Category Archives: Retired

Read the damning nature of this joint report.. GP shortages …. Our very own post-code lottery.

Just read the joint report of the Nuffield Trust, Kings fund, and Health Foundation reflect on the retired doctor commenting below the Times report. Developing a strategy for the Health and Care workforce In England: Summary of a roundtable discussion. 

This crisis was seen 20 years ago. What the media and the politicians should be asking is why nothing has been done, and what options are possible. The implications of doing nothing are too important. There are not enough physiotherapists, nurses, Occupational Therapists, Psychologists etc. as well as GPs and Oncologists. 

The report does not cover the other 3 health dispensations, and the situation is just as bad in Scotland N Ireland and Wales. Wales in particular has a tradition of exporting professionals, and at least 20% of all graduates leave. It will be much more for the medical professions….

I have no good news to counter this abrogation of planning. I can only apologise to the Times for reproducing their whole article as it is so important. There is a world shortage of doctors…. If we still believe in open markets then every country has to train more. Meanwhile it has to get worse, and private care will flourish, especially in cities. The Health Divide will worsen. 

Chris Smyth reports this in the Times 21st March 2019: Experts warn shortage of GPs will last for at least a decade

The shortage of GPs will last for at least another decade and patients will have to be treated by physiotherapists and pharmacists instead, a report on the NHS staff crisis has concluded.

The shortfall of nurses will also triple to more than 100,000 unless almost £1 billion is spent on training and hiring thousands from abroad, it added.

“Dire” workforce planning may derail the NHS ten-year plan because there will not be the staff to hire with £20 billion budget boost, three think tanks have said. The Nuffield Trust, King’s Fund and Health Foundation united to warn that a dearth of qualified professionals has become the critical problem facing the NHS.

They said it “defied all logic” that training budgets have been cut by 17 per cent to funnel money into NHS England as the shortage worsened. The NHS has 100,000 vacant posts in a workforce of more than 1.2 million.

“You have to run to stand still in the NHS,” said Anita Charlesworth of the Health Foundation. Ministers must restore bursaries for nursing students, giving them £5,200 a year to reduce an attrition rate in which only three in five who enrol become full-time nurses, she said, adding that overseas recruitment should grow from 1,600 a year to 5,000 annually.

The report said that for GPs there was no prospect of closing the gap for at least a decade. In 2015 ministers promised 5,000 more GPs by next year but numbers have since fallen by 1,000.

The shortfall of 2,700 will triple in five years without action, but even an intensification of efforts to train more and stop early retirement will produce only 3,500 more over a decade, leaving the NHS more than 7,000 short, the report estimated. The gap can be closed only by sending more patients to see physios and pharmacists for problems such as back pain and medicine reviews, it suggested.

Efforts to hire GPs from abroad had been unsuccessful Richard Murray, chief executive of the King’s Fund, said. “We are just not that competitive on pay and lifestyle. The numbers just haven’t come through but that isn’t for want of trying,” he said.

Baroness Harding, chairwoman of NHS Improvement, welcomed the review. “Our staff are our biggest asset and so it is vital we do more to retain, recruit and develop them,” she said.

Times on line comment:

“Baroness Harding, chairwoman of NHS Improvement, welcomed the review. “Our staff are our biggest asset and so it is vital we do more to retain, recruit and develop them,” she said.”
Staff are treated abysmally so what is actually being done. Not much. Anyone who works in a hospital who trys to raise a problem is silenced and hounded out.

World shortage of doctors:

Research Shows Shortage of More than 100,000 Doctors by 2030

U.S. faces 90,000 doctor shortage by 2025, medical school …

Canada’s doctor shortage will only worsen in the coming …

On solutions to the shortage of doctors in Australia and …

NZ’s doctor shortage: What needs to be done? – NZ Herald


A naturalised and retiring consultant airs his views – the implications are stark. We have not trained enough doctors, and we could lose many of those we have attracted.

A letter in the BMJ : Uncertain times for EU doctors

See the source image

I qualified as a doctor in Italy in 1982 but felt I wanted to gain some experience in a different healthcare system. In January 1985, I moved to the UK with my then Italian girlfriend who is now my wife. My first proper job was in Stockport as a pathology SHO, whilst my wife started a paid PhD in electronic engineering at the University of Manchester.

I would not have come to work here if the UK had not been part of the EU. The recognition of my medical qualifications and the fact that no work permit was required, for both myself and my girlfriend, were important factors in our decision. Perhaps more importantly, I did not feel I was a migrant.

At the time, I was an EU citizen moving into a fellow EU country under freedom of movement. I then worked as a microbiology registrar in Oxford and as a senior registrar in London. In 1996 I took on a microbiology consultant post in Sunderland, where I have worked since.

By this stage it was apparent we would not go back to Italy, so both myself and my wife acquired British nationality in order to have the full right to vote and to feel full members of British society.

All four of us, including our two sons, have dual British and Italian nationality. I define myself as a British Italian and have now spent more than half of my life in England.

After the Brexit vote in June 2016 I was gutted. I felt as if I had been personally rejected from my adoptive country. Had I made the wrong choice when I moved to the UK in 1985? Two German colleagues of mine, both consultants in my hospital, left in 2017 to go and live in France. This is not really an option for me as I am close to retirement and my two sons have grown up and work here. Although I am sure had this happened some years ago then this may have been different.

Initially, I did not quite understand why Brexit had happened. When I moved into the UK, I did not feel the local culture was very different from my culture; maybe my lasagne recipe is slightly different, but the fundamental values and professional standards are the same.

It is discouraging to think that maybe I was wrong about this. Perhaps all this time myself and others like me were perceived as EU migrants and ultimately, as a problem. I personally think we all have to do our bit to improve society. As a result of Brexit, I have now joined a political party and have started campaigning for a People’s Vote.

I am retiring next year but I am going to carry on doing things with others, hoping to achieve a greater good. I find all of this helps with morale. Despite what our Prime Minister recently said, I do not think I jumped any queue in 1985.

Dr Giuseppe Enrico Bignardi is a microbiology consultant working in Sunderland.

See the source image

The disintegration of professionals – is happenning all at once. Standards are falling in general, but in exceptional cases they have fallen drastically.

Older people consume more services. Health and social care services. Whilst Health is free and not means tested, Social Care is means tested and only free when down to the last £17.000 or thereabouts. The disintegration of social services, of the ambulance service, and lack of standards in Hospitals is coming all at once. At my own surgery in West Wales the patients today are concerned about the same issues as they were 20 years ago when the PPG ( patient Participation Group) started: Access and appointments… The standard of politicians and politics is the real underlying problem. As a country with short term first past the post politics, we can only expect short term decision making. The quality of life improvement for GPs, who now do little out of hours, has led to NHS111 (useless) and an overworked ambulance service using up vast resources inefficiently.. Continuing undersupply of doctors, despite the applicants to medical school has been rationing of the most inexcusable sort. It is in Primary Care that the big savings in demand can be made, but it needs more GPs and nurse practitioners. How much of the new £20m will go to primary care?

Image result for falling standards cartoon

The Nuffield Trust and the Kings Fund: Reports show it is dangerous to dodge decisions any longer: Nuffield Trust response to Skills for Care data – Unless social care becomes a more attractive sector to work in, ongoing migration will be necessary

The Kings Fund talks about “home truths” through a combination of stats and interviews.

Tom Houghton for the Liverpool Echo reports 15th September: Ambulance service slammed for “continuous failures” as serious incidents soar.The North West Ambulance Service (NWAS) has failed to hit crucial targets in recent months

and in Wales 4th February: Thousands of complaints made against the Welsh Ambulance Service

Today the Neil Johnson of Times’ reports: Shrewsbury and Telford Hospital baby deaths inquiry to cover two decades (This is possibly the result of weak management, and of a midwife led service – lets await the report!!)

The Times 26th September: £20bn cash boost for NHS ‘could be lost to waste’

On September 18th Chris Smyth for the Times Crisis team sent into St George’s cardiac unit

and 10 days later, on 28th September: Doctors fear NHS catastrophe as early retirement depletes surgeries (And this excludes Wales and Scotland and Northern Ireland, emphasising that there is no “N” HS)

More than 2.5 million patients are at risk of losing their family doctor as GPs retire early, according to the Royal College of General Practitioners.

Hundreds of surgeries are likely to close because three quarters of their GPs are close to retirement and not enough younger doctors are coming through to replace them, the college calculates. Falling numbers threaten a collapse of the family doctor system, senior doctors said as they lobby for a bigger share of a promised boost to the NHS budget to go to local surgeries.

However, NHS leaders dismissed the claims as scaremongering. They acknowledged three years ago that a lack of qualified GPs was a key problem for the health system, promising to recruit 5,000 more by 2020. GP numbers have since fallen by more than 1,000, accelerating

the closure of surgeries. (Here there is a map of England with colour coded areas of shortage)

Last year 458,000 patients in England had to find a new practice because their existing surgery shut, up from 38,000 in 2013. The college has found that 762 UK practices are relying on an ageing workforce, with three quarters of doctors aged over 55. The 625 practices in England alone care for 2.5 million people, with a further 71 surgeries in Scotland, 37 in Wales and 29 in Northern Ireland at risk.

“These new figures paint an extremely bleak picture of the scale of the GP workforce crisis,” Helen Stokes-Lampard, chairwoman of the college, said. “If these GPs do leave and these practices do close, it will have a catastrophic impact on our profession and the patient care we are able to provide.”

GPs can start to claim their pension at 55 and the average age at which they retire has fallen to 58, down two years since 2011. Simon Stevens, head of NHS England, has previously blamed rules that cap tax-free pension pots at £1 million for encouraging GPs to retire early.

In Southend, more than a third of surgeries are at risk of closure from an ageing workforce, covering 39,000 people, more than a fifth of the population, the college estimates. In Sandwell and west Birmingham, 85,105 patients, or one in seven, could lose their doctor because a quarter of surgeries are at risk of closure. Only a quarter of England has no surgeries at risk.

Image result for falling standards cartoon

Should dementia from sports injuries and concusion be subject to “deserts based rationing”?

If the dementia risk rises by 17% when the risk of dementia is 10%, the absolute risk only rises to 11.7%. The article by Kat Lay in the Times chooses to use relative risk calculation, but it is important just the same. NHSreality has been saying since inception that certain sports persons, especially those that “ask” for head injuries, such as boxing, and riding, should always be insured. The insurance should cover their long-term care. But what if they still participate without the cover? NHSreality is against deserts based rationing. It is for wealth based co-payments and rationing overtly, especially the high volume low cost treatments that each individual should be expected to cover for themselves. The health services are “regional mutuals”, less powerful and with less choice than the former “national mutual” (NHS), but there has to be a disincentive to make a claim, for everyone. Deserts based rationing, along with most rationing, will be regressive, as the poor are fattest, least fit, and least informed…. At least means based co-payments would mean the wealthy pay more.

Image result for dementia from head injury cartoon

Dementia risk rises 17% after suffering a single concussion – Kat Lay in the Times 11th April 2018 – Dementia risk rises 17% after suffering a single concussion

A single case of concussion raises a person’s dementia risk by 17 per cent, a major study has found.

Researchers analysed data on 2.8 million people for the study, published in The Lancet Psychiatry. The findings are likely to lead to renewed calls for contact sports such as rugby to be made safer.

The study found that people who had sustained a traumatic brain injury (TBI) were 24 per cent more likely than their peers to be diagnosed with dementia during the 36-year study period. Some 5.3 per cent of participants with dementia had a recorded TBI, compared with 4.7 per cent without dementia. TBIs occur when a bump or blow to the head disrupts the normal function of the brain – for example in falls, car accidents or assaults.

The study found that the younger someone was when they first sustained a TBI, the greater their risk of developing dementia. Those who suffered a TBI in their 20s were 63 per cent more likely to develop dementia in later life than those who did not. The figure for people who suffered a TBI in their 30s was 37 per cent.

The results are likely to be seized on by campaigners who believe that participation in sports such as rugby or American football is putting young people’s brain health at risk, although the study did not address sports injuries directly.

Researchers found that the risk of dementia increased in line with severity of the injury. A single severe TBI increased the risk by 35 per cent, while a mild TBI – a concussion – increased it by 17 per cent. It also rose in line with the number of injuries. One TBI was linked to a 22 per cent higher risk of dementia, rising to 61 per cent after four TBIs. Five or more tripled the risk of dementia.

Image result for dementia from rugby cartoon

Jesse Fann, a professor at the University of Washington in Seattle, who led the study, said: “Our analysis raises some very important issues, in particular that efforts to prevent traumatic brain injury, especially in younger people, may be inadequate considering the huge and growing burden of dementia and the prevalence of TBI worldwide.”

In a linked comment article, Carol Brayne from the University of Cambridge, wrote: “It is likely that prevention needs to be considered at societal, community, and local levels.”

The researchers also looked for a link between dementia and those who had had fractures not involving the skull or spine, and did not see an association. This suggests that TBIs specifically, rather than general trauma, play a role in developing the disease.

Other studies have suggested that TBIs cause some of the same pathological changes in the brain as those seen in Alzheimer’s disease. About 850,000 people in the UK have dementia and numbers are expected to rise to more than a million by 2025.

The researchers used data held in Danish national registries from 1977 to 2013. Over the 36 years, 132,093 people had at least one diagnosis of traumatic brain injury, with 85 per cent being mild. Between 1999 and 2013, 126,734 people aged over 50 were diagnosed with dementia.

Their models took into account factors linked to dementia such as diabetes, heart disease, depression and substance abuse, but they were unable to account for others, including education, smoking and high blood pressure.

Experts said that more research would be needed to tease out which specific types of head injury, such as sports concussions, were implicated.

Image result for dementia from rugby cartoon

Rugby and Dementia pugilistica…. an unfair cost on the health service

Rugby is sleepwalking into concussion crisis. Touch rugby or sevens seems much safer..

Chronic Traumatic Encephalopathy ? Time for a change to rugby tackle laws

Should sports injuries all be covered by the UK Health Services? The brain damaging season of international rugby is about to begin.

Too many Rugby World Cup injuries?

School rugby plan ‘too dangerous’

Politicians need to speak out for or against deserts based rationing. If they don’t it will occur by post-code and by default.

Obese and Smokers could be “punished” by deserts based rationing?

A deserts based approach to bed blocking and obesity? How could we encourage families to take their relatives home?

Which party will embrace any form of deserts based rationing?

Its not news to GPs or the Surgeons: Covert, Post-Coded, deserts based rationing is official policy

Devon Health Board deserts based rationing – and political dishonesty & denial at Cabinet level at PMQs.

Overt (deserts based) rationing? – “NHS to ‘ration’ routine operations for obese people and smokers”.

Interesting suggestion low cost or high volume treatments to be excluded… GPs will take no notice as their job is to put their patient “at the centre of their concern”.

Image result for dementia from head injury cartoon




Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

If you have a stroke on your way to the hereafter, your life expectancy is short, demand for services is high, and nobody listens to you, even if you can be understood.  Dumped is the right political word. Congratulations to the reporter on his understatement however, The real word, especially with regard to intensive physiotherapy, is abandoned. Dead patients don’t vote, and those near death don’t appear to count. Commissioners have a perverse incentive to save money, richer areas can have more physio as more patients go privately, and the post-coded, covert rationing lottery continues..

Image result for stroke cartoon

Jon Ungoed-Thomas in the Sunday Times reports: Stroke survivors ‘are dumped by the NHS’

Sufferers feel abandoned after leaving hospital and face waiting up to a year for the right treatment — or paying for it themselves

Stroke survivors are being left to languish at home with a “shocking” lack of support. Many say they feel abandoned by the NHS.
Juliet Bouverie, chief executive of the Stroke Association, said a new national plan was required to help the 1.2m stroke survivors in the UK. Some have to wait up to 12 months for psychological help.
“As a stroke survivor, your life and the life of your family is turned upside down,” she said. “Many stroke survivors say they feel abandoned, as if they have dropped off a cliff. The provision in some areas is shocking.”
About 100,000 people suffer a stroke every year in the UK; it is one of the country’s leading causes of death.
Andrew Marr, the broadcaster and journalist, who suffered a stroke in January 2013, said better support for stroke survivors — many of whom are of working age — could help them return more quickly to employment. He was back at work within six months, but largely because he paid for additional physiotherapy.

Stroke survivors can wait up to four months for speech therapy and up to a year for psychological support, according to data from the Royal College of Physicians. Stroke survivors say there is insufficient physiotherapy, a treatment which would ensure the best recovery.

Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner<img class=”Media-img” src=”//″ alt=”Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner”>
Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work soonerDavid Cheskin/PA

A stroke strategy, launched in 2007, outlined a 10-year plan to overhaul stroke services and has seen significant improvement in acute treatment. The Stroke Association is calling for a new action plan to build on improvements and outline a new strategy for the rehabilitation of stroke victims.

Nathan Ridgard, 40, a self-employed businessman and a father-of-two from Harrogate, North Yorkshire, suffered a stroke on New Year’s Eve 2012. After being discharged from hospital, he said he was given some leaflets by the NHS on coping with a stroke, but struggled to read them because of his poor vision.

“I just felt I had been dumped out in the world,” he said. He received some NHS physiotherapy, but also paid for private sessions to supplement them. He has since made a good recovery.

Professor Tony Rudd, National Clinical Director for stroke at NHS England, said: “The quality of care and survival rates for stroke are now at record highs. We are working with the Royal College of Physicians and others local health service leaders to improve rehabilitation care for everyone who suffers a stroke.”

Image result for stroke cartoon


A reminder in poetry: “I am a child of the NHS”

On the 60th Year of the NHS I read a poem “I am a child of the NHS”… Unfortunately I don’t have the author… Reader –  let me know..

I am a child of the NHS
And despite my complaints you cannot guess
How grateful I am for the service I get.
Sometimes I reflect on the media and press
Which are patently unable to cope with the stress
Of  projecting the truth to the Nation.
The whole concept
Of cradle to grave
Caring for the dying, the elderly, the depraved,
(of nothing to pay, and no duty to save)
For that rainy day or medical surprise
Is “in place of fear”; A fantastic idea.
Aneurin Bevan was the constructor/designer
But time and reality are mean destroyers
Budgets and acronyms abound
To confuse the public in getting around
The shape of a wonderful dream
Which is becoming a nightmare
Said our friend Anne today:
“you can go to hospital well (if you dare)
And come out smelling of MRSA”.
So what is bringing back the fear?
And to compound the rationing, beware
For now both Dental and Physio care
Are unavailable to most – were you aware
That those  words “commissioning” and “fund-holding”
Were parodies of the truth?
And hidden deep in the morass
Of a beurocracy this crass
Is absenteeism so perverse,
It is shamed by every organisation
In the whole Universe
A reflection of a system designed
For the assertive, with morale much worse.
Forget Equity, Forgive Access,  Remove Choice, Allow unfairness
Remain National, not regional,
Counter litigation paranoia with no-fault compensation (none can afford lawyers)
And save my NHS.
So who is the “gatekeeper” in this mess? Your GP,  would you guess.
(that person who does sustained, unpredictable, often imperative, multitasking, for individuals families or groups)

I am a child of the NHS
And, still, despite my complaints you cannot guess
How grateful I am for the service I get.

and it’s worse in wales..

NHS cuts back on IVF treatment due to cost pressures – The Mail 3rd November 2015

Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war.

In the Times 17th July 2015 Laura Pitel, and Jenny Booth  report: ‘Get real’ and work at weekends, doctors told and “Doctors ordered to work at weekends”.… as if they don’t already. This is not the way to win hearts and minds. Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war. The problems of August changeover (August comes around again – don’t be ill this month) for trainees/juniors are well known to the profession, and an easy gain would be to change the changeover dates by 3 months. Mr Hunt is betraying how he does not understand the profession, the altruism that drives all new consultants, and the long term mismanagement of manpower planning. The Health services really do need to be de-politicised to win back the hearts and minds of the professionals…

Hospital consultants will be forced to work at weekends, the health secretary announced today as he opened a new front in his war with doctors.

Jeremy Hunt laid down an ultimatum to the doctors’ union, ordering it to discuss a radical overhaul of hours and pay or face having new terms imposed from on high.

He said that 6,000 patients die needlessly each year because of the lack of an adequate seven-day hospital service. Patients are 15 per cent more likely to die in hospital if admitted on a Sunday than if they go in on a Wednesday, he said.

In a stark message likely to provoke doctors, Mr Hunt told the British Medical Association that it has six weeks to negotiate. “I will not allow the BMA to be a roadblock to reforms that will save lives,” he said. “Be in no doubt: if we can’t negotiate, we are ready to impose a new contract.”

The BMA has previously told Mr Hunt to “get real” about seven-day working, but in his speech to The King’s Fund this morning, Mr Hunt accused BMA leaders of being out of touch with what their own members believed.

“I have yet to meet a consultant who would be happy for their own family to be admitted on a weekend, or would not prefer to get test results back more quickly for their own patients ,” said Mr Hunt.

“Hospitals like Northumbria that have instituted seven-day working have seen staff morale transformed as a result.”

He added that he expected the majority of hospital doctors to be on seven-day contracts by the end of this parliament in 2020.

“No doctors currently in service will be forced to move onto the new contracts, although we will end extortionate off-contract payments for those who continue to exercise their weekend opt-out,” he said.

He denied that the reforms were an attempt to claw money back from consultants’ pay, telling the BBC this morning that he thought that they would end up being “cost-neutral”.

Dr Mark Porter, the chairman of the BMA council, said today that many consultants already worked at weekends, and that the whole of the NHS needed to gear up for seven-day working, not just the most senior staff.

“Putting a doctor in is not going to solve the problem – you need the support services to go with it,” he told BBC Radio 4’s Today programme, adding that the NHS was too underfunded and understaffed to move to seven-day working.

A “truly seven-day NHS” was part of the Tory manifesto but it has triggered bitter exchanges with doctors.

Terms agreed in 2003 under the Labour government gave hospital consultants, who earn an average full-time equivalent of £118,000, the right to opt out of non-emergency work outside the hours of 7am to 7pm on weekdays.

Those who agree to work at night or over weekends can negotiate higher rates of pay. A 2012 report by the National Audit Office found that 71 per cent of doctors struck local deals for these shifts, earning up to £200 an hour.

Mr Hunt has tried before to redraw consultants’ contracts but talks collapsed in 2014 after the BMA warned that the plans threatened patient safety by failing to guard against excessive working hours. The BMA also raised questions about how the new system would be funded.

Mr Hunt returned to battle today with a warning that thousands die every year due to a lack of senior doctors who can oversee emergency care and interpret tests and scans. “No one could possibly say that this was a system built around the needs of patients,” he said. “And yet when I pointed this out to the BMA they told me to ‘get real’. I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real’.”

While ministers are powerless to change the terms of existing contracts, the government can force an arrangement on new consultants and Mr Hunt made clear that he is willing to do so if the BMA does not co-operate.

The proposed deal would remove the opt-out of weekend working by April 2017 and shake up pay incentives, with rewards for performance rather than years of service. The existing model for compensating doctors who work antisocial hours would be replaced with a system of variable allowances based on the demands of a doctor’s job plan.

Whitehall sources suggested that this new pay model would encourage many existing consultants, particularly those in A&E units or obstetrics wards, to move over to the new contract. They said that the government hoped that half of all hospital doctors would be on the new deal by 2020. They insisted that the aim of the reforms was not to increase the numbers of hours worked by individual doctors, adding that these should remain within safe limits.

Dr Porter has accused politicians of peddling “lazy caricatures” in pursuit of easy headlines. Last month he said that senior doctors were delivering 24-hour emergency care despite inadequate funding. He warned that the biggest danger to patients was an NHS budget shortfall, expected to reach £22 billion by 2021, and questioned whether weekend and evening services should be the priority against this backdrop.

Letters 18th July 2015:

Sir, A costly “one size fits all” solution may not be the best way to avoid 6,000 unnecessary weekend deaths in the NHS (report, July 16, letters and leading article, July 17). It is unlikely that such deaths are evenly distributed across all hospitals. If that is the case, problem hospitals should be identified for intensive correction.

Sadly, as every experienced hospital doctor knows, expertise, leadership and collegiate practice are not evenly distributed. As a workplace, some hospitals are much more desirable than others. That is one of the tragedies of the NHS.

J Meirion Thomas, FRCP, FRCS London SW3

Sir, Your leader implies that hospital doctors can opt out of weekend working. This is misleading. I was a consultant from 1989 to 2014, and can assure you that none of us can opt out. This paragraph in the 2003 contract relates only to non-emergency work. Almost all acute hospitals already have seven-day consultant ward rounds, but scans and operating space remain in short supply.

Tony Narula, FRCS Wargrave, Berks

Sir, Your headline “Get real and work weekends, doctors told” inspired me to go and do just that. Just as I have done for the past 18 years.

dr mark luscombe Consultant anaesthetist and intensivist, Doncaster Royal Infirmary

Consultants have always been reluctant to get involved in management. Doctors treat individuals first, management is divided, and the duty of government is to populations. In this regard the US is no example to follow.. The same Perverse Incentives apply to GPs who are equally reluctant to get involved in Commissioning..

The contract that lays out the terms for hospital consultants was drawn up in 2003, when John Reid was the Labour health secretary.

His predecessor, Alan Milburn, wanted to extend their standard hours to include evenings and weekends, triggering threats of the first BMA strike in 30 years. Mr Reid settled for 7am to 7pm, Monday to Friday. It included an opt-out for non-emergency weekend work.

Margaret Hodge, the former chairwoman of the public accounts committee, said in 2013 that the deal had been a “missed opportunity” to improve performance and provide value for money.

A first debate in West Wales BMA – on rationing – wins a majority in favour