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'''Working towards a medical crisis'''

''HELEN PUTTICK, Health Correspondent	October 09 2007''

Doctors continue to face an uncertain future in Scotland following an unprecedented medical training fiasco. With three weeks until their current contracts expire, scores of young doctors are still waiting to find out if they have a job to go to with the NHS.

Yesterday, the Scottish Government said it was waiting for health boards to tell them how many junior doctors faced unemployment before making decisions about what would happen next.

The pressing situation emerged as a report was published into the series of disasters which plagued the shake-up of medical training this year.
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It described the crisis as "a deeply damaging episode for British medicine" and made 45 recommendations which would again radically change the training process.

Around 200 junior doctors in Scotland faced the dole this summer amid fierce competition for training places in the redesigned UK-wide training regime. The report, the result of an independent inquiry led by Professor Sir John Tooke, said there were 9402 more applications than available posts in the UK.

With the level of unemployment becoming clear at the end of June, Nicola Sturgeon, Scottish Health Secretary, announced junior doctors who had not secured positions would have their current contracts extended until the end of October.

Some of these medics have since secured longer-term positions, but how many are again facing the dole and what alternatives they have remains unclear.

Kevin Cormack, spokesman for Remedy Scotland, a pressure group formed in response to the crisis, said: "These people are living with terrible uncertainty.

"Not only are they going to be losing their jobs in three weeks' time, they might never get into a proper training job again.

"They may have to look at either changing their career or moving away from friends and family and loved ones. These are the very real worries these people have as well as how they are going to pay the mortgage.

"People are becoming depressed and unwell with the stress because there is not any clear way for them to go. There is very little useful advice for them because no-one seems to know what to do with them."

Dr Katie MacLaren, deputy chairwoman of the British Medical Association's Scottish Junior Doctors Committee, said they had worked well with the Scottish Government during the crisis. However, she added: "We are disappointed they do not know who these doctors (facing unemployment) are by now The immediate pressing thing, as well as thinking about next year, is these people needing to know what they are doing next month. It must be horrendous."

A spokeswoman for the Scottish Government said: "We have asked for a return from boards about the number involved by the middle of the month and we will make a decision about the way forward at that time.

"The number has reduced because some of the doctors will have found permanent positions."

Fears about the new training system, called Modernising Medical Careers (MMC), have weighed heavily on doctors for more than a year.

Last September The Herald revealed hundreds had signed an online petition demanding a postponement of the system.

While reassurances were given at the time, the disaster which ensued and the Tooke report findings vindicate their stand.

First, a catalogue of problems occurred with the online application process, Mtas, including technical failures and security breaches.

There were also allegations that the shortlisting process, using this system, failed to take sufficient account of experience and previous high flyers found themselves without interviews.

As 32,649 people were going through the system, including 10,000 applicants from overseas, anxiety was quick to spread.

The Tooke report proposes entirely reworking MMC.

Sir John said: "This has been a sorry episode for British postgraduate medicine, which has caused great distress to many trainees and their senior colleagues.

"From this experience we must learn and put in place the mechanisms to ensure that in the interests of the health of our population excellence prevails."

Health Minister Ben Bradshaw said the government had learned lessons from the process and would consider the report fully.

Changes to the recruitment system in England for next year have already been outlined. There will be no national online application system and selection will be handled at a more local level.

There will also be staggered start days. This year all doctors moved to their new jobs on August 1 leading to concerns about how hospitals would cope.

The Scottish Government is yet to announce arrangements for recruitment next year. Ms Sturgeon said: "We will be considering the review's findings in detail, in consultation with wider Scottish interests, and will publish our response to it in due course.

"We are, however, already committed to making changes to the selection and recruitment process in 2008."


I have had to move because of being unstable financially'

When Dr Ashleigh Duthie learned she had passed her clinical exams this summer, it should have been a happy time.

The 27-year-old, from Aberdeen, had completed her third year of psychiatry training without dropping a single test.

But instead of enjoying the celebrations, she felt anxious and despondent.

Like thousands of medics across the UK, her existing job was coming to an end and she had no secure post to go to.

Dr Duthie faced massive competition to secure a post at the right level in her chosen field of old age psychiatry under the new junior doctor training system.

She was willing to move anywhere but only got one interview and was unsuccessful. "Medicine has always been fairly competitive," she said. "There have always been times when you have not been successful for interviews.

"But this was different in that there were problems with the selection process and this was an annual intake, meaning if you were left without a job you were left without a job for a year."

The announcement by Nicola Sturgeon, the Scottish Health Secretary, that the contracts of people in Dr Duthie's situation would be extended until the end of October allowed her to continue working.

In addition, Dr Duthie was offered part-time work, on a short-term contract, at Cornhill Hospital in Aberdeen. However, this does not include training to progress her skills towards becoming a consultant.

When this contract and the extension period expires at the end of this month, Dr Duthie does not know what to expect.

She said: "As far as I know everything comes to an end then. I might get the three-month part-time job extended but there might be interviews for that."

The uncertainty is affecting all areas of her life. "It is very difficult to plan anything," she said. "Simple things like where to live. Holidays are just impossible.

"I have had to move because of this, because of being unstable financially. I would not have been able to support the mortgage that I had with part-time wages."