Back-seat driver

Published: 24/07/2003, Volume II3, No. 5865 Page 18 19

New BMA chair Dr James Johnson says there are plenty of other issues occupying his mind apart from the contract negotiations, including foundation hospitals and NHS managers

James Johnson has probably been interviewed more times in the past year than the NHS has been given targets. But a few days after his election as the British Medical Association's chair of council, he admits to having become 'tetchy' with media interrogators.

Asking Dr Johnson personal questions is politely discouraged by his press office and a strict 45 minutes has been put aside for HSJ before the old-school surgeon trots off to lunch with yet another hack, this time from The Daily Telegraph.

Dr Johnson hides a wry sense of humour beneath a serious, no-fuss exterior. But pity the misguided soul who utters his nickname within earshot, even though this 'Jimmy' lives on the outskirts of Liverpool.Apparently the moniker J-Jo, after pop star J-Lo, may also be catching on - but There is no time to explain that to him now.

The consultant general/vascular surgeon, who won the BMA council chair by just one vote earlier this month, is used to life at the top of the health service, since he is outgoing chair of the joint consultants' committee, the group that represents his profession at the Department of Health.

In the coming months, however, he will be expected to address a problem not of his own making - healing the scars of the consultant contracts debacle with the DoH, managers and doctors.

Dr Johnson is apparently not the easiest person to work with.

His straight talking could be mistaken for moodiness - or plain rudeness. Yet those who worked on the contracts issue say he is sincere and will try to do what in his opinion is the right thing.

When Dr Johnson was interviewed the BMA was involved in intense, behind-the-scenes negotiations with new health secretary John Reid. These bore fruit on Thursday, with the two sides announcing they have found a 'way forward'.

The BMA had been worried about managerial control of job planning - the new deal says this will 'give priority to the professionalism and clinical judgement of clinicians'.

It had also been concerned to secure a 'fair and balanced' appeals process, voluntary night and weekend work, paid at a higher rate, and parity of treatment for consultants undertaking private work - all of which have been agreed.

Dr Johnson was reluctant to discuss the talks. As he observed: 'It is moving so fast that by the time your report comes out it will either have been sorted out or it will have gone pear-shaped.'

But he is obviously wary of what managers will try to do with the contract. Managers, he says, 'want a contract that will better deliver their access targets, which are hugely problematic.'

'The plan is to have a sort of three-session day - morning, afternoon and evening - instead of a two-session day, and also to have weekend mornings as fairly standard working times, ' he says.

'If you could do that, you would turn a 10-session week into a 17session week and, theoretically at least, you could do 17 10ths of the current work.

'I say theoretically because it is not just a matter of getting consultants to agree, ' he continues.

'There is no point having a willing consultant if there are no nurses to run the clinic, the operating theatre is full, there are no operating department assistants or there are no porters.'

Dr Johnson concedes that managers in industry would bring in a shift system rather than get just eight hours' use from expensive equipment: 'I do not think the BMA dissents in any way from that general objective.'

However, he says shortages of doctors and the desire for familyfriendly working are major barriers. The obvious way to induce medical professionals to work outside nine to five is to agree to 'pay them more'.

In the longer term, Dr Johnson says he will address the fact the BMA has let non-contractual issues drift in the past two years.

On foundation hospitals, for example, 'we didn't really have have a policy that we didn't like these until the [annual representative] meeting in Torquay'.

He also feels there is work to be done in repairing relations with external bodies, including the DoH, royal medical colleges, educational deans and managers.

'We have no problem with managers, 'Dr Johnson says. 'There is a problem in that we have different perspectives on things and different pressures. They get sacked if they do not achieve targets that we might be quite happy to poohpooh.

'The best way is to start talking to managers about our respective problems and accept that we can't come at it from the same angle.

Then [we] can start to work through problems, rather than just slagging each other off.'

But Dr Johnson warns that as a doctor he 'absolutely' cannot go along with the utilitarian philosophies of executives: it is not part of a doctor's job to prioritise amongst patients.

'When you're sitting in front of me in the consulting room with a problem, my job is to do the best that I can for you.'

Dr Johnson is based at Halton General Hospital in Runcorn, Cheshire. He was born in 1946, the year the original NHS Bill was passed, and stands by what the then BMA secretary, Dr Charles Hill, asked the nation on Pathe News: 'Do you want your doctor to be the state's doctor?'

He says: 'That question is just as important today. People want their doctor to be their doctor, not an agent of the state, deciding what would be the most appropriate use of money and what wouldn't.

'You do get to the stage when as a manager you are totally swamped by targets. You have no room to manage anything other than how to massage figures to achieve yet another target.

'We are getting some signals from the prime minister, if perhaps not from anyone else, that they feel the target culture has gone a bit too far.We'll have to see whether anything comes from it.'

Dr Johnson feels that as an alternative to creating foundation hospitals, the whole service should be freed from 'the yoke ofWhitehall'.

'The way to do it is to stop micro-managing hospitals. If you stop doing that then I do not think we need to have a discussion about foundation hospitals, ' he says.

'[The proposals] have been watered down so much that one wonders if they're worth having any more. It is extremely difficult when you're in that position to withdraw from it, but I think we rather side with the Labour Party, rather than the government, on foundation hospitals.'

The last thought makes him chuckle. But Dr Johnson does give credit where he thinks it is due on the funding poured into the NHS in recent years.

'You have to take your hat off because whatever you feel about [former health secretary] Alan Milburn, he had a huge achievement in persuading the government, and the chancellor, to cough up all that money for the NHS.'

Returning to the subject of targets, he says: 'Every package of money comes with a tag on it: 'This is not to be spent on X, this is not to be spent on Y.' That is a real problem. It absolutely stops you managing it if you're a manager.'

Further, he says: 'The underfunding runs so deep and is so chronic that even with the huge amounts of money that are being put into the NHS you do not actually see any benefit.My hospital is deeply in the red, it is not looking any better, nor is there any light at the end of the tunnel.'

The pace of reform is also a problem for Dr Johnson.He says he has a 'real fear' that ministers will decide: 'We have been doing this for a year or two now and It is showing absolutely nothing - so let's spend the money somewhere else where it will be more appreciated.'

That, he says, would be a disaster, adding by way of warning: 'We hope they will keep their nerve, but so chronic is the underfunding that they are not going to see results for quite a while.'