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On-Call Trainees Face £65 Fee to Rest this week MORAL INJURY page 129 • PENSIONS page 130 • GP TECHNOLOGY page 130 On-call trainees face £65 fee to rest EXCLUSIVE Junior doctors are calling predominantly a non-resident on-call Many junior doctors are forced for their contracts to stipulate they will not pattern,” she said. “The time sensitive to sleep where they can on be charged to stay overnight in hospital nature of our on-call work means that it is night shifts, or pay an average of £25 a night for a room accommodation, after an investigation usually not possible to live within a safe found one in five acute trusts in England distance. So, staying on site for on-calls is charge—some as much as £65 a night. something we expect. This issue can affect The trainees’ section of the British any doctor working a non-resident on-call Association of Urological Surgeons (BAUS) rota, not just urology.” sent freedom of information requests to She added that a trainee working a non- 213 trusts for accommodation charges for resident on-call shift once every eight days doctors working a 24 hour non-resident and paying £25 each time would spend on-call shift as part of its #DontPayToStay £1140 in a year. BAUS is calling for contract campaign. It received responses from 182 changes to make time critical specialties (93%), of which 145 had rooms available exempt from room charges. for non-resident on-calls, and 30 trusts Sheona MacLeod of Health Education (20%) charged to use them. England said, “It is essential doctors in LATEST ONLINE Charges ranged from £65 a night at St training have access to somewhere to sleep. A&E consultant whose George’s University Hospitals in London to This is something we highlighted in our wife skipped triage £9.14 at Warrington and Halton Hospitals. NHS Staff and Learners’ Mental Wellbeing and was treated at The median charge was £25 a night. Commission. It is also part of the BMA’s home is suspended Three trusts said the charges were fatigue and facilities charter, which we for a month reimbursed, and one said it waived the encourage trusts to adopt.” Congo’s fight against charge if trainees were using the room A St George’s spokeswoman said the Ebola stalls after because they were too tired to drive home. trust organised rotas to minimise the need epidemiologist is Although non-resident on-call trainees for junior doctors who live far away to stay shot dead can stay at home until they are called overnight, but when that was not possible Cancer drug into the hospital, this is not feasible in it offered a reduced rate with a local resistance needs some cases, explained Katie Chan, a accommodation provider. urgent attention, urology trainee and the founder of the Abi Rimmer, The BMJ says research chief #DontPayToStay campaign. “Urology is Cite this as: BMJ 2019;365:l1836 the bmj | 4 May 2019 127 SEVEN DAYS IN Doctors who make one-off clinical mistakes are unlikely to face full GMC inquiry The GMC is to reduce the number of full investigations into single, one-off mistakes by doctors, after its two year pilot of an inquiry process for single clinical incidents. Under the pilot a complaint or referral prompted a rapid gathering of information from sources such as medical records, responsible officers, and the doctors themselves to assess any ongoing risk to patients. Only then did the GMC decide if a full investigation was required. Of the 309 cases considered during the pilot, 202 were closed after initial inquiries without the need for a full investigation, the GMC said. Charlie Massey (left), GMC chief executive, said that although the new process would not be suitable for all complaints, it would allow the regulator to deal with concerns more quickly, reduce the impact of investigations on doctors, and better protect patients. However, he said that the GMC was still required by law to investigate any allegation that a doctor’s fitness to practise was impaired. “We continue to ask the government for legislation to give us more flexibility, and which would allow us to further improve the ways we can resolve fitness to practise concerns,” he said. Abi Rimmer, The BMJ Cite this as: BMJ 2019;365:l1829 Career development over-the-counter drugs delivered Public health Lung health Survey of non-traditional only £25.9m of savings in 2018, Opioids to carry addiction NRT combinations show working practices the government disclosed, as the warning in UK better success rates The GMC’s first comprehensive year’s total spending fell from All opioid medicines will carry a Just over 17% of people who used survey of specialty, associate £475.3m to £449.4m. Andrew message warning they can cause a nicotine patch and another type specialist, and locally employed Green, clinical and prescribing addiction, including those for of nicotine replacement therapy doctors opened on 1 May (see policy lead for the BMA’s General sale over the counter. England’s (NRT) such as gum (left) or www.gmc-uk.org) for feedback Practitioners Committee, was not health secretary, Matt Hancock, lozenges to stop smoking on working practices, workplace surprised, saying that most GPs said, “Things are not as were successful, support, and opportunities for were already prescribing sensibly bad here as in America, compared with about career development. This is before the guidance was issued. but we must act to protect 14% who used the regulator’s first dedicated people from the darker side to only one type of survey of the 45 000 UK doctors Athletics painkillers.” From 2008 to 2018 NRT, a Cochrane review working outside traditional End unethical rules on the number of opioids dispensed found. Higher dose nicotine training routes, which will classifying women—WMA in the community increased by gum (containing 4 mg nicotine) include questions on bullying, Doctors should have no more than 60% from 14 million to also worked better than lower undermining, and burnout. part in implementing new 23 million, while codeine related doses. Although higher dose eligibility regulations requiring deaths in England and Wales nicotine patches (25 mg or 21 mg General practice female athletes with specific more than doubled. nicotine) probably increase quit Record numbers enter differences in sex development rates, said the reviewers, more GP specialty training to medically cut their natural Cosmetic clinics to assess evidence was needed. Recruitment to GP specialty blood testosterone, said the patients’ suitability training was the highest ever for World Medical Association. The The Joint Council for Cosmetic Lung cancer is missed in this time of year: 2598 trainees regulations were introduced Practitioners is to train its “never” smokers were accepted on courses, up last year by the International members to spot mental ill Some 6000 people in the UK who from 2533 in the same period Association of Athletics health in clients and refer them have never smoked die of lung last year, showed figures from Federations after a South to NHS services. Stephen Powis, cancer a year—about a sixth of Health Education England. The African runner, Caster Semenya NHS national medical all such deaths, doctors wrote in GP specialty training fill rate for (right), had to undergo gender director, said the checks the Journal of the Royal Society of round 1A is up 2% on last year verification testing to confirm were a “major step” in Medicine. Secondhand smoke, and, if the trend continues, HEE is her eligibility for women’s improving the duty of care occupational carcinogens, on course to meet its 3250 target. events. The Court of companies show to pollution, x rays, and radon Arbitration for Sport clients. But he exposure were largely to blame. Drive to curb OTC is due to issue warned not But recognising cases could be prescribing falls short a decision all clinics difficult, they warned, especially A major policy push by NHS on the were for GPs who must balance England to save £100m a year IAAF rules council over-investigation with early by curbing GPs’ prescribing of next week. members. diagnosis. 128 4 May 2019 | the bmj SIXTY SECONDS MEDICINE ON . Children should be Child health kept active from the MORAL INJURY WHO advises physical age of 1, says WHO activity from age 1 THAT SOUNDS . PAINFUL? Young children should engage It could be. The term was originally used to in at least 180 minutes of describe soldiers’ responses to their actions physical activity a day from in war. It’s now used in the US to describe age 1 to improve their health, what we would call burnout in the UK. the World Health Organization IT DOES SOUND LIKE AN AMERICANISM recommended. New guidelines The term was first used in a medical context for children under 5 also by US based psychiatrist Wendy Dean. recommend no sedentary screen Andrew Goddard (below), Royal College of time for children under 2 and a Physicians’ president, has suggested it could limit of one hour a day for children also be used in the UK instead of “burnout.” aged 2-4. It recommends 14-17 WHAT EXACTLY IS BURNOUT ANYWAY? hours of good quality sleep a day at age 0-3 months, 12-16 hours at Depression The RCP defines it as “a syndrome of emotional exhaustion, involving the 4-11 months, 11-14 hours at age Guided self led or group ASSISTED development of negative self concepts, 1-2, and 10-13 hours at age 3-4. CBT is effective negative job attitudes, and a loss of concern A meta-analysis of 155 DEATH and feeling for patients.” Scotland randomised clinical trials of CMO promotes more cognitive behavioural therapy In the first 10 IS IT COMMON? personalised care (CBT), reported in JAMA months of 2018, It would seem so.
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