The must-read stories and debate in health policy and leadership.

Money for nothing

New British Medical Association guidance has laid out how senior doctors could get a higher pension in return for cutting the number of hours they work.

This quirk in the system is caused by a combination of the annual allowance taper and the scheme pays interest.

The former is a widely-reported worry, and concerns have already been raised it could be leading higher earners to cut their hours to avoid being stung by high tax charges. But the BMA pointing out to doctors that dropping back on workload could result in more money for them once they have retired is a newer take on the tale. 

The latter is a less well-known issue. On the contrary, scheme pays is often mentioned in a more positive light, as a way to defer hefty tax bills to a date when they might be more affordable. The BMA’s guidance is a stark reminder that it is not, however, a silver bullet to the pensions crisis. 

Tony Goldstone, a consultant radiologist at Hull and East Yorkshire Hospitals, said the findings “should be of the utmost concern to all within the NHS”, while BMA consultant committee chair Rob Harwood warned it could result in a significant workforce crisis as doctors aim to reduce the work they do to avoid “punitive charges”.

This is, of course, not just an issue for senior medics. Jon Restell, chief executive of Managers in Partnership, stressed pension tax is one of several issues also affecting the recruitment and retention of senior managers.

Airing the laundry

Tensions between managers and clinicians are commonplace in any hospital. But when one group starts publicly criticising the other, it suggests a serious breakdown in relationships.

Worryingly, some senior emergency doctors at Lancashire Teaching Hospitals Foundation Trust have done just that, taking to social media to raise concerns over patient safety and criticising executives.

One of the doctors was Stuart Durham, an emergency medicine consultant, who posted on Twitter on Friday: “Absolutely ashamed of our exec! Despite repeated attempts to tell them how bad it is in the ED they don’t understand. We warned them again in a letter today and again they blame us!

“The 4 hour standard is just a metric but what concerns me more are the patient safety issues, poor clinical standards, public perception, staff stress, burn out…”

The letter he referred to was sent to divisional managers by the emergency department’s consultant team at Royal Preston Hospital.

The trust’s performance against the four-hour waiting target has been among the worst in England over recent months.

Chief executive Karen Partington said the trust “fully recognise(s) the challenges that our ED team is experiencing” and has been doing all it can to help medics cope with the rising demand and high bed occupancy.”

It’s not been an easy last few years for LTHFT, what with a glaring deficit, deteriorating performance, the loss of several senior managers, and plenty of controversy around the fragile A&E department at Chorley.

A major reconfiguration of emergency services between Preston and Chorley is key to helping the trust address some of these problems. But there is a lack of consensus in the county as to what the long-term solution should be, and no clear access to the capital funding that would be needed.