debtmedical.co.uk

The care of pregnant women in England is being undermined by the lack of involvement of GPs, experts say.
The King’s Fund said over the past 30 years the role of the family doctor in helping women before, during and after pregnancy had “all but disappeared”.

It suggested they should be paid more as an incentive to take on greater responsibility.

GPs said they would be willing to get more involved, but midwives said doctors needed more training.
The King’s Fund compiled the report as part of a larger investigation into GP care generally, which will be published later this year.

Deliver babies

It said GPs have traditionally played a key role in helping pregnant women, including – in some cases in the 1970s – delivering babies themselves.

The report is not suggesting a return to this as the professionalisation of midwives and the development of hospital maternity services had done much to improve care.

Instead, the King’s Fund said GPs should be doing more to work alongside other services.

It found women often go to their GP to get a pregnancy confirmed, but after that involvement was “very limited”.

Researchers argued this was a wasted opportunity. In particular, they said GPs could get involved with pre-conception lifestyle advice and make sure women get the right screening and testing in the early part of pregnancy.

As the pregnancy develops, GPs could then liaise with midwives and obstetric services to share any medical concerns.

And, after the baby is born, doctors could talk to new mothers about common problems such as back pain, mental health issues and contraception.

Dr Laurence Buckman, of the British Medical Association, said GPs wanted to be more involved in maternity care.

But he added: “There has been a succession of health policy changes in recent years, which have led to the wider primary care team becoming increasingly fragmented.

“Many GPs have watched with growing concern as long-established and valued midwife colleagues have been withdrawn from practice teams and continuity of care for pregnant women has been lost.”

A Department of Health spokesman agreed GPs had a “vital” role to play and said this would happen under the shake-up of the health service announced in a White Paper last month.

But Cathy Warwick, head of the Royal College of Midwives, said: “We would argue that if GPs are to have a wider role in maternity care, they must be able to demonstrate an up-to-date knowledge of maternity care and be actively engaged with their local maternity services.”

- Courtesy of BBC News

Ministers are to review European rules that restrict the number of hours doctors can work.

Surgeons have long challenged the 48-hour limit on their working week saying it puts patients’ lives at risk. About 80% of 980 NHS surgeons and surgical trainees surveyed said care had worsened since the European Working Time Directive started last August.

A Department of Health spokesman said the way the European Working Time Directive was being applied was “clearly unsatisfactory”.
The rules were designed to stop doctors working up to 80-hour weeks that were commonplace under the old system. However the Royal College of Surgeons – which surveyed surgeons and surgical trainees in all nine surgical specialties – warned the changes had left hospitals overstretched and much less safe than they were a year ago.
More than a quarter of senior surgeons said they were no longer able to be involved in all of the key stages of a patients’ care, up from 18% in October 2009.
The survey also found two thirds of junior surgeons said their hours in training had been cut – 25% more than a year ago.
More than 60% of consultants who used to do surgery assisted by trainees said they were now often forced to operate alone, while 45% of consultants and 37% of trainees reported “inadequate handovers”.
In addition, more than half to those surveyed said they consistently worked more than the permitted hours because of stretched rotas.
‘Great problems’
RCS President John Black said surgeons not only thought patient safety was worse, but doctors’ work and home lives were also poorer for it.
“To say the European Working Time Regulations has failed spectacularly would be a massive understatement.
“There is not a moment to lose in implementing a better system which would enable surgeons to work in teams, with fewer handovers and with the backup of senior colleagues,” he said.
Charlie Giddings, president of the Association of Surgeons in Training, said “new innovative solutions” were needed, “rather than the minor short-term tweaks that artificially produced compliance at the expense of training and patient care”.
Howard Cottam, president of the British Orthopaedic Trainees Association, said the directive had “largely failed” and the system “remained reliant on the professional integrity of trainees who continue to cover the gaps in the rota”.
A spokesman for the Department of Health said: “The Health Secretary will support the Business Secretary in taking a robust approach to future negotiations on the revision of the European Working Time Directive, including maintenance of the opt-out.
“We will not go back to the past with tired doctors working excessive hours, but the way the directive now applies is clearly unsatisfactory and is causing great problems for health services across Europe.”
The survey covered all Strategic Health Authorities in England as well as surgeons based in Scotland, Northern Ireland and Wales.
The RCS said it endorsed calls for a working week of up to 65 hours – including time spent on-call – to provide the ideal balance between adequate training opportunities, good patient care and work-life balance.

Tax officials have harvested £9m in unpaid tax from 1,500 medical professionals, although 30,000 were approached in a disclosure campaign.

Letters were sent to doctors and dentists asking them to come forward with any admissions of unpaid tax from previous earnings.

A deadline was set for the end of June before HM Revenue and Customs (HMRC) started their investigations.
HMRC said it was happy with the results and urged others to come clean.

“We did not have a target in mind, but nonetheless, the campaign has resulted in millions of pounds of tax that might otherwise have been lost being paid to HMRC as required by law,” a spokeswoman said.
“Anyone who has been evading tax should talk to us as a matter of urgency, as voluntary disclosure always makes financial sense.”

Deadline

Medical professionals who admitted unpaid tax before 30 June could pay past tax, plus interest, and a penalty of 10% of the unpaid tax.

For those found out after the deadline, the fine would increase to between 20% and 100% of the unpaid tax.
However, accountants have said they considered the response to be muted, with many medical professionals now facing investigation and, in the most serious cases, prosecution.

“HMRC is making it clear that it holds information, particularly in relation to doctors and dentists, that still has not been disclosed,” said Stephen Camm, tax partner at PricewaterhouseCoopers.

“From the disclosures that have been made, HMRC have uncovered individuals who should have come forward but who have failed to do so.

“Investigations will start in the autumn in earnest. HMRC is already working on cases for prosecution and expect numbers to rise. There is no doubt that any medical practitioner that has something to disclose to HMRC must deal with this issue now.”

The medical professionals are the latest group to be targeted by the Revenue.

Chas Roy-Chowdhury, head of taxation at the Association of Chartered Certified Accountants, said: “This whole process is very much about HMRC focusing on collecting taxes, from plumbers to gas fitters to doctors.
“The message is that the tax authority has become more authoritative and will continue to be so.”

- Courtesy of BBC News

Figures released by the NHS Information Centre show that administration workforces in the NHS grew 8 times faster over the past 6 months than the number of doctors.

Compared with 103722 doctors working in hospitals, there are now over 237000 managers and administrative staff. From October 2009 to April, the total number of bureaucrats rose by 1800, a growth of just less than 1% in the total workforce. During the same period doctor numbers rose by only 100 – a 0.1% increase.

These figures come at a time when there are concerns that the NHS budget is being squeezed by the growing cost of bureaucrats. A case in point is the recent recognition that hospital chief executive pay had increased by 7% over 12 months, more than twice the increases awarded to nurses. Of greater concern is that the NHS Information Centre data also show that doctor numbers have begun to fall.

In April alone, the number of nursing posts fell by 857, whilst the number of doctors decreased by 261 in the same period, with training and junior registrar posts most affected.

Similarly the number of health visitors has fallen, now with just over 10000 employed by the NHS, compared with 45000 managers.

UNISON union officials have expressed great concern that the loss of frontline positions will have a devastating impact upon patient care.

This is the first budget from the coalition Government; George Osborne has issued the toughest budget in a century outlining the Governments plans to balance the books of this country and to get Britain back to work. Here are some of the key points at a glance:

Public Sector Pay

Public sector workers face a two-year pay freeze if they earn above £21,000 per annum. Those earning less will get a flat fixed pay rise worth £250 in both years.

Armed services personnel in Afghanistan will see their operational allowance doubled to £4,800.

State Benefits

Child benefit: Current rates will be frozen for the next three years. Existing benefits: Eldest or only child £20.30 per week any additional children – per child £13.40 per week

Tax credits: Payment rates are reduced for families earning over £40,000pa, next year. However, low income families will get more Child Tax Credit – the amount per child will rise by £150 above the rate of inflation next year.

Housing benefit: Changes to the maximum limits, new limits of £400 a week for properties with more than three bedrooms, £250 a week for a one-bedroom flat, £290 for a two-bedroom property and £340 for a three-bed property.

New changes to housing benefit for unemployed people will see their benefit rates cut by 10%, after 12 months of claiming Jobseekers Allowance from April 2013. Also lone parents will be expected to look for work when their youngest child goes to school. Part of Osborne’s tough love to force Britain back to work.
The government will introduce a medical assessment for Disability Living Allowance (DLA) from 2013 for new and existing claimants.

Taxation

Overall we will all probably pay more tax in one way or another. Taxes are going up, and the chancellor made no excuses about it.

Personal income tax allowance: To be increased by £1,000 in April to £7,475 – worth £170 a year to basic rate taxpayers. It is expected that 880,000 of the lowest-paid will be taken out of income tax altogether.
Council tax could be frozen for one year from April 2011 in England, and extra funds will only be offered to councils which keep their own costs down. Reputedly worth about £35 per household.

VAT: Rate will rise from 17.5% to 20% from January 4, 2011. So if you have any large purchases planned, it would make sense to buy them before January next year.

Capital Gains Tax (CGT): To rise from 18% to 28% from midnight for higher rate taxpayers. The “entrepreneur’s relief” rate of 10% on the first £2m of gains will be extended to the first £5m.

Fuel, Alcohol & Tobacco

No increases this time round. Labour’s plan to increase the duty on cider by 10% above inflation will be scrapped from July.

Business

From April 2011, the threshold at which employers start to pay National Insurance will rise by the rate of inflation plus £21 per week.

People setting up new businesses outside London, the South East and the east of England will be exempt from £5,000 of National Insurance payments for the first 10 workers.

Corporation Tax will be cut next year to 27%, and by 1% annually for the next three years, until it reaches 24%.

The small companies’ tax rate will be cut to 20%.

Regions

The upgrade of the Tyne and Wear Metro, extension of the Manchester Metrolink, redevelopment of Birmingham New Street station and improvements to the rail lines to Sheffield and between Liverpool and Leeds will go ahead.

The Budget 2009 proposal to repeal the special tax rules for furnished holiday lettings will not be implemented. Instead, the Government will consult over the summer on an alternative proposal. This will benefit an estimated 4,800 individuals in the North West who receive an income from furnished holiday lettings.

A Regional Growth Fund will be created to help fund regional capital projects over two years.
Pensions

Excluding the state pension and pension credit, from 2011 benefits, tax credits and public service pensions will rise in line with the Consumer Price Index, rather than the, generally higher, Retail Price Index.
The basic state pension will be linked to earnings from April 2011, with the pension guaranteed to rise in line with earnings, prices or 2.5%, whichever is the greater.

The government will also consult on phasing out the default retirement age – to ensure those who want to work past 65 are able to do so.

What does this budget mean to you?

Tell us what it means, how will it affect you? What do you like or dislike? All comments welcome below.

Doctors leaders are concerned that chancellor George Osborne has overridden the negotiation process between the BMA and the Doctors and Dentists Review Body.

The coalition government’s first budget this week announced a two-year pay freeze for public sector workers earning more than £21,000 a year, which will include doctors.

BMA council chairman Hamish Meldrum said doctors understood the need to be responsible over pay, but added: ‘The public sector did not cause the financial crisis and should not be singled out as the main vehicle for dealing with it.’

He said the BMA would cooperate with the forthcoming pensions review, but stressed that the association wanted to protect the value of current and future pensions.

Source: BMA

“Governments use student debt surveys to decide new policies like top-up fees. The policies are often applied to all students regardless of the discipline. They ignore the fact that medical students spend around two years longer studying. This is why medical students need their own finance survey” says the British Medical Association (BMA).

BMA debt modeling predicts that if the cap on fees was to be raised to £7000, those medical students studying outside London would run up almost £57,000 worth of Student Loans Company debt, peaking at over £73,000 eight years after they graduate. After 25 years, over £13,000 would still have to be written off. This scenario would be disastrous for medical students and would not bring expected savings for any Government.

Under a system where tuition fees could be as high as £15,000 a year, levels of graduate debt are likely to reach crippling levels at around £90,000 and take over 31 years to pay off.

In addition, the Government uses a higher measure of inflation (The Retail Price Index) to calculate interest on student loans than it does to calculate public service workers pay (the Consumer Price Index). This will adversely affect all students, as their salary will not keep pace with increases in their student loans leading to increased debt and money worries for medical Doctors.

Recommendation 4 from the 2009-10 BMA Review of Higher Education Funding says “ Students studying medicine should have their total fees capped at the same level as students on three year undergraduate programme. This should ensure that they are not further disadvantaged on top of the loss of income already suffered by studying for additional years.”

Furthermore, there is no alternative route into the medical profession without studying medicine at medical university.

Although certainly not the only factor, concern about debt has a major adverse impact on decisions about applying to higher education. A recent study, commissioned by the Sutton Trust17, found that almost two thirds of students deciding not to pursue Higher Education cited avoiding debt and money worries as a major factor in their decision.

In fact a recent article in the Telegraph reports that Medical students are having to borrow almost £16,000 from their parents to get through their degrees, in what doctors’ leaders have dubbed a “hidden tax” on families.

Please feel free to post your comments below.