Antibiotics for back pain? Conflicts of interest?

The 'antibiotics for back pain' study has not been out of the headlines this week, certainly the PR campaign that has seen headlines made across the board in the likes of the Guardian and the Mail has been successful.  Really one has to look in depth at the paper and the literature to appreciate just how overly sensationalist and hysterical much of this media reaction has been.

Firstly 3 of the 4 authors are involved with a private company that appears designed to make money out of patients and clinicians in diagnosing and treating back pain with antibiotics.  Indeed these 3 authors are all MAST 'Academy' members.  The first major problem I have with their study is the fact that they declared to the journal that they had 'no competing interests'.  This appears dubious at best.  It is also dodgy that Peter Hamlyn, a surgeon from London who is also a member of this 'Academy', is quoted in the papers saying some very positive stuff without any hint that he may also have a rather glaring conflict of interest:

"More work needs to be done but make no mistake, this is a turning  point, a point where we will have to re-write the textbooks.....It is the stuff of Nobel prizes."

The 'MAST medical' concept appears rather dubious in itself.  Patients with Modic changes are encouraged to pay money to have their MRI scans interpreted, while clinicians are encouraged to become 'MAST certified' so that they can treat patients with Modic changes!  Why on earth an experienced clinician needs accreditation by 'MAST Medical' before treating a patient with antibiotics is beyond me, this just appears a cheap money making stunt.  It would be interesting to know just what the authors' exact financial interests are relating to MAST Medical.

There are also some rather significant problems with the study itself.  The bacteria attributed to be the cause of so many patients' back pain has been researched for many years, in fact since being reported as a cause of back pain in 2001 in the Lancet, Proprionobacterium Acnes (P Acnes) has been linked with other problems including shoulder arthritis.  The problem with this bug is that is is notoriously hard to grow in the laboratory, it is of unknown pathological significance and many groups have failed to replicate much of the P Acnes research.

The biggest flaw I have seen in the research is that about 50% of the patients treated with antibiotics had had previous spinal surgery, so it is highly possible that the benefits of antibiotics only apply to patients who have had previous surgery, so the way the study has been reported in the media is highly misleading.  P Acnes seems likely to be a bug that is only problematic after medical intervention like injections or surgery, there simply isn't any good evidence out there that it is likely to be a cause of back pain in the 'virgin' or 'intervention naive' back.

Overall this all just reminds me a bit of the MMR scare, but it is obviously the reverse of a scare.  The problem is that the way the study has been written, reported and spun out of context mean that many patients are going to be extremely let down when they realise what the reality of this study actually is.  A majority of the authors have significant conflicts of interests which they failed to declare, the benefits of antibiotics may only apply to patients who have had previous injections or surgery, and more research is badly needed to confirm this work with a more rigorously defined group of patients taking part.  Sadly the reality of the research wouldn't make any headlines and it certainly wouldn't have attracted as much attention for 'MAST Medical'.

The GMC on Francis - not clear

Following up on my synopsis of the implications of the Francis report, here is the GMC's response to the key recommendations relating to medical training:

" 155. The General Medical Council should set out a standard requirement for routine visits to each local
education provider

GMC - We are committed to a thorough and consistent inspection regime and we are addressing all of the issues raised in points a-d of this recommendation in our review of quality assurance in education.

161. Training visits should make an important contribution to the protection of patients.

a. Obtaining information directly from trainees should remain a valuable source of information – but it should not be the only method used.
b. Visits to, and observation of, the actual training environment would enable visitors to detect poor practice from which both patients and trainees should be sheltered.
c. The opportunity can be taken to share and disseminate good practice with trainers and management.
Visits of this nature will encourage the transparency that is so vital to the preservation of minimum standards.

GMC - We agree that visits/inspections are an important tool for assuring high quality training and protection of patients, and they form a major part of our existing quality assurance programme. The education QA review is looking at how we can strengthen the role of visits/inspections and at how we report on them. In the meantime, from the summer of 2013, where we have validated any concern about an educational setting we will publish that information on our website."

I am slightly concerned by the GMC's comments for several reasons. Firstly they have not stated that they will reinstated routine training visits to all local providers as Francis has recommended. Secondly they refer to their 'education QA' in their answer to both key Francis recommendations, as if their review is the ultimate truth and that this may overrule Francis.  Thirdly in their answer to 161, they state that visits form a 'major part' of the current system, this is worrying as it is exactly this system that failed at Stafford and that will fail again unless the GMC comes out of its state of denial.

Perhaps I am just paranoid, maybe, but I am deeply concerned that the GMC is going to ignore the key piece of advice from Francis, that being the reinstatement of routine workplace visits for all providers of medical training.  We need to hold the GMC to account on this, perhaps they will take it all on board and I will be proven to be a paranoid fool, but perhaps not, and if so we need to have anticipated this fact.

The Francis report and what it should mean for medical training - part 3

Now to part 3, in parts 1 and 2 I have highlighted Francis' key observations relating to training, that being the failing regulatory system.  The key recommendation is that routine visits to all local providers should be reinstated:

"The General Medical Council should set out a standard requirement for routine visits to each local education provider, and programme in accordance with the following principles:

- The Postgraduate Dean should be responsible for managing the process at the level of the Local Educational Training Board, as part of overall deanery functions.

- The Royal Colleges should be enlisted to support such visits and to provide the relevant specialist expertise

where required.

- There should be lay or patient representation on visits to ensure that patient interests are maintained as the

priority.

- Such visits should be informed by all other sources of information and, if relevant, coordinated with the work of the Care Quality Commission and other forms of review."

Francis also makes it clear that the DH must support this process and that the system must take these routine regulatory visits into account:

"- The Department of Health should provide appropriate resources to ensure that an effective programme of monitoring training by visits can be carried out.  All healthcare organisations must be required to release healthcare professionals to support the visits programme. It should also be recognised that the benefits in professional development and dissemination of good practice are of significant value.

- The system for approving and accrediting training placement providers and programmes should be configured to apply the principles set out above."

Francis also mentions that the role of routine visits in terms of patients safety:

"Training visits should make an important contribution to the protection of patients:

- Obtaining information directly from trainees should remain a valuable source of information – but it should not be the only method used.

- Visits to, and observation of, the actual training environment would enable visitors to detect poor practice from which both patients and trainees should be sheltered.

- The opportunity can be taken to share and disseminate good practice with trainers and management.

Visits of this nature will encourage the transparency that is so vital to the preservation of minimum standards."

Francis also adds that LETBS should have a medically qualified postgraduate dean:

"All Local Education and Training Boards should have a post of medically qualified postgraduate dean responsible for all aspects of postgraduate medical education."

Overall Francis' recommendations are good.  Routine regulatory visits have needed reinstating for some time.  It is utterly vital that the Colleges have a prominent role in this new regulatory structure.  The concern I have concerns the role of visits in terms of patients safety.  Of course if trainees mention things relating to concerns for patient safety then there must be mechanisms in place for ensuring that these are dealt with appropriately. However it is important that visits are primarily about training quality and training problems.

It is also vital that those  who are entrusted to take part in these visits are trusted by trainees and are properly independent.  I sorely hope the government act on these recommendations and do not ignore them as they did with John Tooke's excellent report.  It is a little worrying that there is no mention of medical training in the government's initial response to Francis.

The Francis report and what it should mean for medical training- part 2

Here is my part 2. The first chunk is extremely significant, it highlights the gross failings of the current regulatory system.  PMETB, the GMC and the Deaneries are all mentioned, it is made abundantly clear that the system was superficial and that it was not properly looking at training experience on the ground. Francis reiterates much of what I have already said in a BMJ Careers article, the system is toothless and ineffective:

" Deanery/universities

1.84 The system of regulation and oversight of medical training and education in place between

2005 and 2009 failed to detect any concerns about the Trust other than matters regarded as

of no exceptional significance. There were a number of factors contributing to this:

-While patient safety was theoretically given primacy in the system, the domain to be monitored was unduly limited to the potential risk posed to patients by the trainee.

-Insufficient consideration was given to the relevance of good quality training of practice in a setting which complied with minimum patient safety and quality standards, and to the professional obligation to protect patients from harm.

- The Postgraduate Medical Education and Training Board (PMETB)/GMC/deanery wide reviews focused on deanery systems of quality management, resulting in only superficial examination of the standards being observed. Such reviews did not consistently consider compliance with patient safety standards.

- When concerns were raised about inappropriate pressure or bullying by staff towards trainees these were not followed up or investigated.

- Systematic communication of indications of serious concern, such as the HCC investigation, was almost completely lacking between the regulators, and between them and the deanery.

- A reluctance to prejudice the provision of a service or the training of trainees has resulted in the implied threat of removal of approval for providing training places being largely theoretical."

The next two  paragraphs make the obvious but necessary point that training cannot be allowed to take place in clinical areas in which patient safety is not adequate:

"1.85 While requirements for remedial action must be proportionate, training should not be allowed to take place in an environment where patient safety is not being adequately protected. Perceived difficult consequences should never be permitted to hinder steps required to protect patients, and the oversight of medical training should not condone or support unacceptable practice. As elsewhere in the system, a sense of urgency may have been lacking, even after the scale of the deficiencies at the Trust had become apparent.

Medical training and education

1.172 Medical education and training systems provide an opportunity for enhancing patient safety. Students and trainees should not be placed in establishments which do not comply with the fundamental standards, and those charged with overseeing and regulating these activities should, like all other participants in the system, make the protection of patients their priority. A number of recommendations for this purpose have been made."

Overall these sections I have highlighted sum up all that is wrong with medical training as things currently stand.  The regulation of quality is poor and as a result it is far too easy for trainees to be put into dangerous clinical environments.  Francis hits the nail on the head in my opinion.  Part 3 is still to come.

The Francis Report and what it should mean for medical training -part 1

Obviously the problems at Stafford are complex and I have no hope of summarising everything in one.  For my first stab I go back to the first report by Francis in 2009, it is interesting to go back this far as some of the key messages and themes recurred in 2013's report.  Here is recommendation 4 from 2009:

"Recommendation 4: The Trust, in conjunction with the Royal Colleges, the Deanery and the nursing school at Staffordshire University, should review its training programmes for all staff to ensure that high-quality professional training and development is provided at all levels and that high-quality service is 

recognised and valued. "

Then one sifts through the lengthy document and finds some rather key comments concerning the regulation of training:


"72. I received a set of comments about the lack of any system requiring regular monitoring or approval visits by the various clinical Royal Colleges or the general medical and nursing councils.
73. In a letter to the Inquiry the Royal College of Obstetricians and Gynaecologists said that it had had no involvement in the Trust since its visit in 2002. Responsibility for visiting and approving hospitals for training passed in 2006 to the Postgraduate Medical Education Training Board.
74. In another letter, the Royal College of Physicians referred to representations it had made to the Health Select Committee about the loss of regular visits to trusts in the early 2000s.  These were linked to medical training but “were a valuable source of intelligence about clinical issues locally”. The letter also said that “[the] Royal Colleges’ professional networks are invaluable” in cases falling between those resolved locally and those that are reported to regulators.
75. Royal Colleges do continue to operate an invited review system. The Royal College of Surgeons conducted reviews at the Trust in 2007 and 2009. "

I don't want to force opinions into your heads, just read through the above and consider things for a moment.  I shall be back with Part 2.

Calling all BMA members on GMC social media guidance

The BMA are keen for all members to email them with any concerns they may have over the GMC's social media guidance.  I have written an email summarising my concerns and it is below. Feel free to use the letter yourself, or do email me at bendean1979@gmail.com if you are a BMA member and you want me to add your name to the letter, obviously email me your BMA membership number with your name!

"Dear BMA

I am writing to you regarding several concerns I have about the GMC's social media guidance:

1. "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

This piece of guidance appears to contravene the Human Rights Act, article 8, which entitles doctors with the right to a private life.  'Any material written' could refer to political opinion, sporting opinion or even gardening.  Surely every doctor should have the right to anonymity in the social media unless they are giving out clinical advice to individual patients.  This needs further clarification and if the GMC state that this applies to all material written, then legal advice must be sought and the guidance challenged, as it appears in breach of the Human Rights Act.

2. "You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession."

This piece of guidance is incredibly vague.  It is again arguable that doctors, when discussing non-clinical matters in their private time on the social media, have every right to behave in any way that they choose, providing that this is within the law.  It is arguable that this contravenes the Human Rights Act, article 8, again.

3. "Good medical practice says that doctors must treat colleagues fairly and with respect.  This covers all situations and all forms of interaction and communication.You must not bully, harass or make gratuitous, unsubstantiated or unsustainable comments about individuals online"

This piece of guidance is extremely vague and needs further clarification.  What is a 'colleague'? Most people would define a colleague as someone they have had direct contact with at work (face to face or by telephone for example).  If 'colleague' refers to any doctor on the GMC register then this piece of guidance has truly bizarre implications.  It may mean that criticising a politician who is a doctor may be something that the GMC could investigate and punish.  Again, surely doctors should be able to behave as they see fit in their private time when discussing non-clinical matters in the social media.  There is again an argument that this contravenes the Human Rights Act by interfering with the right of doctors to a private life. 

Yours Sincerely"

Stop Cameron selling of the NHS!

Unfortunately our political system is bent and this means that all our major political parties are very happy to ignore the well being of the public in order to keep a few rich elite party donors happy.  The endless privatisation of our public services is a great example of this, there is no evidence that it will be of any benefit to the public, rather the opposite in fact.  However the major parties have all been complicit in the privatisation of several of our key public services.

The NHS is just one of many chunks of the public sector that our corrupt government is intent on selling off.  They want to drive the NHS into the ground in order to catalyse its takeover by numerous huge multinational health care corporations.  Billions have been wasted doing this and the new system will be far less efficient due to a burgeoning bureaucracy that is needed to enforce the corrupt privatisation process.  International trade agreements are a key part of this antidemocratic process that works against the best interests of the general public.

The sad fact is that the political parties are largely funded by rich elite businessmen in whose interests it is to sell of vital public services such as the NHS.  The corporations owned by this rich elite will destroy the NHS and cut services in order to increase their profits, as soon as they have got their foot hold in the system.  The only hope we have of stopping this process is by putting pressure on David Cameron to exempt the NHS from the US/EU free trade agreement that is to be discussed later this year.  So please click on this E-Petition and sign on, every little helps!  The politicians should be the pawns of the public and not the evil weapons of elite billionaire businessmen.

The GMC on doctors and the social media

The GMC's guidance on doctors' use of the social media has attracted much comment and for very good reason. I would firstly urge anyone to actually read the GMC's full guidance before commenting, I have done and here is my two pence worth.

Firstly I think guidance has to be clear to be interpretable or meaningful, and this is one area in which the GMC's guidance badly falls down.  There are numerous elements to their guidance which are poorly defined and consequently extremely vague in terms of meaning.  When treating 'colleagues' fairly and with respect, what is a 'colleague'?  Most people would see a ‘colleague’ as someone one has come into direct face to face or telephone contact with in the workplace about a clinical matter, not a random person encountered on the web about a non clinical matter.  Also 'fairly and with respect', what does this mean?  The social media sees numerous very different people interact, people are routinely offended, often unintentionally, and this is a huge can of worms in itself.  Here is another massive vaguery:

"You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession."

This is so vague and so incredibly subject to the interpretation.  Why on earth should a doctor's conduct in their private life, as long as it is within the law, have to be any different to that of a general member of the public?  Personally I think the GMC's guidance in this regard rides roughshod over the Human Rights Act, which clearly states that all of us have a right to a private life.  Conduct in the workplace is different, but this is contact in the private lives of doctors that the GMC is referring to, and do they have any right to offer this guidance?  I think not.  It is akin to regulating how we behave on the sports field, with our children or at a social event.  Arguably the most contentious piece of guidance refers to 'confidentiality':

"If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

This piece of guidance is based on foundations of sand.  For one thing it is rather insulting that the GMC assumes that the general public are so stupid that they take everything said by a doctor as being the complete truth, this borders on the nonsensical for me.  It is also ludicrous to assume that the views of one individual doctor will be taken to represent the views of the profession.  Also how does being named help with these stated problems?  It doesn’t and it shows that the GMC may well be hiding the real, potentially more sinister, motives for clamping down on our anonymous use of the social media.

Overall I am deeply unimpressed with the GMC's guidance.  I took the choice a long time ago that I would not be anonymous in the social media, however I can appreciate that for many people this is not possible, for example it is impossible for psychiatrists given their job, it is also impossible for those who are effectively whistle blowing online, there are many other good examples of where doctors must keep their anonymity online or risk serious physical harm to them or their families.  The GMC's logic for doctors having to name themselves in the social media is weak and arguably incoherent.  Most seriously the GMC appears to be paying scant regard for the rights of doctors to have a private life that is free from the interference of government or regulatory bodies, as laid out in the Human Rights Act, and this kind of disdain for the rights of doctors shows the GMC up in a very bad light indeed.  I am very deeply unimpressed. 

ps I would also urge everyone to sign this petition which urges the Department of Health to rethink this invasion into the private lives of health care staff

The friends/family test is moronic rubbish

"From April 2013 all patients will be asked a simple question to identify if they would recommend a particular A&E department or ward to their friends and family. The results of the test will be used to improve the experience of patients by providing timely feedback alongside other sources of patient feedback. It will highlight priority areas for action."

For any of you who didn't know already, the government, in its infinite wisdom, has decided to bring in a new test, the 'friends and family' (FF) test.  One would think that if lots of money were to be spent on introducing a new test like this, it would have been well tested, validated and confirmed to be of meaning in health care.  One would think that, but with the government this is often not the case, it appears that these kind of hare brained ideas are plucked from the back side of some uneducated inexpert 'special' adviser and then forced on hospitals up and down the country, without even the glance of an expert, without even a thought that this may not be a great idea.  

Sadly for us, as tax paying members of the public, the FF test is a complete waste of our money, unless Jeremy Hunt knows something that the academic experts do not know, something I think is rather unlikely, I have seen insects with more intelligence than the insincere smug Hunt.  This is taken from a recent article in the New England Journal of Medicine:

" Limiting patient-experience measurement to a single dimension may exclude the interactions that most strongly affect experiences and outcomes. This fact alone could explain why many studies show no relation between outcomes and patient experiences."

Patient surveys to measure satisfaction are excellent tools to measure various aspects of their care, there is no doubt of this, the problem is that there are certain things one must do for one's questions to lead to meaningful answers and the FF test simply fails to do these.

The FF test is one general, vague and therefore meaningless, and useless way of gathering information about the quality of health care received by patients.  It is not focused on specific aspects of the care, it is therefore likely to result in answers that are of no meaning at all, as the answers will be skewed by so many things that may or may not be of any relevance at all.  The FF test is also unvalidated in health care, it has been plucked from business and just thrown into the NHS without any testing in this context.

So the end result of all this is that a lot of completely meaningless data will be gathered and analysed to give a lot of meaningless results, and a lot of our money will have been wasted in the process.  Sadly rather than consult any of the UK's academic experts in patient satisfaction, the Department of Health has acted on the whim of an idiot or idiots.  Typical lazy slack jawed work, how very depressing.

Stafford is the result of failing government policy

The Francis report has been in the headlines for much of this week and everyone has had their opinion as to what precisely went wrong.  Certainly blaming one part of the system on its own is not sensible, many things have to fail for things to go as badly wrong as they did in Stafford.  The health care system is a very complex beast, a bit like a human body in some ways, and for something to be painful, one not only needs problems with the peripheral tissue, but one also needs pain to be signalled up to the spinal cord and then to the brain.

Many hospitals provide a very good standard of care, in fact I would say a large majority of NHS hospitals are in this category, however to pin this success on the government and the Department of Health's door is completely wrong in my opinion.  Many of the successes of the NHS are despite the terrible top down style of management led by our 'esteemed' politicians and civil servants/'special' advisers in the DH.  It is only in this context that one can understand the gross failings of certain hospitals like Stafford.

The biggest factor in Stafford's failings was the terrible autocratic top down management system that exists in the NHS.  This is led by our politicians who are closely allied with the bullies in the DH, they then feed down to the SHAs, who then enforce things in the hospitals.  This top down bullying style is in place because successive corrupt governments have only been able to push through their awful damaging privatising reforms by force.  The front line staff and the good managers care for quality and for patients, the government and the  politicians do not, they care only for themselves.  The corrupt policy being pushed through, the current example being Lansley's deadly reforms, has to be bullied through, as it is fundamentally antidemocratic and corrupt by its very nature.

Essentially our corrupt political system has led to a top down bullying system of NHS management, the so called 'command and control' model.  All three major parties are behind the current privatisation of the NHS, against the democratic will of the electorate, and all three parties are partly to blame for this terrible dysfunctional style of abusive management.  The 'command and control' style comes with top down targets left, right and centre.  One must obey or be sacked, whether a manager or clinician, the whistle blowers are gagged and buried.

The NHS has become overly bureaucratic and less efficient in the process, leaving a dysfunctional half privatised shambles in places, the simple efficient NHS that existed before the market came is no more.  The market has failed, yet the government continues to bully it through, the privatisation has failed, yet they persist in forcing it on us, the recurrent theme is obvious, unpopular antidemocratic policy has to be introduced by nasty force and nasty tactics.

The cure is obvious but incredibly unlikely given our stinking political system, he market must go, the NHS must be publicly funded and 100% publicly provided, we need local autonomy, we need the front line engaged, we need a functional bottom up system.  The problem is there is zero chance of this happening with Hunt and Cameron in power, the private sector know all they need do is throw a few pounds their way and these corrupt Tories will oblige, they will bully through more harmful disasters on the NHS like the corrupt Labour government that did the same before them.

The failings of medical training

The 'new and exciting' broad based training program is a sad indictment of the rushed reform of UK medical training that has taken place in the form of Modernising Medical Careers (MMC).  The fact that such a program is needed says more about the lack of consistent training value of many Foundation Year jobs than anything else, with the lack of a proper robust regulatory process overseeing medical training being a key factor in this failure.  There are also several significant flaws in this broad based program, including the obvious potential for a lack of medical experience for those wishing to pursue a career in hospital medicine.  

Key elements of MMC continue to be jettisoned in the dustbin; these include run through training in several specialities including Orthopaedics, the misuse of minimally validated workplace based assessments and shortened GP training.  It is just a great shame that the robustly regulated PRHO year of six months medicine and six months surgery cannot be resurrected.  What medical training really needs is the proper robust regulation of all training posts, not the reinvention of wheels.

Dear Dr Dan Poulter

In your most recent piece of spin you bravely claim Pete Deveson's New Statesman article is "factually inaccurate" but fail to explain why this is so?  Interestingly you also fail to answer any of Pete's simple 3 questions.  

It seems Dr Dan has been compelled into a response:

"Although in theory, until the full introduction of the EWTD, the maximum number of hours a doctor could work in a single week was 91 hours (7 consecutive 13 hour shifts). The process of ensuring proper continuity of patient care through patient handovers to colleagues and being present on the morning consultant-led ward rounds for handing over patients admitted overnight meant that the reality for doctors like me, in some specialities was a working rota pattern involving regular 100 hour weeks.

A typical obstetrics and gynaecology rota (as it appeared on the official rota) which I performed as a doctor as recently as 2009 was; 12 days of consecutive day shifts (including 7 days of 11.5 hour on call shifts) followed by two days off, followed by 12 further consecutive day shifts (including 7 days of 11.5 hour on call shifts), followed by 2 days off, followed by 7 consecutive 13 hour night shifts, followed by 6 days of compulsory rest and a week of training/annual leave (then working pattern repeats in a cyclical nature).

This was a gruelling and tough medical work rota by anybody’s standards, notwithstanding the fact that patient handover meetings and required attendance on post admission patient ward rounds were not ‘counted’ as officially timetabled hours on the rota. The demands of ensuring proper patient care and continuity of care, required junior doctors, like me, to work 100 hour weeks as recently as 2009."

Dr Dan is digging himself into a hole in my opinion. His claims of regular 100 hour weeks are based on a slightly dubious use of the word 'regular' and some rather interesting hand overs.

Interestingly Dr Dan also probably worked regular zero hour weeks if we take his argument to its logical conclusions. Strange he didn't spin this line in Parliament.

At best Dr Dan has been caught engaging in some blatant spin that is arguably highly disingenuous. Dishonest? Well, we simply don't have the facts to make this judgement but it wouldn't surprise me knowing most Tory politicians.

A successful day of Industrial Action

Despite certain biased media outlets including the BBC/Telegraph/Mail et al deliberately seeking negative views on our industrial action and despite the constant stream of dishonest propaganda from the Department of Health press office, I think today has shown anyone around a GP surgery or a hospital that there is a fair bit of support for doctors in our battle against the lying dictators in government.

A majority of our fellow workers and many patients were very much behind our decision to stage this day of protest and personally speaking, I was heartened by what many people had to say.  Of course there were a few people who did not agree with us, however this was inevitable and these people are entitled to their opinion, even if some of them were more motivated by petty jealousy than anything logical.

If this battle is to be won then we need to dig ourselves in, it will take repeated days of protest to make this corrupt regime listen to our calls for fairness and negotiation, not yet more unilateral arrogant dictation.  Well done to all the doctors and all those who supported us, for doing things in such a sensible and caring manner.  

Also please make the effort to sign this E-petition that calls for Lansley et al to pay the same % that doctors are being asked to pay.

Doctor pensions - stick it to Lansley!

Whatever you think of doctors, if you believe in fairness then you should sign this E-petition.  Doctors do not expect special treatment, all they want is fairness, and the fact that government are unilaterally forcing doctors to pay far greater percentages of their income into their pensions than other workers in the public sector is grossly unfair, there is no credible argument against this I'm afraid.

Unfortunately large sections of the media have swallowed up a lot of Lansley and the DoH's lies.  Well, if Lansley and the DoH think doctors should be forced to pay 14.5% of their incomes into their pensions, then Lansley and his DoH cronies should also pay the same amount.  Currently MPs like Lansley, civil servants like those at the DoH, teachers, judges and many other public sector workers pay nowhere near the 14.5% that is being unfairly forced on doctors.

Please sign the E-Petition, post it on Twitter and Facebook, let's help force Lansley and his cronies to pay the same as doctors, let's see if they are happy to eat their own pudding.  I doubt it.

Dear Joe Public - the doctor strike facts

There will be a lot of disingenuous and dishonest information spread by the government and various biased sections of the media in the forthcoming weeks ahead, and it is vital that you, the public, are informed of the facts so that they can make up their own minds as to whether a strike is justified.  Just remember that this is the same media that is being shown to be rather free of honesty and morals in the Leveson inquiry.

First and foremost a strike is completely safe and ethical, any strike will not involve emergency services, it will only affect anything that is non-emergency, in fact ironically emergency patients may well get better care than normal during a strike as all elective work will be cancelled.

Secondly there are several key facts that you will not hear in certain sections of the media, certain journalists and newspapers have massive vested interests, they cannot be trusted with their propaganda.  The facts that no one from the government can deny are as follows:

1. Our pension fund is in surplus of about 2 BILLION pounds per year.  It is sustainable and it is simply being raided by government to subsidise losses and deficits elsewhere.

2. Doctors have had numerous pay cuts and freezes over the last 20 years or so, compared to their peers from equivalent backgrounds and levels of education, doctors earn significantly less money over their careers.

3. Doctors agreed a new pension deal in 2008 which the government wants to tear up, this already increased contributions hugely, the new proposals which have already been enacted involve doubling the current contributions.

4.  Strangely the pension contributions of politicians and civil servants are not being plundered in the same manner, I wonder why this could be?  Surely the whole public sector should be treated in the same manner and doctors, who already pay a good chunk of their salaries, should not be selectively robbed.

I am biased, I will not deny this but a line in the sand needs to be drawn now and a strike is utterly essential for numerous very solid reasons.  The government is privatising the NHS as we speak and they have no democratic mandate for this.  They now want to steal money from the pension funds of doctors to pay for their errors, of note from pension funds that are accruing about 2 billion pounds of surplus cash per year.

We, doctors, need the public's support and we need you to ignore the dishonest bile that will be thrown in your direction from the likes of the Daily Mail and the BBC.  The vast majority of doctors feel this way.  I love being a doctor, however I am relatively poorly paid in comparison to most of my peer group who did not go into medicine, and all I ask is that our reasonable pensions are not plundered by the incompetent and dishonest fools in government who will tell you numerous porkies in order to make you think that I am greedy or selfish.  This is not the case, I just don't want the government to steal from my pension fund to pay for their negligence and incompetence.  Thanks for listening.

Risk-free profits for the vultures begin

This excellent article from Allyson Pollock sums up the disaster that Lansley's terrible NHS reforms are.  It is clear that the market is fake and that many private sector vultures are set to make massive profits at the expense of the tax payer.  It is an utter scandal.

There is no accountability or transparency, meaning that the market is a sham, there is no real competition.  This Bill has been created with the help of the private sector for the private sector, the conflicts of interest are a disgrace.  This is the Lansley and Cameron's idea of open accountable democracy:

"The public cannot make a fully informed judgement about the contract, because both the Treasury and Department of Health have refused to release key information, despite repeated requests under the Freedom of Information Act. "

Pollock sums it all far better than I can:

"The speed at which contracts have been let and the lack of public consultation inevitably seeds suspicions of corruption; but it is politicians who have seriously misled the public over the NHS.......The current lack of disclosure is a public scandal."

It is good to see the current corrupt government paying for their sins in the local elections, the problem is Labour are not much better, the real disgrace is that our democracy is but a sham, voters have no real choice and this will result in reducing voter turnout in elections, increased apathy and a rise in the extremist far right vote.  Thanks Cameron and Clegg, you are a disgrace to this country.

Dr No - nail on head? Can of worms exploding

I stumbled upon this excellent piece by Dr No on the proposals for extra years of training for GPs, I have to agree with Dr No, I do not trust the Royal College of GPs and suspect some cynical motives may be at play:

"There are of course those who see the extension of training as a cynical ploy by the general practice establishment to extend the pool of sub-GPs (and so cheap GPs) available for exploitation by the establishment. While this may indeed happen as an unwelcome side-effect, Dr No suspects the primary motive of those who wish to extend GP training is to enhance professional standing and status, and so distance the profession from its trade roots; and in this objective, Dr No believes the College proposals will fail."

I am not sure Dr No is right on this, however in the comments it is abundantly clear that there are major problems with medical training that continue to be ignored by the powers that be.

Medical training has been taken over by educationalists in Ivory towers, many of whom reside at the GMC, the focus is now barmy, it is all about paperwork and reflective practise.

There is no decent regulation of training.  There is no focus on hours and experience.  It is a joke.

The problem is that this situation is getting worse, there is a huge disconnect between those involved in training on the ground and those in the Ivory towers who are telling them what to do.  A key part of John Tooke's review talked about this disconnect and the lack of involvement of those on the ground in running training.

The GMC is not democratic, the Royal Colleges are not democratic, the BMA is not democratic, and all this combines to result in the continued disastrous reform of training.  It is nothing but a shambles.

Andrew Lansley - popular compared to Hitler

So the antidemocratic farce that is Andrew Lansley's 'Health Bill' has not yet been scrapped.  Today the deeply unpopular and arrogant health minister needed a police escort to visit an NHS hospital.  This really should tell the government and Lansley himself that things have gone far enough, if these cretins cared one iota for democracy they would have chucked Lansley's  deranged manifesto of privatisation firmly in their privatised dustbin.

If the NHS Bill does end up going through it will only prove just what a complete lack of democracy we now have in this country.  The wealthy people in power can push through terrible legislation that shafts the average man on the street but furthers their own selfish interests, it is such a sad indictment of the state in which we live.  Lansley need a police escort and a media blackout, yet even with this his every move is still a PR disaster, such is the idiocy of his Bill.

I hold out a lot of hope that Lansley's toilet roll will be flushed down the bog where it belongs.  The momentum appears to continue to gather, the Royal Colleges look close to full blown opposition, the public are getting angrier and some of the media are taking more notice.  It is just a great shame that so much of the mainstream media is so unable to call a spade a spade, there is too much corrupt conflict of interest around for the truth to be broadcast far and wide as it should be, even so lying Lansley has been found out, we all know that his bill is a dishonest piece of privatising filth designed for one thing, making the rich richer and the poor less healthy in the process.

Lansley on the run - write to your President now!

Lansley's disastrous Bill appears to drifting towards the rocks, the BMA, RCN, RCM, Unison and Unite already oppose the Bill.  The Colleges are not covering themselves in glory with their failure to oppose the Bill.

Now is the time for them to stand up, be counted and represent their members and the people of this country by openly stating their opposition to this destructive and incoherent Bill of idiocy.

It will not take long to email the Acadamy of the Medical Royal Colleges and your specific Royal College President to pressure them into opposing the Bill, so get emailing and do it now:

Everyone:(AOMRC) academy@aomrc.org.uk

Medics:     enquiries@rcplondon.ac.uk

Surgeons:   president@rcseng.ac.uk

GPs:        president@rcgp.org.uk

Anaesthetists: president@rcoa.ac.uk

Psychiatrists: cchurchill@rcpsych.ac.uk

Here is a brief letter template:

"Dear President

I am writing this email to complain about your abject failure to oppose Andrew Lansley's Health and Social Care Bill.

If you fail to publicly oppose this Bill then I feel you are failing your members, your patients and yourself.

Yours."

Lansleys lies some more

So Lansley is now claiming that nurses' and doctors' unions are opposing the health bill because of pay and pensions, what an illogical and incoherent view from this cockroach of a man.

The pension reform is part of the package that is the whole scale privatisation of the NHS, the white paper and the pension reform are all part of this antidemocratic privatisation campaign.  The pension looting is a quite deliberate part of this privatisation, as private firms will not take staff on if they have decent pensions.

We are against the NHS and what is stands for being destroyed, we are against patient care going down the toilet, and privatisation will do both of these things, and this privatisation is being catalysed by the white paper and the pension reform.

If a doctor had lied and lied in order to privatise the NHS in such fashion there would be a good case to strike them off for their rank dishonestly and lack of integrity.  Sadly this kind of malignant weasel-like behaviour has become standard for all politicians of all three major parties who have joined in the NHS privatisation in recent years.

The public do not want it, doctors do not want it, nurses do not want it, only Lansley and a few rich people with vested interests want the NHS sold off and it is quite disgraceful.  While Bevan is remembered fondly, Lansley will be remembered in quite the opposite manner and this will be thoroughly deserved.