The BMA has called for guidelines for doctors on the prescribing of new and expensive medicines so that patients receive unambiguous information. But it also said that clinical guidance from the government on sildenafil (Viagra) was “almost irrelevant” because general practitioners had had no alternative but to prescribe it on the NHS to their patients where clinically indicated.
The chairman of the BMA council, Dr Ian Bogle, has told the health secretary that the council was disappointed that guidelines on prescribing Viagra had still not been issued. In his letter to Mr Frank Dobson, he says, “Doctors have been placed in an impossible position: on the one hand they are mindful of the department’s request not to prescribe Viagra, but on the other have to respond to the needs of their patients. Indeed, to refuse to prescribe this licensed medicine on an FP10 form when it is clinically necessary would leave GPs open to accusations of breaching their terms of service.”
Juniors to be surveyed on 48 hour directive
The Junior Doctors Committee is planning to survey doctors for their views on the extension of the 48 hour working time directive to junior hospital doctors.
The directive, which came into force on 1 October 1998, covers senior hospital doctors (26 September 1998, p 833), but juniors were excluded until the European Commission proposed that they should be included (28 November 1998, p 1473).
The BMA and the NHS Executive have reached agreement for career grade doctors because a literal application of the provisions would make it impossible for them to work in a professional way. Special arrangements have been made because of their continuing commitments and on call responsibilities.
If the directive is adopted for doctors in training there will be a special transitional arrangement. For a period of seven years and subject to agreement between representatives of doctors in training and their employers the maximum average number of hours worked over a four month reference period may be increased to 54. This is based on a notional six day week, with an extra hour added for each day.
It could take up to two years for the directive to be adopted, and, to get its views across, the JDC, through the BMA, will need to lobby the United Kingdom government, and members of the European parliament, and the commission.
Junior doctors want higher rates for 1999-2000 new year
Representatives of junior hospital doctors have voted unanimously for their negotiators to achieve “appropriate rates of pay and time off in lieu for those junior doctors required to work over the 1999-2000 new year holiday period.” 
Junior doctors receive between 50 and 100% of their standard pay for working above 40 hours a week—this can be as little as £3.88 an hour—and at last month’s meeting of the Junior Doctors Committee members reported that nurses and security staff were being offered lucrative amounts to work outside the NHS. This would increase the workload of junior doctors, particularly in accident and emergency departments, and there were already reports from some trusts that all leave would be cancelled. This was on top of the problems that might be caused in hospitals by the millennium bug.
It was suggested that two ways of protesting would be for doctors in casualty departments to resign from 31 December, forcing the trusts to employ locums for a month, or not to apply for posts which started in August.
GPs submit proposals on the £60m job weight award
The General Practitioners Committee has submitted its evidence to the review body on targeting the additional £60m to reward general practitioners with increased job weight from 1 April 1999.
Agreement has been reached with the health departments that, subject to the review body’s endorsement, £25m should be used to enhance the deprivation payments scheme to reward GPs providing services to patients in deprived areas. New lower thresholds will ensure that more GPs, both in urban and rural areas, will be rewarded for their efforts. It has also been agreed, again subject to review body approval, that up to £5m should be used to encourage the introduction of local general medical services development schemes to reward GPs providing extended general medical services to particular needy groups of patients.
The GPC is also proposing that the review body should use £20m to enhance the seniority payments scheme, which rewards GPs for their experience and commitment to delivering quality patient care. Finally, the GPC has proposed that the remainder of the £60m should be used to enhance the basic practice allowance for GPs in practices which are delivering quality patient care.
Young people’s health surveyed
The Department of Health has published the most extensive survey of young people’s health that it has ever commissioned. It provides comprehensive information on the prevalence of specific health conditions and lifestyle patterns of children and young adults between 1995 and 1997.
The survey covers eating habits, blood pressure, asthma, smoking, drinking, physical activity, and psychological wellbeing. Analysis by household income, social class, and geography is included.
The chief medical officer, Professor Liam Donaldson, said that the report gave an unprecedented insight into the formative years when the foundation for a healthy lifestyle could be laid.
Health Survey for England: The Health of Young People is available from the Stationery Office, price £70, or on the internet at http://www.open.gov.uk./doh/dhhome.htm