UK Consultants Conference Wednesday 28 February 2018 #consultantsconf. British Medical Association bma.org.uk

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1 UK Consultants Conference 2018 Wednesday 28 February 2018 #consultantsconf British Medical Association bma.org.uk

2 British Medical Association UK Consultants Conference 2018

3 Agenda 1 UK Consultants Conference 2018 Agenda To be held on Wednesday 28 February 2018 At BMA House, London, WC1H 9JP Chair Dr Stephen Austin Deputy Chair Dr Anil Jain Conference Agenda Committee Dr Philip Banfield Dr Helen Fidler Dr Rajeev Gupta Dr Robert Harwood Mr Derek Machin Dr Kevin O Kane Dr Anne Thorpe Dr Gary Wannan

4 2 British Medical Association UK Consultants Conference 2018 A brief guide to the 2018 Consultants Conference Function of conference The primary purpose of the Consultants Conference is to provide policies for the Consultants Committee (CC) to take forward over the coming year. Agenda outline The conference agenda outlines the schedule for the day, with the morning session comprised of motions for debate, a keynote address by the chair of the committee and a guest speaker followed by a Q&A session. The afternoon is comprised of workshops and further debates. Motions are received from a number of constituent bodies such as medical staff committees (MSCs) regional consultants committees (RCCs) and from the subcommittees of the CC. In addition, motions from other BMA conferences are sometimes transferred to the Consultants Conference for consideration if they are directly relevant to consultants. The deadline for receipt of motions was 12pm on 19 January What is a motion? A motion is a proposal for action or statement of opinion which, if passed, becomes CC policy. How are the motions organised? A number motions are received each year from our constituent bodies. These are grouped and prioritised for debate by the conference agenda committee. This year a number of key topics were identified for debate and the majority of motions are based around these areas. In the agenda, each new topic appears in bold with the time allocation alongside. Similar motions on a specific element of that topic are grouped in a bracket (appearing as a thick black line to the left) with only the starred motion being debated and voted on. As such, the starred motion is the only motion that has the potential to become policy. Any constituent is able to speak in a debate although the chair will usually give priority to speakers from constituencies with motions within the bracket. Greyed out motions signify motions that are unlikely to be reached for debate. You may object to the choice of starred motions either because you do not agree with what the motion is proposing or you feel that another motion within that bracket would be preferable. In such instances, you are able to suggest changes to the bracketing/starring. These must be received by noon on Friday 23 February In addition, conference can vote to prioritise three further motions for debate. A ballot paper for this purpose is issued with the agenda. Types of motion A motions prefixed with A are in line with accepted BMA policy and are therefore not debated. P motions prefixed with P are motions which are to be given priority. They are debated with a short opening speech from the proposer of the motion and then the debate is opened out to the entire conference with speakers being able to speak for a maximum of one minute each at open microphones positioned around the hall. At the conclusion of the debate, the motion is voted on in the usual manner. Topical motions consider issues which have arisen since the deadline for receipt of motions and which could not have reasonably been considered before that date. If you wish to submit a topical motion, the deadline is noon on 27 February Revision of the agenda post-publication Amendments to the motions on the agenda must be submitted to the agenda committee by noon on Friday 24 February. You can do this by ing info.cc@bma.org.uk. An updated Supplementary Agenda will be issued on the day of conference. The agenda committee continues in session through conference to help and guide you through the day and to advise and provide the chair with a list of speakers for each debate. Withdrawn motions or minor clarification on the day must be in writing for approval by conference.

5 Agenda 3 How is the debate conducted? In order to take part in a debate you will need to complete a speaker s slip (with the exception of P motions see above). These are provided in the conference packs. You should complete the speaker slip as appropriate; indicating whether you are the proposer, speaking for or against, and if you have any particular expertise in the area of debate. Hand in your speaker slips for the motions you would like to speak on to the agenda committee table. Please note that filling out a speaker slip does not mean that you are obliged to speak. You may decide not to speak when the time comes and in such cases it is possible to pass when you are called. The agenda committee will provide a list of speakers for the chair. The conference chair balances debate by calling speakers both for and against. The proposer speaks up to three minutes whilst other speakers have two minutes. The chair of CC then has the opportunity to respond to the debate. The proposer has the right to reply to the debate in up to two minutes. However, no new points may be made in the reply. To help move the debate along, proposers may be asked to waive the right of reply. (a) Proposing a motion: Move to the waiting area near to the podium as your motion s time approaches in order to minimise delay. Try to communicate your point as briefly as possible; the debate is time-limited. It is useful to back your point up with supporting evidence in order to communicate your message as effectively as possible. Avoid defamation. We would like to remind all representatives and members of conference that this is a public arena and they are prohibited from making any allegations and/or statements direct or indirect, towards any individual or organisation or any other entity which could give rise to a claim in defamation. In the event that any comments made give rise to any such claim or result in damages or any other costs to any third party then the member or representative making the comment will be deemed to take sole responsibility and liability in respect of the consequences. Having proposed a motion, listen to and note the debate as you may wish to reply before the vote to the points raised. If there are concerns from other speakers about parts of your motion, consider taking your motion as a reference to the CC to see if a part of it can be enacted. (b) Speaking for or against If you are called to speak for or against a motion, the chair will call for you to approach the podium. You will be given two minutes to speak on the points that the proposer has raised, or the motion as a whole. Debate ends when time runs out or a call of vote be taken, or to pass to next business is agreed. A vote is taken on the motion, normally by a show of hands or voting cards. Motions that have more than one part may be voted on separately. The chair may order that a count be made. The chair has a casting vote if necessary. Most decisions are made upon a simple majority. Some motions however required a two-thirds majority such as: rescinding a resolution of conference, proceed to the next business, vote be taken, Standing Orders be suspended, or if substantial expenditure of the Association s funds be incurred. The chair can rule that if a motion is carried linked subsequent motions are either covered or fall. After motions have been passed, they are referred to the CC for consideration and action. Some can also be referred to the BMA s annual representative meeting for further debate. New attendees Before the start of the conference, there will be an introductory session for new representatives to outline the format of the day, set out how the conference works and to answer any questions. NOTES Under standing order 7, in this agenda are printed all notices of motions for the annual conference received up to noon on 19 January Although 19 January was the last date for receipt of motions, any RCC, MSC or member of the conference, has the right to propose an amendment to a motion appearing in this agenda, and such amendments should be sent to the secretariat by noon on Friday 23 February 2018 prior to the conference (info.cc@bma.org.uk). The agenda committee has acted in accordance with standing order 17 to prepare the agenda, grouping together motions or amendments, which cover substantially the same ground and marking with an asterisk in the agenda, or forming a composite motion or amendment, on which it proposes that discussion should take place.

6 4 British Medical Association UK Consultants Conference 2018 The committee has identified the most important topics in the agenda and selected for priority in debate an appropriate number of motions or amendments on those topics that it deems to be of outstanding importance. Representatives are also able to indicate motions (other than those already scheduled to be discussed) which they would like to see given preference for debate during the meeting. Ballots for chosen motions will be included in your delegate pack on the day. The ballot closes at 11am on Wednesday 28 February.

7 Agenda 5 Schedule of business Wednesday 28 February 2018 Time Motions Preliminaries Report by the Chair of the Consultants Committee NHS Funding Crisis Healthcare policy and commissioning Workforce Speaker Questions and answers session Quality and patient safety Lunch Workshop Sessions Workshop Sessions Regulation Pay and pensions Terms and conditions of service Mental health BMA structure and function Chosen and topical motions Other motions A motions Any other business Close

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9 Agenda 7 RETURN OF REPRESENTATIVES Return of members attending the conference (CAC 19, to be tabled). MINUTES 2 Minutes of the last conference held on 1 March 2017 (CAC 20, enclosed herewith). REPORT OF THE AGENDA COMMITTEE 3 (i) That the agenda committee is charged under standing order 17 with recommending the order of the agenda and selecting for priority in debate an appropriate number of motions or amendments on those topics which it deems to be of outstanding importance; (ii) That in accordance with standing orders 16 and 17, the conference agenda committee, having considered those resolutions due to lapse as policy, recommends the following continue to be policy (CAC 21, herewith). REPORT FROM THE CHAIR OF THE CONSULTANTS COMMITTEE Report from Dr Rob Harwood, acting chair of the Consultants Committee. NHS FUNDING CRISIS P 5 H1125 Motion BY CONFERENCE AGENDA COMMITTEE That this conference recognises that the NHS winter crisis is predictable and is precipitated by underfunding and understaffing and calls upon government to: i. recognise and apologise for the lack of planning for the current crisis which has led to cancellation of tens of thousands of operations ii. cease wilfully misrepresenting data on the NHS iii. put in place proper annual plans for future seasonal variations in health and social care demand in order to avoid the drastic measures of cancelling elective operations iv. provide an immediate cash injection and subsequently fund the NHS to the European average spend per capita. 6 H1120 Motion BY CC EMERGENCY MEDICINE SPECIALTY That this conference asks the BMA to continue to highlight the current crisis in the NHS, the worst crisis that the NHS has ever experienced, which is no longer a winter crisis but a crisis which has detrimental effects on patients, families and NHS staff all year long and one which the government has failed to fully acknowledge, mitigate or develop an adequately resourced strategy to prevent the collapse of the NHS. 7 H1026 Motion BY NORTH WEST RCC That this conference notes that winter is predictable, the winter crisis is predictable and the inept and inadequate response of the Secretary of State for Health and Prime Minister is also predictable. We ask the BMA to demand proper annualised planning from NHS England for future seasonal variations in health and social care demands without the government resorting to drastic measures such as cancellation of elective operations. 8 H1105 Motion BY CC ORTHOPAEDICS SPECIALTY That this conference recognizes that seasonal centrally dictated embargos which limit elective surgery at certain times of year are particularly damaging to the training of Orthopaedic surgeons. It asks of BMA through HEE to ensure that no trainee will be disadvantaged as a consequence.

10 8 British Medical Association UK Consultants Conference H1057 Motion BY LONDON SOUTH RCC This conference recognises that the NHS in England is in a crisis precipitated by underfunding and understaffing. We condemn the Prime Minister s insouciance about the problem and her continuing support for the Secretary of State Jeremy Hunt. We call upon the government to: i. Recognise and apologise for their lack of planning which has plunged the NHS into acute crisis, including cancelling 55,000 operations. ii. Provide an immediate cash injection and subsequently fund the NHS to the European average spend per capita and iii. Sack the Secretary of State for Health. 10 H1072 Motion BY NORTH WEST LONDON RCC That this conference believes that: i. the Prime Minister denying that the NHS is in crisis is an Emperor s new clothes situation and that the government wilfully misrepresents data ii. the cancellation of tens of thousands of operations and the delays for patients attending Emergency Departments are unacceptable We urge the government to acknowledge and correct the funding deficit for health and social care. 11 H1055 Motion BY LONDON SOUTH RCC This meeting opposes the proposition of the Naylor report that NHS land and property be sold off to the private sector and calls upon regional councils to oppose local instances where this is proposed, including working with local campaigns. 12 H1047 Motion BY LONDON SOUTH RCC This Conference calls upon Council to lobby for the removal of VAT from medical products. 13 H1103 Motion BY CC ORTHOPAEDICS SPECIALTY That this conference asks the BMA to work with Medical Royal Colleges and Surgical Specialty Associations to support [Orthopaedic] Surgical Services for our patients by calling jointly for a better funded NHS and better funded social care. 14 H1119 Motion BY CC EMERGENCY MEDICINE SPECIALTY That this conference asks the Secretary of State for Health & Social Care to acknowledge that, in the depth of the worst ever crisis to be faced by the NHS, the emergency care system is being sustained in the face of extraordinary adversity by the extreme efforts of frontline emergency department staff, including consultants in emergency medicine and those in other acute specialties, sometimes at the cost of consultants physical and mental health. This conference: i. recognises that the extreme efforts of frontline consultants are unsustainable ii. demands that the Secretary of State for Health & Social Care takes immediate action to mitigate the damaging effects of working conditions in emergency departments on consultants and other healthcare workers iii. demands that the government develop an adequately funded policy for health & social care delivery that will prevent this crisis from destroying our NHS

11 Agenda 9 HEALTHCARE POLICY AND COMMISSIONING * 15 H1008 Motion BY NORTH WEST RCC That this conference rejects the precept behind policies such as Procedures of Low Clinical Value as currently deployed by commissioners. This conference believes that such policies serve no purpose other than to ration demand for popular surgical interventions, and sit in direct conflict with Good Medical Practice. It asks the BMA to confirm that such policies need not be recognized or executed by clinicians in the course of their direct clinical or supportive professional practice and that it will support members who may have been sanctioned by doing so. 16 H1102 Motion BY CC ORTHOPAEDICS SPECIALTY That this conference asks the BMA to work with Medical Royal Colleges and Surgical Specialty Associations to challenge NHS bodies which unfairly deny or delay access to [Orthopaedic] Surgical Services for our patients 17 H1104 Motion BY CC ORTHOPAEDICS SPECIALTY That this conference agrees with the President of the BOA that the re-categorization of Hip and Knee Arthroplasty as a procedure of limited clinical value, such as happened in Derbyshire, is unjustified. It asks the BMA to work with the BOA, prevailing on NHS England to instruct commissioners and Trusts in Derbyshire and elsewhere to abandon that position. * 18 H1127 Motion BY CONFERENCE AGENDA COMMITTEE This conference notes: NHS England s planned substantial reform of services through ACOs (Accountable Care Organisations); ACOs vulnerability to private tender; and the lack of consultant engagement in their planning. This conference therefore asks that: i. The BMA opposes any further privatisation of services through the introduction of ACOs. ii. The BMA lobbies for a system similar to Scottish Health Boards (responsible for protecting and improving a population s health and publicly delivering medical care) to be introduced in England. iii. The Health Secretary issues a directive to ACOs to engage front line clinicians, including consultants and GPs, in designing patient-focussed care. iv. The BMA oppose the introduction of ACOs unless legally ring-fenced from privatisation. 19 H1083 Motion BY YORKSHIRE RCC That this conference condemns the act of STPs and ACSs not engaging hospital consultants for planning the patient care in the region. We call upon the health secretary and the government to issue directive to the accountable care Organisations to engage the front line clinicians including the consultants and GPs to design the best care for the patients. 20 H1023 Motion BY NORTH WEST RCC That this conference is concerned that the government has launched another substantial reform of the NHS through Accountable Care Organisations and asks the BMA to challenge this by any and all means. 21 H1056 Motion BY LONDON SOUTH RCC This conference notes that Accountable Care Organisations are currently vulnerable to bids from the private sector thus opening the NHS in England & Wales to potential large scale privatisation. We call upon Council to take all necessary steps to oppose their introduction.

12 10 British Medical Association UK Consultants Conference H1062 Motion BY LONDON SOUTH RCC This Conference notes that Scotland has abandoned the internal market in health care and has introduced regional NHS Boards responsible for protecting & improving the population s health and for the delivery of medical care. We call upon Council to lobby for a similar, NHS-delivered approach in England and Wales and for rejection of the ACO model unless it is legally ring-fenced from privatisation. 23 H1067 Motion BY LONDON SOUTH RCC This Conference recognises that Scotland is not subject to the Health & Social Care Act (2012), has health boards which are responsible for protecting and improving the population s health and for publicly delivering health care. We call upon Council to lobby for such health boards in England and Wales rather than Accountable Care Organisations (ACOs) & to actively oppose the introduction of ACOs. 24 H1010 Motion BY NORTH WEST RCC That this conference notes that consolidation of elective surgical services is a common theme in most transformation plans and accountable care initiatives, and is concerned that this coincidence is fiscally driven rather than quality driven. This conference asks the BMA to make clear to NHSE that it should block consolidation proposals wherever: i. quality of service is not substantially improved ii. access to service is degraded iii. Asks the BMA to demand that NHS England should approve consolidation proposals only where it will improve quality of services and access to services 25 H1027 Motion BY NORTH WEST RCC That this conference considers that the crisis in NHS funding cannot be resolved by creating super Trusts which only serve to produce super debts and are a recipe for super failures in the future. We demand a halt to senseless mergers and acquisitions until independently verified evidence is obtained of their effectiveness and efficiency. 26 H1106 Motion BY CC ORTHOPAEDICS SPECIALTY That this conference notes that Get It Right First Time considers the ring-fencing of elective [Orthopaedic] surgical beds as best practice. It will therefore ask the BMA to lobby NHSE for an increase in overall bed-stock that reflects that fact. 27 H1002 Motion BY OXFORD RCC That this conference believes that people in immigration centres of any type should have equal access to physical and mental health care as the general population. 28 H1052 Motion BY LONDON SOUTH RCC This Conference notes with concern recent restrictions on overseas visitors and illegal immigrants and their access to NHS treatment. In particular, we are concerned about the potential implications for homeless people immigrants and their ability to access medical care. We call on the BMA to ensure that adequate safeguards are in place to ensure that homeless people, irrespective of their immigration status, can access emergency care and the necessary follow-up resulting from the acute episode. 29 H1070 Motion BY NORTH WEST LONDON RCC That this conference notes that: i. the collapse of Carillion is far from the first and will not be the last of disastrous outcomes for outsourcing public sector work ii. such outsourcing does not transfer risk away from the tax payer quite the opposite. We urge the government to halt the tendering out of big government contracts and think again.

13 Agenda H1073 Motion BY NORTH WEST LONDON RCC That this conference welcomes the recent report from the National Audit Office that supports the BMA s position on the use of Private Finance Initiatives in the National Health Service, in which the auditors found that the cost of privately financing public projects can be over 40% higher than government borrowing and that in the last year alone, the cost to the taxpayer was over 10 billion. Private finance initiatives should be abandoned in favour of better value public funding. 31 H1012 Motion BY NORTH WEST RCC That this conference notes with concern the introduction of minimum waiting times by at least two NHS Trusts and asks the BMA to insist that NHS England makes clear its position and that it will instructing those Trusts and their commissioners to desist. 32 H1022 Motion BY NORTH WEST RCC That this conference believes that the health service is now in state of wilful neglect by the government and asks that the BMA organises an action day on the anniversary of the birth of the NHS involving all interested parties and unions. 33 H1028 Motion BY NORTH WEST RCC That this conference believes that the crisis in the NHS would be lessened if there were greater emphasis and awareness of prevention of disease by nonmedical means rather than over reliance on prescription drugs. WORKFORCE * 34 H1123 Motion BY CONFERENCE AGENDA COMMITTEE This conference i. acknowledges the value to patients of drawing high quality non-medical graduates into the NHS, ii. believes that training of Physician s Associates must not reduce the training available to junior doctors. iii. asks the BMA to work closely with the relevant Royal Colleges, educational institutions and regulatory bodies to ensure that Physicians Associates and similar roles support doctors. 35 H1013 Motion BY NORTH WEST RCC That this conference i. acknowledges that balanced initiatives to draw high quality non-medical graduates into the NHS as carers has considerable potential to benefit patients. ii. asks the BMA to liaise tightly with the Royal Colleges to ensure that the introduction of non-medical graduates into Physician Associate roles improves the working lives of doctors in all branches of practice. 36 H1045 Motion BY EASTERN RCC That this conference believes that Physicians Assistants can be a useful addition to the clinical workforce but should never be employed at the expense of the training of Junior Doctors. 37 H1080 Motion BY NORTH WEST LONDON RCC That this conference notes that junior doctors are the next generation of consultants and vital to providing a safe and effective NHS now and in the future. Whilst welcoming the work that MAPs (Medical Associate Professionals) can bring to teams, junior doctors should not be denied training opportunities nor training places shrunk. We therefore request that the BMA continues to advocates for juniors, and ensure that the high standards of medical registration, including at CCST level, are maintained.

14 12 British Medical Association UK Consultants Conference H1066 Motion BY LONDON SOUTH RCC This conference recognises the success of the Junior Doctors Committee Less Than Full Time Forum and asks that a similar initiative be considered for Less Than Full Time Consultants. * 39 H1107 Motion BY SCOTTISH CONSULTANTS COMMITTEE This conference regrets the failure of the Scottish Government to act meaningfully to address the consultant vacancy crisis in Scottish hospitals and calls upon the Scottish Government to return to valuing its doctors. 40 H1109 Motion BY SCOTTISH CONSULTANTS COMMITTEE This conference regrets the failure of the NHS Orkney and NHS Shetland Health Boards to effectively succession plan services for their populations and calls on the Scottish Government to commit to equitable consultant delivered services for the people of the Northern Isles. 41 H1074 Motion BY TRENT RCC That this conference insists that NHS organisations are not disadvantaged against Private and Independent Sector units and are permitted address their considerable recruitment gaps on a level playing field by i. the removal of the cap on locum payments only applying to NHS organisations ii. the removal of the restrictions on retired staff returning to work in NHS organisations 42 H1081 Motion BY YORKSHIRE RCC That this conference recognises the detrimental impact of Government s Locum cap policy on the supply of doctors and resulting negative impact on the doctors morale and the quality of care. The consultants are often asked to cover the gaps of junior rota resulting into stress and poor morale. The policy is has particular detriment in geographic areas and specialities where recruitment and retention is an ongoing challenge. We call on the Health Secretary to reverse the ill-considered decision resulting into adverse impact on patient services and patient safety. 43 H1085 Motion BY NORTHERN IRELAND CONSULTANTS COMMITTEE That this conference abhors the need for use of outsourcing and private sectors to fill the ever-increasing shortages of consultant radiologists, not only in NI, but throughout the UK. We call on the Health Minister, when appointed, to rapidly increase the number of trainee radiologists to meet demand, especially with the spiralling need from specialist cancer services so that the HSC can appropriately respond to patients needs for imaging. 44 H1048 Motion BY LONDON SOUTH RCC Following the recent report of the Royal Medical Benevolent Fund showing that two thirds of doctors would not recommend a future in medicine to their children, this conference believes that Medicine is now a poor career choice in the UK. 45 H1051 Motion BY LONDON SOUTH RCC This conference calls upon the BMA to facilitate communication skills courses helping overseas doctors integrate into the NHS and wider culture. 46 H1087 Motion BY NORTHERN IRELAND CONSULTANTS COMMITTEE That this conference is appalled that 73% of consultants in Northern Ireland have stated their morale is either low or very low and call on DOH NI to identify and address the causes immediately.

15 Agenda H1032 Motion BY NORTH WEST RCC That this conference asks the BMA through the DH and NHSE to seek to better retain older doctors as many such doctors have considerable contributions to make to NHS clinical activity, teaching, research and leadership at a time when services are under great stress. However currently many such older doctors are increasingly retiring from GP and secondary care for a variety of reasons. KEYNOTE SPEECH Presentation from Mr Martin Bromiley QUESTIONS AND ANSWERS SESSION QUALITY AND PATIENT SAFETY P 48 H1126 Motion BY CONFERENCE AGENDA COMMITTEE That this conference believes that most errors in medical practice ultimately are due to failures in the complex systems of healthcare itself and therefore calls for: i. government to stop blaming doctors for error resulting from system failures ii. government to support the no blame culture required to ensure that all errors are raised to allow systems to be changed to improve safety for patients. iii. establishment of anonymous reporting systems for concerns about patient safety iv. appointment of Freedom to Speak Up Guardians as recommended in the Francis Report. 49 H1099 Motion BY NORTHERN IRELAND CONSULTANTS COMMITTEE That this conference believes that most errors in the medical care ultimately are due to failures in the complex systems of healthcare itself and therefore calls on the government and GMC to stop blaming doctors for errors but instead support the no blame culture required to ensure that all errors are raised so that systems can be changed to improve safety for patients. 50 H1059 Motion BY LONDON SOUTH RCC This conference recognises that workload now routinely outstrips medical staffing in many parts of the NHS. There are significant systemic safety concerns & staff are sometimes held individually accountable for systems failures. We call upon Council to: i. Establish an anonymous reporting system for NHS staff concerned about systemic failures in patient safety ii. Liaise with the GMC about protection of medical staff from being held accountable for systems failures iii. Takes legal advice and initiates discussions with appropriate ministers about protecting doctors. 51 H1064 Motion BY LONDON SOUTH RCC That this conference is concerned that there is a collective failure to act upon the recommendations of the Frances report. We recognise that the appointment of Freedom to Speak Up Guardians (whistleblowing) is pivotal in these recommendations. We demand that Member Relations i. Determine how many Trusts have these in place ii. Report how many Trusts have a whistleblowing policy or have taken the BMA guidance as policy iii. Investigate local awareness of the availability of Freedom to Speak Up Guardians, when in place.

16 14 British Medical Association UK Consultants Conference H1098 Motion BY NORTHERN IRELAND CONSULTANTS COMMITTEE That this conference believes that, as patient safety is paramount, there should be a no blame culture in the NHS. 53 H1101 Motion BY NORTHERN IRELAND CONSULTANTS COMMITTEE That this conference believes that, to make real changes in the quality and safety of patient care, it is essential that there is more focus and importance attached patient outcomes and that this is actively supported using robust data collection. 54 H1100 Motion BY NORTHERN IRELAND CONSULTANTS COMMITTEE That this conference believes that the BMA must take a bigger role in patient safety and provide leadership in this vital area as a champion of patient safety. 55 H1009 Motion BY NORTH WEST RCC That this conference i. supports the Getting It Right First Time [GIRFT] initiative to reduce variation and improve quality as long as quality considerations sit above financial considerations. ii. recommends to NHS England that money realised within the NHS through GIRFT should be put directly into further NHS quality initiatives. LUNCH Lunch will be in available in the Snow and Paget rooms WORKSHOP SESSIONS REGULATION P 56 H1128 Motion BY CONFERENCE AGENDA COMMITTEE That this conference notes that recent high profile cases highlight that doctors can be held personally responsible for system failures and face multiple jeopardy in terms of legal proceedings and i. insists that individual doctors must not be held accountable for systems failures ii. believes there must be a genuine no blame culture iii. insists that when there are systems failures, legal proceedings should not be considered against doctors Calls on Council to demand creation of an urgent task and finish group with the, BMA, the Academy of the Royal Colleges, the Department of Health and the GMC to consider the future of professional regulation. 57 H1029 Motion BY NORTH WEST RCC That this conference believes that the recent case of the paediatric senior trainee Dr Hadiza Bawa-Garba illustrates that overworked and overstretched trainees do not get proportionate justice. We ask the BMA to mount an awareness campaign that regulators no longer allow for grace and favour work and so all medical practitioners must adhere to agreed duties and job plans.

17 Agenda H1113 Motion BY MERSEY RCC That this conference notes a trend of increasing requirements for evidence to be available for electronically driven appraisals. The production of such evidence consumes vast amounts of time, that may be better used for patient care. This conference: i. Demands that the GMC produces objective evidence that appraisal and revalidation have resulted in improvements in clinical practice sufficient to justify the expense, time pressure, stress and loss of practising doctors that it causes. ii. If there is insufficient evidence of significant improvement in clinical practice then the process of revalidation should be re-evaluated with a view to it being discontinued. 59 H1112 Motion BY MERSEY RCC This conference is concerned by the burden of mandatory training and requests that the BMA enters into negotiations with the relevant Departments of Health to define the requirements and frequency of mandatory training. 60 H1042 Motion BY EASTERN RCC That this conference believes that, while NHS managers, unlike doctors, have no regulatory body the CQC should exercise its power to order a change in management and remove managerial staff whose actions put patients at risk or cause patient harm. Such powers should be enhanced to prevent the re-employment of those managerial staff, for a defined period of time, in another role at any organisation undertaking NHS work. 61 H1043 Motion BY EASTERN RCC That this conference believes that NHS trusts should be obliged to report to the CQC any cases where patients or staff have been put at risk that have been brought to light by whistleblowing. 62 H1044 Motion BY EASTERN RCC That this conference believes that the CQC should review all whistleblowing reports within a trust as part of its review of that trust. All such reports should be signed off by the CQC as being reviewed and that adequate action has been taken by the trust to mitigate the issue that was highlighted. 63 H1108 Motion BY SCOTTISH CONSULTANTS COMMITTEE This conference condemns any effort to diminish the value of a CCT by the introduction of credentialing. PAY AND PENSIONS H1050 Motion BY LONDON SOUTH RCC This conference calls upon the BMA to lobby for the Doctors London Weighting Allowance to be updated and held in line with London house prices. 65 H1071 Motion BY NORTH WEST LONDON RCC That this conference i. notes that the Treasury has recently increased the pay threshold for senior NHS managers above which Trusts have to seek approval from 142,500 to 150,00, an increase of over 5% ii. contrasts this with the restraint applied to the salaries of NHS clinical staff iii. believes that this approach contributes to the difficulties in recruitment and retention that the service is facing It is time that the government recognised the value of clinical staff.

18 16 British Medical Association UK Consultants Conference 2018 TERMS AND CONDITIONS OF SERVICE * 66 H1049 Motion BY LONDON SOUTH RCC This conference calls upon the Consultants Committee to withdraw from the current consultants contract negotiations. 67 H1020 Motion BY NORTH WEST RCC That this conference questions the wisdom of a new contract of employment which not only fails to increase the overall pay envelope for consultants, but also makes them pay the cost of implementing it. * 68 H1115 Motion BY LEWISHAM AND GREENWICH LNC This conference notes the importance of workable job plans, and notes that in the 2017 BMA National Consultant Survey 40% of consultants felt their workload had a negative effect on patient care, with 60% reporting low morale. A local Trust survey has shown that 40% of consultants dread job planning and find it combative with high rates of bullying during such meetings. Conference asks that i. Local surveys are conducted widely to find out how common bullying of consultants is during job planning ii. Trusts with a high rate of bullying are advised to suspend job planning for the safety of their consultant body iii. Such Trusts should not recommence job planning until training has been put in place for those leading job plan meetings, and that this should be run with support from the BMA. 69 H1016 Motion BY NORTH WEST RCC That this conference notes that new consultants have been appointed and commenced in post in both Manchester and Liverpool without a proper job plan, and in some cases have continued in post for many months in this way. We believe that this practice should stop and that the BMA must agree with NHS Employers a time limit for new appointees working to indicative job plans to be converted to substantive job plans 70 H1111 Motion BY MERSEY RCC That this Conference is concerned that the use of electronic systems for job planning is being abused by some employers by the addition of constraints preventing some work being recorded. This conference requests that the BMA: i. works with NHS Employers and LNCs to prevent trusts introducing constraints within e-job planning ii. produces clear guidance on e-job planning iii. advises consultants to keep their own job plan diaries and rejects any downgrading of PA allocation that may result from entering this into an e-job planning system 71 H1084 Motion BY YORKSHIRE RCC That this conference deplores the decision of some NHS Trusts not doing Clinical Excellence Awards round and recommend that NHS England should send directive to such NHS Trusts to do a catch up round and allow the consultants to receive their due awards. 72 H1114 Motion BY EASTERN RCC This conference believes that all NHS Trusts should be mandated to run annual Local CEA rounds and award all of the agreed funding for those awards so as to reward consultants for the excellent work they do. 73 H1116 Motion BY CC EMERGENCY MEDICINE SPECIALTY That this conference requires the BMA to develop the concept of sustainable consultant working into policies which ensure that the interests of those consultants who continue to work the most antisocial hours (including emergency medicine consultants) are at the forefront of any further contractual negotiations with: i. NHS England or NHS Employers ii. any future negotiations with NHS bodies in the devolved nations.

19 Agenda H1118 Motion BY CC EMERGENCY MEDICINE SPECIALTY That this conference recognises that some consultant working patterns, particularly those commonly worked by emergency medicine consultants such as full shift 24 hour rotas, become increasingly difficult to sustain in the latter part of a typical consultant career. This conference asks the BMA to: i. Support the view that it is unreasonable to expect consultants over the age of 50 to work resident night shifts in hospitals ii. Ensure that this issue is taken into account during any further or future contractual negotiations with national NHS bodies in the UK iii. Ensure that this issue forms part of any workforce planning publications or lobbying or negotiations with national NHS bodies or the governments of the UK 75 H1076 Motion BY CC ANAESTHETICS SPECIALTY That this conference considers doctors fatigue must be addressed by i. educating all doctors who do night work about the importance of managing their own fatigue. ii. requiring all employers who have doctors working overnight shifts to provide a quiet dark private place for each doctor to have a power nap during their shift. iii. requiring all employers who have doctors working overnight shifts to provide a quiet dark private place for each doctor to sleep after their shift so they remain safe to drive home. 76 H1117 Motion BY CC EMERGENCY MEDICINE SPECIALTY That this conference recognises the detrimental effects of sleep deprivation on (amongst other healthcare workers) consultants productivity, physical and mental health and asks the BMA to move forward with work to: i. Highlight this important issue in the media by laying out the evidence ii. Demand that employers take action to recognize and mitigate these risks iii. Ensure that this issue is taken into account during any further or future contractual negotiations with national NHS bodies in the UK. 77 H1068 Motion BY LONDON NORTH EAST RCC The much delayed position of Medical Examiner (ME) in Cause of Death will most likely commence in April 2019 in England and Wales. It is expected that the 800+ doctors from all branches of practice will be employed by Local Authorities. In order to ensure that these posts are fit for purpose this conference: i. Calls for the BMA to negotiate clear, satisfactory national terms and conditions for this position with the appropriate government and local government bodies. ii. Calls on BMA to consider the mechanism for local or regional negotiations for enhancement of national terms and conditions for these positions. iii. Believes that there should be full support and involvement from the appropriate BMA secretariat and policy units iv. Believes that these new positions should be represented at appropriate local, regional and national committees of the BMA. 78 H1011 Motion BY NORTH WEST RCC That this conference notes the movement of many transformation plans toward accountable care models and the greater involvement of independent sector providers, and asks the BMA to secure clarification on the status of a nationally negotiated terms and conditions contract in those circumstances where an individual doctor s contract is transferred to a non-nhs body. 79 H1041 Motion BY EASTERN RCC That this conference believes that DBS checks should be paid for by the employer and not by the employee.

20 18 British Medical Association UK Consultants Conference H1018 Motion BY NORTH WEST RCC That this conference decries the Consultant Committee s unwillingness to test the legal status of Clinical Excellence Awards, and insists that the already initiated process is continued in court without further delay. MENTAL HEALTH * 81 H1031 Motion BY NORTH WEST RCC That this conference calls on the BMA to lobby the Department of Health to ensure that, with respect to any new mental health legislation in England and Wales: i. the Appeals and Tribunals are robust, and protects patients rights; ii. clinicians involved in Appeals and Tribunals have adequate time and resources to meet the requirements of the process; iii. adequate funding is provided in primary and secondary care for implementation. 82 H1030 Motion BY NORTH WEST RCC That this conference calls on the Department of Health to ensure that the impending review of the Mental Health Act for England and Wales is underpinned by the following principles: i. parity for mental and physical health; ii. the Responsible Clinician for any detained patient must be suitably experienced in treatment of both mental and physical disease; iii. the Act must seek to remove discriminatory elements for detained Black and Minority Ethnic patients; iv. conditions for applying Community Treatment Orders must be strengthened to prevent overuse. 83 H1001 Motion BY OXFORD RCC That this conference believes that NHS England must set out clear and measurable plans to solve the mental health workforce crisis and deliver on its 5 year forward plan. 84 H1092 Motion BY NORTHERN IRELAND CONSULTANTS COMMITTEE That this conference asks the government to put some money behind their pledge to hold mental and physical health in equal esteem, and to address the fact that mental health spending has grown at a much lower rate than that of physical health. 85 H1003 Motion BY OXFORD RCC That this conference believes that a review of talking therapy provision in specialist mental health services by NHS England is urgently required BMA STRUCTURE AND FUNCTION * 86 H1124 Motion BY CONFERENCE AGENDA COMMITTEE That this conference: i. notes the increasingly complex and less rewarding nature of NHS consultant pensions ii. notes that the Pensions Committee no longer meets iii. asks that the Pensions Committee should be reconstituted immediately iv. believes that the BMA must urgently establish an independent and appropriately staffed unit to advise members on the tax implications of pensions contributions, separate from the BMAS approved financial advisors v. believes that the BMA should produce and frequently promote additional basic pension guidance and circulate it as a member benefit.

21 Agenda H1007 Motion BY NORTH WEST RCC That this conference notes that the Pensions Committee no longer meets and i. considers that any decision to decommission the Pensions Committee to be short sighted ii. asks that the Pensions Committee should be reconstituted immediately iii. asks for additional resource for the pensions service so that they properly serve the needs of membership 88 H1021 Motion BY NORTH WEST RCC That this conference believes that the BMA must urgently establish an independent and appropriately staffed unit to advise members on the tax implications of pensions contributions, separate from the BMAS approved financial advisors and Pensions Department. 89 H1040 Motion BY EASTERN RCC That this conference believes that the BMA should produce and frequently promote additional basic pension guidance and circulate it as a member benefit. 90 H1079 Motion BY NORTH WEST LONDON RCC That this conference notes the increasingly complex and less rewarding nature of NHS consultant pensions. Whilst welcoming the advice that the BMA Pensions Department gives, we ask that the Pensions Committee be revitalised and provide guidance to the Department to extend its remit and role in assisting members. * 91 H1121 Motion BY CONFERENCE AGENDA COMMITTEE That this conference: i. asks Member Relations to check at least annually the membership of regional consultants committees, LNC forums and LNCs and to provide this information to the officers of the relevant committees ii. believes that the BMA should re-introduce annual Service Level Agreements (SLAs), for LNCs, RLNCs and RCCs to agree and sign up to, specifying the support that the BMA will provide. Such SLAs should include the six-monthly review of the members of each committee iii. believes that members of committees such as RLNCs, RCCs and LNCs should be asked on joining the committee to agree that their contact details may be disclosed to the officers of the committee who may use those details to contact them only in the pursuance of their BMA responsibilities 92 H1035 Motion BY EASTERN RCC That this conference believes that the officers of BMA committees such as RLNCs, RCCs and LNCs should be provided with an accurate list of members of their committees at six monthly intervals. 93 H1034 Motion BY NORTH WEST RCC That this conference believes that the BMA should check at no less frequently that six month intervals that it holds correct and accurate membership details for RCCs, RLNCs and LNCs. 94 H1006 Motion BY NORTH WEST RCC That this conference asks Member Relations to ratify all regional mailing lists of LNC and MSC officers on an annual basis with the Medical Directors or Work Force Directors of constituent Trusts as well as internally and with former officers. 95 H1033 Motion BY EASTERN RCC That this conference believes that the BMA should re-introduce annual Service Level Agreements (SLAs), for LNCs, RLNCs and RCCs to agree and sign up to, specifying the support that the BMA will provide. Such SLAs should include the six-monthly review of the members of each committee. 96 H1036 Motion BY EASTERN RCC That this conference believes that members of committees such as RLNCs, RCCs and LNCs should be asked on joining the committee to agree that their contact details may be disclosed to the officers of the committee who may use those details to contact them only in the pursuance of their BMA responsibilities.

22 20 British Medical Association UK Consultants Conference H1063 Motion BY LONDON SOUTH RCC That this conference reaffirms the increasing challenges facing Local Negotiating Committees and recognises that these are a vital component of the Trade Union role of the BMA. We propose that Member Relations i. provide data on the variation in facilities time across England and describe any difficulties in obtaining this for full and part time LNC members ii. produce and distribute a template letter to Trusts describing the legal position on facilities time and pursue this proactively where not acted upon iii. source and fund secretarial support to IROs attending LNC meetings iv. plan a strategy to tackle the inequalities for less than full time doctors undertaking LNC roles. 98 H1065 Motion BY LONDON SOUTH RCC That this conference recognises that Regional Consultants Committees play a vital role in engaging the local Consultant workforce yet are not always fully active. Some have inquorate meetings, are unaware of their membership list and find it difficult to recruit new members from their region. We ask that i. RCC Industrial Relations Officers should be appointed from within the region. ii. Each IRO for the region should either attend or send a report to each RCC meeting to provide an update on local activity and ensure changes in key contacts (LNC Chairs, Medical Directors etc) are up to date. iii. A newsletter should be produced from each RCC meeting and distributed to consultants within the region. 99 H1005 Motion BY NORTH WEST RCC This conference asks Member Relations on a regional basis, i. to look at all existing LNC recognition and bargaining agreements. ii. to determine whether sole negotiating status for the BMA on behalf of the medical staff bargaining unit is formally established at each Trust. iii. to request this status from Trusts formally without delay, where sole negotiating status is not established. 100 H1122 Motion BY CONFERENCE AGENDA COMMITTEE That this conference i. recognises the importance of LNCs and the need for legitimacy in representing all medical and dental staff by facilitating membership by popular vote of anyone in an appropriate staff group consultant, trainee or SAS irrespective of whether they are a member of any nationally recognised union or no union. ii. asks the BMA not to sanction LNCs who decline to expel or prohibit willing representatives who are not BMA members believes that any doctor who deals with other doctors job plans or their disciplinary matters as a manager should not be a member of the LNC. 101 H1075 Motion BY MAIDSTONE AND TUNBRIDGE WELLS LNC That this conference recognises the importance of LNCs and the need for legitimacy in representing all medical and dental staff by facilitating membership by popular vote of anyone in an appropriate staff group consultant, trainee or SAS irrespective of whether they are a member of any nationally recognised union or no union. 102 H1004 Motion BY NORTH WEST RCC This conference asks the BMA not to sanction LNCs who decline to expel or prohibit willing representatives who are not BMA members. 103 H1025 Motion BY NORTH WEST RCC That this conference believes that any doctor who deals with other doctors job plans or their disciplinary matters as a manager should not be a member of the LNC.