The General Medical Council

ThThe General Medical Council said the scale of the action, planned at such short notice, could not be justified.

The first of four five-day walkouts is due to begin from 12 to 16 September, with the last being in mid-December.

Junior doctors are striking over a new contract which is being imposed.

• The dispute explained
• Analysis: A step into the unknown
• Views from the nations

The GMC has set out advice to doctors before next week's series of one-day strikes and voiced a stronger warning than previously about the possible impact of the strike action.

GMC chair Prof Terrence Stephenson, said doctors have a right to strike but they must consider whether it will cause significant harm to patients.

The GMC will investigate any case where a patient has come to significant harm because of actions by a doctor.

Prof Stephenson told the BBC's Today Programme: "The idea that you can take a third of the workforce out of a busy emergency service for five days and have no consequences seems to me unlikely.

"We are quite clear in our guidance that every single individual doctor most put their patients first. And we make it clear that they are personally accountable for their actions and must be able to justify what they did afterwards if allegations our made against them."

He urged every doctor in training to "pause and consider the implications for patients."

Meanwhile, Chris Hopson, of NHS Providers, said: "The GMC is right to be 'extremely concerned' about the impact the series of strikes by junior doctors will have on patients.

"We share the GMC's view that the scale of action planned at such short notice cannot be justified."

Consultants will cover junior doctors in providing emergency care, as they did during two days of walkouts in April.

Hospitals will see junior doctors stage walkouts from 08:00 to 17:00 from:

• Monday 12 September to Friday 16 September
• Wednesday 5 October to Tuesday 11 October (although the weekend will be covered)
• Monday 14 November to Friday 18 November
• Monday 5 December to Friday 9 December

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The warning from the GMC comes after senior doctors last week urged the government and junior doctors to restart negotiations to avoid the series of strikes.

While some medical colleges have said the planned strikes are disproportionate, others say they support the junior doctors' stance.

The row over their pay and conditions has escalated into the worst industrial relations dispute in the history of the NHS.

The BMA has said the government could stop the strikes by calling off the imposition of the contract, which is due to be rolled out from October.

A spokesman said: "Patient safety remains doctors' priority and, since the announcement last week of further action, the BMA has been liaising with NHS leaders so that plans can be put in place swiftly to minimise disruption for patients."

But Prime Minister Theresa May last week told doctors to stop "playing politics" in the dispute and urged the union to cancel the strikes.

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The imposed contract

Image copyrightPA

• Basic pay to rise between 10% and 11% on average
• Supplements paid for frequent weekend working - those working one in two will get 10% on top of basic salary
• Nights to attract an enhanced rate of 37% above normal time
• Replaces old system whereby weekend or night work can attract up to double time
• First doctors to go on new terms in October with much of the rest of the workforce to follow by next summer
• The British Medical Association says it is not fair on those who work the most weekends or part-timers

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Junior doctors have already taken part in six strikes this year, including two all-out stoppages.

Industrial action was put on hold in May when the two sides got back round the table at conciliation service Acas.

That resulted in the agreement of a new contract, which BMA leaders encouraged members to accept.

But when it was put to the vote, 58% of medics rejected it, prompting the resignation of the BMA junior doctor leader Johann Malawana and causing ministers to announce once again that they would impose the new terms and conditions.

London Ambulance Service rated 'inadequate' by inspectors

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Image captionInspectors rated the trust as good for caring but inadequate for meeting target response times

London's Ambulance Service (LAS) NHS Trust has become the first to be put into special measures after a recommendation by inspectors.

The NHS trust serves an estimated 8.6m people in the capital and has been performing "poorly" since March 2014.

Slow response times were highlighted as a major concern, along with a high number of unfilled vacancies.

The Trust said it had taken action to address its failings.

More on this story and updates from London.

Image captionThe cost of housing in London was possibly making it harder to recruit paramedics, London Ambulance Service chief executive Fionna Moore said

Prof Sir Mike Richards, chief inspector of hospitals, said: "I am recommending that London Ambulance Service be placed into special measures, because I believe that this is the step necessary to ensure this vital service gets the support it needs to improve.

"The trust has been performing poorly on response times since March 2014. This is a very serious problem, which the trust clearly isn't able to address alone, and which needs action to put right."

A Care Quality Commission (CQC) inspection, which took place in June, found poorly trained staff, a lack of equipment and a reported culture of harassment and bullying.

Trust chief executive Dr Fionna Moore said: "We would like to apologise to Londoners and say how sorry we are that we haven't come up to the standards they should expect of us and we are working really hard to address those issues."

She said problems in recruiting staff were partly due to the high cost of living in London and a shortage of housing.

Despite this, she added, the trust had managed to recruit 167 new members of staff and more than 200 others were in training.

Until 2014 the trust was ranked as the best performing service in the country for dealing with emergency category A calls - requiring attendance within eight minutes - but was now only hitting that target 25% of the time.

Image captionOnce an ambulance arrived, patients could be assured of a good service, Professor Sir Mike Richards said

GMB union national officer Rehana Azam said: "The underlying problem is a shortage of staff. There is a seriously high vacancy rate in the LAS and other ambulance services.

"We are pleased the CQC identified this and perhaps now it can be addressed in full.

"As a result of staff shortages, existing staff have had to shoulder more responsibility."

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Analysis by BBC London political correspondent Karl Mercer

It was not the news they had hoped for, but it is perhaps no surprise that London's ambulance service has become the first to be put into special measures.

For more than a year it has struggled to meet response times and to find enough paramedics to work on the frontline.

Its well publicised search for staff has seen it recruit in Australia and New Zealand as it competes against an ever rising tide of calls.

This year will be its busiest ever with 1.9 million calls. That is more than 5,000 a day. But it knows it has to do better.

It is filling more of those vacancies and there is a new chief executive in place, but being put in special measures means they will get more help.

A new improvement director and experts from the Association of Ambulance Chief Executives will help. But here is the thing. Does being in Special Measures mean it will be harder to recruit new staff?

Being labelled as "inadequate" is hardly a great sales pitch to would-be paramedics. The LAS is not alone in London though.

It now sits with BartsHealth and Barking Havering and Redbridge hospitals as trusts wearing the unwanted tag of being in special measures.

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The report identified the following problems at the trust:

• A high number of frontline vacancies

• Inappropriate staff training, exacerbated by low staffing levels

• Demoralised and stressed staff some of whom reported issues with bullying and harassment without any resolution

• Lack of senior staff supervision

• Failure to meet response target times

'Shocking'

Trusts like the London Ambulance Service are overseen by the NHS Trust Development Authority (TDA), whose associate director for London, Andrew Hines, acknowledged "significant improvements are required".

He said the TDA was making sure the Trust "has access to the best expertise available to help them to deliver their ambitious improvement plan".

"Londoners should feel confident that it is safe to call the ambulance service and that care is of good quality," he added.

Labour candidate for mayor Sadiq Khan described the report as "shocking" and joined calls from both the Lib Dems and Greens for the service to be devolved to City Hall.

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shocking' cases in dignity care

Oxfordshire health watchdog reports 'shocking' cases in dignity care report

• 1 hour ago
 
• From the sectionOxford

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Image captionA Healthwatch Oxfordshire report found people were reluctant to complain when they thought they had been treated badly

"Shocking" cases of patients not being treated with dignity in care have been uncovered by a health watchdog.

Healthwatch Oxfordshire also highlights staff fears that "workforce pressures" are making it harder for them to deliver acceptable levels of care.

Its report, written with Age UK, was based on 161 patients and 57 staff completing questionnaires, as well as six focus groups and 10 case studies.

The majority of patients were still treated with dignity, the report added.

Patients with communication difficulties and dementia were particularly unhappy with their care.

One patient, who had suffered a stroke, said she was left for hours in her own excrement.

She said: "I was sedated and my health needs were neglected."

Another described finding her mother-in-law, who has Alzheimer's, "soaked, dirty" and ignored by nurses.

Their report said that, in a small number of cases, their experiences were "shocking".

'Much can be improved'

A woman who suffers from trigeminal neuralgia, a condition which causes severe facial pain, said that while she was normally treated with respect, on one occasion she was called "unclean" by a staff member when she was in too much pain to wash.

Healthwatch also found people were often reluctant to complain and did not always feel properly involved in decisions about their care.

But 93% of patients who responded said they had been treated with dignity or respect "some of the time", "most of the time" or "always".

While patients were receiving "a high level of dignity in their care", Healthwatch chief executive Rachel Coney said there was "still much that can be improved about how people are treated".

The report, written in partnership with charity Age UK, said the county's care organisations have made commitments to improve.

These include drawing up formal dignity standards, reviewing staff training, and involving patients more in decision making.

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EU doctor suspended from UK work for 'poor English test'

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An Italian doctor has been suspended from practising medicine in the UK after failing English language tests.

Dr Alessandro Teppa is one of the first EU doctors to face disciplinary action over language skills following a change in the law in 2014.

His suspension will last at least nine months, the Medical Practitioners Tribunal Service (MPTS) has ruled.

Another medic - a Polish doctor who failed language tests three times - has been allowed to work under supervision.

Dr Teppa qualified in 1998 in Italy and was granted a licence to practise in the UK in 2012.

He failed an English assessment two years later and was put under an interim suspension order that year.

Repeated tests

In a document, the tribunal panel said the standard of his English was currently "insufficient to support safe and effective medical practice in this country".

He told the panel he had since been taking English language lessons at his home in Italy.

He must return for a further hearing in the next nine months.

The medical regulator for the UK - the General Medical Council (GMC) - agreed with the decision.

Niall Dickson, chief executive of the GMC, added: "This doctor should not be able to practise in the UK again until he can demonstrate he is able to communicate effectively."

Image copyrightPAT ISAACS

Image captionDr Tomasz Fryzlewicz has worked in various hospitals across England

A separate case involved a second doctor, Dr Tomasz Fryzlewicz, who qualified in Poland and has held a licence to practise in the UK for the last nine years.

He failed English language assessments in October 2014, December 2014 and again in February 2015.

The panel ruled he must only work under direct supervision for the next year and must pass an English language assessment within 12 months.

But the chief executive of the GMC said there should have been tougher sanctions.

Mr Dickson added: "We are disappointed that the MPTS panel did not suspend Dr Fryzlewicz as we had requested but we are satisfied that the panel has placed sufficient conditions on his clinical practice to make sure that patients will be protected."

'Understanding instructions'

Dr Fryzlewicz was previously employed as a heart specialist at various hospitals, including the Royal Stoke University Hospital, the Princess Alexandra Hospital in Essex and the Good Hope Hospital in Sutton Coldfield.

Some colleagues who worked with Dr Fryzlewicz said they weren't always sure he understood what they said.

Dr Simon Woldman, clinical director of specialised cardiology at Barts NHS Trust told the tribunal: "When I spoke to Dr Fryzlewicz, I was never really sure that he had understood the instructions he was being given...

"When Dr Fryzlewicz spoke, you had to concentrate quite hard to understand what he was saying."

Other colleagues and patients wrote to the panel in support of the doctor's command of English.

New powers allowing the medical regulator to check doctors' English language skills came into force in June 2014.

Previously only doctors from outside Europe could have their language skills tested by the General Medical Council (GMC).

The risk of a doctor not being fluent in English was highlighted by a lethal mistake made by Dr Daniel Ubani, a German doctor doing an out-of-hours shift who gave a lethal dose of a painkiller to patient David Gray in 2008.

As a German citizen the doctor was able to register to work in the UK without passing a language test.

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Meddyg UE hatal o'r DU yn gweithio ar gyfer 'mhrawf Saesneg wael'

'Tampon tax' issue to be raised with the European Commission

• ectio

Image copyrightALAMY

The issue of the so-called "tampon tax" on sanitary products will be raised with the European Commission, a UK Treasury minister has said.

David Gauke said the government sympathised with efforts to force a negotiation with the EU for a reduction in the 5% VAT rate on sanitary items.

But he said the UK was unable to apply a zero rating under EU law.

MPs rejected the Finance Bill amendment, which would have forced a negotiation, by 305 to 287 votes.

HM Revenue and Customs (HMRC) says the VAT rate charged on the items is the lowest allowed under EU law.

The government said any change would require a European Commission proposal and the unanimous agreement of all 28 member states.

Mr Gauke, the financial secretary to the Treasury, said: "This debate illustrates there is very considerable cross-party support for the UK to abolish VAT on sanitary products.

"To that end… I will raise this issue with the European Commission and other member states setting out our views that it should be possible for member states to apply a zero-rate to sanitary products."

Labour cut the rate when it was in government from the then-standard rate of 17.5% - imposed in the 1970s - to the lower rate of 5%, but was prevented from going any lower by the European rules.

A petition calling for a change in the law has more than 250,000 signatures.

'Absurd'

Labour MP Paula Sherriff's amendment, backed by shadow chancellor John McDonnell, would have required Chancellor George Osborne to publish, within three months, a strategy for negotiating an exemption with EU institutions.

One of the Conservatives supporting the motion, Bernard Jenkin, said the situation was "an example of where the EU has taken over jurisdiction over our tax where it should not have".

SNP MP Alison Thewliss added: "It is absurd that while men's razors, children's nappies and even products like Jaffa Cakes, exotic meats and edible cake decorations are free from VAT, women are still having to pay additional costs on what is already an expensive yet vital product."

A Treasury spokesman said: "The UK has set the VAT on sanitary products at the minimum rate permissible under EU rules."

Asked about the calls for a zero VAT rate, the prime minister's spokeswoman said: "What is being proposed is not something that being looked at we think is achievable."

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