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Medical staff shortages in coastal areas must be tackled to help narrow stark health inequalities, England’s chief medical officer has recommended. In his annual report1 for 2021 focusing on health in coastal communities, Chris Whitty highlighted that people living in coastal areas of England have some of the worst health outcomes in the country, with low life expectancy and high rates of many major diseases. “If we do not tackle the health problems of coastal communities vigorously and systematically there will be a long tail of preventable ill health which will get worse as current populations age,” Whitty said. The report includes case …

The humanitarian charity Medecins Sans Frontieres (MSF) has condemned Brazilian authorities for their failure to control the spread of covid-19, which has led to thousands of needless deaths, caused the health system to nearly collapse, and left staff exhausted and traumatised. MSF called on the government to urgently adopt evidence based public health measures to control the disease and treatment guidelines for those infected. The refusal to act appropriately has led to “the unmitigated spread of covid-19 over the past year,” said Christos Christou, international president of MSF, and “sent far too many to an early grave.” “The federal government has all but refused to adopt evidence based comprehensive public health guidelines, leaving Brazil’s dedicated medical staff to …

Anadolu Agency/Getty Images Medical staff at Yangon General Hospital join the nationwide protest against the military coup in Myanmar. Making the three finger salute and wearing the red ribbons …

The proposed pay rise for doctors and other medical staff in England and Wales1 is not what it seems. Alongside the entire NHS workforce, I have worked hard on the covid-19 frontline, managing “the biggest challenge to face the NHS.”2 The support from the nation has been humbling and encouraging. Nevertheless, salaries remain a common metric for official expressions of …

New Zealand has a shortage of medical staff across many different fields. The Royal New Zealand College of General Practitioners published a survey this year that showed that almost half of GPs intend to retire in the next 10 years and that 70% are working in a practice with a GP vacancy. It’s little surprise that the country relies heavily on doctors from overseas. According to the Medical Council of New Zealand (MCNZ), 40% of doctors practising in the country were trained abroad—and those from the UK and Ireland are highly sought after because of their similar training. New Zealand is also a favourite destination for doctors looking for adventure, proximity to the great outdoors, and a more relaxed way of life. There is demand for junior doctors across all areas of …

For the past four years, Canada has been ranked as the best country in the world for quality of life, a measure that covers everything from housing to education and the environment. With its wide open spaces, sophisticated cities, and active lifestyle, it is a popular destination for doctors seeking new challenges abroad and a better work-life balance. Canada has an ongoing shortage of locally trained medical staff which is likely to continue for some time. Statistics Canada estimates that 4.5 million people across the country are without a family doctor and the Canadian health authorities are actively recruiting overseas doctors to fill the gaps. Nova Scotia, the Canadian province with the most acute shortage, has sent representatives from the College of Physicians and Surgeons of Nova Scotia together with provincial immigration officials to medical recruitment fairs in the UK. Canada suffers from …

Healthcare professionals need training on how to refer homeless patients treated in emergency departments to organisations that can provide them with housing, UK medical colleges and homeless charities have advised.1 The organisations were responding to the government’s call for views on implementing the Homelessness Reduction Act 2017.2 The act aimed to provide earlier support to prevent or relieve homelessness. It introduced a new duty on certain public authorities, including NHS emergency departments, to refer homeless people who use their services to a local housing authority. Andrew Goddard, president of the …

Gerada calls for better suicide prevention for medical staff . 1 The Society of Occupational Medicine’s recent report on the mental health of UK doctors notes that occupational and individual factors (such as emotional labour, personality, and coping styles) contribute to distress in doctors but that poor working conditions seem to have the strongest effect on wellbeing. …

I recently experienced a first in my career: while presenting at a conference, I shed tears. To put things in context, I was talking at a session on preventing suicide in the NHS. Before mine, we heard brilliant talks from two paramedics, an ambulance controller, and a nurse, talking from their respective fields. As they gave their presentations I found myself reflecting on the group I had run that week—one I’ve written about before in BMJ Opinion.1 It’s a group no one wants to belong to, but it’s one that’s vital for the survival of its members. This is …

We welcome the Royal College of Physicians’ statement Delivering Research for All and agree with Maben and King that the major barriers to the engagement of medical staff in research are lack of research knowledge and skills and poor access to research training.12 Such training is a fundamental skill that should form part of all specialty …

Nearly three years ago, Rimmer reported that senior doctors needed to do more to boost the morale of junior doctors.1 I am nearing the end of my first year working in medicine, and there is one frustration that I …

The World Health Organization has halted some of its activities in areas of the Democratic Republic of the Congo (DRC) affected by the Ebola virus until it can ensure the safety of medical staff and others responding to the outbreak. It said that it was working with the DRC government to review and strengthen security measures, including establishing security perimeters around staff residences and ensuring that staff comply with curfews. The moves follow the killing on 19 April of Richard Valery Mouzoko Kiboung, …

Robin Irvine Russell, an internationally recognised consultant physician and gastroenterologist, head of department of gastroenterology at the Glasgow Royal Infirmary, and honorary professor at the University of Glasgow, died peacefully at the Prince and Princess of Wales Hospice in Glasgow on 21 November 2018, aged 81 years. Born in Wishaw, Lanarkshire, on 21 December 1936, Robin became dux of Wishaw High School before graduating as a bachelor of medicine and surgery in 1960, a doctor of medicine in 1972, and a doctor of philosophy in 1976, all from the University of Glasgow. From 1966 to 1968, Robin was a member of the scientific and medical staff at the …

Most hospital doctors say that ending the decline in their pay and benefits is more important than any other issue, a survey has found. The Hospital Consultants and Specialists Association (HCSA) surveyed its members late last year and received responses from 975—about a quarter of members. Of 940 hospital doctors who responded to the question “Which of the following do you think are the three most important issues to you and your colleagues?” some 75% (702) selected an end to declining pay and benefits …

A specialist registrar in maxillofacial surgery has been struck off the UK medical register after a tribunal found that he lied repeatedly to cover up his removal of the wrong tooth during an operation. Panagiotis Stathopoulos, who qualified in Greece, was working at the Royal Derby Hospital in January 2017 when he removed a patient’s lower right molar 7 and 8 teeth, instead of 6 and 7 as requested by the referring dentist. The patient, who was particularly troubled by his LR6 tooth, realised the mistake within hours and wrote an email of complaint. Stathopoulos told the hospital trust—and, later, General Medical Council (GMC) investigators and his medical practitioners’ tribunal hearing—that …

Restoration of the Medical Practitioners Tribunal’s decision to allow Hadiza Bawa-Garba to remain on the medical register, though highly welcome, has not erased the sense of alarm felt by the medical profession throughout the handling of this case.1 Frontline medical staff have made clear their fear that they are increasingly acting as scapegoats for services that are …

Allwood and colleagues’ article raises a good point but brushes over how involved students and junior doctors currently are in quality improvement.1 Many medical schools now expect students to complete a quality improvement project in …

The Russian double agent and his daughter who were targeted by an assassination attempt in Salisbury in early March may have permanent brain damage and may never fully recover, a High Court judge has said.1 The first details to be made public about the condition of Sergei and Yulia Skripal came in a Court of Protection judgment authorising medical staff from Salisbury NHS Foundation Trust to take blood samples from the two for testing by the independent Organisation for the Prevention of Chemical Weapons. The trust may also show the organisation the Skripals’ medical records since 4 March, when the attack took place, Mr Justice Williams ruled. Blood tests carried out by the UK government’s Porton Down laboratory after the attack identified the …

Most of us don’t know, and will never know, whether Hadiza Bawa-Garba was concentrating on the day or lacked specific knowledge.1 The same is true for other cases that have come to court or the General Medical Council. But comments imply that at least some people think that this was not malicious and was affected by the pressures of work and making decisions. Medical staff failures seem to become public when it is a child or an emotive issue such as sepsis. Errors occur every day. No action occurs for a single error if a problem does not arise. …

Summary points Circumcision is the commonest surgical procedure in males, because routine infant circumcision is practised in many countries for religious and cultural reasons. It originated over 15 000 years ago, being performed for religious, ritualistic, and cultural reasons, and it was not until the 19th century that the procedure was “medicalised.” It is one of the most controversial surgical interventions: proponents claim benefits such as improved hygiene and reduced risks of infection (urinary and sexually transmitted) and of penile and cervical cancer, whereas opponents deny or minimise these benefits and cite substantial complication rates and reduced penile sensation. Many parents and patients have firmly held beliefs, placing medical workers under extreme pressure at times when dealing with requests for circumcision. It is vital for all medical staff to be aware of the various indications for circumcision and the operative techniques and their complications to cope with these consultations with an evidence base. This review concentrates solely on the medical indications for circumcision and does not address the issues of routine, religious, or ritual infant circumcision. It highlights clinical conditions frequently referred for circumcision but which are normal physiological variants and do not require surgery. It also lists the absolute medical indications for circumcision and the complications of the procedure. The various surgical …

Doctors in training grades can gain experience ranging from independent, lightly supervised practice to a more constant, “helicopter” presence of consultants directing most decisions.1 Is the current balance right, or has it tipped too far towards the hands-on boss? Helping junior doctors to feel ready for more senior, unsupervised roles as they ascend the training ladder means allowing them to work more in difficult scenarios involving team leadership, autonomy, and risk acceptance.2 If opportunities to step up are limited, the lack of opportunity becomes self reinforcing as doctors lack the confidence to take on more senior roles. In adult internal medicine specialties, surveys have shown that doctors are very concerned about their capacity to take on medical registrar roles. This isn’t just because of …

One of the biggest stressors in work for me and my colleagues, junior and senior, is the relentless demand for information—not from patients themselves but from their relatives. It’s taboo to talk about this in public for fear of appearing callous and uncaring. But it comes up whenever a group of medics unburden themselves in a safe space. I’m happy to break the taboo and to be found wanting for doing so. The source of this stress is rarely visitors who are involved carers, supporting the patient day in, day out. They are often highly present on the wards, making frequent interaction and updates easier. It’s crucial to involve …

Some NHS trusts are being too heavy handed in enforcing the new junior doctor contract, the BMA has warned, after juniors at one trust were found to have been threatened with referral to the General Medical Council for refusing to take on locum work. Jeeves Wijesuriya, chair of the BMA’s junior doctors committee, told The BMJ that several trusts around the country had been “misinterpreting” a clause in the new junior doctor contract requiring trainees to initially offer the spare hours they wish to work as a locum to an NHS staff bank.1 Wijesuriya said that he had recently asked University Hospitals Birmingham NHS trust to …

A third of junior doctors think that they have lost opportunities for learning because of gaps in rotas, a survey by the UK General Medical Council has found.1 On Tuesday 4 July the GMC published the initial findings from its 2017 national training survey. The survey received 53 335 responses from UK doctors in training (a 98% response rate) and was conducted between 21 March and 10 May 2017. Responding to the survey, 32% of trainees disagreed or strongly disagreed with the statement, “In my current post, educational/training opportunities are rarely lost to gaps in the rota.” The survey also received responses from 24 577 trainers (a …

A junior doctor who helped to falsely record nurse Pauline Cafferkey’s temperature on her return to Heathrow airport from fighting Sierra Leone’s Ebola epidemic in December 2014 has been suspended from the medical register for one month for dishonesty. Hannah Ryan, 31, a tropical diseases specialist at the Liverpool School of Tropical Medicine, had been working with Cafferkey in West Africa. The returning group of medical staff were all eager to reach their homes, …

In a damning report of the war in Syria, UN investigators have accused Syrian regime forces of systematically destroying hospitals and of deliberately targeting a UN and Red Crescent convoy that was bombed from the air last September, killing at least 14 aid workers and sparking international outrage. “For months, the Syrian and Russian air forces relentlessly bombarded eastern Aleppo city as part of a strategy to force surrender,” said the UN commission’s chairman, Paulo Pinheiro, announcing its findings on Wednesday. “The deliberate targeting of civilians has resulted in the immense loss of human life, including hundreds of children.” During the city’s recapture, Syrian government forces arrested doctors and aid workers and committed reprisal executions, the investigators found. The Independent International Commission of Inquiry on the Syrian Arab Republic also accused Syrian forces of systematically destroying hospitals.1 Russian aircraft, too, had repeatedly targeted hospitals, water distribution stations, markets, and bakeries with indiscriminate weapons, completely obliterating …

The head of the NHS in England has told The BMJ that he will push for a major overhaul of medical training to focus more on the needs of the modern NHS and rejuvenate morale among the junior workforce. NHS England’s chief executive, Simon Stevens, said that he wanted to use the government’s recent announcement of 1500 extra medical school places by 2018 as a springboard for change to how doctors are trained.1 This refocus should include a stronger emphasis on primary care and psychiatry and an increased recognition of the importance of multimorbidity and frailty, he said. Alongside this, Stevens said that the NHS would work urgently to provide a more …

Junior doctors have raised concerns about differences in pay that have arisen after the introduction of the new contract for junior doctors in England. Since November, foundation year 1 (FY1) and FY2 doctors in England have been moving to the new contract. The contract gives a period of pay protection for doctors who were already in training programmes on 2 August 2016 and for FY1 doctors who began their training programme on 3 August 2016. These doctors were guaranteed to receive a minimum amount of pay based on the job that they were working on the day immediately before moving to the new contract, plus the value of the GP supplement or banding supplement payable on 31 October 2015 for that job. Junior doctors have said that, as a result of …

The importance of lifelong learning in medicine is well recognised. This article explores how junior doctors can develop learning strategies for use throughout their working life

Consultants, GPs, and trainees respond to the BMA’s announcement that next week’s strike action has been suspended. Tom Moberly reports

Expanding the work of non-medical staff can give doctors more time for training, says Matthew Limb , but it also prompts concerns about the boundaries of different roles

An NHS hospital trust is considering closing its emergency department at night owing to a chronic shortage of staff. United Lincolnshire Hospitals NHS Trust (ULHT) said that it had reached “crisis point” and warned that patient safety could be at risk if it did not take drastic action at Grantham and District Hospital. The trust, which runs three emergency departments in Lincolnshire, said that it had been “seriously affected” by a national shortage of emergency medicine doctors and did not have enough medical staff to fill shifts in three departments 24 hours a day, seven days a week. After considering its options the trust said that it may close Grantham’s emergency department at night, as the hospital had …

Jeremy Hunt will remain health secretary for England despite a flurry of rumours that he would be sacked or at best transferred to another position. His reappointment is seen at Westminster as a strong signal of support for Hunt’s long running disagreement with junior doctors over a new contract. Whatever his personal wishes may have been, the new UK prime minister, Theresa May, recognised that moving him would signal a lack of conviction in the dispute and embolden fresh industrial action by doctors who voted against a deal struck between Hunt and the BMA. “Reports of my death have been greatly exaggerated,” tweeted Hunt after his reappointment. “Thrilled to be back in the best job in government.” On the morning of Thursday 14 July Hunt had undergone death by Twitter, as a series of tweeters, …

Cancer specialists have called for action to tackle the staff shortages that threaten plans to improve care and outcomes for people with cancer. In July 2015 the Independent Cancer Taskforce published a five year strategy for achieving world class outcomes in England by 2020.1 Sarah Woolnough, a taskforce member and Cancer Research UK’s head of policy, spoke about the progress that had been made during the last year at a cancer care seminar in London on 11 July. …

Pawel Supernak/Polish Press Agency Around 5000 junior doctors from across Poland took part in a demonstration in Warsaw last weekend in protest at poor wages and quality of training, and a lack of regulation of working hours. Organised by the Porozumienie Rezydentow (Residents Association), which represents junior doctors, the protest drew attention to the working conditions faced …

The royal colleges have expressed their support for the proposed new contract for junior doctors and have urged their members to accept it. Junior doctors and final or penultimate year medical students in England will vote on whether to accept or reject the proposed new contract between 17 June and 1 July. Jane Dacre, president of the Royal College of Physicians, issued a statement encouraging junior doctors to accept the proposed contract.1 She said, “I know that opinion is likely to be split but, after a lot of thought about what I would do if I were …

Private discussions should not be mistaken for BMA strategy, the association has said in the light of leaked messages between members of the BMA Junior Doctors Committee (JDC) executive group. On 26 May, the Health Service Journal (HSJ) published an article that showed leaked conversations between members of the JDC executive group, discussing the ongoing contract dispute. The messages revealed that JDC chair Johann …

Junior doctors in England will have the chance to vote on proposals for a new contract regardless of the outcome of fresh talks, the BMA has said. Commenting on the BMA’s decision to re-enter negotiations with the government, Johann Malawana, chair of the association’s Junior Doctors Committee, said that the BMA would call for “any contract offer—agreed or not—to be put to a referendum of junior doctors.” The BMA and the government returned to talks on a new contract for junior doctors in England on Monday 9 May.1 The move came …

The BMA has been urged to join forces with the Trades Union Congress for a national day of demonstration and strike action to support the junior doctors and the NHS. The proposal was made at the BMA’s special representatives meeting in London on Tuesday 3 May and was backed by a series of speakers at the event. At that meeting the BMA’s chair of council, Mark Porter, accused the government of being in “denial” over the financial crisis facing the NHS. Funding cuts, diminishing morale among doctors, and ever growing demand from patients were placing intolerable pressure on the medical workforce, he said, and he called on ministers to take immediate action.1 Junior doctors held the first all-out …

Kate Granger, a doctor and the founder of the successful “Hello, my name is” campaign, which encourages medical staff to introduce themselves to patients, won a Special Achievement Award at The BMJ Awards 2016 in London on 5 May. Granger, a consultant in geriatric medicine at Mid Yorkshire Hospitals NHS Trust, whose experiences as a patient with cancer led to the campaign, was the first recipient of this one-off award. Her campaign now has 42 000 Twitter followers globally. Granger was joined by doctors and teams who have excelled in their fields, such as anaesthesia, diabetes, cancer care, cardiology, clinical leadership, dermatology, and gastroenterology. Competition for this year’s BMJ Awards, now in their eighth …

A far reaching clause in the new NHS contract for junior doctors in England allowing employers to vary the terms and conditions unilaterally is highly unusual and could well be successfully challenged if acted on, employment law experts say. Under the clause, NHS employers “reserve the right from time to time in our absolute discretion to review, revise, amend or replace any term or condition of this contract and to introduce new policies and procedures, …

England’s health secretary, Jeremy Hunt, has offered to meet with the BMA’s chairman of council, Mark Porter, in a last ditch attempt to avert this week’s plan for an all-out strike by junior doctors. In a letter to Porter sent on Saturday 23 April,1 Hunt said that he would be willing to meet to discuss “a range of issues that can improve the terms and conditions for junior doctors” if the BMA agreed to call off the full withdrawal of labour by junior doctors on Tuesday 26 and Wednesday 27 April. But Porter said that talks could take place only if the health secretary removed his threat to impose the new contract on junior doctors. Against this backdrop, the heads of 13 medical royal colleges wrote to the prime minister, David Cameron, on Monday 25 …

Child health services are being put at risk because the imposition of the new junior doctors’ contract is forcing trainees out of the profession, the Royal College of Paediatrics and Child Health has warned. In a statement issued after a meeting on 14 April with England’s health secretary Jeremy Hunt, Neena Modi, the college’s president, said that the government’s decision to impose a new contract on junior doctors in England …

The BMA has urged the government to return to negotiations on a new junior doctor contract in England, ahead of a fourth round of industrial action. Junior doctors are set to take industrial action, providing emergency care only for 48 hours, between 8am on Wednesday 6 April and 8am on Friday 8 April. Johann Malawana, chair of the BMA’s Junior Doctors Committee, said that junior doctors were taking action because …

Where have you been? The BMA has been holding road show events across England and Northern Ireland over the past couple of weeks to explain the proposed changes.1 These involve scrapping the current clinical excellence awards system and removing the clause that allows consultants to opt out of non-emergency out-of-hours work.2 Negotiations on the contract …

Health Education England (HEE) has told hospital trusts that they could lose funding for training posts if they decide not to impose a new contract on their junior doctors. In a letter sent to the chief executives of all hospital trusts in England, Ian Cumming, HEE’s chief executive, said, “Implementation of the national contract will be a key criterion for HEE in making its decisions on our investment in training posts.” Last week the health …

A new contract will be imposed on junior doctors in England, the health secretary has announced. Speaking in the House of Commons on Thursday 11 February, Jeremy Hunt said that David Dalton, the government’s chief negotiator during negotiations, had said that a breakdown of negotiations meant that a negotiated agreement was unlikely to be reached. Hunt said that Dalton had asked him to “end the uncertainty” and proceed in introducing a new contract for junior doctors, which Dalton considered to be safer for patients and fair for junior doctors. “I have therefore today decided to do that,” Hunt said. He said that, under the new contract, the maximum hours in a week that junior doctors could work would reduce from 91 to 72 and the number of nights from seven to four, and that the maximum consecutive days a junior doctor could work would reduce from seven to five. “We will also introduce a new guardian role into every trust, who will have the authority to impose fines for breaches to agreed working hours, based on excess hours worked,” he said. Hunt said that the …

Junior doctors have welcomed the BMA’s decision to suspend their industrial action on Tuesday 26 January. The association announced on Tuesday 19 January that it had suspended the action, so as to continue talks with the government on the new contract for junior doctors, facilitated by Acas (the Advisory, Conciliation and Arbitration Service).1 Rhiannon Harries, president of the Association of Surgeons in Training, said that the move was a positive step. “Ultimately all junior doctors do not want to unnecessarily inconvenience patients, but we simply cannot allow a contract that is unsafe for patients, doctors, or the NHS,” she said. …

In November the chief executive of St Christopher's, Mr Vincent, announced that the oncology ward would be closed for five months from the following week, for redecoration. Medical staff were outraged: this ward provided specialist oncology care for children from all over the region, and their parents gained a good deal of support from each other and from the medical staff. The oncology service had been built up over many years and provided specialist training courses for nursing and other staff. Patients were to be dispersed around the general wards and thus put at considerable risk of infection. Staff were also sure that the specialist nurses would find work in other oncology units so the hospital would lose its oncology nursing expertise. The consultants' anger was further fuelled by the fact that, on the face of things, doctors were being encouraged to take part in management, an involvement vociferously endorsed by the general manager. The hospital had a clinical directorate structure, but very little in the way of significant decisions seemed to be discussed at the clinical directors' meetings. The atmosphere had become increasingly sour over the previous two years, and several highly respected clinicians had left for posts in the pharmaceutical industry and abroad. The following week several consultants challenged Mr Vincent about his decision. He explained that he had taken advice from some senior key clinicians, but he refused to name them. This resulted in much speculation, suspicion, and ill feeling among the consultants. The nurses were also furious and felt that they had been betrayed by trusted colleagues. The atmosphere was extremely tense, and at the end of the week Dr Roberts called a meeting of the medical staff. At the meeting it transpired that no one had, in fact, advised Mr Vincent about the subject of …

The aid agency Medecins Sans Frontieres has reported that an airstrike by the Saudi led coalition has hit one of its clinics in Yemen, in the southern city of Taiz. Nine people were wounded, including two medical staff, and two of the wounded people are in a critical condition.1 The bombing was the second by the Saudi led coalition of an MSF facility in Yemen in a matter of weeks. The organisation’s hospital in the northern city of Saada was hit on 26 October. It is the fourth air attack on MSF facilities around the world in two difficult months for the agency, which began …