The Scottish government has to take urgent action if it is to avoid creating a generation of inadequately trained doctors and compromising patient safety.
This is a warning from the Royal College of Physicians of Edinburgh which believes there are major problems with medical training throughout Scotland and the UK, and it threatens the sustainability of the health service north of the border.
The college believes the government has been unresponsive to successive reports and surveys which suggest the traditional balance between training and the provision of direct patient care has been eroded, with many juniors being required to plug gaps in hospital rotas.
A recent Scottish Academy of Medical Royal Colleges’ survey of trainees reveals that only 42% believe they would be adequately trained by the end of their specialty training.
The 2010 research also showed that 15 months after the implementation of the working time regulations more than 70% of respondent trainees stated that their rotas were not compliant in reality. Because of this, the college fears the full impact of the working time regulations may yet to be realised.
The college says there are insufficient numbers of doctors in some hospitals to safely staff rotas, particularly out-of-hours, leading to a number of patient safety incidents or ‘near misses’.
Furthermore, many consultants have insufficient time within their job plans to adequately supervise the training of juniors.
The college is recommending a series of measures which must be adopted by the incoming Scottish government as an urgent priority. These include guaranteeing protected training time for juniors, and for consultants involved in supervising training, thus readjusting the balance between service and training.
The government has to ensure that NHS Boards, as doctors’ employers, recognise these training needs.
It also has to account for training time when planning future workforce numbers, and protect patient access to consultants.
Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said: “Successive reports and surveys have highlighted major problems within the NHS in relation to the training of doctors and their ability to provide high quality patient care. We have now reached a tipping point, where this evidence can no longer be ignored or considered in isolation. Instead, it is imperative that policymakers look at the totality of this evidence and recognise the fundamental problems which exist.
“It is essential that we safeguard the future ability of the NHS in Scotland to deliver safe, high-quality, patient care. To do this, we need to ensure an adequately planned, trained and resourced medical workforce. Failure to do so could lead to a generation of inadequately trained doctors and in turn, compromise patient safety. This would not be in the interests of patients, doctors or policymakers and we urge politicians from all parties to recognise the gravity of this situation and to commit to the recommended actions.”
The college is urging the Scottish and UK governments to secure a “relaxation” of the working time regulations, and to expand the medical workforce - a proposition it acknowledges as “unpalatable” in the current financial climate.
Medical organisations are currently submitting views to the European Commission, as part of its review of the Working Time Directive.
UK bodies are seeking changes in the way time spent on-call is counted and more flexibility in the timing of compensatory rest.
Last year’s Temple Review recognised that as a result of working less hours juniors were being less well trained, and called for a fully consultant-delivered health service.
Later that year, the Collins Review of Foundation Training found that many young trainees are being required to practice beyond their competence and without adequate supervision.
Dr Kerri Baker, chair of the college’s trainees committee, said: “Trainee doctors report feeling disillusioned and let down by their training experience gained within the NHS. Many believe they are gaining insufficient training to enable them to function safely and efficiently as the consultants of the future and are also increasingly used only to plus gaps in hospital rotas, often being forced to sacrifice quality training for service provision.
“It is vital that they receive protected, quality training time which will enable them to become fully trained to provide the standard of specialist care rightly expected by patients.”
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