bmj.com NEWS ЖЖUrgent action is UK news GPs and specialists lack understanding and respect for each other, report says, p 4 needed to improve World news GlaxoSmithKline is fined record $3bn in US, p 2 chronic pain care, ЖЖReferences on news stories are in the versions on bmj.com says report Dutch GPs agree to refer fewer patients and prescribe more generics

Tony Sheldon UTRECHT The long running dispute between the Dutch ministry of health and Netherlands general prac- titioners is over in a deal seen as guaranteeing stability and growth for the profession, defining their position as the gatekeepers of care. But in return for annual budget growth and extra funding for modernisation and innovation, GPs must realise savings worth millions of euros from generic prescribing and refer fewer patients to more expensive hospital care. GOLDMAN/AP/PA DAVID Supporters of the Affordable Care Act celebrate the court’s decision on Capitol Hill The minister of health, Edith Schippers, and the GPs Association chair, Steven van Eijck, signed the “covenant” barely eight months after US Supreme Court upholds almost two thirds of the Netherlands general practitioners had demonstrated against cuts in funding which, they feared, threatened modern Obama’s health reform act Dutch primary care.1 Janice Hopkins Tanne and vowed to repeal it on his the individual mandate was not Schippers had intended to claw back €99m NEW YORK first day in office if he is elected supported by the commerce (£80m; $125m) from the GPs’ budget, which By a vote of five to four, the US president. clause in the US Constitution, they had overspent in 2011, arguing that the Supreme Court upheld the However, when Romney was because people who did not rate of increase in health spending was “unten- health reform act, known as the governor of Massachusetts, he buy insurance did not engage in able.” Affordable Care Act. endorsed that state’s health commerce. The government had But the new deal cancels any proposed claw Health reform immediately reform law, which included a relied on that clause to support back which would have seen the tariffs GPs can became a hot issue in this year’s mandate that all residents buy the individual mandate. charge for care cut from January. In addition she election campaign, which ends health insurance. Today about Instead, the court said the has promised to make every effort to ensure any with voting on 6 November. Many 95% of the state’s residents mandate could stand as it relied overspend in 2012 will not result in tariff reduc- US citizens object to the health are insured. Massachusetts’ on Congress’s power to tax, such tions. In particular increased costs related to reform act as an expansion of health reform served as a as the penalties levied on those cooperation between GPs’ out of hours services government and the government model for President Obama’s who do not buy health insurance. and hospital accident and emergency depart- telling them what to do. health reform bill. Now Romney Republicans said this showed ments would not be clawed back. President Barack Obama as presidential candidate is Obama was raising taxes, an Instead the budget for GP care will, in line made a television address saying denouncing a plan similar to the anathema in an election year. with other areas of healthcare, increase by that the decision showed that one he supported. The individual mandate is 2.5%. In addition an extra 0.5% will cover mod- “here in America, the wealthiest Republican leaders in the important for health reform ernisation and innovation to promote what the nation on earth, no illness or House of Representatives said because it spreads the cost of ministry of health says is GPs’ “central role” in accident should lead to any they would vote to repeal the healthcare among a larger pool providing a concentration of care locally. family’s financial ruin.” He said it health reform law on 11 July, as of insured people—the young The ministry recognises GPs’ “gatekeeper role.” “was a victory for people all over they have done before. There and healthy as well as older and The GP, in turn, is charged with “limiting as far this country whose lives are more is no chance the Democratic sicker individuals. as possible” referrals to specialist hospital care. secure because of this law.” majority in the Senate will The court ruled in favour of the The GPs Association and the ministry are ­urging Mitt Romney, the Republican approve such a repeal. expansion of Medicaid to cover closer cooperation between out of hours GP candidate for president, said, “If The Supreme Court’s ruling on as many as 17 million uninsured services and emergency departments to prevent we want to get rid of Obamacare 28 June sustained the individual people who were on low and patients’ “unnecessary” attendance at hospital. [health reform], we’re going mandate, the key requirement middle incomes but above the In return, GPs must make savings of €50m to have to replace President that US citizens buy health poverty level. a year savings by cutting back on prescribing Obama.” He called health insurance or pay a penalty. Cite this as: BMJ 2012;344:e4498 expensive patent medication. reform bad policy and bad law However, the court ruled that ЖЖEDITORIAL, p 12 Cite this as: BMJ 2012;344:e4510

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GlaxoSmithKline is fined record Capturing $3bn in US for unlawful practices patients’ lives

Bob Roehr WASHINGTON, DC boards, and supposedly independent continu- Annabel Ferriman BMJ GlaxoSmithKline has agreed to plead guilty and ing medical education (CME) programs,” and This portrait of an 85 year old Londoner, Jack Hardy, pay $3bn (£2bn; €2.4bn) in penalties for unlaw- lavish travel inducements to promote unauthor- is one of 25 photographs portraying the home lives ful promotion of prescription drugs, failure to ised uses of the drug. of patients at an inner city practice in east London. report safety data, and false price reporting. The company was fined for failing to report The exhibition, called “What counts rather It also signed a 123 page corporate integrity certain data on the safety of the antidiabetes than what can be counted,” was conceived by agreement with the US Department of Justice drug rosiglitazone to the FDA. That included two doctors at the practice, Kate Adams and Paul that regulates its activity for the next five years.1 information on cardiovascular risk obtained Kelland, who wanted to emphasise the importance The fine is the largest on record imposed on through post-marketing studies, including those a drug company in the United States and fol- ordered by European regulators. lows closely on the heels It also promoted off- Bill Corr, deputy secretary of the Department of another huge penalty, label use of the anti- of Health and Human Services, said in a state- $1.6bn, levied on Abbott asthma drug fluticasone, ment, “Today’s historic settlement is a major Laboratories in May for the anticonvulsant lamo- milestone in our efforts to stamp out healthcare its marketing of valproic trigine, and ondansetron, fraud.” acid.2 which is approved only The deputy attorney general, James Cole, GSK’s agreement cov- for postoperative nau- added, “At every level we are determined to stop ers several of the its sea. Kickbacks were paid practices that jeopardise patients’ health, harm leading drugs. It illegally to healthcare profession- taxpayers, and violate the public trust.” promoted the antidepres- als for prescribing these Andrew Witty, GSK’s chief executive officer, sant paroxetine for treat- and other drugs. This said in an extended statement released by the GSK’s chief executive Andrew Witty: “In the ing patients under the age US, we have taken action in all levels” defrauded federal health company: “Whilst these [violations] originate of 18, even though the insurance programmes in a different era for the company, they cannot Food and Drug Administration never approved such as Medicare and Medicaid. and will not be ignored. On behalf of GSK, I want the drug for that age group. The company also The company reported false drug prices that to express our regret and reiterate that we have created “misleading” journal articles claiming “resulted in GSK’s underpaying rebates owed learnt from the mistakes that were made.” efficacy of paroxetine in that population, when under the Medicaid Drug Rebate Program,” the He added, “In the US, we have taken action in fact “the study failed to demonstrate efficacy,” justice department’s statement said. at all levels in the company. We have funda- the justice department said in its statement, and Under the corporate integrity agreement GSK mentally changed our procedures for compli- it hid trials that had negative findings.3 may no longer pay its marketing employees ance, marketing, and selling. We have removed GSK illegally promoted bupropion for weight according to sales figures. Company executives employees who have engaged in misconduct. In loss, sexual dysfunction, substance addictions, may be held personally accountable and forced the last two years we have reformed the basis on and attention-deficit/hyperactivity disorder and to give back bonuses and long term incentives which we pay our sales representatives.” other off-label uses. It also used “sham advisory “if they . . . engage in significant misconduct.” Cite this as: BMJ 2012;345:e4568

Closure of surgery in Camden was a casualty of NHS changes

Tom Foot LONDON closed surgery, adding: “We remain no competitive tender—as is normally A public inquiry into the closure of a concerned about the remaining two the case—and the new company was GP surgery in north London that was contracts held by The Practice at the not vetted by its NHS paymasters. run by a private company says there Brunswick Centre and King’s Cross, as The report said: “In our view is “a serious loophole” in the national contracts will end in 2013.” primary care by GPs should not be contract for alternative providers. UnitedHealth was awarded five- a commodity traded in the private It raises concerns about two other year contracts by Camden Primary market and prompt action should be practices in the area. Care Trust to run three surgeries in taken to remedy this.” MARKTHOMAS Camden Road surgery closed on 2008. The trust became part of NHS It added that a “lack of planning” Camden Road surgery: how care 13 April, four years after it was taken North Centre London Cluster, along had led to the failure of NHS North was commoditised over by US health giant UnitedHealth, with four other trusts, in April 2011. Central London to find alternative leaving more than 4500 patients The inquiry’s report found a premises for a new surgery. who could provide GP services, says without a doctor.1 “serious loophole” in the original The surgery was a “casualty” of the report. The manner and timing The inquiry panel of three contract that allowed the surgeries to NHS cuts, major NHS reorganisation of the closure led to “unnecessary councillors said there was an “urgent be suddenly sold to another firm, The because of the Health and Social Care anxiety” among patients. need” to find a replacement for the Practice plc, in April 2011. There was Act, and changes to NHS policy on Cite this as: BMJ 2012;345:e4545

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of the “narrative” in medicine. The photographer, Michael von Graffenried, from Switzerland, visited each of the patients in their own homes, accompanied by one of the doctors, who recorded details of the patient’s life. These accounts are displayed alongside the pictures. Adams said: “It was lovely to just sit and listen. I have heard some touching, funny, uplifting, and shocking stories.” The exhibition will transfer in September to the Royal College of General Practitioners. The exhibition is at Shoreditch Park Surgery, 10 Rushton Street, London N1 5DR, Monday to Fridays, 9 am to 6 pm, until 31 August.

Cite this as: BMJ 2012;345:e4540 MICHAELGRAFFENRIEDVON Women report agony and Trust was warned not to sign PFI turmoil over PIP implants scandal on web forum deal that left it needing a bailout

Adrian O’Dowd LONDON Zosia Kmietowicz LONDON of more than £40m (€50m; $62m) and had an Some women have undergone a “harrowing” An NHS hospital trust ignored warnings from estimated deficit of £46m for 2011-2, more than experience following the scandal over breast the NHS regulator that a deal for a new hospi- a fifth of its £200m revenue. implants made by discredited French manufac- tal under the private finance initiative (PFI) was Peterborough was one of seven trusts that turer Poly Implant Prosthèse (PIP). unaffordable and could leave it bankrupt, says shared the £1.5bn government bailout fund for First hand accounts of the experience of an independent report into the events.1 trusts in financial difficulties over PFI schemes.2 almost 200 affected women in the UK have been Monitor, the regulator of foundation trusts, In addition to these, South London Health- submitted to a web forum set up by the parlia- had told Peterborough and Stamford NHS care NHS Trust, which is £150m in debt largely mentary health select committee, which pub- Foundation Trust (as well as the Department because of two PFI schemes, this week became lished a summary of the comments on 2 July.1 of Health and the Treasury) that its financial the first trust to be put into administration by the A scandal emerged last year over how bank- targets appeared unachievable, says the report health secretary.3 rupt manufacturer PIP, which used non-medical from management consultants KPMG, which A further 21 trusts in England that run about grade silicone in breast implants that were given was commissioned by Monitor to analyse what 60 hospitals are facing serious financial difficul- to around 47 000 women in the UK.2 3 lessons could be learnt from the events around ties because of longstanding revenue problems During May, 194 women registered with the deal. related to underlying debt from PFI schemes.4 the forum and left 279 posted comments; 189 The trust had believed it could increase its The Daily Telegraph quotes a coalition source women had received PIP implants, with the earnings by more than 9.2% a year in the three as saying that the “disastrous blunder” by the remainder not knowing what implants they had. years up to the opening of Peterborough City Labour government had brought Peterborough When asked about the government’s response, Hospital in November 2010, despite 7% growth hospital “almost to its knees.”5 The source women were, in general, unimpressed and one at the time, says the report. added, “Labour were warned repeatedly by woman said: “I think we have been very let down KPMG found that the trust had prepared their own regulator that this dodgy PFI deal by our current government. “inaccurate” budgets and its figures “did not could bankrupt Peterborough hospital but they “The health committee seem to have concerns reflect a realistic expectation of actual events pressed on regardless. for our health and the government sees our situa- and costs” after the new hospital opened in “Since we announced bold action to clear up tion from a purely financial point of view, avoid- November 2010. the mess left to us by Labour in South London, ing any liability for itself. My life and my family’s In January 2007 Monitor had warned that it Andy Burnham has repeatedly tried to deflect life have been turned upside down by this.” believed “the long term affordability of the Pro- the blame. But his fingerprints are all over it.” When asked if women had experienced prob- posal [the PFI deal] to be in significant doubt.” The KPMG report said that in 2007 Monitor lems with their implants, one woman said: “I However, the trust stood by its predictions of had very limited power to stop the Peterborough am in agony taking codeine prescribed from my increased activity and said that Andy Burnham, deal going through but that Monitor could have doctor.” a health minister for the Labour government at asked the board to demonstrate its business case Committee chair and Conservative MP for the time, had given it a “clear endorsement to for the years after 2007 and that this could have Charnwood, Stephen Dorrell, said: “The testi- update our current facilities.” shown up “a growing affordability gap.” Moni- mony we received is valuable, and some of it is In April 2007 Monitor had reiterated that it tor has been given new powers to step in and harrowing. What it demonstrates is that women had “significant concerns as to the scheme’s block risky deals under the Health and Social have significant concerns about how the matter affordability.” Care Act 2012. has been handled by private clinics, by the NHS, But the deal was signed in June 2007. And the Andy Burnham’s office said it was not com- and by the government.” watchdog was proved right when in February menting on the report. Cite this as: BMJ 2012;345:e4560 2012 the trust was given a government bailout Cite this as: BMJ 2012;344:e4472

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IN BRIEF Case reopens against cardiologist MP calls for inquiry into doctors reporting safety concerns: The Conservative MP Peter Bottomley has called for the health facing charges of sexual abuse select committee to conduct a Leveson style inquiry into the gagging of doctors with safety Clare Dyer BMJ The GMC alleges that Bonhoeffer “abused his concerns. He thinks that doctors should be The General Medical Council is to reopen a hear­ position of trust when he behaved in a way which free to speak out without being penalised ing into sexual abuse allegations against Philipp was sexually motivated, inappropriate, and mis­ and those who have refused silence money Bonhoeffer, former head of cardiology at Great leading towards several boys under the age of should be asked to come forward. Ormond Street Hospital in London, nearly two 16.” The regulator says he “provided gifts and years after the original hearing was stayed. financial support to other children and young Deaths on British roads rise for first time in The case, alleging misconduct by Bonhoeffer adults and arranged for them to stay with him.” eight years: The number of people killed in with boys in Kenya, which he visited often while A further allegation is that he contacted wit­ road traffic incidents reported to the police in doing humanitarian work for the Circle of Hope ness A, whose claims were investigated by the Great Britain increased by 3% last year, from charity, was halted in October 2010 pending an Metropolitan Police, and asked him to withdraw 1850 in 2010 to 1901 in 2011, show figures application by the cardiologist to the High Court. his statement. A, now in his late 20s, alleges from the Department of Transport. This is the Bonhoeffer objected to the GMC’s decision that the abuse took place when he was in his first increase since 2003. The total number to rely on hearsay evidence from the main wit­ early teens. of casualties (slight injuries, serious injuries, ness, “Witness A”—transcripts of police inter­ Police from London travelled to Kenya to and fatalities) in road incidents continued to views, mobile phone calls, investigate in 2008 after fall, by 2%, from 208 648 in 2010 to 203 950 and texts—instead of calling being alerted to the claims in 2011.1 him to appear in person to face but Bonhoeffer was not inter­ German court outlaws circumcision: A cross examination.1 The regu­ viewed and no prosecution court in Cologne, Germany, has ruled that lator had been told by police was brought. UK residents or circumcision of minors for religious reasons that A’s safety could be put at nationals can be prosecuted should be outlawed, and that neither parental risk by homophobic attitudes for offences against children consent nor religious freedom justified the in Kenya, or by reprisals from abroad but only for those com­ procedure. It follows charges of bodily harm Bonhoeffer’s supporters, even mitted after 1 May 2004. against a doctor, identified only as Dr K, who though A was willing to come Bonhoeffer, who strongly circumcised a 4 year old Muslim boy. Dr K was to the UK to testify in person. denies the allegations, has Philipp Bonhoeffer visited Kenya acquitted but the court ruled that in future The High Court ruled last been suspended from the UK for the charity Circle of Hope doctors who carried out circumcisions should June that the decision to rely on medical register pending the be punished. hearsay evidence was “irrational” and a breach hearing and stopped working at Great Ormond Mortality is three times higher in people of Bonhoeffer’s right to a fair trial under the Street in 2009. 2 with serious mental illness: Around 13 European Convention on Human Rights. Chain of Hope, set up by the heart transplant in every 1000 people in England aged The hearing will begin again on 18 July before pioneer Magdi Yacoub, brings children from between 18 and 74 with a serious mental the Medical Practitioners Tribunal Service in the developing world to the UK for surgery and health condition (in contact with specialist Manchester, with a new panel hearing the case provides treatment by UK doctors in developing secondary mental health services over from the beginning and witness A giving evi­ countries. Bonhoeffer, described by the GMC as the previous three years) died in 2009-10, dence in person. After preliminary legal mat­ “an internationally renowned paediatric cardiol­ compared with about four in 1000 of the ters have been dealt with on that day, it will be ogist,” sponsored a number of boys and youths general population, show new figures from adjourned till 3 September with an estimated in Kenya and paid for their education. the Health and Social Care Information finishing date of 5 October. Cite this as: BMJ 2012;344:e4508 Centre. The finding forms a new measure, which will be used to monitor the progress of the NHS Commissioning Board. Psychiatrists call for guidelines on treating GPs and specialists lack understanding transgender patients: The American Psychiatric Association’s task force on and respect for each other, report says treatment of gender identity disorder has Anne Gulland LONDON Speaking at the report launch, chair of the recommended the development of clinical GPs need longer training and better communica­ RCGP Clare Gerada emphasised the importance practice guidelines for psychiatrists caring tion with specialists, a report into the future role of the role of the GP. “The GP is at the centre of for patients who are transgender. The report of the medical generalist has urged. the NHS, is at the centre of healthcare, and it’s also encourages the development of position The report by the Royal College of General the GP who makes the NHS safer, fairer, kinder, statements regarding the healthcare and civil Practitioners, a response to the college and and, dare I say, cheaper.” rights of people who are gender variant or 2 Health Foundation’s independent Commission The report repeated previous calls by the transitioning gender. on Generalism published last October, said that RCGP for extended GP training from the current Cite this as: BMJ 2012;345:e4556 the “vital” role of the medical generalist must be three years to four. The report stated: “The com­ more widely recognised and enhanced. plexity of the GP role, especially for developing

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fertility treatment and human tissue, the health Up to two thirds of the department said its preferred option is to trans­ 100 trusts will not fer regulation to the Care Quality Commission and responsibility for research issues to the achieve foundation status Health Research Authority. The Care Quality Commission is the independ­ Ingrid Torjesen LONDON ent regulator of health and adult social care More than 100 NHS trusts in England have yet to providers in England, and the Health Research achieve foundation status, but up to two thirds Authority protects and promotes the interests of are unlikely to get there alone and will need to patients and the public in health research. merge, be taken over, or even close, a conference The department proposes two further options at the King’s Fund has been told. in the consultation: transferring most functions Candace Imison, deputy director of policy at to the Care Quality Commission but with a lim­ the King’s Fund, told attendees at an event on ited number, such as assessing living donors, NHS providers on 28 June that of the 248 trusts transferring to other organisations; and allowing that were originally eligible for foundation status the HFEA and HTA to retain their functions but

more than 100 have not yet attained that status. JOHNMCLEAN/SPL requiring them to deliver further savings. “Actually the FT [foundation trust] pipeline Two bodies currently regulate fertility services, a Commenting on the consultation, Peter has almost dried up. There have only been seven situation that must change, said Alison Murdoch Braude, emeritus professor of obstetrics and authorisations per year in the last two years,” she gynaecology at King’s College London, cautioned said. “And of that 100, 20 have actually declared Plans are discussed on the department’s preferred option, “IVF is a that they can’t go forward in their current state. complex and controversial area to regulate. “The NHS Trust Development Authority reck­ for regulating fertility Patients are anxious and often require specialist ons that only about a third of the current pipe­ care and human tissues advice and help in a bewildering market. It is hard line might proceed in their current form.” to see how these tasks simply can be added to the Robert Naylor, chief executive of UCL Hospitals Susan Mayor LONDON burden of the Care Quality Commission, which Foundation Trust, said that while politicians had Responsibility for regulating fertility treatment has been shown recently to be struggling with its implied that only six hospital trusts would not and use of human tissue in the UK should be existing load and found wanting so frequently.” achieve foundation status this was because of transferred to the Care Quality Commission and Alison Murdoch, head of Newcastle Fertility “political concerns about admitting to failure.” research in these areas to the Health Research Centre for Life, backs the government’s recom­ “It is pretty obvious to people like me that the Authority, the Department of Health has recom­ mendation, particularly in relation to the trans­ figure is perhaps 10 times that number,” he said. mended in a consultation published on 28 June. fer of research regulation to the HRA. Detailed A report from the National Audit Office last The consultation is part of government plans, scrutiny of research proposals is best done by autumn predicted at least 20 trusts would fail announced in July 2010, to halve the number those with appropriate experience, she said. to make foundation status by 20141—the origi­ of NHS quangos (quasi-autonomous national In relation to clinical work, she said, “Those nal deadline set by the Department of Health, governmental organisations) to save an esti­ clinics providing routine IVF treatment are now but since relaxed. It cited financial concerns as mated £180m by 2014-5 to help reach its target regulated by both the CQC and the HFEA. At a the most common barrier for trusts, with many of reducing the NHS’s administrative costs by time when we are losing nurses from frontline locked into expensive private finance initiative 45%.1 The Human Fertilisation and Embryology medical services to save money, duplication of (PFI) deals. However, it added that poor clinical Authority (HFEA) and the Human Tissue Author­ regulation cannot be justified.” quality and governance were also issues for the ity (HTA) were kept temporarily but were set to The consultation is open for responses until trusts, which provide a variety of NHS services, be abolished by April 2013. 28 September at www.dh.gov.uk/health/2012/06/ most commonly acute hospital care. After hearing arguments from organisations consultation-regulators/. Cite this as: BMJ 2012;344:e4532 to retain the two bodies that currently regulate Cite this as: BMJ 2012;344:e4499

skills of service improvement and population commissioner-provider split had introduced GPs and specialists lack understanding health, is difficult to embed in a training of only additional barriers. three years and makes the status of this career Ilora Finlay, chair of the Commission on and respect for each other, report says look weak.” G­eneralism and professor of palliative care The medical programme board, a sub­ medicine at Cardiff University, warned that the committee of Medical Education England, development of clinical commissioning groups agreed to extend GP training in April, and the might erode the relationship further. college says it will work to implement this. “It’s as if there’s some sort of magical divide, The report also warned that the relationship and I worry that the current political climate will between GPs and specialists was “eroding.” It make this worse not better,” she said. reported a lack of understanding and respect She added that it was difficult for different between GPs and specialists; reduction in the parts of the health service to integrate when the number of shared meetings; and a lack of com­ “pound sign gets in the way.” munication channels. It also said that new The report is at www.rcgp.org.uk/medicalgeneralism. incentives such as Payment by Results and the Cite this as: BMJ 2012;344:e4438

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Doctors call for further industrial BMA members reject calls to switch to neutral action in bitter pension dispute stance on assisted dying

Helen Jaques BOURNEMOUTH BMA members have rejected calls for the organi- sation to take a neutral stance on assisted dying after a tense debate at the union’s annual repre- sentative meeting in Bournemouth on 27 June. A motion stating that assisted dying is a matter for society and not for the medical profession and that the BMA should adopt a neutral position on any change in the law was rejected by a consider- able proportion of delegates at the conference. The BMA’s 2010 guidance advises doctors to avoid all actions that might be interpreted as assisting, facilitating, or encouraging a suicide attempt, including advising patients on what JOHNBEHETS/BMA NEWS New BMA chairman Mark Porter: “Doctors remain angry at the government for tearing up a pensions deal” constitutes a fatal dose of any drug and suggest- ing the option of suicide abroad.1 Helen Jaques BOURNEMOUTH the normal pension age to 68, in line with the In proposing the motion Raymond Tallis, Doctors at the BMA’s annual representative state pension age; and increase the proportion emeritus professor of geriatric medicine at the meeting have called for further industrial of salary that doctors pay into their pensions by University of Manchester and chair of Healthcare action in their dispute with the government over an average of 3.2% over three years from April Professionals for Assisted Dying, argued that the changes to the NHS pension scheme. 2012, with higher earners expected to contrib- BMA’s continued opposition to assisted dying is The association’s governing council, headed ute up to 14% of their salary to their pension. at odds with the views of the public and many by its newly elected chairman, Mark Porter, has The London acute medicine consultant Kevin in the medical profession and relegates the job deferred a decision on the next steps on indus- O’Kane told representatives at the conference in of helping the terminally ill to die to amateurs, trial action and is instead seeking an urgent Bournemouth that the government was making a “morally repugnant” position. meeting with Andrew Lansley, the health secre- these changes to support bank bailouts and to Around 80% of the public support a change tary for England, to discuss the dispute. make employing public sector staff more attrac- in the law allowing assisted dying,2 3 although Porter said, “It was clear from the debates tive to the private sector. opinion among doctors is more divided. One poll today that doctors remain angry at the govern- “Andrew Lansley isn’t content to milk the found that around two thirds (65%) of doctors ment for tearing up a pensions deal reached only cash cow: he thinks he can slaughter it and carry are against legalisation of euthanasia or physi- four years ago and that made the scheme sus- on milking, but it just doesn’t work that way,” cian assisted suicide,4 whereas a more recent tainable for the future. Our preferred option has he said. “He wants doctors to pay more, work poll of 1000 GPs commissioned by Dignity in always been to find a fairer way forward through longer, and get less—this is not fair, it’s not nec- Dying found that almost two thirds (62%) sup- negotiation, and I want to explore that with the essary, and we’re not going to take it.” port neutrality among medical organisations.5 secretary of state for health.” Further industrial He added, “We need to send out a very strong Tallis said that in opposing assisting dying action is, however, a “possibility,” he added. message to the government that we are serious “the BMA is riding roughshod over the majority Representatives at the annual meeting agreed about this. Mr Lansley: we don’t want to take of patients, expressing a paternalistic view that that the council should consider a range of industrial action, we want to talk to you. But if we thought we had put behind us.” options for further industrial action, including you continue to refuse to talk to us, and you con- Other speakers, however, argued that a doc- withdrawing from clinical commissioning, pro- tinue to pick a fight with us, we will fight back, tor’s primary responsibility is to alleviate patient viding a Christmas Day style emergency only we will fight hard, and we will fight for as long suffering rather than suggest that patients end service in hospitals, and coordinating action as it takes to get fair treatment.” their lives and that it would be impossible to with other unions. The outgoing chairman of the BMA council, ensure sufficient safeguards to guarantee no Around a third of general practices and four in Hamish Meldrum, said in his opening speech to patient was coerced into ending their life. five hospitals were affected when doctors across the conference that doctors had demonstrated Ilora Finlay, a consultant in palliative medi- the United Kingdom took industrial action for 24 “a powerful and united voice” during last week’s cine in Cardiff and crossbench member of the hours on 21 June.1 day of action but urged doctors not to rush to House of Lords, told the conference: “Neutrality On the day of action, when doctors attended repeat or escalate the industrial action.2 does not bring balance to the debate. It will tell their place of work but provided only urgent and “I am not, for one moment, suggesting that parliament we see this as an acceptable option. emergency care, around 2700 elective opera- the profession gives up on pensions, but I urge The BMA would inadvertently signal that it has tions and 18 750 outpatient appointments were all parties to think very, very carefully about the relaxed its paramount concern of public safety cancelled and rescheduled. next steps, because there has to be a resolution rather than insist that doctors should redouble The government’s changes to the NHS pen- eventually—and the longer it takes. . . the more their efforts to bring comfort to the sickest, the sion scheme will end final salary pensions in difficult it will be to reach that resolution.” dying, and to never walk away.” favour of a career average scheme; increase Cite this as: BMJ 2012;344:e4486 Cite this as: BMJ 2012;344:e4448

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