Time to junk the appointments system for doctors
From Mmc
Time to junk the appointments system for doctors
Sir, The chaos of the new appointments system for junior doctors, which left one third without interviews at the beginning of March, returned to the news with the resignation of Alan Crockard (report, March 31 ) from his position in the Department of Health as principal architect of the attempt at Modernising Medical Careers (MMC). “From my point of view, this project has lacked clear leadership from the top for a very long time,” he says in his resignation letter. His departure and Parthian letter appear to hole beneath the waterline the edifice he created, and underline the folly of senior doctors struggling to keep it afloat by “following orders”. Whose orders?
We recognise the need for evolutionary changes in medical training, always adapting to patient need and taking into account changes in supply and demand for doctors in the UK and Europe.
However, there are two principles that cannot be compromised. One is that entry into specialty training programmes is based on the use of objective criteria which recognise scholarly and clinical achievement. The other is flexibility in training programmes, so that patients do not find themselves cared for by disillusioned doctors working in specialties for which they lack enthusiasm or aptitude.
MMC enforces premature choices by doctors only two years out of medical school, and expects candidates to sign over five critical years of their career without being told the detailed specification or location of the training and mentorship they will receive.
As for the much trumpeted concept of MMC as saviour of “the lost tribe” of senior house officers (SHOs) — the group of doctors two to four years postqualification — salvation seems hard to square with the random carnage of at least 8,000 doctors, mainly SHOs, who will shortly drop out of the NHS after costing the taxpayer £2 billion to train to their present level.
The legality of restricting the number of job applications for specialist training posts is being seriously questioned. Remarkably, the review body established in early March is seeking to impose a reduction in choice from the four that were advertised to just one interview per candidate. Because the preinterview shortlisting process has been abandoned (after costing tens of millions of pounds), more taxpayers’ money is to be thrown at interviewing all applicants without selection, including the possibility of repeating under new rules thousands of interviews already conducted.
The royal colleges recognise the burden this places on consultants and trusts, including cancellation of clinical activities that are bound to have adverse effects on patient care. In every poll conducted, more than 80 per cent of several thousand doctors have declared against continuation of the new Medical Training Application System (MTAS), in favour of an immediate return to the previous selection system for this year. If the review body will not listen, this is the week for grassroots democracy to act. MTAS cannot progress without participation by individual consultants in interviews. We hope they will say no, that individual trusts will ballot their consultants, and that medical directors and chief executives, putting patient care first, will say no.
We urge, instead, an immediate return to a regionally based appointments system led by the same expert doctors as will be responsible for the specialist training. This solution is still feasible; it will minimise the adverse impact of the hugely expensive and ill-considered reorganisation on patient care, while providing much needed breathing space for careful planning and validation of new training and appointment processes.
MORRIS BROWN, Professor of Clinical Pharmacology, University of Cambridge
JOHN CAMM, Professor of Clinical Cardiology, St. George's Hospital Medical School
MARK CAULFIELD, Professor of Clinical Pharmacology, Queen Mary College, London
PAUL CORRIS, Professor of Thoracic Medicine, University of Newcastle
EDWIN CHILVERS, Professor of Respiratory Medicine, University of Cambridge
PAMELA EWAN, Consultant Physician, Addenbrookes Hospital
JOHN GIBSON, Professor of Respiratory Medicine, University of Newcastle
GEORGE GRIFFIN, Professor of Infectious Diseases and Medicine, Chairman of Association of Clinical Professors of Medicine
ASHLEY GROSSMAN, Professor of Endocrinology, Queen Mary, University of London
ALISTAIR HALL, Professor of Clinical Cardiology, University of Leeds
GEORGE HART, Professor of Medicine, University of Liverpool
TONY HEAGERTY, Professor of Medicine, University of Manchester
HUMPHREY HODGSON, Vice-Dean, Royal Free and University College School of Medicine
PHILIP HOME, Professor of Diabetic Endocrinology, University of Newcastle
RICHARD HUGHES, Professor of Neurology, Kings College London
KAY-TEE KHAW, Professor of Clinical Gerontology, University of Cambridge
JOHN LAZARUS, Professor of Clinical Endocrinology, University of Cardiff
JOHN MONSON, Professor of Surgery, University of Hull
STEPHEN O’RAHILLY, FRS, Professor of Clinical Biochemistry, University of Cambridge
BRIAN ROWLANDS, Professor of Surgery, University of Nottingham
NEIL SCOLDING, Professor of Neurology, University of Bristol
ROBERT SUTTON, Professsor of Surgery, University of Liverpool
ROY TAYLOR, Professsor of Medicine & Metabolism, University of Newcastle
NICK WRIGHT, Warden, Queen Mary College, London
