NHS Employers briefing for opposition day debate on modernising medical careers on Tues 24 April 2007
From Mmc
NHS Employers briefing for opposition day debate on modernising medical careers on Tues 24 April 2007
Briefing for opposition day debate on modernising medical careers on Tues 24 April 2007
NHS Employers is the employers’ arm of the NHS Confederation and provides support and representation to NHS employers in England. For further information, please contact Emma Robinson, Public Affairs Manager at NHS Employers at emma.robinson@nhsemployers.org or 020 7074 3307.
Modernising Medical Careers (MMC)
The NHS Plan (2000) committed the government to modernising medical training to provide better educational and career pathways for junior doctors. At the same time the government also increased significantly the number of places in UK medical schools.
The policy was developed by the Department of Health and launched in the UK in February 2003. It was supported by the medical profession and NHS organisations. While NHS Employers has no formal mandate to implement MMC, we, along with all the medical professions, are represented on the different committees responsible for implementation.
In line with best modern employment practice, MMC provides more standardised training based on competency. It focuses on both clinical and generic skills such as communication. It was designed to remove the traditional patronage and bias which was well recognised in the old system and has been a source of concern to medical educators.
There are two parts to the programme; a two-year Foundation Programme following medical school, introduced in 2005, and a three or four year training period in a medical specialty which is being introduced from August 2007.
Why was the Medical Training and Application Service (MTAS) introduced?
Recent concerns have focused on the Medical Training and Application Service (MTAS). MTAS is an electronic web-based system for applying for training places which was devised to provide fair and transparent recruitment. A similar system has operated in the United States for many years.
MTAS was developed through a series of detailed meetings, workshops and user groups involving postgraduate deaneries, royal college representatives, consultants, medical staffing personnel, NHS Trust staff, BMA Junior Doctors Committee and Medical Students’ Committee representatives. It is overseen by the Department of Health and the MMC UK strategy board and is operated through the deaneries, which have responsibility for medical education on a regional basis.
This service was launched for Foundation Programmes in October 2006. 6000 applications were submitted with no significant IT or selection problems reported.
The service went live for recruitment into specialty training programmes on 22 January 2007. It enables applicants to apply to different levels of specialty training appropriate to their previous training and experience. The training programmes are offered at the level of first year (ST1), second year (ST2), third year (ST3) and in paediatrics and psychiatry fourth year (ST4) as well as some fixed term specialty training appointments.
For the first time recruitment and selection to specialty training follows a national timetable with nationally agreed person specifications, eligibility criteria and scoring guidelines. Applicants fill out an online form and can choose up to four training programmes to be considered for. They can track the progress of their application, book interview slots and receive messages from recruiters online.
How does this differ from previous years?
In the past, applications were paper based, spread through out the year and were managed locally. Applicants were required to submit multiple paper applications and deaneries and trusts convened interview panels separately for each programme they wished to fill.
More popular specialities have always had very high numbers of applicants but it was impossible to gather national figures. The new process provides a national standard for recruitment but also for the first time contains recruitment within a fixed period and makes the level of competition transparent.
We expect there to have been an increase in the number of training posts available as some employers have converted ‘service’ posts into training posts. Responsibility for numbers sits with the Department of Health.
Does the electronic form mean that candidates aren’t able to describe their experience and skills fully?
Selection into each specialty is based on person specifications agreed with the Postgraduate Medical Education and Training Board and with the medical royal colleges. These describe the attributes that a doctor needs for each specialty.
The application form asks applicants to provide evidence of their skills, experience and commitment and, where appropriate, of their achievement in the specialty. The application form asks the applicants to discuss their clinical practice and behaviours and give examples of how they have treated patients in the past.
The selection criteria have been developed to give increased emphasis to “softer” skills such as team working and communication as well as clinical skills. Patients and employers see these as important for doctors at all levels and they have been developed by the medical profession, in conjunction with employers and other organisations. They are skills which are associated with good clinical practice as, where problems in practice occur, a breakdown in team working and communication are common factors.
Shortlisting was carried out by senior doctors in each specialty who were given training on the new system. Lay chairs were also involved so that the interest of patients and the service are taken into account. Based on the scores achieved, applicants were invited for interview or to a selection process established for the specialty in their local deanery.
How many applicants are there for how many posts?
The number of training posts has been agreed following local discussions between NHS trusts, Strategic Health Authorities and postgraduate deans. There has been an increase in the number of training posts available in this transition year with some non-training (known as service) posts converted into training posts by employers.
In the UK as a whole there are over 23,000 training posts available this year with more than 19,000 of those in England. Around 3,000 of these have already been filled through the earlier general practice recruitment round, so the number available through MTAS is approximately 20,000.
The Department of Health estimates the total number of applicants to be approximately 34,500. Of these, approximately half are UK graduates, and a further 10% are other EEA nationals. The remaining 40 per cent are other overseas doctors.It is estimated that around 10% of all applicants are currently not working in the NHS.
A significant number of applications from doctors currently employed in the NHS are expected to be from doctors working in ‘service’ or ‘trust’ posts applying to re-enter training. These posts offer no formal training but doctors working in them make a significant contribution to the day-to-day management of patient care. If these doctors are unsuccessful in securing a training place they will remain in their current job (they hope! If they leave the country what then! Also above the "expansion" in training posts might have been by curtailing these posts?). Those who are successful will leave a vacancy which can then be filled by a doctor with appropriate experience who has failed to get a training post. Why after this abusive process would anyone want to take up a non ST post?
So what where the problems with the process?
The past few months have been difficult for many junior doctors. This was the first year of the process and there have been a large number of applicants for the training places available.
Employers have told us that the tools for assessing competencies through the electronic application form need to be built on and further improved and we have communicated this to the MTAS team.
There was also doubt in some deaneries over whether all shortlisters were trained well enough on the new system.
Some applicants were concerned that they did not have enough guidance in completing the electronic form.
There were many more applicants than had been anticipated due to the policy of allowing doctors from outside the UK to compete on a level playing field with UK and EEA graduates.
What is being done to resolve the issues?
A review group, chaired by Prof Neil Douglas, President of the Royal College of Physicians in Edinburgh was established by the Department of Health in March to examine the reported problems. NHS Employers has one representative on the group.
The group, with senior representation from across the medical profession, has met several times and has confirmed that interviews should continue and that every eligible candidate in England who applied through MTAS will be guaranteed an interview of their preferred specialty and geographical location.
Candidates were able to confirm the order of their preferences using MTAS between April 20 and 23. Additional information has also been made available to candidates on the MTAS website including competition ratios for specialties.
Employers are working with their consultants and junior doctors now to ensure that services for patients are not adversely affected by the change in timing. This is vital as employers need to be confident that well qualified doctors are in place to deliver safe and high quality patient care from August 1 when the new training programmes are available. So why were 7 weeks wasted after early March?
The Secretary of State has set up an independent review under chairmanship of Professor Sir John Tooke, Dean of the Peninsular Medical School.
Is there evidence of MTAS working well?
Interviews have been taking place over the past few weeks and interview panels report that they are seeing good doctors and expect to be able to fill high numbers of posts. Deaneries in many areas including Trent, Eastern, Yorkshire, Severn, Wessex and Oxford have reported that candidates interviewed are of a very high calibre.
The recruitment process for general practice has been operating well and results of the applications will be confirmed as soon as possible.
What opportunities will be available for doctors who are not successful in the first recruitment round?
Applicants who are successful in securing a training place in the current recruitment round will be notified by June 8. Immediately after there will then be a further opportunity for applicants to apply for any unfilled posts, though applicants may need to choose specialties or geographies that are less competitive in the next round.
When all training posts are filled we also expect that there will several thousand vacancies in ‘service’ posts. These posts will be advertised on NHS Jobs.
NHS Employers is working with deaneries, the Department of Health and medical bodies on a range of careers support including a new medical careers website and creating a dedicated service on the NHS Jobs website highlighting suitable vacancies for those candidates who do not get a training place. We have been asked by the review group to think widely about the range of opportunities that may be available, including those that align with other national policies.
What is the view of employers?
NHS Employers supports the main principles of MMC, as does the medical profession
We support the concept of selection for specialty training based on competencies which ensure fairness and prepare doctors better than before for their specialty. Information we have gathered from individual trust boards indicates that this view is strongly held within the service.
Employers have the same interest as the medical profession in ensuring that the best candidates are short listed and appointed to training places and that staff are treated fairly. It is important to retain some perspective - this is a huge logistical exercise which has worked well in many areas. We are pleased that many of the training posts will be filled by good doctors by mid-June.
We do not believe that there should be radical changes to the process of recruitment to speciality training at this stage. However, NHS Employers is committed to working with other national organisations and NHS trusts to ensure the system is fit for purpose.
We support the independent review and the urgent work going on nationally to ensure candidates applying for specialty training places have all the information they need. Both doctors and trusts must have confidence in the system and we need to work together to ensure the best aspects of the system whcih are? are retained and lessons are learned.
NHS organisations want to do all we can to minimise uncertainty, to ensure services for patients aren’t compromised and that doctors get the careers advice and support they need.
