The junior doctor contract: the BMA must pick up the pieces and move forward

The latest episode of the four year battle between the Government and the British Medical Association (BMA) serves as stark reminder of the loneliness of ministerial office. But, argues Tony Hockley, in the end the buck really does stop with the Secretary of State. If the BMA works with the Health Secretary they could make further progress on the new contract, even after the decision on imposition. Perhaps more importantly, the BMA must now address the wider issues that face the NHS and start negotiating on next steps

An unhealthy alliance

The NHS junior doctors' strike on 12 January was a timely reminder of the productivity agenda having an impact on working practices. The unprecedented dispute between the Department of Health (DH) and the British Medical Association (BMA) concerns, among other things, pay progression, relaxing rules on rest, working a Saturday for the same pay as a weekday, and what constitutes a night duty (BMA, 2016). If the contractual demands are accepted then the likely effect would be the same pay for working a Sunday, and night duties being extended to nursing and throughout the NHS

“Should I stay or should I go now?” : A qualitative study of why UK doctors retire

Funding information Our thanks go to the University of Aberdeen Development Trust and the British Medical Association (Scotland) for funding this work. ACKNOWLEDGEMENTS Our thanks to all those doctors who participated in the study. Our thanks also to the BMA (Scotland) for distributing the invitation to take part in the study to their members. No patients or any members of the public were involved in this study.Peer reviewedPostprintPostprin

Ethics and health care 'underfunding'

There are continual “crises” in health care systems worldwide as producer and patient groups unify and decry the “underfunding” of health care. Sometimes this cacophony is the self interest of profit seeking producers and often it is advocacy of unproven therapies. Such pressure is to be expected and needs careful management by explicit rationing criteria which determine who gets access to what health care. Science and rationality, however, are unfortunately, rarely the rules of conduct in the medical market-place

Point-of-care genetic counselling : should family physicians counsel patients on genetic testing and screening?

Family medicine has come of age, with family doctors/general practitioners taking on greater roles and responsibilities and health care systems recognizing the important role of primary care. It is in this scenario that the question of pre- and post- testing counselling of genetic tests which are or would be offered directly to the general public through advertising and over-the-counter testing is being raised. This type of counselling would require enough personnel to deal with a large number of people; people who may not have genetic disorders in their families but who are curious about testing such as that for Breast Cancer (BRCA). It is argued that family doctors, albeit needing continuing professional development in this area, already have a solid foundation in genetics and are strategically placed in the community and numerous enough to impart such counselling. This would also liberate the responsibility from specialised geneticists who need to deal with families and individuals who have more serious genetic disorders to be managed.peer-reviewe

Development and validation of prognostic survival models in newly diagnosed Parkinson’s disease

Acknowledgments We would like to thank study participants, study personnel, and study funders. Funding agencies: The Parkinsonism Incidence in North-East Scotland (PINE) study was supported by Parkinson's UK (Grants G-0502, G-0914, G-1302), the Scottish Chief Scientist Office (CAF 12/05), the British Medical Association (BMA) Doris Hillier award, RS Macdonald Trust, the Bupa Foundation, National Health Service (NHS) Grampian endowments, NHS R&D, and SPRING. The ParkWest study was supported by the Research Council of Norway (Grant 177966), the Western Norway Regional Health Authority (Grants 911218 and 911949), and the Norwegian Parkinson's Disease Association.Peer reviewedPublisher PD

Electronic cigarettes: fact and faction.

There are a number of public health advocates who appear to consider electronic cigarettes (e-cigarettes) primarily as a threat to public health, and bodies such as the British Medical Association (BMA) and the World Health Organization (WHO) are warning smokers about their potential dangers.1 This editorial takes a close look at the evidence

Readability, presentation and quality of allergy-related patient information leaflets: a cross sectional and longitudinal study

Objective: Patient information leaflets (PILs) are widely used to reinforce or illustrate health information and to complement verbal consultation. The objectives of the study were to assess the readability and presentation of PILs published by Allergy UK, and to conduct a longitudinal assessment to evaluate the impact of leaflet amendment and revision on readability. Methods: Readability of Allergy UK leaflets available in 2013 was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch-Kincaid Reading Grade Formula. Leaflet presentation was evaluated using the Clear Print Guidelines of the Royal National Institute of Blind People (RNIB) and the Patient Information Appraisal System developed by the British Medical Association (BMA). Changes in the leaflets’ readability scores over five years were investigated. Results: 108 leaflets, covering a wide range of allergic conditions and treatment options, were assessed. The leaflets had average SMOG and Flesch-Kincaid scores of 13.9 (range 11-18, SD 1.2) and 10.9 (range 5-17, SD 2.1) respectively. All leaflets met the RNIB Clear Print guidelines, with the exception of font size which was universally inadequate. The leaflets scored on average 10 (median 10, range 7-15) out of a maximum of 27 on the BMA checklist. The overall average SMOG score of 31 leaflets available in both 2008 and 2013 had not changed significantly. The process of leaflet revision resulted in 1% change in readability scores overall, with a predominantly upward trend with six leaflets increasing their readability score by >10% and only three decreasing by >10%. Conclusion: Allergy-related patient information leaflets are well presented but have readability levels that are higher than those recommended for health information. Involving service users in the process of leaflet design, together with systematic pre-publication screening of readability would enhance the accessibility and comprehensibility of written information for people with allergy and their careers

Competent children?: minors’ consent to health care treatment and research

This paper concentrates on controversies about children's consent, and reviews how children's changing status as competent decision makers about healthcare and research has gradually gained greater respect. Criteria for competence have moved from age towards individual children's experience and understanding. Uncertain and shifting concepts of competence and its identification with adulthood and childhood are examined, together with levels of decision-making and models for assessing children's competence. Risks and uncertainties, methods of calculating the frequency and severity of risks, the concept of 'therapeutic research' and problems of expanding consent beyond its remit are considered. The paper ends by considering how strengths and limitations in children's status and capacities to consent can be mirrored in researchers' and practitioners' own status and capacities. Examples are drawn from empirical research studies about decision-making in healthcare and research involving children in the UK

Multi-disciplinary research ethics review: is it feasible?

This paper reviews the currently rapid changes in research ethics governance affecting many kinds of social research. Arguments for and against single‐discipline and multidisciplinary research ethics committees will be considered, with examples of how medical and social research ethics can inform one another. We conclude that the use of multidisciplinary research ethics committees, guidance and governance can be an effective and necessary part of social research methodology