British Journal of Healthcare Management 2007 (13) 120-1
From Mmc
The announcement on 22nd March by the Department of Health Review Panel (www.mmc.nhs.uk ) was an admission that the MTAS selection process had totally failed in selecting Junior Doctors to interview. A carefully planned selection process must appoint the best doctors to the best posts to provide the best care. Many of the best candidates were not called to Round One interviews. The current solution is that all 32,000 applicants will now be called to an interview i.e. no long nor short listing at all. In this article I shall discuss the problems that arose, and will start with some background. I want to clarify the term “Junior Doctor”. Somehow this carries a connotation that they are not “real doctors” and perhaps do not matter to the service. I will use an analogy with the teaching profession. Junior Doctors are equivalent to classroom teachers, but are not Heads of Department or Head Teachers. They are the essential workforce of frontline medical care in A and E, the acute medical and surgical wards, and throughout all areas of hospitals. They are the doctors you will see first when you have a heart attack, meningitis or appendicitis. Without high performing Junior Doctors, the quality of care is at immediate risk.
Junior Doctors now complete a 2 year Foundation Programme, equivalent to the New Qualified Teacher (NQT) year. The Foundation Programme has generally been successful, and an improvement. After F2 doctors would then spend 1 or 2 years at the “SHO” grade, pass craft exams (e.g.MRCP), and move onto GPVTS or SPR training to become a GP (3 years) or a Consultant (5 to 10 years). The change with MMC and MTAS has been that the decision to train to be a GP or Consultant, has to be made at the end of Foundation. MMC and COPMED decided that rather than apply at the end of Foundation for a specific job in a hospital, and be selected locally by the hospital’s Consultants, the Foundation doctors would have to apply to up to four Units of Application (a large geographical area , eg Northern Region), and to up to four specialities. To me this looked like saying to a NQT at the end of the probationary year “We really like the way you work in teaching GCSE physics, as seen in your school in London, we are offering you the chance to work somewhere in the North, but we can’t say whether it is Newcastle or Whitehaven, and if the interview does not go well, you will be offered a post teaching primary art in Weston Super Mare. You are fortunate.” In addition a new centralised application process was set up (MTAS), which actually worked rather well at a hardware and software level. However the weighting for short listing was very much in favour of creative writing e.g. in 150 words describe how you show empathy, team working etc. These questions may be valid in an interview, but certainly not for shortlisting. No one shortlisting ever saw a whole application (which was in fact very much like a CV), and I liken this to seeing one or two pieces of a jigsaw of the Mona Lisa, and trying to score the whole picture. The shortlisting was also dogged by delays following on a change to merge London and KSS into one UoA, mid application, and this resulted in rushed scoring, and possible losing some applications completely. The result has been that some outstanding applicants were not even called to interview for the highly competitive jobs leading to Consultant or GP status. It is obvious that if the best are not interviewed they cannot get the job. The administration of the interviews has also failed, with Juniors called to interview for example for Urology, appearing before a General Surgery panel, or giving up a day’s work to arrive and find no interview panel at all!
The Review Panel to date has not acknowledged how badly wrong the process has gone. I believe the only way ahead is to call the whole of Round One null and void. I doubt there is time to fix and run Round Two and deliver good doctors to Trusts for August 1st. The only solution that I can see is to declare 2007-8 a “General Training Year” and swiftly move SPRs up to Consultant to create space for SHOs to move up to SPR or ST3, to in turn allow F2s to move up and let students start F1. F2s and SHOs could also be allowed to work abroad for the year. In some cases Trusts could simply extend Juniors’ contracts without the need for interview. Trusts can easily run an ordinary Spring recruitment round for other vacancies.
Then by August 2008, or maybe better 2009, we could be ready to start MMC on a proper basis after review and repair. During that time the rotations must be planned in detail, and candidates allowed to apply for a specific set of rotations, rather than a large UoA, and know several months in advance their starting job. This would indeed match the USA Match.
Then there is the question of who was responsible for this fracas. There should be an independent enquiry by professionals from outside medicine, maybe from teaching, or King’s Fund? However even now it is clear that MMC was Sir Liam Donaldson’s “ig plan”and his contribution to the NHS to resolve the problem of the lost tribe. Sir Liam was given the unusual privilege in the NHS of power, authority, money and personnel to implement change. He devolved the power and money to MMC and COPMED, who chose the format and philosophy of MTAS, and pushed through major change at high pace on a large scale. They would have celebrated success and should be accountable for failure. The NHS must learn form this disaster. It is very risky to introduce change on a large scale, without understanding well tried processes, acknowledging work place expertise, and listening to criticism, even if it is from the Junior Doctors Committee or a lowly DGH Consultant. It is dangerous to change process and software simultaneously. There are other major projects such as the CRS in NPfIt, and Settings of Care happening right now backed by similar power and money, being forced through at high pace. I maintain hope that on August 1st first high quality junior doctors will be in excellent posts preparing them for senior roles in providing health care.
