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Wednesday, 4 July, 2001, 15:13 GMT 16:13 UK
The head of the BMA, Ian Bogle quizzed
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Doctors say the NHS is in need of mouth-to-mouth resuscitation.

Dr Ian Bogle, the chairman of the British Medical Association, launched a vitriolic attack on the government's handling of the health service at the BMA's annual conference on Monday.

He said doctors simply could not cope with ever-increasing demand, and that new targets, such as a guaranteed appointment with a doctor within 48 hours, would bring the service to the point of collapse.

GPs, who say they do not have enough time to provide proper care and attention to patients, are threatening to tear up their NHS contracts en masse.

Hospital doctors are fuming at plans to stop them working in the private sector and health workers throughout the NHS are fearful of the implications of a greater role for the private sector in the provision of services.

Is the NHS really in such a bad way? What are implications for patients? Dr Ian Bogle chairman of the BMA joined us for a live forum and answered a selection of your questions.


Transcript:


Newshost:

Before we go to the e-mails, can I ask you about the question of morale - it does seem that morale is very low at the moment in the profession?


Dr Ian Bogle:

Morale has not been lower in the 16 years that I have been involved representing doctors nationally - right across the board in hospital and in general practice. Moral is low for a variety of reasons - criticism of doctors in the media, criticism by Ministers and a workload that is mounting and unmanageable.


Newshost:

Let's get to the first e-mail which is from Dr. Pesola in Borough Green, Kent, UK he asks: As GP I welcome the increasingly tough line with the Government which I hear from BMA leaders but I notice that each public statement is accompanied by a commitment to the NHS. Many of my doctor acquaintances are starting to question whether the state can afford to fund all of the nation's healthcare out of taxation. My question is whether the BMA has devoted any effort to exploring other methods of healthcare provision and if so, what its conclusions were?


Dr Ian Bogle:

During the last year and reporting early this year - we took at year looking at a funding review, not just within the BMA but health service management, health economists and patients groups helped us to look at what the possibilities were. So we have studied this in a great deal of detail. The conclusion eventually was that the most satisfactory and fair way of providing a national health service was to base the vast majority of the funding from taxation - realistic taxation and not gimmicky taxation like a hypothecated tax but actually straight from direct taxation. The only caveat was that we really should be looking at what we can afford to give in the NHS as a free good. Our belief is that patients should be involved, the public should be involved in deciding whether everything should be available under the National Health Service. Certainly what is available should be freely available across the country but should we just put everything available under the health service and that is the big query that we raised.


Newshost:

Any answers on that yet?


Dr Ian Bogle:

No - we really need the Government to take this up. It isn't our job to impose that. The public need to decide what sort of health service they want. In the NHS plan, the Government talk about public participation in decision-making. We would have thought that in that chapter it gave them the key to setting some sort of mechanism where the public could express a view on the matters that actually are available under our healthcare system.


Newshost:

Margaret Evans, Cardiff, UK asks: GPs are threatening to quit the NHS. What does this mean and what will happen to patients if this actually happens? Will patient care be damaged?


Dr Ian Bogle:

What has happened is that on the back of the low morale that we have talked about and the very high workload and the impossibility of giving patients the sort of care that we think they should have, the GPs have called for a new contract - a new contract that will make them work at a pace that is safe and that will reward doctors who provide high quality care - which is the majority. In a ballot the GPs have said that if that contract isn't delivered satisfactorily in a year's time, then we would consider resigning our NHS contract. That is an important difference. Resigning a contract doesn't mean that a GP isn't available any more. Undoubtedly a Secretary of State would have a duty to provide care and would make some arrangements with GPs. So it isn't a removal of general practitioner services from patients. It is a cry for help from the general practice community.


Newshost:

But if it actually happens, would you say there would be some ad-hoc temporary arrangement or each GP would sell their services individually? I can see you are saying that you are hoping it will never reach that point but if it did reach that point - you can't make an idle threat.


Dr Ian Bogle:

What I am saying is that the GPs will still there with their staff and their premises. The Secretary of State would need to make a contractual arrangement with the GPs who are prepared to contract their services under different arrangements. Some GPs would provide different sorts of services. We are going to work over the course of the next year to flesh out proposals as to what would happen. But it is our belief patients will not be without general practitioners.


Newshost:

Anwar Singh, Accrington, UK asks: In the light of the scandals at Alder Hey in Bristol, isn't it fair to suggest that doctors themselves should take some of the blame for the current problems of the NHS? Isn't it a bit disingenuous of the BMA to try to lay the blame at the door of the Government?


Dr Ian Bogle:

The blame I was laying at the door of the Government was they were actually fuelling the criticism so that it criticised the vast majority of good doctors and demoralised them. That's the criticism I was making. In the individual cases, where doctors have behaved badly, inappropriately, dangerously - we have not attempted to say other than they are guilty and we are not attempting in any way to support them.

Alder Hey was somewhat different in that an immediate and blanket referral of doctors to the General Medical Council was made. I say that is inappropriate - I still say it is inappropriate. Mr Milburn does not agree with me. But nevertheless, we are not attempting to say where doctors are to blame for the situation that we are not sorry because very often were hurt, relatives were hurt, and so the first thing we need to say - we are sorry on behalf of the medical profession for that happening but we mustn't tar all doctors with the brush of being uncaring. At the end of the day, the opinion polls show that the patients still respect the doctors and still think they tell them the truth - the vast majority, 90% say that.


Newshost:

Jane Squire, London, UK asks: I have a friend who is a doctor but also a refugee. He speaks English and passed the USA medical exams - he wanted to enter the UK and become a doctor here but he found the entry restrictions prevented him doing this. Why, if we are really so short of doctors, is it so difficult for a well-qualified doctor with refugee status to enter the UK and take up a post as a doctor here?


Dr Ian Bogle:

Our mandate, following this morning's debate, is that we have got to go and discuss with the appropriate government departments - and it is more than one - how it can be made easier. We also have to look at our own training authorities to make sure that we can make it easier.


Newshost:

But of course there is the danger which we have all spoken about over the last year or two of us stripping doctors from countries that really need them.


Dr Ian Bogle:

Yes, it is one thing going out and denuding under-developed countries of their medical staff. But the question was about people coming over here - seeking asylum - and who have a medical qualification - they are not going to go back - they are a different category. What we did say was that we should not be going out to Third World countries where - whatever we think of our health service - they would give their eye-teeth for the sort of service we get here, and to take their medical staff just to fill vacancies over here. The two things are different. With those people coming here permanently we ought to try and use their skills.


Newshost:

Colin Tanner in Lincoln, UK asks: The NHS is in a bad way but nearly didn't off the ground at all. Doctors have to be given the concession to continue with their private practice alongside their NHS contract. This put a fundamental flaw into the NHS at day one. Does the BMA condone the situation where doctors are going on doing private practice as well as public practice or if not what do they intend to do about it?


Dr Ian Bogle:

I would not condone a practice if doctors were doing any sort of private work to the detriment of their National Health Service contract. But once they have fulfilled the terms of their contract - like anybody else in this country - they should be free to do what they will with what is then their time. I have no objection therefore to them doing private practice. It is easily said that it makes a difference to the health service care but in fact consultants work more than their contracted hours on average so that isn't so.


Newshost:

There has always been a suspicion that in some particularly lucrative specialities, doctors might find it rather convenient that their waiting lists on the NHS were long - several months - and as a result for every person who could afford to jump that waiting list, that doctor benefits.


Dr Ian Bogle:

I have never had actually had facts put before me to substantiate that. I think in the current climate if that practice were taking place it would be very, very short-lived. I can understand the anxieties but nevertheless the discussions on the new consultant contract, I think will make sure that the person who sent in the question will probably be satisfied. When we get a new consultant contract, there will be clarity in this particular area.


Newshost:

Colin Tanner further asks: For most people, doctors seem to enjoy a life of privilege and high financial reward and the BMA seems to be a club for the protection and the continuation of that privilege for doctors. Does the BMA feel it has any responsibility to the general public? Aren't you just acting in your own self-interest all the time?


Dr Ian Bogle:

No, but on the other hand I am here to represent doctors. I have worked 38 years in the city of Liverpool - not exactly the most privileged life, it was very hard work indeed and my colleagues work exceedingly hard. But we are not the worst off in society - we are not saying that at all. But what we try and do in putting forward our views is to try and align them with good patient care. So that while we are trying to get benefits for doctors and make doctors lives better, we are trying to actually bring about patient care.

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