29th April 2016

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Niall Dickson Boss of the General Medical Council in conversation with Roy Lilley
'We feel generous deal'
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Fifty three million 
News and Comment from Roy Lilley
It's been a long week.  If you are a health manager, working on keeping the services going through the strike, you deserve a bit of peace and quiet and a pat on the back. 
You planned the plan...it worked.  Well done.  Even Tarzan and the Jim-Reaper think you did a good job.  I hope your boss sends you a copy of this letter.  In case they don't, I will.  They are saying thank you.  Good move.
If you are a consultant I dare say the week has been busy, a challenge and a bit of a 'back to the floor' experience for some?  Rediscovering camaraderie or knowing that the team will come through.  Thanks to you the junior doctors have been able to stand in the cold and have a laugh, tell their story to the public...
Guitars and drums and singing on the Ging-Gang-Goolie picket line. Balloons.  Woolly hats and scarves.  Kids, Costa, sandwiches and stickers, hooting horns.  Picket-line tourists turning up with a 'well done'.
If you're a GP, who cancelled appointments to make room for an A&E overflow, you are probably waiting for the dam to burst on Monday morning.
If you were a patient, bounced off a waiting list, denied an operation or whatever; sanguine is about the best you can be and a plastic apology is about the best you'll get.  

An empty, contrived and rehearsed institutional statement of 'regret' about how much better and safer everything will be now that 120,000 patients have been bumped of the list.  A price worth paying?
If you are the press, you moved on, on Wednesday night; Hillsborough, BHS, Naz Shah, the US elections. 
What's been achieved by all the brouhaha?
You can dress it up how you like; public attention, time for reflection, time to compose yet another letter... actually, nothing.  Zilcho, zero, naff all.
An almost comedy Tweet from one of the protesters; 

'Jeremy Hunt wanted this strike'. 

I'm bound to ask; 'Then why give it to him?'
The list of demands the BMA considers outstanding is considerable;

".. missed breaks, 13hr shifts too long, gaps between shifts only 11hrs, definition of night shift, twilight shifts and weekends, compensatory rest, pay for all work done and not time off in lieu... and more."
If you though it was all about JDs being exhausted and working unsafely... well, another demand; 

"... first refusal of all locum work, on an agreed national locum rate."  

A bit of overtime?  Work that one out.
Nothing has been achieved by this misbegotten, ill judged, strategic vacuum that the BMA has persuaded its members is 'a campaign'.

Tarzan and the Jim-Reaper think there is more to come.  Worse even.  They say so in this letter.  They are invoking the Civil Contingencies Act for the next planning stage.
I have no beef with the JDs; vocation brings with it a strong hint of idealism.  JDs want to practice the best medicine they know how, in circumstances that are resourced, relaxed and really nice places to work.
Instead, they are battery-docs in an austerity NHS, over-run with patients, gaps in rotas and kettle-pressure.  Nurses feel the same, as does every allied health professional.  As do the managers bullied and regulated and targeted into making one pound do the job of two.
John Appleby points out;
  • UK health spending has gone from 6.3% of GDP in 2000, to 10.1%, nine years later. 
  • In 2014/15 it was 7.3%, and will fall back to 6.6% in 2020. 
  • The OECD shows, in 2013, the UK was 13th out of the 15 original EU countries.
There isn't enough money in the NHS because the Chancellor has taken the political decision to balance the books by 2020 and accumulate a surplus, in the bank, of 10bn.
The strike is over.  The BMA would be stone bonkers to pursue this with a protracted walk out.  The Tinkerman is going nowhere.  The BMA look like they are living in the 80's.  They will deny it but their union is split, top to bottom, over what comes next.
All the while; Trusts, who live in the practical world of getting things done, have rolled up their sleeves and quietly been sorting out work-place guardians and local rotas.
What next for the BMA?  More strikes, longer strikes?  More, longer strikes?  Striking more for longer?
Junior doctors are the brightest and the best and they have been badly let down.  They need new leaders and more intelligent representation.
Johann Mulawana, the JD leader, has done his best, but set adrift by the BMA Council and pushed by left-wing activists, taken the dispute into a cul-de-sac.  

He is charming and erudite but out of his depth.  Knowing when to quit is a mark of true leadership.  Mulawana can only dig a deeper hole for himself and his members.  

A fresh face is needed, prepared to work with the Trusts, solving what can be solved and joining forces to challenge what cannot be delivered... a new joint way forward.
There is a much greater reality than a contract for 57k doctors; the reality is; healthcare for 53m people.
Have a good weekend.
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