The BMA says that lack of clarity is confusing the issue of NHS spending in England and calls for less “spinning” of funding announcements.
In a briefing paper from its health policy and economic research unit the association says that establishing a clear picture of the exact level of funds available to the NHS and the way that it is distributed is not straightforward. The paper examines several press notices announcing spending decisions. It concludes: “The three year settlement for the NHS established by the comprehensive spending review has provided some stability for the NHS. However, to some extent this has been undermined by the way that the funding allocations have been presented. Top slicing, by means of the modernisation fund and, in some instances, repeat announcements of the same new funding have made it difficult for those delivering services to understand what money is available and to plan accordingly.” The BMA says that in future the government should make clear what the source of funding is.
The paper will be used as a resource document for the BMA's review of healthcare funding which was announced in December (1 January, p 62).
The document is on the BMA's website: http://web.bma.org.uk/public/polsreps.nsf/repsvw
Guidance issued on discretionary points
The BMA's Central Consultants and Specialists Committee has produced interim guidance on the changes to the discretionary points system, which will start in April.
From 1 April employers will be able to award a minimum of 0.35 points per eligible consultant each year. The criteria have been extended to allow greater recognition of service achievement and two have been added: significant contribution towards the achievement of local NHS service priorities and undertaking recognised significant heavy workload or responsibilities in pursuit of local NHS service goals. The five point scheme will be extended by a further three points of equal value.
Decision making groups will have to take into account the new criteria, the minimum ratio of additional points available, and the fact that eligible consultants will not include those currently receiving five points or the equivalent C award. The consultants with five points, or an old C award converted to five points, will need to be included in the new calculation of the minimum number of points available.
The CCSC advises that the groups should suspend current deliberations and circulate the amended criteria to eligible consultants; CV forms should be amended and any scoring systems agreed locally should be adjusted to reflect the amended criteria; and all changes should be agreed in the local negotiating committee and medical staff committee or their equivalent.
The full guidance is on the CCSC website: http://web.bma.org.uk/public/ccsc.nsf
Deaf patients do not get such good treatment
More than a fifth of deaf and hard of hearing patients leave a doctor's appointment unsure what is wrong with them, according to research by the Royal National Institute for Deaf People (RNID). A quarter said that their GP did not check that they understood their diagnosis, and a fifth felt upset by the way they had been treated. More than one in 10 put their health at risk by avoiding doctors because of the communication difficulties.
The findings contrast with GPs' perceptions—87% of them think that they communicate well with deaf and hard of hearing patients—and have led to a new initiative by the RNID and the Doctor Patient Partnership to improve access to health services. The two organisations have produced a pack giving guidance to GPs and other surgery staff on simple and inexpensive steps they can take to improve communication.
The information pack for GPs is available from the RNID: tel 0870 60 50 123 or 0870 60 33 007 (text).
Patients with hip fracture need better care
A study by the Audit Commission shows that patients with hip fractures are still waiting too long in accident and emergency departments, that operations are often delayed, and that joint working by consultant physicians and surgeons is still exceptional.
The study is a follow up to a 1995 report which also found that too high a proportion of operations was carried out by junior surgeons and that discharge arrangements were inadequate.
The chairman of the BMA's consultants' committee, Dr Peter Hawker, said that it was regrettable that only 23% of trusts were achieving the 1995 recommendation that physicians should work alongside surgeons to provide optimal care. “This may reflect poor organisation,” he said, “but it is much more likely to be due to sheer pressure of work and shortages of consultant staff.” But he agreed that delays in waiting for surgery were unacceptable. “Trusts must learn from the hospitals that are performing best and put organisational effort and resources into improving services.”
United They Stand. Coordinating Care for Elderly Patients with Hip Fracture is available from the Audit Commission, price £10 (tel 0800 502030).
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The BMA has appointed Dr Bill O'Neill as its new Scottish secretary. Dr O'Neill, who is 47, is the association's science and research adviser. He graduated from Dublin in 1979 and worked as a GP in London for five years. After specialist training in palliative care he was appointed a consultant senior lecturer in 1991 and worked at St Thomas's Hospital and in Bristol. He will take up his post in April