Press releases Monday 4 April to Friday 8 April 2011

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

• (1) Overseas doctors more likely to face serious GMC action
• (2) Climate change threatens global security, warn medical and military leaders
• (3) Alcohol causes a significant burden of cancer in eight countries in Western Europe
• (4) Health Bill could open up the NHS to EU competition law
• (5) Live from Fukushima: doctors share their experiences with delegates at Quality Forum

(1) Overseas doctors more likely to face serious GMC action

(Research: Place of medical qualification and outcomes of UK General Medical Council "fitness to practise" process: cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1817
(Editorial: Migration of doctors and the "fitness to practise" process)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1641

General Medical Council (GMC) decisions about doctors who qualified outside the UK are more likely to have far reaching consequences (high impact decisions), finds research published on bmj.com today.

The authors, led by Professor Charlotte Humphrey from King's College London, say there is no clear reason why overseas doctors do worse in GMC fitness to practise processes than their UK-trained peers.

Humphrey argues that perhaps "real differences exist in fitness to practise between groups of doctors who are referred to the GMC" or "that the GMC processes tend to discriminate against certain groups of doctors."

However, the authors stress that their research makes it "difficult to reach a conclusion that clearly supports either of these potential explanations and both might be valid."

The study looked at GMC cases between 1 April 2006 and 31 March 2008. The researchers reviewed the background to 7,526 inquiries to the GMC concerning 6,954 doctors. They assessed how many inquiries were referred for further investigation, how many were investigated and then referred for adjudication, and how many resulted in doctors being erased or suspended from the medical register.

The results show that of the 7,526 inquiries, 4,702 related to doctors who had qualified in the UK, 624 in the European Union (EU) and 2,190 who had qualified outside the EU. At the initial GMC stage (triage) 29% of inquiries concerning UK qualified doctors had a high impact decision compared with 43% for EU doctors and 46% for non-EU doctors.

At the adjudication stage 1% of UK qualified doctors were erased or suspended from the medical register compared to 4% of EU doctors and 3% of non-EU doctors.

The authors conclude that their research raises questions about the GMC fitness to practise processes. They speculate that perhaps inquiries involving UK-qualified doctors are being assessed less seriously than those involving non-UK qualified doctors.

Humphrey and colleagues also question whether some non-UK qualified doctors may not be well placed to defend themselves or challenge decisions compared to their UK-trained colleagues.

In an accompanying editorial, Marcella Nunez-Smith, Assistant Professor at Yale University School of Medicine, says that given the rise in the dependence on foreign-trained doctors in countries like the UK and US, it is essential to determine "whether international medical graduates offer the same quality of care as doctors who train and practise in destination countries."

Nunez-Smith argues that Humphrey's research is a critical contribution to the debate but that "additional research on the association between other doctor related characteristics, such as ethnicity, and the fitness to practise process is needed."

Contacts:
Research: Charlotte Humphrey, Professor of Health Care Evaluation, Florence Nightingale School of Nursing and Midwifery, King's College, London, UK
Email: frances.dodd@kcl.ac.uk
Editorial: Marcella Nunez-Smith, Assistant Professor of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
Email: marcella.nunez-smith@yale.edu

(2) Climate change threatens global security, warn medical and military leaders

(Editorial: Climate change, ill health, and conflict)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1819

Medical and military leaders have come together today to warn that climate change not only spells a global health catastrophe, but also threatens global stability and security.

"Climate change poses an immediate and grave threat, driving ill-health and increasing the risk of conflict, such that each feeds upon the other," they write in an editorial published on bmj.com today. Their views come ahead of an open meeting on these issues to be held at the British Medical Association on 20 June 2011.

The authors point to several reports, highlighting the threat that climate change poses to "collective security and global order."

For example, the Pentagon's 2010 Quadrennial Defense Review to Congress stressed the potential for climate change to contribute to "poverty, environmental degradation, and the further weakening of fragile governments."

The UK's Ministry of Defence also states that "climate change will amplify existing social, political and resource stresses" and will shift "the tipping point at which conflict ignites," while the UK's Foreign Secretary, William Hague, recently described climate change as "perhaps the 21st century's biggest foreign policy challenge."

A recent report by the International Institute for Strategic Studies concurs: "Climate change will increase the risks of resource shortages, mass migration, and civil conflict. These could lead to failed states, which threaten global stability and security." It stresses the need for "sustained investment in infrastructure and new technologies" of which "a shift to renewable energy sources will be the most visible effect of efforts to mitigate emissions."

"It might be considered unusual for the medical and military professions to concur," say the authors. "But on this subject we do."

They conclude: "Although discussion is good, we can no longer delay implementing tough action that will make a difference, while quibbling over minor uncertainties in climate modelling. Unlike most recent natural disasters, this one is entirely predictable. Doctors, often seen as authoritative, trusted, and independent by their communities, must make their voices heard in calling for such action."

Such subjects will be discussed at a forthcoming open meeting "Climate change - how to secure our future wellbeing: a health and security perspective" to be held at BMA House on 20 June 2011.

Journalists wishing to attend should contact Emma Dickinson on 020 7383 6529, Email: edickinson@bma.org.uk
Click here for more information: bit.ly/climatechange2011

Contact:
Lionel Jarvis, Surgeon Rear Admiral, Ministry of Defence, London, UK
Email: sgacds-acdshealth@mod.uk

(3) Alcohol causes a significant burden of cancer in eight countries in Western Europe

(Research: Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.d1584

Almost one in ten (9.6%) cancers in men and three in ten (3%) cancers in women in Western Europe is caused by former and current alcohol consumption, finds a paper published on bmj.com today.

The study focuses on France, Italy, Spain, United Kingdom, The Netherlands, Greece, Germany and Denmark.

The authors, led by Madlen Schütze at the German Institute of Human Nutrition in Potsdam-Rehbruecke, argue that a substantial proportion (40 to 98%) of the alcohol-attributable cancers occurred in individuals who drank more than the recommended guidelines on upper limits of two standard drinks a day in men and one standard drink a day in women. (A standard drink contains about 12 g alcohol and is equivalent to 125ml glass of wine or a half pint of beer).

These results are based on risk estimates from the European Prospective Investigation into Cancer (EPIC) Study and representative alcohol consumption data compiled by the World Health Organisation (WHO).

In the EPIC Study 363,988 men and women, mostly aged between 35 and 70 years at the time of recruitment were followed for cancer since the mid 1990s. The participants completed a detailed questionnaire on diet and lifestyle at entry into the study. Alcohol consumption was measured by specific questions on the amount, frequency and type of beverage that was consumed at present and in the past.

According to the International Agency for Research on Cancer (IARC) of the WHO, there is a causal link between alcohol consumption and cancers of the liver, female breast, colorectum, and upper digestive tract. However, data had not been available on the number of cancer cases linked to total alcohol consumption or the proportion of cases caused by alcohol consumption beyond the recommended upper limit.

The study calculated that in 2008, current and former alcohol consumption by men was responsible for about 57,600 cases of cancer of the upper digestive tract, colorectum, and liver in Denmark, Greece, Germany, Italy, Spain, and Great Britain. Over half of these cases (33,000) were caused by drinking more than two alcoholic drinks per day.

Alcohol consumption by women in the eight countries caused about 21,500 cases of upper digestive tract, liver, colorectum, and breast cancer, of which over 80% (17,400) was due to consumption of more than one drink of beer, wine, or spirits per day.

"Our data show that many cancer cases could have been avoided if alcohol consumption is limited to two alcoholic drinks per day in men and one alcoholic drink per day in women, which are the recommendations of many health organisations," says Madlen Schütze, first author of the study and epidemiologist at German Institute of Human Nutrition in Potsdam-Rehbruecke. "And even more cancer cases would be prevented if people reduced their alcohol intake to below recommended guidelines or stopped drinking alcohol at all."

Contact:
Manuela Bergmann, Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
Email: bergmann@dife.de

(4) Health Bill could open up the NHS to EU competition law

(Analysis: Challenges of EU competition law for general practice commissioning)
http://www.bmj.com/cgi/doi/10.1136/bmj.d2071

Healthcare delivery in England could be bound by key elements of EU competition and procurement law where bidders from across the European Union have the same rights as local NHS providers, say two experts on bmj.com today, Dr Rupert Dunbar-Rees and Robert McGough.

The authors question whether the government has fully considered the impacts of the Health and Social Care Bill and in particular the 'Any Willing Provider' (AWP) proviso.

They say that, while parallels have been drawn between the proposed GP commissioning model, GP Fundholding and Total Purchasing Pilots of the 1990s, the reality is that "the regulatory landscape has changed beyond all measure since then".

The authors argue that "the National Health Service has moved from a position 20 years ago, where most healthcare spending was essentially the state purchasing care from itself" and that now it is possible that EU procurement rules would apply to the commissioning process.

This could mean, say the authors, that GP consortia would have to advertise all relevant tenders in the EU's official journal and competitively tender for those services in an open and transparent way.

The consequences for consortia not abiding by EU rules can be very serious, explain the authors. A consortium who fails to tender a service which should have been tendered could find a contract being cancelled by a court. It could also be fined and be forced to pay damages. Additionally the contractor who was awarded the contract might then sue for breach of contract by the consortium.

While the vast majority of secondary care services can be exempt from some of the detailed requirements of the advertisement and tendering processes, the case law supports a legal requirement to follow the general EU principles, say the authors.

And despite Department of Health assurances that there may be circumstances ('service integration' and 'continuity of care') where GP commissioners would be able to offer a tender to only one contractor - the authors say it is unclear whether this would be legal as these circumstances do not fall within current exemptions under EU law.

The authors argue that "procurement skills will remain be a key requirement for commissioners" and that GP consortia will need to be exceptionally careful when purchasing services to ensure that procurement and conflict issues are dealt with effectively.

Dunbar-Rees and McGough conclude that "the technical argument reinforces the logical argument that the reforms further open up the NHS to EU competition law".

Contact:
Jonathan Mitchell, Account Manager, Edelman, Victoria Street, London, UK
Email: Jonathan.mitchell@edelmann.com

(5) Live from Fukushima: doctors share their experiences with delegates at Quality Forum

Watch the session at YouTube
http://www.youtube.com/watch?v=IQm163PM_zE

Delegates attending the International Forum on Quality and Safety in Healthcare in Amsterdam today heard a live panel discussion about last month's tsunami, earthquake, and subsequent radiation emergency in Japan.

The session included a live video link with two doctors from Fukushima: Ryuki Kassai, professor and chair at the Department of Community and Family Medicine, Fukushima Medical University, and a member of the BMJ's editorial advisory board, and Shigeatsu Hashimoto, professor and chair at the Department of Clinical Quality Management, Fukushima University Hospital.

They shared some of their personal experiences of the disaster and set out some crucial lessons learnt, including the need for timely, accurate, clear, and credible information to help save lives, reduce injuries and illnesses, and help maintain people's trust and confidence.

They also stressed the vital role that healthcare professionals have in providing information to the public.

For more information please contact: Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

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