More must be done to reconcile reduced working hours for junior doctors with meeting their training needs, reports an inquiry by the Health Select Committee.
Dr Patricia Hamilton, director of medical education at the Department of Health, told the inquiry into education, training and workforce planning that work was underway to move away from junior doctors providing most of the service to a more “consultant-present” service.
Christine Outram chief executive of Medical Education England (MEE) said some hospitals had already begun to structure their hours differently so that more senior doctors were available to oversee the work of juniors and give guidance and advice when needed. The intention was to spread this good practice.
MEE chairman Professor Sir Christopher Edwards, said some hospitals had shown it was possible to change working patterns to accommodate the European Working time Regulations (EWTR) and allow junior doctors to access training.
Dr Tom Dolphin, chair of the BMA’s junior doctors committee, said their preferred model was a “trained-doctor” service. This would involve using all trained doctors – consultants, GPs, clinical academics and staff and associate specialists – to ensure that the service was not so reliant on juniors. This would give juniors more opportunities to get the training they needed within the 48-hour week. In some cases the curriculum might have to be extended to cover an extra year but it would be for each individual specialty to make that decision.
“While training occurs through exposure to patients and delivering patient care, our view is that junior doctors ought to be viewed as being employed primarily to train. It is the current arrangement they have for GP trainees and we think that ought to be the same in hospitals,” said Dolphin.
Professor David Sowden, chair of the Conference of Postgraduate Medical Deans of the UK (COPMeD) said there was a case for a new “modularised” approach to training based on credentialing. This would involve doctors reaching certain levels which would allow them to do a set range of activities within the system. This would enable trainees to step on and off the education and training escalator in contrast to the current relatively inflexible system.
The all-party committee of MPs conclude: “We have received a broad basis of evidence which shows how it is possible to reconcile reasonable hours for junior doctors with high quality training and, most importantly, high standards of care for patients.”
But a spokesman for the Royal College of Physicians said they felt the committee had failed to recognise the difficulties caused by limitation of the hours for training doctors particularly in acute medicine caused by EWTR and New Deal. The RCP was calling for greater flexibility in application of these policies.
The report goes on to warn that the government’s plans to reform handling of the £5 billion annual training budget lack clarity. MPs are particularly concerned about the lack of detail about how postgraduate medical deaneries, Local Education and Training Boards (LETBE’s) and Health Education England will fit into the new system.
Committee chair Stephen Dorrell said the government had not yet published a detailed plan of how the new structures were intended to work. “We are concerned about this apparent lack of urgency and we believe that failure to address these issues quickly will lead to risk for patients and confusion for staff,” he said.
Professor Wendy Reid, vice president (education) of the Royal College of Obstetricians and Gynaecologists, said: “We welcome this report as it highlights the gaps in postgraduate medical education and training – gaps which require further thought if our system is to maintain its reputation of being world class.”
RCP president Sir Richard Thompson, said: “Postgraduate deans need to be integrated into the new education and training system as soon as possible to prevent uncertainty. We must also improve national workforce planning, so as to have not just enough doctors to treat the growing numbers of acute medical patients, but the right doctors in the right places to ensure high standards of care for patients everywhere.”
Read the report.