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The explanation for the disproportionate number of black and minority ethnic (BAME) doctors being referred to the General Medical Council (GMC) for fitness to practise concerns may be the result of poor induction, inadequate support, and unhelpful feedback, according to a recent GMC report.

Between 2012 and 2017, 1.1% of BAME doctors were referred to the GMC compared with 0.5% of white doctors. Doctors who qualified outside the UK are 2.5 times more likely to be referred to the GMC compared with UK graduates (1.2% compared with 0.5%).

The ‘Fair to Refer’ report is based on interviews and focus groups, with 262 people including GPs, locums, specialty and associate specialist doctors, and consultants from different ethnic backgrounds – including a mixture of those from overseas and the UK.

The report, commissioned by the GMC, found a combination of factors could explain the disproportionate referrals of BAME doctors. Some doctors who are new to the UK or the NHS have inadequate induction or lack support when they first arrive. Another problem is that BAME doctors – whether new to the NHS or not – do not always get effective, honest, or timely feedback which could have helped to prevent later problems. The report says some clinical and non-clinical managers avoid or defer difficult conversations, particularly if they are of a different ethnic group to the doctor.

The report also says that some working and contractual patterns leave doctors isolated, meaning they lack exposure to learning experiences and resources. In addition, some groups of doctors are treated as ‘outsiders’, which creates barriers to opportunities and makes them less favoured than ‘insiders’ who experience greater privileges and support.

The report also says that some organisations have a culture that looks to find an individual to blame when something goes wrong, rather than investigating the system in which he or she works, or trying to learn from the mistake so it doesn’t happen again.

Charlie Massey, Chief Executive of the GMC, said: ‘We want to avoid doctors being referred to us for problems that can be resolved earlier locally. We want patients to get the best possible care, which is best delivered by doctors working in supportive and inclusive surroundings.’

The report makes four key recommendations:

  • Improve support for doctors new to the UK or the NHS, or whose role is likely to isolate them;
  • Ensure engaged and positive leadership more consistently across the NHS; 
  • Create working environments that focus on learning, rather than blame, when something goes wrong; 
  • Develop UK-wide mechanisms to ensure delivery of these recommendations.

What are your views? Do you believe that there are significant elements of institutional racism embedded within the NHS? If so then what should be done?

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The NHS is currently facing a workforce crisis. One in 12 posts (8%) are now vacant around England. This is partly a reflection of a growing global shortage of healthcare workers, but has its own particular causes: failure to train and retain enough home grown health professionals; inability to recruit sufficient numbers from abroad; trainee departures to work overseas, to other occupations and to locum agencies; as well as early retirement of senior staff driven by rota gaps, overwork, burnout and damaging pension rules. An aging population and the social impact of years of austerity have also exacerbated the crisis.

Despite promises of 5000 extra GPs, there are fewer GPs per patient for the first time since the 1960s, 40 000 nurse vacancies, and 10% of specialty medical and 32% of psychiatry training posts unfilled. The result is a vicious cycle of low morale and disillusionment driving doctors and nurses out of the NHS and deterring others from joining, which puts yet more unsustainable pressure on those who choose to stay.

The scale of the problem has finally begun to hit home with government, and an interim workforce plan has made some suggestions. But new staff and new roles will take years to materialise, and the NHS has a huge task ahead if it is even to retain its current staff. A referendum on the offer of a new contract that provides an 8.2% pay rise over four years and improved working conditions for junior doctors is being held between the 14th and 25th of June.

Other recommendations for more motivated and safer hospital doctors include the return of ‘the firm’. The firm is a shorthand for many of the things that the best employers have always known: that for people to flourish in their work they need nurture, support, community and a sense of belonging, and the assurance that your leader knows who you are and will support you when things go wrong.

The reduced working hours and early retirement of experienced senior doctors is largely a reflection of the pension taper, which has resulted in massive tax liabilities for higher earning consultants and GPs as a result of the NHS’s inflexible pension system. It is not at all clear that the proposed 50:50 solution will ease the problem, since the generous pension arrangements have been a major motivation for doctors to continue working within the NHS.

Are things really this bad? What are your experiences and suggestions? Do add a comment to this blog.

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TUF cycling: Costa Rica - YouTube

The Urology Foundation (TUF) is planning a cycle challenge across Costa Rica from the 16th – 27th November. Take a look at this video, which has images from the previous seven rides in Sicily, Malawi, Madagascar, Patagonia, South Africa, Rajasthan and most recently Vietnam/Cambodia. Do sign up at :https://www.dream-challenges.com/challenges/the-urology-foundation-cycle-costa-rica/ and join our merry and intrepid band to help to raise much need funds for urology research, training and education.

You can access some of our stories on previous cycle rides by clicking on the links below:

Hike for Hope VI: Ethiopia
Five Previous Hikes for Hope, and now a Sixth in Ethiopia!

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Men’s Health Week starts on 10 June and is 25 years old this year. It began in the USA in 1994 following a Senate Joint Resolution to establish the Week by Senator Bob Dole. The Week was linked to Father’s Day in the USA (the Week always ends on that day, the third Sunday in June) and it became an international event in 2002 when it was first marked in the UK. It has since been adopted in Australia, Canada, Denmark, Ireland, New Zealand and beyond. The Week has helped hugely to put men’s health on the map both nationally and globally.

During Men’s Health Week 2019, Global Action on Men’s Health will be promoting its recently-published report on men and self-care, Who Self-Cares Wins. The main findings of this report are also covered in a paper in Trends. In the UK specifically, the Men’s Health Forum will be focusing on the impact of inequality and deprivation on men’s health. The theme for Ireland will be ‘Men’s Health Matters’ and the call to action is ‘Make the Time. Take the Time’.

Although male life expectancy has improved significantly over the past 40 years, many men’s health outcomes remain unnecessarily poor, globally, nationally and locally. Average global life expectancy for men lags behind women’s by four years, for example, and there is not a single country where men live longer than women. Around half of the sex difference in mortality from all causes in Europe is due to smoking and one fifth is due to alcohol consumption. Globally, about 45% of male deaths are due to health behaviours. But men’s health remains largely overlooked by health policymakers and practitioners.

The Week provides a great opportunity for a wide range of organisations and individuals to draw attention to the state of men’s health, organise activities that engage men, and advocate changes to health policy and practice.

What will you be doing to mark Men’s Health Week’s silver anniversary? Sharing this information will inform and inspire others as well as help to demonstrate the Week’s impact.

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The risk to non-smokers of developing lung cancer is rising significantly: in the UK 6000 people each year now die of lung cancer despite having never smoked, or having smoked a negligible number of cigarettes. This is thought to be as a result of increasing exposure to toxic air.

This makes lung cancer among non-smokers alone the eighth biggest cancer-related cause of death in the UK, ahead of leukaemia, lymphoma and head and neck cancer. However, as lung cancer remains strongly associated with smoking it has created stigma around the disease as self-inflicted, which has had an impact on the level of research into its other causes. Consequently, there is a need to raise awareness with clinicians and policy makers of the other risk factors – including indoor and outdoor air pollution.

While smoking is the single biggest lifestyle factor that affects lung cancer, accounting for around 86 per cent of cases, air pollution, fumes from coal fireplaces, and second-hand smoke are also linked to its development. Smoking history is often the first question clinicians will ask patients who come in with respiratory symptoms that could be an early warning cancer, but a history of not smoking could give false reassurance and send them down the wrong diagnostic path.

Even more worrying is the fact that worldwide nearly four million children develop asthma every year as a result of air pollution from cars and heavy vehicles, equivalent to 11 000 new cases a day. The key pollutant, nitrogen dioxide, is produced largely by diesel vehicles.

Childhood asthma has now reached global epidemic proportions: one in eight of all new cases is due to traffic pollution and evidence shows that existing WHO standards are not protective against childhood asthma. As a result of their high populations and significant pollution levels, the three countries with the greatest number of children developing asthma each year are China (760 000), India (350 000) and the USA (240 000). However, these data may underestimate the true levels in many poorer nations where asthma often goes undiagnosed and undertreated.

The risks to us all – and to all other species – from a combination of environmental pollution and climate change are plain to see: we cannot pretend to be unaware. Each and every one of us could and should modify our lifestyle, and encourage our friends, colleagues and patients to do likewise, by cutting back on air travel, reducing or cutting out the consumption of red meat and converting to a more plant-based diet.
What are your thoughts? How should we respond to the climate change emergency?

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What do patients really think of the NHS and its staff? That was the question NHS England wanted to know the answer to when requesting Paul Baker and Gavin Brookes to make sense of comments that patients leave online. This was no small task – with a total of 228 000 comments, or 29 million words, collected from the NHS Choices website!

From these responses, it was evident to see that the majority of complaints about the NHS centred around frustration over time delays. The phrase ‘took forever’ was used repeatedly, along with descriptions on the difficulties of getting appointments and time wasted in waiting rooms.

However, overall NHS England has come out rather well – with many more positive evaluations than negative ones. Interestingly, surgeons, dentists and paramedics received particularly good results, being evaluated positively 95% of the time. The language used suggests surgeons, who gratifyingly came top, tend to receive positive feedback because many people are impressed by the job they do: ‘My surgeon was someone I could trust with my life,’ wrote one patient. As a result, surgeons were most likely to be referred to as ‘outstanding’, while midwives were often described as ‘exceptional’.

Moving down the chart, however, receptionists fare much less well, only attracting 57% positive evaluations. Everyone seems to have their ‘horrible receptionist’ story, using terms such as ‘rude’, ‘unprofessional’, ‘patronising’ and even ‘aggressive’.

Should we perhaps conclude that the NHS should give surgeons, dentists and paramedics, as well as hard working GPs, a pay rise and send receptionists on training courses? What is your view? Does the ‘attitude’ or the ‘culture’ of the NHS – particularly that of the ancillary staff – need to change? Do add your thoughts and reactions to this blog.

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Image of John cycling for The Urology Foundation in Madagascar

On the 14th May 2014, exactly five years ago, Professor John Fitzpatrick died very suddenly from an intracranial haemorrhage. The obituary I wrote for him then has has an amazing 90 000 views and more than 200 comments. 


Image of John trekking across England with John Dick, FRCS camping on the mountainside on a The Urology Foundation Challenge

John was a great character, a true friend and an outstanding academic urologist. His extraordinary international reputation was based on his insatiable appetite for travel – he was a visiting professor in innumerable institutions all over the world – and everywhere he went he was greatly liked and admired. John, we still remember you and miss you badly.


Image of John cycling for The Urology Foundation in Malawi 

John was also one of the co-founders of The Urology Foundation (TUF) which now does amazing work to support research, education and training in the specialty that John loved. As the images attest, John also regularly attended the fundraising efforts of TUF. 


Image of John trekking across Great Britain

Please feel free to use this blog as an opportunity to share your memories of John. 


Image of John trekking in Nepal


Image of John Climbing Mount Kilimanjaro for Prostate Cancer UK

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Panorama highlighted an analysis by the Nuffield Trust think tank for the BBC last night, which showed the number of GPs per 100 000 people has fallen from nearly 65 in 2014 to 60 last year.

The last time numbers fell like this was in the late 1960s, and it comes at a time when the population is ageing and demands on GPs are rising. Patient groups said the fall in GP numbers was causing real difficulties in making appointments.There have been reports of waits of up to seven weeks for a routine appointment, while those needing urgent appointments have been forced to queue outside practices in the early morning to guarantee to be seen.

The Nuffield Trust analysis looked at the number of GPs working in the NHS – both full and part-time – per 100 000 people across the UK. It shows that during the late 1960s the numbers were falling, before four decades of almost continuous growth. A peak of 66.5 was reached in 2009, before the increases tailed off, and there have now been four consecutive years of falls, with the biggest drops being seen in England.

The NHS has been struggling to attract junior doctors to become GPs for a number of years. At one point, as many as one in 10 training places were going unfilled. This has now been rectified – and the number of training places has increased. Last year, nearly 3500 GP trainee posts were taken up in England, up by 800 since 2014. This boost in numbers has yet to be fully felt as it takes at least three years to train a junior doctor to become a GP. What is more, one in three junior doctors who accept places on GP training courses drop out of the system, according to the Nuffield Trust.

Meanwhile, the numbers retiring early have been increasing (two-thirds of retirements by GPs come early – double the rate seen just five years ago) and this is partly due to burn-out, but also the pension issue. Dr Richard Vautrey, of the BMA, said workloads were now ‘unmanageable’ for many, with doctors being asked to work longer and harder, without recognition or an increase in pay.

With hospitals referring more patients back to primary care, the system is under now extreme strain. Of course, more support staff would help, but at the end of the day the patients like to see their own GP. However, it feels as though too little is being done too late. Do you agree? What are you thoughts on the fall in GP numbers? 

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The NHS is currently facing a staffing crisis resulting in increasing rota gaps and a severe loss of workforce morale. The recent squeeze on tax breaks for consultants saving for their retirement is producing extremely bad outcomes for wider society in general, and the NHS in particular, that need to be urgently reviewed.

The tapered annual allowance, introduced in 2016, is aimed at clawing back billions of pounds in pensions tax relief handed each year to high earners. The tapered annual allowance sees the standard allowance whittled down from £40 000 to £10 000 for those with ‘adjusted’ yearly incomes of more than £150 000 and ‘threshold’ incomes of more than £110 000.

When the taper was announced it was described as ‘horrific’ and ‘nightmarish’ by pensions experts because of ‘fiendishly’ complex rules around when a reduction to the allowance is triggered.

The reasons for the introduction of the taper were sound enough. The lion’s share of the £25 billion or so annual net cost of pensions tax relief is racked up by higher and top-rate earners, who are in least need of help from the taxpayer to fund their pensions.

But far from hitting the private sector high-earners, who can take steps to swerve the taper, in reality it is wreaking havoc on key public sector workers, with large numbers of senior hospital doctors and GPs radically cutting their hours, or retiring early, to avoid landing in the taper zone. At a time when the NHS is already under severe pressure, these actions are having a direct impact on patient care.

The reason why the taper is having such a pernicious effect on the NHS is that, unlike the private sector, staff have few options to avert these tax bills, such as asking their employer to swap their pension for cash, or to reduce their pension contributions.

Doctors getting pay rises, promotions, or working extra shifts to help clear a patient backlog, are getting landed with shocking six-figure tax charges as high as £87 000 in some cases.

In a particularly egregious anomaly, senior doctors working overtime to help the NHS are facing marginal tax rates of as much as 100% on their overtime due to taper charges.

Further reform of pensions tax relief will not come without pushback, particularly in the public sector, but the Treasury cannot ignore the negative impact of the taper. It is bad medicine for us all and needs to be scrapped.

Do you agree? What are your thoughts and experiences? Do add your comments to this blog?

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Following a poll of its members, the Royal College of Physicians (RCP) has now adopted a neutral stance on the issue of assisted dying.

Some groups have spoken out against the change, saying a respected medical body’s reputation has been damaged. Others called the decision ‘absurd’.

Under UK law, it is currently illegal to encourage or assist a suicide.

Nearly 7000 doctors voted in the online poll:

  • 43% thought the college should oppose a change in the law
  • 32% wanted the college to support a change 
  • 25% were neutral

As a result, the college has shifted to a neutral stance because neither side achieved a necessary majority of 60%.

This shift by the Royal College of Physicians has no effect on the law and does not bring assisted dying any closer. However, it is symbolic that a respected medical institution should change its stance, which has been warmly welcomed by campaigners aiming to change the law. 

The decision has infuriated those opposed to the change, who argue that it is unreasonable to demand a majority of 60% or above in order to maintain the status quo. 

What are your views? Please do add your comments to this blog.

You can also read the editorial on the RCP’s survey by clicking here

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