Inquiry raps doctor training reform
From Mmc
Inquiry raps doctor training reform
The fiasco that left thousands of junior staff unable to continue their training was due to 'weak leadership', says report
Jo Revill Whitehall Editor Sunday October 7, 2007
The fiasco over junior doctors' training - which left thousands of young medics in turmoil earlier this year - was the result of weak leadership by health officials and doctors' leaders who felt 'alienated and deprofessionalised' by government reforms, according to the authors of an independent inquiry.
A radical overhaul of the system for training doctors is recommended by the report, to be published tomorrow, which is highly critical of the current process. If adopted, it will give doctors much longer to decide which specialism they would like to follow, and will rely not just on a computer system but also on face-to-face interviews to pick the best candidates for specialist posts.
The changes are also aimed at producing more 'super-generalist' doctors who will be able to work in the community with older patients who have a range of different conditions.
In May the then Health Secretary, Patricia Hewitt, asked Professor John Tooke, chair of the Medical Schools Council, to look at the training debacle, which saw thousands of young doctors left in limbo over their future. Under sweeping changes, they had to apply online for specialist training posts in hospitals through the medical training application service (Mtas). But this was badly flawed and often broke down, so the whole system eventually had to be abandoned.
About 30,000 junior doctors were left to compete for around 23,000 posts, partly because leaders had not taken account of the fact that thousands of doctors had also, legitimately, arrived from abroad for jobs. The appointments to specialist posts are critically important to young doctors, mostly in their mid-twenties, as it is these training posts that will lead on to qualification for consultant jobs.
The crisis, which left many of the most skilled doctors without the right jobs, culminated in calls for Hewitt to resign and led to a march in London, which Conservative leader David Cameron joined, to protest about the future of medicine.
In an interview with The Observer, Tooke spelt out that Modernising Medical Careers (MMC), the five-year programme to reform postgraduate medical training, was a 'whole systems failure' involving health officials, doctors' leaders and the medical royal colleges. 'There were concerns about deprofessionalisation and alienation, a sense that the command and control approach of the NHS was really diminishing the role of the doctor,' he said. 'The situation facing the trainees was morale-sapping and damaging. They were faced with a highly complex application process which was rushed in its implementation, and then there were technical glitches which resulted in some really good candidates not getting interviews for posts.'
The interim report also warned of a looming problem, 'a policy vacuum regarding the potential massive increases in trainee numbers', as more doctors graduate and come from other parts of the EU.'
The new proposals suggest doctors should go through two stages of specialist training. About 18 months after graduating, they would do three years of more specialised work involving six different areas of medicine, and then would go through a full interview process to be finally selected for a post, en route to becoming a consultant.
Tooke said that the current situation was also created by the fact that 10,000 extra doctors had come from abroad for specialist posts, which had not been allowed for in the NHS workforce plans. He added that the debacle had proven to be 'a deeply damaging episode for British medicine'.
