regulation of medical associate professionals published in 2019, despite being a GMC registered doctor, I do not recall ever being made aware by the GMC that the public consultation was taking place.

“Asking my medical friends and colleagues elicits the same negative response. Obviously we may all have forgotten such a communication from the GMC, however I note that only a small number of doctors responded to the consultation despite over 300,000 being registered with the GMC so this would suggest most were simply not aware, or were not aware of the significance of the consultation.

“As the GMC was founded and is funded by UK doctors I believe many would have liked to participate in the consultation, or at the very least been informed of what was being considered by their own professional regulatory body.

“Can the GMC confirm whether it actively sought the views of UK registered doctors, or made them aware of the consultation with respect to regulation by the GMC?”

The GMC’s eventual reply was “In July 2019, the Department of Health and Social Care (DHSC), with the support of the four UK governments, asked us to regulate physician associates (PAs) and anaesthesia associates (AAs).

“These changes are dependent on new legislation and subject to consultation. Based on the government’s timetable for consultation we expect regulation to begin in the second half of 2024 at the earliest. We’re now designing the processes and policies needed to regulate PAs and AAs.

“The UK government is funding all set-up costs and we won’t use doctors’ fees to cover this work.”

‘Cut’ subscribers (being smarter than the average bear) do not need me to point out that the GMC’s reply does not answer the question.

At all.

It is clear that the GMC made an active choice not to inform the 300,000 GMC-registered doctors about this consultation, run by the Department For Health But Social Care. Of the 2,256 respondents to the DHBSC consultation, just 738 were GMC-regulated.

The GMC “work with doctors, patients, and other stakeholders to support good, safe patient care across the UK. As part of this role, we:

• set the standards of patient care and professional behaviours doctors need to meet.
• make sure doctors get the education and training they need to deliver good, safe patient care.
• check who is eligible to work as a doctor in the UK and check they continue to meet the professional standards we set throughout their careers.
• give guidance and advice to help doctors understand what’s expected of them.
• investigate where there are concerns that patient safety, or the public’s confidence in doctors, may be at risk, and take action if needed.”

The GMC are also fond of talking about their values, claiming to “have five core organisational values underpinning everything we do.

• Integrity – We are honest and share what we see. We listen to our partners, but remain independent.
• Excellence – We are a learning organisation, committed to achieving high standards.
• Collaboration – We work with others to support safe, high-quality care.
• Fairness – We respect people and treat them without prejudice.
• Transparency – We are open and account for our actions.

These values form the basis on which we operate. We want every decision we make, every interaction we have and every email we write to embody these values.”

Mmmmmmmm.

Can you see a few areas there which mean that the GMC should have made some proper efforts to make their members (it’s a mandatory thing, innit) aware of a consultation that was going to impact their careers in a significant way?

Yep, me too.

This state of affairs isn’t going to stand, I suspect. Significant professional pressure for change is being exerted through the medical royal colleges.

The Royal College of Physicians is facing requests for an Extraordinary General Meeting due to the profession’s discontent with the MAP scheme: this will be discussed at their next Council meeting on Thursday.

That should be lively.

Towards further consultants’ strikes?

The BMA consultants ballot on the Government’s offer over pay and conditions offer closes on Wednesday, so we will know this week whether they are going to accept or reject this deal.

The members of smaller trades union for hospital doctors, the HSCA, have rejected the Government’s proposed deal to end the industrial action.

BMA consultants committee leaders have not reported on their personally having voted against the deal.

Their pensions expert made clear that he has done so, and explained why.

When BMA consultants’ voting on this deal opened, I wrote that “I think there is a reasonable chance of the deal being rejected, but the margin may not be huge”. Looking at the Government’s handling of both subsequent junior doctors’ strikes, and at the widespread sense of the new/expanded medical associate practitioner roles being damagingly out of control, my sense today is that BMA consultants will reject this deal, and that the margin of their vote may not be small.

Meanwhile, junior doctors co-lead Vivek Trivedi early last week noted that Health But Social Care Secretary Victoria Atkins had not leapt to resume negotiations, the latest strikes being over.

It all gets noted, this stuff: the lack of urgency.

Health Service Journal’s Lawrence Dunhill later tweeted (or Kissed) that “talks with junior docs due to restart, with Govt intimating a new offer will be made”.

As yet, no kind of official confirmation has followed.

Indeed the BMA junior doctors’ committee co-lead Vivek Trivedi stated on Thursday that “even now, with no strikes, they won’t negotiate with us”.

You’d think he might know.

Rishi Sunak: the candidate

Social media got a bit exercised about this short version of a clip of PM Rishi ‘The Brand’ Sunak being accosted in the street by a former NHS member of staff complaining about the state of the service. It segues into a discussion about the impact of the industrial action.

A longer version of the clip was subsequently published, and this was even more striking. (Pun intended.)

The PM blatantly lies to this woman that the Government has settled with the staff groups other than the junior doctors. His claim that every group of medics bar the junior doctors have accepted the Government’s pay offer is an obvious untruth.

It is depressingly remarkable (and vice versa) that this point did not get more traction. It needs to matter that politicians casually lie. “The first rule of Political Lying Club is that nobody cares about political lying any more, until they do again.”

After Mr Sunak’s appearance at the Covid19 Public Inquiry, I wrote that “Sunak’s impatience, irritation and tetchiness when questioned hard or confronted will be a massive liability if he leads the Conservative And Unionist Party into the next General Election campaign”. I think it’s a comment that will continue to age well.

HSJ analysis shows political bias in the choices of the 40 New (If Fictional) Hospitals

Exclusive: Tory marginals favoured in ‘new hospitals’ selection

A process in which the government added and overlooked trusts for the “40 new hospitals” programme appears to have benefited marginal constituencies, according to analysis and documents obtained by HSJ.

Health Service JournalZoe Tidman

It’s not that surprising, but it had to be substantiated, and hats off to HSJ’s Zoe Tidman for putting in the hours for this analysis showing how marginality of Conservative seat was a clear factor in the selection of the 40 New (If Fictional) Hospitals.

She shows how “an initial list of potential schemes was proposed for the programme by NHS England. But several trusts prioritised during this stage were then overlooked, while others not on NHSE’s suggested list were added by the Department of Health and Social Care, with no reasoning given.

“Analysis suggests the 14 trusts added to the programme were twice as likely to be marginal seats being fought by the Tories, compared to those that were on the NHSE list but ultimately overlooked.

“Twenty-nine per cent of constituencies served by the added trusts were close seats for the Conservatives, compared to 14 per cent of the trusts overlooked from the NHSE list. For example, the acute trusts in Milton Keynes and Reading both made the final list, despite not being listed by NHSE. Both cities had two seats each, all of which were marginal.”

This is, perhaps, just what Governments do: longstanding folk will remember that HSJ revealed in 2003 that leaked emails from 2002 showed then-SOS Alan Milburn’s interventions which helped ensure that Tony Blair’s constituency hospital got upgraded from two stars to three by the Commission for Health Improvement.

(Milburn was later possibly sort-of cleared of doing this by Sir Nigel Crisp, for those who take that sort of thing seriously.)

Monewatch

Tax Policy Associates’s Dan Neidle has been investigating the businesses of the husband of nominative determinista supreme, Everybody’s New Favourite Noble Baroness Michelle Mone.

Tory peer Mone’s husband and partner in alleged PPE Medpro crime Douglas Barrowman has a fascinating track record.

Neidle accuses Barrowman of committing blatant fraud with the tax avoidance schemes that made him rich. This allegation won’t be lightly made.

Recommended and required reading

HSJ reveals that Sandwell and West Birmingham Hospitals Trust has been breaching national guidance by excluding some long waiters from its reported waiting list figures, which appears to have helped them report zero patients waiting more than two years for treatment during most of 2023. Ooops.

A very good FT piece on the toxic end to PFI in the UK: there are lessons aplenty here, and of course some of the original PFIs are now approaching their end.

Times report on the topic of pharmaceutical shortages.

This Lancet study on the entire UK population’s medical records concludes that thousands of hospital admissions and deaths might have been averted in the summer of 2022, had everybody been fully vaccinated against Covid.

Another Lancet paper on modelling the effects of the COVID-19 pandemic on NHS England waiting times for elective hospital care.

Fairly dull Times interview with opposition leader Sir Keir Starmer about the Labour Party’s health plans: nothing new here.

Times piece on whether the NHS should have minimum staffing levels.