Council and the Professional Standards & Education committee have both met very recently and there are a number of important issues which are currently being discussed. I will prepare a full report covering both meetings for the next newsletter and wish this month to report briefly from the September council meeting held during the Guildford autumn BNMS meeting.
The Molybdenum crisis remains high on the agenda for BNMS, the Department of Health, EANM and our fellow national societies throughout Europe. With the support of the Department of Health BNMS will continue, via the website, to provide up to date information as it becomes available. Many members (and their respective managers) are concerned about potential breeches of the ‘6 week rule’ but should be aware that the Department of Health are fully informed regarding current and likely future shortage periods. It is important that the Trusts report targets that are about to be breeched and our understanding is that Trusts will not be penalised. A working party has been set up through ARSAC to evaluate the medium to long term consequences of the Molybdenum crisis. The nanocolloid shortage is another key issue on which the society is working.
The society has engaged a new website provider and the new look website will actually be launched within a week of writing this newsletter. It will therefore have been operational for several weeks by the time you, the consumer, read this. Comments on any aspect of the website would be greatly appreciated and it is hoped that users will find the improvements beneficial. In the near future a set of patient information leaflets which have been through all possible vetting processes will be available through the website and can be downloaded, personalised and used by members without having to go through the usual consultation processes. Many thanks to Dr Ann Tweddel and colleagues for their hard work and perseverance in producing these leaflets.
The IAEA distance learning SPECT/CT course which BNMS were asked to oversee has not yet got off the ground. A planned meeting in October to discuss co-ordination of the course was deferred and has not yet been rescheduled. To date therefore, a start date and mechanism for rolling out this course to those nuclear medicine technologists/radiographers who volunteered to take part has not been established. Bernadette Cronin, on behalf of council, will continue to liaise with IAEA and it is hoped that a meeting date will shortly be decided. To all those willing volunteers; you are not forgotten and as soon as Bernadette has more information she will be in touch.
A council subgroup, ‘The Drugs administration Working Party’, led by Dr Maria Palmer has produced a set of comprehensive templates pertaining to drugs administered within the practice of Nuclear Medicine by non-medical personnel. Theses templates should be available on the BNMS website by November and comments are invited, in particular with respect to additional drugs that are not currently covered. The intent is for these guidelines to provide basic information which can then be adapted in accordance with local practice and governance procedures. Individual Trusts/departments would decide on training needs and competency assessments for individual staff groups in accordance with local policies. Please take the time to look through these documents and email any comments to Mrs Sue Hatchard as soon as possible (email@example.com). They will provide a valuable resource for departments and it is important that they are as comprehensive as possible.
Non consultant grade doctors have recently been completing logs documenting their working hours in order to monitor compliance with the EWTD. Moving away from council business I wish to include a contribution from one of the Nuclear Medicine Specialist Registrars on this subject.
‘Thoughts from a junior doctor…
On Saturday, 1st August 2009 the European Working Time Directive (EWTD) came into full force marking the introduction of the 48-hour working week for doctors in training. For those who are unfamiliar with the terminology, EWTD is a European legislation designed to protect the health and safety of all workers in the European Union (EU). It lays down the minimal requirements in relation to working hours, rest periods, annual leave and working arrangements for employees working in the EU. EWTD was enacted into UK law in 1998 as Working Time Regulations (WTR) which limits all healthcare professionals to an average of 48 h of work per week. Back in 1998, the government negotiated an extension to delay full implementation of EWTD for doctors in training until August of this year. In preparation for full implementation of the law, the last ten years saw a gradual reduction in junior doctors' hours and hundreds of millions of pounds were spent on NHS hospitals by the Department of Health.
I expect most readers to be quite bored by this stage. The world of nuclear medicine might be short of a few things (think Technetium!) but it certainly isn't short on legislations and regulations. Nonetheless, EWTD is important because it affects all healthcare professionals and in particular junior doctors in training, the NHS trusts they work for, hospital staff who work with them and the general public who get treated by them. As things stand at the moment no junior doctor is allowed to work more than 48 h per week unless he or she signs an ‘opt-out’ waiver. The latter can only be done on an individual basis and must be voluntary i.e. no junior should be pressurised into opting out by an employer or line manager. For months, medical staffing personnel and clinical directors across the country have been working relentlessly in order to ensure that all junior doctors' rotas are EWTD-compliant (at least on paper). EWTD poses a great concern for NHS trusts who don't want to get fined or even face prosecution if their employees' hours are not EWTD-complaint. More importantly, it provides a major challenge for a lot of junior doctors who in the past may have preferred to gain more ‘hands-on’ experience by spending more time at work. Many trainees in surgical specialties for example, feel that that their ‘cutting time’ and experience may be significantly affected by the reduction in their weekly training hours; a view shared and publicly voiced by some of their senior leaders.
EWTD is yet another example of how medicine and medical training in the UK have changed in recent years. Although change is perceived by many to be a good thing, the future is not very clear for current trainees including myself. A lot of us remain apprehensive about what current and future changes to the system will bring despite the rosy picture currently being painted by politicians, overzealous educationalists and some members of the consultant body. Most trainees I know are worried that the 48-hour week may lead to poorer training of junior doctors, poor continuity of patient care and in the midst of a global economic crisis and growing inflation, lower pay. The re-structuring of the junior doctor recruitment process that occurred in 2007 (also known as Modernising Medical Careers or MMC) has left a lot of juniors demoralised as they could not (and still can't) get into the training programme of their choice. To make matters worse, a drastic change in the immigration rules resulted in a mass exodus of international medical graduates who after years of serving the NHS were told by the Home Office that they had to pack their bags and leave the UK. This has resulted in vacancies and rota gaps throughout the UK. Many junior doctors who were lucky enough to get training jobs are probably very grateful for what they have but nonetheless, many remain unsure about what the future holds for them. The main worry is that the new system will produce a large number of CCT (Certificate of Completion of Training) holders in the near future and given the financial recession and cuts that will inevitably hit the NHS in the next couple of years, there might not be enough consultant jobs for every trainee who completes specialist training. It is widely accepted that not every single junior doctor in the country can enter a training post and become a consultant; however the real fear is that an oversupply of CCT holders may result in the creation of a ‘sub-consultant’ grade. Several other issues complicate the situation even further, e.g. the increasing numbers of medical students coming out of the system (now that new medical schools have been opened), NHS trusts' increasing reliance on ‘non-doctor’ practitioners and establishment of foundation trusts. Some foundation trusts already seem to think that their ‘foundation’ status gives them the right to set their own rules and disregard national terms and conditions when it comes to employment of doctors. This is the type of thing that must be fought on all fronts. If not, the last person leaving the profession should switch off the lights on the way out.
There is no denying that the UK medical system is changing rapidly amidst the government's plans to instil reform in a profession that has traditionally resisted change. The junior doctor training and recruitment systems have already been changed, the royal colleges are not as powerful as they used to be and consultants will soon be faced with a major new challenge in the form of Revalidation soon to be instigated by the General Medical Council.
Personally, I feel that apathy and lack of solidarity remain a problem in the medical profession. Many consultants did not show enough interest in junior doctor training issues when the hurried introduction of MMC and MTAS (computerised Medical Training Application System) caused so much chaos in 2007. One of my relatives, an NHS consultant for more than 15 years, only started showing interest in junior doctors' issues after rota gaps and shortages of junior doctors on the ward added to his personal workload. Only last week he was complaining that he ended up finishing a surgical list on his own following his registrar's swift exit at the end of his shift at 4 p.m. Gone are the days when the surgical registrar would be left to ‘close’ whilst the consultant nips off to the staff room for his cup of Earl Grey and quick fix of rich tea biscuits!
Although times have changed, I keep wondering whether there are still consultants out there who regard today's junior doctors to be no more than a bunch of overpaid, under-worked moaners. A few years ago I worked with an ‘old-fashioned’ consultant who clearly did not grasp the concepts of political correctness and change. Every ward round was an endless critique of junior doctors and modern-day medical training in the UK: ‘Medical schools are not what they used to be; any one can get into medical schools now-a-days as A-levels keep getting easier; educationalists are destroying the system with their Problem Based Learning ideas; when I was a registrar I worked 100 h a week; I worked a 1 in 2 rota for years without complaining; in the old days a male doctor not wearing a tie and ‘women doctors’ wearing trousers would not dream of being on my ward round…'. Play the violin please! I recently heard on the grapevine that he'd opted to take early retirement and now tries to keeps as far away from hospitals and medical politics. Being my cynical self, I suspect that he timed his exit with the EWTD August deadline.
Specialist registrar in Nuclear Medicine
DOI: Member of BMA Junior Doctors' Committee. The views expressed in this article are my personal views and do not reflect the views of the BMA or JDC.
Look at the revamped website and send any comments (positive or negative) or suggestions to Alan Perkins and Sarah Allan via Mrs Sue Hatchard (firstname.lastname@example.org).
Review the templates on the website pertaining to Drug Administration by non-medical personnel. Comments again to Mrs Sue Hatchard. If you or other non-medical personnel within your department are regularly using a drug or drugs which is not listed let us know so that it/they can be included.
BNMS membership brings benefits not least of which is access to the members only section of the website. Promote membership to colleagues in your workplace.
Harrogate 26th–28th April 2010; 38th Annual Meeting. Abstract Deadline 11 January 2010. Start planning now!!
Next month: Full reports from Council & Professional Standards & Education committee.
Happy New Year,
Meetings in the UK
Nuclear Cardiology in Practice
Date: 1st–5th and 8th–12th February 2010
Venue: National Heart and Lung Institute, London
ESRR'10 15th European Symposium on Radiopharmacy & Radiopharmaceuticals
Date: 8th–11th April 2010
Venue: University of Edinburgh
BNMS 38th Annual Meeting
Date: 26th–28th April 2010
Venue: Harrogate Website: www.bnms.org.uk
UKRC NIA and ICC
Date: 7th–9th June 2010
BNMS Autumn Meeting
Date: 13th–14th September 2010
Clinical PET/CT courses, Technologists PET/CT courses Neuroimaging & Paediatric Courses
XIV International Symposium on Radionuclides in Nephrourology 7 The IAEA Regional Training Course on Radionuclides in Nephrourology
Date: 10th–14th May 2010
Venue: Hotel Galant, Mikulov, Czech Republic
An ongoing list of events can be found on the BNMS
There are also a number of interesting meetings listed on the British Institute of Radiology