thedoctor Issue 60 | October 2023

For our future,

for our patients
Doctors’ united call for fair pay

Knife violence ‘Natural Lack of support

Tackling an epidemic campaigner’ ‘Patchy’
at source GPs elect a occupational
new leader health services

20230665 thedoctor – p1 v3.indd 1 09/10/2023 07:26

 In this issue
3
At a glance
A new podcast series with a
focus on communication
4-7
Stop it at source
The ‘public health approach’
to tackling knife violence
8-9
‘I’m a natural
campaigner’
The new GP leader, and her
‘bruised’ profession
10-13
‘We shall fight on’
Doctors unite in support of
pay restoration
14-15
Taking the strain
Pressure on doctors is
intense, but access to
occupational health services
is ‘patchy’
16-19
A precious time
A chronic lack of investment
in paediatric palliative care
is causing unnecessary
anguish
20-21
Supporting each other
Thousands of doctors have
already benefited from the
BMA strike fund
22
On the ground
The BMA helps a member
secure a vital career break
23
Your BMA
Doctors unconvinced by the
Government’s workforce plan
02 thedoctor | October 2023
20230665 thedoctor – p2-3.indd 1
JESS HURD
Welcome
Phil Banfield, BMA council chair
It gives me great pleasure to welcome Katie Bramall-Stainer to her role
as chair of the BMA GPs England committee – and for us to introduce her
to you in more detail in this issue of The Doctor. Katie has been a tireless
campaigner for, and leader of, GPs for many years and will no doubt
bring her great strengths to the BMA’s fight for fair pay, better terms and
conditions and safe working environments for all doctors.
The dispute has an opportunity to make progress. Although Mr Sunak
refuses to discuss pay in a pay dispute, there are increasing and multiple
calls demanding he meets with us. We will not stop until your voices are
heard. In this issue of the magazine we reveal thousands of doctors have
been supported to take industrial action by the BMA’s strike fund. We speak
to doctors who have benefited – who would not have been able to join our
collective action without financial assistance – and to others who have
contributed to the fund to ensure our industrial action can continue for
as long as is necessary. Whether this dispute runs for days, weeks, months
or years, we will continue to fight and we will continue to advocate for our
profession and our patients.
Also in this issue of the magazine we hear from frontline doctors about
the traumas and tragedies of knife crime – and what positive effects
treating the issue as a public health problem can make to the health
service and communities. Among the heartbreaking stories about lives
lost there is also, thankfully, cause for optimism thanks to the brilliant
work of doctors and other health workers who are taking action to try to
intervene in these senseless cycles of violence and suffering.
Elsewhere, we analyse the effects of workplace pressure and a
mounting backlog on doctors, and hear about efforts to improve
occupational health services for staff. We also visit Chestnut Tree House in
Sussex as part of a piece about children’s palliative care. This hospice is a
‘life-affirming’ place where the short lives of terminally ill children are lived
to the full.
It is absolutely inspiring to read about the tireless work of staff and
the bravery of patients – but also eye-opening to uncover the struggles
families face navigating the system and the desperate need for investment
in paediatric palliative care.
Keep in touch with the BMA online at instagram.com/thebma
twitter.com/TheBMA
09/10/2023 11:20

A COMMUNICATIONS
MASTERCLASS
‘There is something magical about the confluence
of medicine and communication. It is an alchemy
which can produce genuine inspiration.’
So observes former BMA president Martin
McKee in his introduction to the association’s
Inspiring Doctors podcast, a series dedicated
to exploring the contributions of doctors and
scientists noted for their achievements in
effectively communicating the complexities of
medicine to the public.
Despite having only launched in June this year,
the podcast has already showcased more than
a dozen luminaries from the medical world, all
of whom have made a name for themselves as
exceptional communicators in one medium
or another.
These include Private Eye’s Medicine Balls
columnist and Edinburgh fringe comedian Phil
Hammond with whom Prof McKee discussed
the Bristol heart scandal and the importance of
protecting whistle-blowers in the NHS.
Others to have appeared on the series
include Trisha Greenhalgh who, like Prof McKee,
is a member of Independent SAGE – a group
that played a pivotal role during the pandemic
in broadening the public’s understanding of
COVID-19.
Prof McKee has also enjoyed audiences with
Bad Science author and long-time Guardian
columnist Ben Goldacre and Alice Roberts, who
along with having presented numerous BBC shows
including Time Team, The Incredible Human
Journey and Origins of Us, also serves as Professor
of Public Engagement in Science at the University
of Birmingham.
Prof McKee notes that, while communication
is an essential and everyday aspect in medicine,
from doctors consulting with their patients to their
referrals to other clinicians, the ability to speak to
bma.org.uk/thedoctor
20230665 thedoctor – p2-3.indd 2
AT A GLANCE
those beyond medical and scientific audiences is
not a skill possessed by everyone in medicine.
Dr Goldacre, who features in the ninth episode
of the series, reflects that while a large part of
his media career focused on communicating
medical and scientific information to a generalist
audience, this skill is a fundamental requirement
to any practitioner.
‘When you’re making a diagnosis, you know,
patients don’t come in and say, “I’ve got central
crushing chest pain that radiates up my neck”,’ MCKEE:
he tells Prof McKee. Effective
communication
‘They come in and describe their bodily can be magical
experiences in their own language, and you’ve got
to negotiate the mapping of all of that on to the
sort of body of technical medical knowledge. So,
I think it’s [good communication] at the core of
everything that everyone does all of the time.’
The importance of good communication was
perhaps most brought home by the late Kate
Granger, a geriatrician who, following her own
experiences as a cancer patient, launched an
NHS-wide campaign #hellomynameis aimed at
encouraging doctors to introduce themselves on
first-name terms to those they were caring for.
Indeed, kindness and good communication GREENHALGH:
are arguably integral to one another, something Member of
Independent
that Dr Hammond touches on in episode three SAGE
of the series.
‘I’ve worked with chronic fatigue, ME/CFS, long
COVID, for 11 years, and there’s loads of stuff we
don’t understand about that,’ he says.
‘But what we do understand is that you have to
acknowledge people’s stories. You may not have
the solution, but you acknowledge their stories
and their suffering, and you legitimise it.’
A new episode from the series is planned for
later this autumn. To listen to the series and to find
out more visit bma.org.uk/inspiringdoctors
thedoctor | October 2023 03
09/10/2023 11:20
 OLIVIA VILLEGAS
PILE ON THE Doctors want to do more
PRESSURE:
Students at for knife-crime victims
the Liverpool
Life Sciences
than just ‘stitch them
University
Technical College
up and send them back’.
undergo training
by KnifeSavers
Going into communities
with a strong educational
message, and using the
best available data, they
tell Tim Tonkin about the
‘public health approach’
to the violence epidemic

STOP IT AT SOURCE

04 thedoctor | October 2023

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OLIVIA VILLEGAS
A
s an experienced
trauma surgeon,
Nikhil Misra is used to
seeing patients in life-or-death
conditions and in desperate
need being suddenly thrust
before him.
While his patients come
from all ages and backgrounds,
many of those he has
encountered on the operating
table are young people who
have been the victims of severe
and violent injury resulting
from knife violence.
One such incident five
years ago, however, proved so
catalytic for Liverpool-based Mr
Misra that he decided he had
to do more than simply treat
the physical wounds wrought
by knife crime, and instead
work with others inside and
outside of the health service to
promote prevention.
‘We had had a really bad
summer for fatalities from knife
wounds in young people that
culminated in a case where
a young lad taking part in an
organised fight in a field near
his school ended up with a
single stab injury to his groin,’
he reflects.
‘He exsanguinated. Ran
across the field and came
into the trauma centre with
cardiac arrest. We did incredibly
aggressive resuscitative
surgery on him and the whole
trauma team were brilliant that
day, but we couldn’t save his life
– I couldn’t save his life.
‘The immediate few minutes
after that [losing his patient] of
having to pause and then go
and speak to his dad and break
the shattering, horrible news.
I went back home that night,
spent time with my family and
thought, “This needs to get
better, this can’t be right”.’
Knife violence, particularly
among young people, is a
20230665 thedoctor – p4-7.indd 2
long-standing and tragic social
phenomenon that blights
communities in all parts of
the UK, with the latest figures
released by the ONS (Office for
National Statistics) painting a
grim picture.
Incidents doubled
While the number of assaults
with injury or with intent to
cause serious harm involving
knives fell from 22,097 at the
end of March last year to 21,555
during the same period in 2023,
this figure is almost twice as
high as that recorded a decade
earlier in March 2013.
ONS data specifically related
to homicide, meanwhile,
reveals that of the 69 murders
involving victims aged 13 to 19
years old recorded at the end
of March 2022, 74 per cent of
these killings were as the result
of a knife or sharp instrument,
compared with just 41 per cent
of all victims of homicide.
Mr Misra’s experience back
in 2018 ultimately led him to
found KnifeSavers, a charity
which primarily seeks to
educate young people about
the dangers of knife violence
as well as provide basic clinical
skills to help save lives in the
event of someone being
stabbed.
The charity has also sought
OLIVIA VILLEGAS
WALL OF to improve victims’ chances
RESOLVE: of survival by caching 1,500
KnifeSavers
volunteers bleeding control packs in
prepare to different parts of Liverpool and
educate young Merseyside, with the locations
people
of these potentially life-
saving resources plotted and
accessible via an app.
KnifeSavers’ work, however,
is just one component
complementing a broader,
‘public health’ response to knife
violence in communities within
Liverpool and Merseyside.
Determining what exactly a
public health approach to knife
‘I thought, violence equates to can vary,
“This needs but one vital aspect is that of
to get better, different institutions such as
this can’t be health services and the police
right”’ sharing data in line with the
precepts set out in the Cardiff
violence prevention model.
Devised by Professor
Jonathan Shepherd, the Cardiff
model prescribes collecting
data on location, nature and
scale of violence, determining
the factors which influence
the risk for violence and then
using this analysis to devise and
implement interventions at a
local level which can later be
scaled up if required.
This approach was used
in the UK back in 2005 with
the launch of the first VRU
(Violence Reduction Unit) by
Strathclyde Police in Glasgow,
thedoctor | October 2023 05
09/10/2023 11:20
 STREET DOCTORS
a city that at that time had one
of the highest murder rates in
Europe.
Data-driven
Underpinned by the belief
that violence is a preventable
not inevitable outcome in
society, the VRU used pooled
data to help direct and target
resources, as well as seeking to
identify and address the factors
deemed likely to increase an
individual or community’s
vulnerability to violence.
It was an approach credited
with delivering a 35 per
cent reduction in Scotland’s
murder rate between 2010
and 2020, and a success story
that ultimately saw the UK
Government provide a total of
£70m to establish VRUs across
18 English police-force regions
in 2019. Alongside his role with
KnifeSavers, Mr Misra now
serves as the health lead for the
MVRP (Merseyside Violence
Reduction Partnership) and
says that sharing data has
been critical to enhancing his
charity’s work.
‘When I first started off [with
the bleeding-control packs] it
was essentially a scattergun
approach, putting them in
areas where we thought they
would be needed,’ he explains.
‘Since then, we’ve made
06 thedoctor | October 2023
20230665 thedoctor – p4-7.indd 3
some incredibly strong
connections with Merseyside
police and work with their
intelligence analysts who have
helped us to identify areas
that may benefit more from
bleeding control packs.
‘We then look at data
from the violence-reduction
partnership in terms of where
the incidents occur as well
as data provided by North
West Ambulance Service and
emergency departments via
the MVRP so that we know
where patients [of knife
violence] are coming to us from
and who they are in terms of
demographics.
‘This approach has made
me totally rethink my way
of how I deliver healthcare
on the wards in the hospital,
how we can effect change as
clinicians. I think we could play
a massive role in that, which
as doctors we may not fully
realise. Just pausing, taking a
beat, and taking time to listen
to the person we are delivering
healthcare to could make such
a huge difference.’
Data sharing between
emergency departments
and other bodies took place
prior to the roll-out of VRUs
via Information Sharing to
Tackle Violence, which sees
the sharing of anonymised
data of patients who have
been the victim of violence
with the police and with
local community safety
partnerships.
Looking at data to develop
a better understanding of
where knife violence may be
happening is, however, only
one part of a public health
response.
While numbers can
provide a better sense of the
bigger picture, being able to
understand and relate to those
PEER SUPPORT: most likely to be affected by
A StreetDoctors knife violence and trying to
volunteer
teaches first-aid provide guidance and support
skills beyond just repairing their
physical wounds, is something
final year medical student
Vishal Chahwala firmly believes.
Having written a
dissertation examining
hospital-based violence
intervention programmes while
studying medicine at Barts and
The London, Mr Chahwala has
‘There’s not for five years volunteered for
that much the charity StreetDoctors.
appreciation As a national organisation,
of the risk it trains young people affected
factors of by violence with emergency
violence’ lifesaving skills and increases
their understanding of its
medical and psychological
consequences.
The training is delivered
by a network of healthcare
volunteers, including
student doctors, nurses and
paramedics to a range of youth
partners across the country
including youth and sports
providers, educational settings
and criminal justice services.
He says interacting with
young people, many of
whom have been directly or
indirectly affected by knife
crime, had given him a much
greater appreciation and
understanding of the societal
causes and risk-factors around
09/10/2023 11:20

the phenomenon.
‘I think as medical
professionals we are slowly
getting better at viewing
people with diseases rather
than just the disease on its
own,’ he says.
‘We’re beginning to move
away from a system where
we stitch people back up
and then send them back
to the same environment
that victimised them in the
first place. However, there
still needs to be a greater
appreciation of the risk
factors of violence and what
makes young people more
vulnerable to violence.
‘I think a lot of the pushback
to a public health approach is
that mentality of “I need to fix
their [patients’] diabetes and
heart disease, I don’t have the
time to worry about their social
issues”,’ says Mr Chahwala.
‘I understand and agree
with the argument that
medical professionals can’t
fix everything on their own,
but we have a responsibility
to know how we can refer
patients to the right services
and refer them to the right
people.’
Mr Chahwala says training
young people in clinical
lifesaving skills not only serves
a practical purpose, but also
bma.org.uk/thedoctor
20230665 thedoctor – p4-7.indd 4
CHAHWALA:
‘It’s allowed me
to have a real
understanding of
violence as
an issue’
MISRA:
Uses data to
learn more about
knife-crime
hot spots
provides a mutually beneficial
opportunity for both sides to
learn from each other.
‘It’s allowed me to have a
real understanding of violence
as an issue,’ he says.
‘One of the really
dangerous and worrying
misconceptions that some
young people have is that
there are safe places in the
body to be stabbed. I’ve heard
a few times young people
talk about knowing peers
who have stabbed someone
in their thigh because they
thought it was safe [and]
they’ve ended up with a
murder charge instead.
‘StreetDoctors sessions
go beyond just teaching
“this is how you save a life”,
it gives these young people
an opportunity to have some
time with a mentor, with a role
model. It’s a safe space for
them to ask questions and talk
about issues that are important
to them.’
Engaging with those
affected by knife violence
in ‘reachable’ rather than
‘teachable’ fashion, is
something Mr Misra also
recognises the value of, having
welcomed non-clinical youth
workers known as youth
navigators into his own ward.
These navigators, who are
OLIVIA VILLEGAS
deployed by the MVRP, aim to
engage with the young victims
of violence and attempt to gain
a better understanding of their
lives and social circumstances,
and what interventions might
reduce their risk factors of knife
‘We have a crime in the future.
responsibility ‘The first thing we [as
to know how doctors] have to do is to
we can refer understand why this person,
patients to who has been stabbed, in front
the right of me – what brought them to
services’ that point in their life and how
can I make a difference?’ says
Mr Misra.
‘I’m a lifelong Liverpool fan
so when I go in to see a patient I
initially talk about football. That
breaks the ice and allows them
to see me in a different light,
and for us to communicate at
‘This a different level, as someone
approach they can talk to as a person, not
has made just a doctor.’
me totally The KnifeSavers training
rethink my team, as well as the senior
way of how leadership team of Kristian
I deliver Tattam and Nicole Russell,
healthcare’ are all volunteers who run
the campaign and deliver the
training in their spare time.
The number of clinical
volunteers has grown from
a group of four to almost 80
people currently, and the
campaign is being started in
a number of other locations
around the country.
thedoctor | October 2023 07
09/10/2023 11:20

‘I’m a natural campaigner’
Katie Bramall-Stainer, recently elected as chair of the BMA GPs
committee, takes on the leadership of a ‘bruised’ profession
with a strong determination to rebuild general practice.
Interview by Peter Blackburn
M
axims about the best
leaders being people
who don’t actively
seek out power are abundant.
It is in this tradition that
Katie Bramall-Stainer finds
herself chair of the BMA GPs
committee – giving up a job
role she loved and taking
responsibility for leading the
profession during arguably
the most challenging period
in the history of the NHS.
It is a change which
comes not out of a desire for
decision-making and being
in charge, but because of
an empathy for colleagues
and patients and, frankly, an
overwhelming number of
appeals for her to ‘step up’
08 thedoctor | October 2023
20230665 thedoctor – p8-9.indd 1
from friends and supporters.
Dr Bramall-Stainer was
local medical committees
UK conference chair and
thriving in the role – not
least in securing a passionate
keynote defence of general
practice from Brass Eye
creator Chris Morris at the
2023 conference – until
taking on the leadership of
GPC in August. The speech,
in which Mr Morris quipped
that 100 per cent of patients
would rather see their GP
than (then health secretary)
Thérèse Coffey, went viral,
with more than 350,000
views on YouTube.
‘It’s a bit of a surprise – not
least to myself. If you had told
BRAMALL- STAINER:
‘I’m probably in my
happy place carrying a
placard and shouting’
SARAH TURTON
me six months ago I would
probably have laughed. I
was asked by a considerable
number of people to take on
this role just under a couple
of years ago but I had only
just become chair of the UK
conference so I felt it would
be wholly inappropriate.
Conference, if I’m truly
honest, is where my heart
lies, and it’s been difficult to
walk away from that role. It’s
a tremendous privilege.’
‘Rock bottom’
Dr Bramall-Stainer’s
analysis, however, is that the
profession and the NHS are
at ‘rock bottom’. And she may
be as well placed as anyone
09/10/2023 07:28
 to try to enact change.
Detractors of general practice
have grown in number and
voice in recent months
and years despite all the
remarkable achievements
during the pandemic and
relentless increases in
demand. The country, she
says, cannot afford to lose
expert generalists in the
gatekeeper role – a ‘unique
feature recommended and
replicated worldwide’.
SARAH TURTON
GP practices across the
country are experiencing
significant and growing strain
with declining GP numbers,
rising demand, and difficulties
recruiting and retaining staff
all having knock-on effects on
the wellbeing and morale of
the workforce and access and
care for patients.
These are pressures
Dr Bramall-Stainer has felt
keenly – and, as a result,
GPs are likely to feel they
have an ally in their new
representative. In 2010,
Dr Bramall-Stainer – a
notably charismatic, and
convincing, public speaker –
was diagnosed with MS which
became so overwhelming
she couldn’t even speak in
consultations. Dr Bramall-
Stainer attributes regular
partnership days of 12 or 14
hours and sometimes more
with creating the ‘perfect
storm’ of conditions for the
aggressive early phases of
her chronic illness. Different
roles as a salaried GP, as well
as a variety of leadership
positions, have helped but
Dr Bramall-Stainer will always
look to protect and advocate
for a workforce too often
pushed to burnout and
illness.
‘We feel very bruised as
a profession – particularly
bma.org.uk/thedoctor
20230665 thedoctor – p8-9.indd 2
through the pandemic when
we were instructed to change
everything overnight and we
did that.
‘We need to think really
carefully about protecting
and sustaining general
practitioners at the heart of
primary care and the NHS and
I’m going to be unashamedly
protectionist about our
workforce in that way.’
In Dr Bramall-Stainer,
GPs have a representative
unafraid to speak truth to
power – even when doing so
might become painful and
problematic personally.
In 2019 Dr Bramall-Stainer
and then GPC colleague Zoe
Norris called out sexism and
sexual harassment within the
BMA and committee, leading
to an independent inquiry, and
subsequent report, by Daphne
Romney KC and a following
programme of cultural reform
within the association.
‘It was difficult,’ Dr Bramall-
Stainer says, reflecting on
the decision to speak out
and the fall-out following
the revelations. ‘But a lot has
changed since then. It was
painful but it was important
for the BMA. We’ve changed
and our demographic is quite
different – but we still have
a long way to go.’
Key proposals
Among Dr Bramall-Stainer’s
immediate ideas and
priorities – a catalogue
of potential solutions to
crises are being drawn up
constantly – are a sharp focus
on the retaining of newly
qualified GPs, continuity of
care as a core principle, and
a removal of overburdening
bureaucracy and regulation.
There are detailed
proposals and projects too.
Dr Bramall-Stainer gives
examples such as the planned
introduction of easy patient
access to medical records.
Her team – which includes
newly elected deputies David
Wrigley, Samira Anane and
Julius Parker – will call for a
suspension on publicity for
patient access to medical
records to give doctors and
‘We feel very other staff time to adjust and
bruised as a urge action to redact parts
profession’ of files which may put people
in abusive relationships
at greater risk, such as
information about abortions
and contraception. Many
other areas of work continue.
Dr Bramall-Stainer is
keen to build on positive
early relations with good-
natured negotiations – ‘the
department is listening to us’
at the moment, she says –
aimed at rebuilding general
practice and protecting the
workforce. But she does not
shy away from action should
that relationship become
unhealthy once again.
‘I think we want the same
things. And I think that’s a
really good place to start. But
‘We need to no one is under any illusion.
think really If conversations become
carefully increasingly difficult, if we
about find ourselves with a record
protecting third contract imposition –
and a historic position – we then
sustaining ourselves would have to
general consider unique, historic
practitioners’ consequences.’
She adds: ‘There’s a lot of
frustration out there. And
goodness knows I share that.
I’m a natural campaigner,
I’m probably in my happy
place carrying a placard
and shouting… I’m not
discounting action. In fact,
I think action might well be
necessary. And I am prepared
to take it.’
thedoctor | October 2023 09
09/10/2023 07:28
SARAH TURTON

SOLIDARITY:
Doctors protest
in Manchester
earlier this
month

‘WE SHALL FIGHT ON’

Consultants and junior doctors came together to show
their commitment to pay restoration and to urge the
Government to resume talks. Ben Ireland reports

D
octors have sent the strongest warning yet to
the Government that they intend to continue
striking up to the next general election as the
fight for fair pay intensifies.
Thousands of doctors gathered in Manchester as
the Conservative Party conference took place in the
city this month, with consultants and junior doctors
travelling from all corners of England on buses
provided by the BMA.
Health secretary Steve Barclay made no mention of
plans to resolve the strikes in his speech to his party’s
conference on the same day and has not met with
either consultants or junior doctors for months.
BMA consultants committee chair Vish Sharma
wrote to prime minister Rishi Sunak to say no new
strike dates would be announced for four weeks from
the latest three-day joint action, which took place
from 2 to 5 October, because the Government has
refused talks as long as strike dates have been called.
Dr Sharma also urged the involvement of arbitration
service ACAS.
‘Scapegoats’
Doctors remain defiant despite the Government
digging in on its ‘final’ pay offer of a 6 per cent uplift for
consultants, and 6 per cent plus a lump sum of £1,250
for junior doctors in England.
And as the action being taken by junior doctors and
consultants progresses, specialist, associate specialist
and specialty doctors and colleagues in Wales and

10 thedoctor | October 2023

20230665 thedoctor – p10-13.indd 1 09/10/2023 11:24

 Northern Ireland are taking steps towards their own ‘The Government is fighting for its survival, and we
industrial action. have the public on our side,’ he said.
Speaking at the lively Manchester rally, BMA council Results of a September survey of 1,765 adults in
chair Phil Banfield said: ‘We will strike until the next England confirm that 42 per cent of the public blame
general election and beyond if that is what it takes. the Government for record waiting lists, while only
‘But our patients need 15 per cent blame striking
the PM to meet with us now; doctors.
restore the value of pay, now; ‘For our future, Mr Barclay used his
make a credible offer, now; conference speech to lay
end these disputes, now.’ for our patients, out plans to update the NHS
He said the dispute was: constitution, to ban trans
‘For our future, for our
patients, and the future and
and the future patients from being seen
in female-only or male-
health of the people of this
country.’
and health of only wards – and announce
funding for technology.
Junior doctors have been the people’
striking since March, and ‘Cruel’ approach
consultants since July. Prof Prof Banfield said Mr Barclay’s
Banfield praised BMA members for being ‘unflinching speech was ‘a distraction from serious NHS problems’,
in the face of a Government scandalously trying to adding: ‘Mr Barclay claims to be focused on outcomes
scapegoat doctors for 13 years of their failures’. all while refusing to speak with those who deliver care.’
Vivek Trivedi, co-chair of the BMA junior doctors BMA consultants committee deputy chair Mike
committee, reflected this sentiment in his speech, Henley told the rally: ‘The Government may tell itself
reiterating that – until a credible offer is made – doctors that avoiding compromise shows strength. But it is
‘are not going anywhere’ because ‘we deserve fair pay’. clear to the eight million voters awaiting care that this

thedoctor | October 2023 11

20230665 thedoctor – p10-13.indd 2 09/10/2023 11:24

 BANFIELD:
Prepared to
take action until
general election

ON THEIR WAY:
Doctors on board
a bus heading for
Manchester

is no more than cruelty and abandonment.’ NHS in increasing numbers.

Doctors descended on Manchester from all over As many consultants do, she also sees the strike
England to attend the rally. as a battle for the future of the NHS as a free-at-the-
The Doctor joined a group on a coach departing point-of-care service.
BMA House in London. Leeds foundation year 4 ‘It won’t be sustainable with continual under-
Rachel Southern-Thomas criticised the Government’s funding and staff who aren’t remunerated properly,’
‘convenient amnesia’, contrasting its attitude towards said Dr Freedman.
striking doctors now and healthcare professionals Gloucestershire psychiatry trainee Amir Palermo
at the peak of the pandemic – adding that workload feared the UK’s healthcare system could fall into a
pressures have not eased. ‘two-tier service’ comparable with that in his home
London foundation year country Malaysia if the pay
2 Robert Gittings agreed, issue was not resolved.
saying: ‘It’s as if we’ve gone Having consultants join
from heroes to enemies
of the state. It’s really
‘This is industrial action in recent
weeks has created a greater
hypocritical.’ not a minority sense of ‘camaraderie’, he
London consultant added.
anaesthetist Rachel
Freedman said the sheer
of doctors’ ‘We’d rather work’
number of doctors travelling That camaraderie was
to Manchester showed how also clear from picket
serious the profession was lines in London during the
about securing the NHS’s future. September strikes, the first joint consultant and junior
‘This is not a minority of doctors, as government doctor strikes in NHS history.
spin might suggest,’ she said. ‘We are a large group of Emergency medicine consultant Simon Walsh, BMA
cohesive doctors who have said enough is enough.’ consultants committee deputy chair, was picketing
outside the Royal London.
DDRB reform call He said: ‘We’d all rather be at work. If the
Dr Freedman reiterated the importance of reform of the Government hadn’t entrenched themselves in a
Review Body on Doctors’ and Dentists’ Remuneration , ludicrous position where they won’t talk to us, perhaps
which a Conservative back-bencher has said is ‘basically we wouldn’t be here.’
rigged’. She insisted it must be fully independent to Margarita Kousteni, a specialty trainee 2 in
help restore trust among doctors who are leaving the psychiatry at Maudsley Hospital in London, said it was

12 thedoctor | October 2023

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 TRIVEDI:
‘We deserve
fair pay’

SHARMA:
Negotiate with us
and end dispute

reassuring to picket alongside consultants.
‘It’s encouraging that doctors who have gone
through what we’ve gone through and reached the
grades we’re aspiring to, are supporting us,’ she said.
‘They know the hardship we go through and have
seen better days in the NHS so can recognise how
things are getting worse.’
More ballots
SAS doctors in England have opened an indicative ballot,
which runs until 16 October.
Committee chair Ujjwala
Mohite said: ‘All we want to do ‘Doctors end
is care for our patients, but
that’s put at risk when doctors up wondering
feel undervalued and end up
wondering whether they even whether they
want to stay in the NHS.’
Consultants in Northern want to stay
Ireland are to ballot for
industrial action, after the
Department of Health – which
in the NHS’
has essentially been left to run
the health service since the collapse of devolution in
February 2022 – said it would not offer any pay uplift
for doctors, despite DDRB recommendations.
Of consultants polled in Northern Ireland, 77 per
cent said they were willing to take industrial action.
Junior doctors in Northern Ireland are also
preparing to ballot. Respondents to a recent survey
reported how workload pressures meant they are
unable to continue with training, and that low pay
meant they are now more likely to leave.
In Wales, junior doctors are to be balloted for
industrial action from 6 November to 18 December.
Consultants and SAS doctors in Wales will also be
balloted. All groups of doctors were offered a pay uplift
of 5 per cent, not just below inflation but below that
offered to colleagues in England.
It is only in Scotland where there has been any
resolution. Junior doctors in Scotland accepted a
17.5 per cent pay uplift over two years, which included
a ‘key’ commitment from the Scottish Government
to work towards full pay
restoration in the future.
BMA Scotland, however,
continues to warn that the
devolved Government must
take ‘real action’ to stem low
morale among consultants
who were handed the same 6
per cent offer as in England,
and have not ruled out
balloting for industrial action.
With various different
groups of doctors coming
together in a collective fight for fair pay, there is a
sense that doctors are growing in confidence that they
are on the right side of the dispute and will find a way
through.
The message from the BMA, as speakers at the
Manchester rally reiterated, is: ‘Stick together, strike
together, win together.’
To donate to the BMA strike fund, go to
bmastrikefund.raisely.com and see the feature on
pages 20-21.

bma.org.uk/thedoctor thedoctor | October 2023 13

20230665 thedoctor – p10-13.indd 4 09/10/2023 11:24

 Pressures on doctors
and other NHS staff have
never been greater, and
yet occupational health
services can be ‘patchy’, and
specialist care hard to access.
Tim Tonkin hears the urgent
need for a comprehensive
and high-quality service

I
TAKING
t is not without a certain degree of irony that,
while doctors dedicate much of their lives to
providing care to their patients, this devotion
often comes with the cost of neglecting their
own health.

THE STRAIN
Making sure doctors’ health needs and
wellbeing in the workplace are being met is of
critical importance, not just for the clinicians
affected by ill health but also for helping to
minimise staff absences and to ensure safe and
effective care is delivered to patients.
In this respect, occupational health units
can play an indispensable role, one that since
COVID has become more visible and increasingly
sought after.
While traditionally viewed by health
professionals as merely a one-stop-shop
for routine health clearances and booster
vaccinations when starting in a new workplace,
occupational health departments are charged
with a range of roles concerning staff health.
These responsibilities include undertaking
health assessments and providing rehabilitation
to staff returning to work following illness or injury
or advising employers about suitable alternative
positions for staff temporarily or permanently
unable to perform their existing roles.
Occupational health also assists in the
development of workplace policies and
practices designed to promote and safeguard
the physical and mental wellbeing of the staff
working there and can serve as a conduit
sign-posting those with health issues to more
specialised forms of support.
A recent example of this collaborative
approach is the SMHS (Staff Mental Health
Service) at Cambridgeshire and Peterborough
NHS Foundation Trust.

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 Launched in September 2020, the service
provides rapid access to psychological
assessments and treatment and is available
to 25,000 clinical and non-clinical staff based
across five trusts.
Reasonable adjustments
Consultant psychiatrist Muzaffer Kaser is part
of the service’s multidisciplinary team, which
includes psychiatrists, psychologists, mental
health nurses and an occupational health nurse.
He says that, while referrals come from
a number of sources, including general
practice, more than 85 per cent of those he
and his colleagues see come from the trust’s
occupational health service.
He says a particular innovative aspect of
the scheme is having occupational health
embedded and part of the conversation when it
comes to determining reasonable adjustments
and supporting staff engaged with the service
in remaining or returning to work.
‘Universally healthcare workers have higher
mental health needs than the general population;
[at the same time] the healthcare they get is
usually quite patchy and there are many barriers
towards them accessing help,’ he says.
‘In the current provision in the NHS, there
are lots of people who fall into the cracks of
the mental health system [and] what we have
seen in the last couple of years is healthcare
workers tend to fall into those gaps quite
easily and then experiencing delays in their
assessments and treatments.’
The success of programmes such as the
SMHS is a good practice example of what
can be achieved for health service staff
when occupational health services are
effectively utilised.
The wider picture concerning the state of
occupational health in the NHS, however, is a
complex one with highly variable standards of
and access to care between secondary and
primary care, and with specialist staff qualified in
occupational health in short supply.
A review of occupational health in the NHS
conducted by Steven Boorman in early 2021
concluded that an increasingly restrictive
financial climate over the previous decade had
seen occupational health taking a more reactive
approach to staff wellbeing resulting in it being
perceived as a ‘breakdown service’.
Dr Boorman’s report, Growing a Healthier
Tomorrow, further highlights the diminishing
bma.org.uk/thedoctor
20230665 thedoctor – p14-15.indd 2
numbers of specialist staff employed in the
NHS with just 98 occupational health physicians
working in the NHS in England in 2021
compared with 172 in 2009.
BMA occupational medicine committee
co-chair Kathryn McKinnon, who is a consultant
in occupational medicine and education,
acknowledges these limitations and the need to
remedy them.
Accessing services
With levels of burnout among NHS staff higher
now than perhaps they have ever been, Dr
McKinnon says that, while universal access to
well-staffed occupational health has never been
more important, huge structural deficiencies KASER:
need to be addressed if these services are to Healthcare
workers can
reach their full potential. face barriers in
‘While there is [universal] access in secondary accessing help
care, the access isn’t always what we would like
it to be,’ she says.
‘There isn’t always a doctor present on
the team, although they may have access
to a doctor. And that doctor may not be an
accredited specialist.’
Occupational health service provision
within general practice is an even more ‘Healthcare
complex situation, in large part because workers have
GPs are their own employer making the higher mental
commissioning of services unclear. health needs
This year’s BMA annual representative than the general
meeting saw doctors successfully endorse a population’
motion calling for a primary care-wide policy
on occupational health to assist GP practices in
managing long-term sickness and return to work
provision for their staff, while Dr McKinnon’s
committee is engaged in work towards creating
a national occupational health service for all
primary care workers.
Dr McKinnon says that, while engaging with
occupational health often results in highly
detailed information being gathered on an ‘There are lots of
individual, much of this data is for the purpose of people who fall
assisting the occupational health team to make into the cracks
appropriate recommendations, and not to be of the mental
passed wholesale to an employer. health system’
‘I always explain to people that we
[occupational health] are like Switzerland,’
she says.
‘We’re neutral and we try and make
both parties better informed about
the medical circumstances and make
recommendations that we think will be
beneficial from a medical perspective.’
thedoctor | October 2023 15
09/10/2023 07:30

LIFE-AFFIRMING:
Here, and on
following pages,
some of the
opportunities for
children at Chestnut
Tree House
A PRECIOUS TIME
A
t Chestnut Tree House,
short lives are lived to
the full. The team does
its utmost to make memories
and grant wishes, whether it’s
zip wiring in a wheelchair or
being dunked in spaghetti.
This children’s hospice
is a life-affirming, colourful
place with beautiful grounds,
wonderful amenities and
the gracious air of a Sussex
country home.
The nurse-led team here
can provide the very best of
care on site to a child with a
life-limiting or life-threatening
condition and their family.
However, they struggle
16 thedoctor | October 2023
20230665 thedoctor – p16-19.indd 1
to offer the same high-
quality care to other families,
especially those whose
children want to die at home.
Because Sussex, like many
areas in the UK, does not have
its own specialist paediatric
palliative care team.
Consequently, many
children needing palliative care
have little choice in where they
die – and deaths can be more
distressing than necessary for
their loved ones.
Families are struggling
to navigate a complex care
system alone and often
come late to palliative care
when their children are
CHESTNUT TREE HOUSE
Immense kindness
and an inspiring
attitude to life are
abundant features of
paediatric palliative
care. So too, sadly,
is a chronic lack
of investment
and specialists.
Seren Boyd
reports
nearing the end of life.
Anna Jones, director of
children’s services at Chestnut
Tree House, is tireless in her
advocacy, fundraising and
‘We think passion. But she is tired of
about the ‘living in the gap’ between
whole child what she and her team want to
and the provide, especially in end-of-
impact a life care at home, and what
treatment they can offer in practice.
might have ‘I have the most wonderful
on them’ team here but there’s only
so much you can achieve as a
nurse-led unit,’ says Anna.
‘It’s distressing when
you can’t give the specialist
medical provision that
children and young people
09/10/2023 07:31
CHESTNUT TREE HOUSE
deserve and need.’
What makes things harder
is knowing the care children
receive depends on their
postcodes. Nationally, the
picture is patchy and wholly
unfair.
ICBs (integrated care
boards) have been required
to commission appropriate
palliative care for people in
their area since the Health and
Care Act 2022.
Yet, because of chronic
underfunding for paediatric
palliative care, there are not
enough specialists, training
places or commissioned
services (see box, ‘Challenges
faced’), let alone community
children’s nurses who do
the lion’s share of children’s
palliative care.
Only a fifth of ICBs in the UK
are meeting National Institute
for Health and Care Excellence
guidelines in children’s
palliative care. Chestnut
Tree House’s ICB does not
commission paediatric
palliative care.
Compounding this injustice
is the fact that a child’s
condition often determines
whether they receive timely
palliative care.
Oncology is relatively
well funded: every child with
cancer comes under the care
of a central treatment centre
and its palliative care team.
But children with neuro-
disabilities, for example, rarely
receive support from specialist
palliative care teams at regional
centres. Their deaths are hard
to predict; they may come
close to death many times
before dying.
And what of the 15 per
cent of Chestnut Tree House’s
patient group with life-limiting
conditions that have no
diagnosis? ‘How do you put a
20230665 thedoctor – p16-19.indd 2
trajectory on that?’ asks Anna.
Meanwhile, demand is rising
for palliative care, which is
about supporting children and
families to live well, managing
symptoms as much as end-
of-life care. Medical advances
mean children with life-limiting
or life-threatening conditions
are living longer: in England,
their number has more than
doubled since 2001 to about
86,600.
Holistic care
Hannah Linford – ‘Dr Hannah’
as her patients know her – was
a general paediatric consultant.
Now, she works in a specialist
paediatric palliative care team,
one of very few in the UK. The
SPACE team is a partnership
between Shooting Star
Children’s Hospice in Guildford
and the Royal Marsden NHS
Foundation Trust.
The team Dr Linford
works with at Shooting Star
comprises a consultant in
paediatric palliative medicine,
other doctors, a nurse
consultant and specialist
nurses, supported by other
services. Dr Linford also works
within a separate team of
specialists based at the Trust,
focusing on palliative care and
symptom management in
children with cancer.
SEREN BOYD
HELP AT HAND: So, she’s well placed to
Anna Jones (left)assess the difference that such
and Hannah
Linford a team could make to Sussex.
She’s visiting Chestnut Tree
House today to help Anna
‘scope a model’ to propose to
the ICB.
It was the death of two
terminally ill babies in her
‘Even the care when she was a general
briefest tour paediatrician that prompted
confirms her career shift. ‘I didn’t have
Anna’s enough knowledge and
mantra: it’s all experience to be able to make
about living’ it better for the families,’ she
says.
Far from withdrawing care,
palliative care is all about
creating a protective support
structure. The families whom
the SPACE team supports can
have 24/7 access to specialist
advice, whether they need
‘We start a hospice stay for symptom
from: how management or a medical
can we handover for paramedics.
make this as Palliative care’s priorities are
good as we different: even the briefest tour
can for as of Chestnut Tree House, from
long as we its gaming hub to its dressing-
can?’ up costumes, confirms Anna’s
mantra, ‘it’s all about living’.
‘We start from: how can we
make this as good as we can for
as long as we can?’ says
Dr Linford.
‘Some of our children are
managed by lots of different
teams and tertiary hospitals.
thedoctor | October 2023 17
09/10/2023 07:31
 Specialists can tend to think
in silos; we think about the
whole child and the impact
a treatment might have on
them. We want to work out
what symptoms are adversely
affecting the child and their
family the most, and manage
them so that they can enjoy
the lives that they have.’
Giving the family choices
and working in partnership
with them is paramount. So too
is preparing families practically
and emotionally for different
scenarios through what’s
called parallel planning.
‘Whatever course the child’s
illness takes, we’re ready so the
child doesn’t have to suffer,’
says Dr Linford. ‘When they fall,
we’ve got them.’
The team works closely
with other professionals to
ensure the family’s wishes
are respected and to spare
them the agony of having to
explain everything repeatedly.
This might involve sending a
directive to the ambulance
service about a child’s
resuscitation plan – or a
specialist nurse to accompany
the family to appointments as
an advocate.
Ultimately, it’s about
ensuring that death, when
it comes, is as smooth and
calm as possible.
CHESTNUT TREE HOUSE
18 thedoctor | October 2023
20230665 thedoctor – p16-19.indd 3
‘If we’re expecting a child
to die at home, we make
sure they’re seen by a GP
regularly to avoid it being an
“unexpected death” so there’s
no need for a post-mortem, the
police don’t have to be called. If
we can help minimise a family’s
trauma on the worst day of
their lives, that’s a privilege.’
Stuck in the system
Without the equivalent of a
SPACE team who can join up
the dots for them, families
are left to find their own way
through the acute sector,
especially those whose child
has a non-oncology condition.
One parent told Anna,
‘It’s not my son’s condition
that upsets me most, it’s
navigating the system.’ The
boy was known to 27 different
agencies.
It means families referred
to Chestnut Tree House often
arrive without the benefit of
parallel planning. Many have
stayed in the care of acute
general paediatricians for too
long because of the lack of
this specialist support, Anna
believes.
‘How do families say,
“Stop”? If they’re having
ventilation for their child’s
breathing, why would they
say no to TPN (total parenteral
CHESTNUT TREE HOUSE
nutrition)? These families are
on a hamster wheel. It takes a
skilled professional to discuss
ceilings of treatment.’
And sometimes there are
delays in children accessing
‘Whatever hospice care because of
course the misconceptions – held by
child’s parents and professionals
illness takes, – that hospices are ‘just for
we’re ready dying’.
so the ‘Parents so often say,
child doesn’t “We wish we’d known. This is
have to nothing like what we thought”.
suffer’ It takes the right people to be
having those conversations
with parents, because some
would hear the word “hospice”
and think, “You’re telling me
my child’s going to die?”’
Most heart-breaking of all
for Anna are the families left
to navigate a child’s death at
home alone – often teenagers
who want to be ‘around all
their stuff’. If the family calls an
ambulance, and the crew don’t
have the benefit of a hospice’s
support, the paramedics
may not know if the death is
‘expected’ or not.
‘You need people who know
what they’re doing, otherwise
that parent’s memory is: It
09/10/2023 07:31
 was chaos. The professionals
CHESTNUT TREE HOUSE
looked terrified.’
The mother of a child who
died in hospital told Chestnut
Tree House: ‘The hardest
thing was having to leave
him in the mortuary. I was so
scared of him being alone in
the dark.’ Baby Rupert was
later transferred to Chestnut’s
bereavement suite – where the
lights were left on.
Brave conversations
If families had 24/7 support
at home such as SPACE
offers, hospital admissions
and hospital stays would be
reduced, Dr Linford and Anna
believe.
‘Acute paediatric wards can
house children with complex
needs during an episode of
illness often for weeks and
weeks,’ says Dr Linford. ‘It’s very
challenging for the ward teams:
they can feel like they aren’t
doing very much medically
but the child is not yet safe to
discharge.
‘If there’s a team that
can help navigate that
time-consuming patient-
management journey and
help arrange stepdown care,
it’s massively beneficial for the
paediatric team, and the child –
and it saves resource.’
It all starts with a referral
to the palliative care team –
which means initiating difficult
conversations. Dr Linford
understands why these can be
hard for her colleagues.
‘There can be a reluctance
with acute paediatricians to
have these conversations
because they worry, “Have
I missed something? Would
someone else know the
diagnosis and I don’t?”
‘You’ve built a relationship
with this family and then you
feel like you’re taking away
bma.org.uk/thedoctor
20230665 thedoctor – p16-19.indd 4
their hope and letting them
CHESTNUT TREE HOUSE
down. As a child’s paediatrician,
making that shift is really
challenging: I haven’t had to
go on that journey with them,
so it’s more straightforward
for me. I can offer support
to my colleagues and be a
friend in the room for those
conversations.’
What makes Anna and Dr
Linford’s work so rewarding,
despite the sadnesses, is
helping a child have a ‘good
death’.
The sooner those brave
conversations begin, the earlier
families access proper support,
the greater the chances that a
death will be ‘good’.
These discussions have to
be euphemism-free. Talking
about a child ‘going to sleep’
can leave young siblings
waiting for the child to wake up
again or afraid of going to bed,
says Dr Linford.
‘If no one’s said to you, “Your
child is dying,” you won’t hear it
as a parent.
‘No parent ever wants
to be the person who calls Challenges faced
time but there will come a
point when the child doesn’t – Together for Short Lives estimates
need a transfusion or to have a £300m gap in NHS funding for
their bloods taken because children’s palliative care to meet
the benefit isn’t worth the NICE standards in the UK
distress.
‘If you’ve signposted these – NHS England said it would end the
things in advance, the parents £25m Children’s Hospice Grant
feel able to say, “I think it’s this year – but recently renewed
time.” And you can affirm them: it for 2024/25
“You’re doing the right thing.
This is what we spoke about.”
– Chestnut Tree House receives
‘And when what should 17 per cent of its £5.5m
have been a really sad day ends annual care costs from
with the child being with their government funding. The rest
family, with their dogs, in their comes from donations and
front room, where everything fundraising
is sorted and smooth, it can be
– England has only 18 specialist
beautiful.’
Or as Anna puts it, ‘when children’s palliative care
a child dies, you have one consultants.
chance to get it right’.
thedoctor | October 2023 19
09/10/2023 07:31
 RUNSWICK:
‘If we all take
part, we can all
win together’

MARK HARVEY

DOLPHIN:
Donations
strengthen
strike action

Supporting each other

Thousands of doctors put under financial strain by taking part in industrial
action have already benefited from the BMA strike fund. Ben Ireland speaks
to recipients and donors

D
octors are taking industrial action because they been junior doctors, but dozens of consultants under
are not paid what they deserve. And every time financial pressure have also been supported.
they strike, they lose out on pay for that shift. For By helping doctors meet obligatory payments, such
doctors who face mandatory professional costs, and as their rent or utility bills, the strike fund has taken the
often have to make costly repayments on eye-watering pressure away from many who may have otherwise had
student loans and fund their own to consider crossing picket lines
specialty training exams, this adds to despite agreeing with the reasons for
their existing financial burdens. ‘Without the industrial action.
The theory is short-term pain for GP trainee Iain Bolton moved to
long-term gain. But with the
strike fund it would less than full-time hours before the
Government having imposed make me think industrial action ballot.
another real-terms pay cut this year whether or not I can ‘I felt like I was getting quite close
and saying that is final, the dispute to burnout,’ he says of switching to
appears to be at something of a
afford to strike’ 60 per cent of a 46-hour full-time
stalemate. week (including on-calls).
Amid a cost-of-living crisis, with
some doctors facing outgoings such as childcare fees Robust support
and rising rent or mortgage repayments, continuing to Dr Bolton backs industrial action but, already on a
strike for your future could be hampered without a reduced wage, says he would struggle to cover essential
safety net. bills with strike deductions. He has spent the money he
In March, the BMA launched its first ever strike fund. has received, which is less than the value of his
Six months, 22 junior doctor strike days and six deductions, on essentials such as his weekly shop.
consultant strike days later, it has now supported more ‘Without the strike fund it would make me think
than 3,000 people. The vast majority of recipients have whether or not I can afford to strike,’ he says. ‘It will

20 thedoctor | October 2023

20230665 thedoctor – p20-21.indd 1 09/10/2023 11:25

 definitely be helping quite a lot of doctors.’ makes it more likely that we will win overall.
Newcastle-based specialty trainee 1 Dr Bolton has ‘I don’t expect everybody who has covered night shifts
mandatory GMC fees and medical indemnity costs to pay, to give their income to the strike fund, because it’s hard
as well as student-loan repayments and car-parking fees work and money well earned, but I want to set an
at his workplace. He also has his AKT (Applied Knowledge example. If everyone donated the income from just the
Test), which costs £470 and is essential to career first hour of their strike cover shift, that would be a huge
progression, on the horizon. boost to the strike fund.
The strike fund is evidence ‘the BMA is looking out for ‘The Government thinks it can wait us out and pick off
you’, adds Dr Bolton. ‘It’s looking after its members’ the least well-off doctors who have less discretionary
interests in quite a robust way.’ income to draw on to weather that deduction they face
He says: ‘The strike fund will definitely have on strike days. The strike fund is a way of preventing the
contributed to more people striking, and more people Government from undermining our action.
being able to get involved in picketing, showing support ‘We want to be able to make the strike fund as strong
and doing what they need to do to look after themselves.’ as possible so the union is as strong as possible and we
Sherie George, a foundation year 2 in West Yorkshire, can win as much as we can for our members.’
was recently married, which depleted her and her Emma Runswick, deputy chair of BMA council, has – for
husband’s savings. They also send money to support the second year in a row – arranged for the amount she is
family members in Singapore. entitled to from her honorarium for union duties that is
Dr George says she would have had to work on strike above what she would have been paid as a full-time junior
days had the fund not been available. doctor to go to the strike fund. This is
And she believes support is more approximately £22,000.
important now than at the start of
‘The word “solidarity” She says: ‘As we take more strike
action, as financial pressures grow. is not just a word. action, more people find it difficult
‘More people are feeling the hit,’ It’s a common financially. So having a strike fund is
adds Dr George. ‘People who are important. If we all take part, we can
scheduled to work all of the strike
understanding that win together. If we help each other
days in one month are facing huge we will back each maintain our action, the action will
deductions. It’s very difficult. At first I other up’ help us all.’ Recalling the 2016 junior
was very nervous [about going on doctor strikes, when there was no
strike] as an IMG (international strike fund, Dr Runswick says some
medical graduate) but I’ve had a lot of encouragement members began to feel under financial strain when the
from colleagues and advice from the BMA. It’s made me strikes progressed. ‘It’s vital to be telling members that we
more confident to strike. For IMGs particularly, it gives know this is hard, and we are going to help,’ she tells The
you reassurance.’ Doctor. ‘By sharing among ourselves, people feel backed
While payments have been made to doctors who need up and feel able to take action now and in the future.
financial support to keep striking, the fund – as it stands ‘The word “solidarity” is not just a word. It’s a common
– relies on generous contributions. understanding that we will back each other up when we
Many of these have come from senior doctors and need it.’ Dr Runswick reiterated that the BMA is pushing
consultants, and from junior doctors based overseas who for a resolution to the dispute with the Government but
support the pay restoration cause. There have also been accepts industrial action could still continue for many
large contributions from organisations such as the months. ‘Whether this dispute runs for two weeks
Hospital Medical Staffs Defence Trust. further, or months and years further, we are trying to put
ourselves in a position where members will continue to
Stronger together be able to take the action required,’ she says.
Tom Dolphin, a consultant anaesthetist and BMA council Going forward, the BMA hopes to raise funds for the
member, has made regular donations to the strike fund, strike fund through regular contributions taken from
including voluntarily donating his honoraria payments member subscriptions. Proposals are being worked on.
from BMA meetings as well as the pay he has received, The money banked would be able to support doctors
after tax, for night shifts he has taken on to cover junior in the future, be it a major national dispute such as the
doctors while they are on strike. For a 12-and-a-half-hour continuing pay restoration campaign or localised issues.
shift, that equates to about £1,880. One-off donations to the strike fund can be made via its
He says: ‘It’s important to remember this isn’t an act of dedicated website bmastrikefund.raisely.com and
charity. Donating to the strike fund strengthens the doctors can submit a pre-approval claim online at
action we are taking, helps more doctors participate and surveymonkey.co.uk/r/Strike_Fund_pre-application

bma.org.uk/thedoctor thedoctor | October 2023 21

20230665 thedoctor – p20-21.indd 2 09/10/2023 11:25

 Time off work was vitally important
on the ground
John Lennon said: ‘Life is what happens while you
are busy making other plans.’
This is rarely more apposite than when it comes
to caring responsibilities. However hard we try to
plan for them, there is always a hefty element of
unpredictability.
A consultant had been granted six months’
unpaid leave by her NHS employer to help her
parents relocate, to reinstate support workers, to
clear their house, and to ensure their healthcare
needs continued to be met. All while being a single
parent herself.
The six months were vital, but she needed
longer. She had an off-the-record conversation
with her departmental lead but was told it would
not be possible because of service needs and
locum cover coming to an end.
The consultant could understand the situation
from her managers’ point of view, but they needed
Highlighting to understand it from hers.
practical help So, she involved the BMA and, with an
given to BMA employment adviser, attended a meeting with
members in her clinical lead and a senior HR representative.
difficulty In the member’s words, the adviser’s ‘empathy,
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22 thedoctor | October 2023
20230665 thedoctor – p22-23.indd 1
confidence, knowledge base and sheer
diplomacy meant that I was able to de-escalate
a tense situation despite having brought the big
guns! Everyone in the room felt better for having
met him’.
The result was a six-month extension to her
career break, in which she not only settled her
parents but arranged a new school for her daughter
and supported her sister through a difficult
pregnancy. She also used the time to think about
her work-life balance. She then returned to a job
plan of approximately 85 per cent rather than
full time.
She reflects: ‘Workload is manageable,
colleagues are really supportive. I feel lucky to
have had the opportunity to get the break, to
stand back and reassess everything. It really
changed my life.’
This column is about the cases the BMA wins for
its members, but in this case it’s a win for everyone.
So many doctors are needlessly burnt out by the
impossible balancing act between their demanding
jobs and their wider commitments. In this case, the
doctor says: ‘I actually enjoy coming to work again.’
09/10/2023 11:25
 Your BMA
NHS England’s long-term plan
has not convinced doctors the
crisis in care will be tackled
Winter will soon be upon us, and with it a period during
which NHS staff will face increased pressure and demand
on services – that is on top of the distressed baseline
service they are already working in.
While seasonal illnesses do affect the health service,
chronic staffing shortages, underfunding and a lack of
resources have, in reality, made it increasingly difficult
to distinguish ‘winter pressures’ from those experienced
throughout the rest of the year.
Doctors and other healthcare professionals know,
however, that this winter is likely to be exceptionally
tough, for a number of reasons.
It hardly needs saying the NHS is still recovering
from COVID-19, a crisis which stretched and tested the
healthcare workforce to breaking point, and which greatly
exacerbated a backlog in unmet patient care.
Indeed, the number of patients waiting for consultant-
led elective care services rose from an already daunting
figure of 4.4m at the start of the pandemic, to 7.7m
recorded in July this year just in England alone.
Meanwhile the health service is desperately
contending with a workforce shortfall, estimated at
around 150,000 full-time equivalent staff.
Improving recruitment and retention rates of all staff
is clearly essential if we are to prevent this black hole in
staffing from expanding let alone improving.
NHS England’s Government-approved Long Term
Workforce Plan launched in June this year was meant
to allay fears and address the crisis, yet analysis by the
BMA has concluded the plan ‘is silent’ when it comes
to elaborating on how it will retain staff, by addressing
doctors’ and others’ demands regarding pay and
workplace terms and conditions.
@drlatifapatel
There was a clear consensus at this year’s BMA annual
representative meeting that the plan is not fit for purpose
and, as doctors, we cannot afford to be dependent on a
strategy we know is set to fail.
The failure to understand and adequately address the
needs of the NHS and its staff are in large part the catalyst
which has this year seen doctors and their consultant
colleagues take the difficult decision to engage in
independent and joint industrial action.
I know full well how painful the decision to strike has
been for our profession, with tens of thousands of you
having bravely sustained your action over many months
in the face of an obstinate Government and often
hostile national press. On top of this, specialist, associate
specialist and specialty doctors in England are conducting
an indicative ballot on strike action, which could
ultimately see them joining their doctor and consultant
colleagues on picket lines up and down the country.
Fortunately, the majority of our patients recognise our
cause and continue to support our struggle, knowing
the crisis in their NHS is not the result of doctors’ striking,
but the culmination of persistent underinvestment in
funding, resources and staffing for the NHS.
If you would like to learn more about how you
can get involved with your BMA, please write to me
at RBChair@bma.org.uk or @DrLatifaPatel
Dr Latifa Patel is chair of the BMA representative body
The full version of the column will
appear online at bma.org.uk/news

The Doctor Editor: Neil Hallows (020) 7383 6321

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BMA House, Tavistock Square, London, WC1H 9JP. Tel: (020) 7387 4499 Chief sub-editor: Chris Patterson
Email thedoctor@bma.org.uk Senior staff writer: Peter Blackburn
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@TheDrMagazine Staff writers: Tim Tonkin (020) 7383 6753
@theBMA and Ben Ireland (020) 7383 6066
Scotland correspondent: Jennifer Trueland
The Doctor is published by the British Medical Association. The views expressed in it are not
necessarily those of the BMA. It is available on subscription at £170 (UK) or £235 (non-UK) Feature writer: Seren Boyd
a year from the subscriptions department. All rights reserved. Except as permitted under Senior production editor: Lisa Bott-Hansson
current legislation, no part of this work may be photocopied, stored in a retrieval system or
transmitted in any form or by any means, electronic, mechanical or otherwise without the Design: BMA creative services
written permission of the editor. Printed by William Gibbons. A copy may be obtained from Cover: Sarah Turton
the publishers on written request.
Read more from The Doctor online at
The Doctor is a supplement of The BMJ. Vol: 383 issue no: 8402 ISSN 2631-6412 bma.org.uk/thedoctor

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