Plans for the future of deaneries and medical education are so vague that they risk becoming the Achilles heel of the government’s entire reform package for the NHS, juniors are warning.
At the BMA’s recent annual meeting junior doctors committee (JDC) co-chair Dr Tom Dolphin described the government’s current proposals for medical education as “the half-baked pie to follow the dog’s dinner of the original Health Bill”.
Juniors are concerned about the future of postgraduate deaneries which are under threat because of proposals in the Health and Social Care Bill to abolish strategic health authorities (SHAs).
Following concerns raised during the ‘listening exercise’ the Department of Health has now promised that it will ensure a “safe and robust” transition for the education and training system. During the upheaval of the NHS reforms deaneries will continue to oversee the training of junior doctors and will be given a “clear home” within the NHS family.
It has also announced that it will be phasing in provider-led skills networks to take on workforce development responsibilities.
But opinions are mixed about the future role of deaneries and who should oversee medical education. JDC co-chair Dr Shree Datta, says: “We are hugely concerned because things are looking very bleak indeed at the moment. Over the last six months we have managed to secure an assurance that deaneries will remain but unfortunately there is a distinct lack of detail beyond that so we don’t know actually where they will be housed.
“Our biggest concern is that this will start to impact on education and training in November when the next recruitment round starts.”
Datta says few of the proposals for the future of deaneries are attractive. They could be housed within trusts but this would effectively mean that employers would be quality assuring their own their own training which would be akin to them marking their own homework.
They could become special health authorities but that would take time, be expensive and would require an additional support network.
Housing deaneries under the new national education authority Health Education England (HEE) could be a possibility that the JDC would welcome.
She says there is little support for the employer led skills networks amongst deaneries or doctors.
“Our problem is that we still have no answers only a simple and half-hearted assurance that deaneries will continue to exist. It’s still very uncertain as to how medical education will be delivered in the next five years let alone the next five to ten years.”
The royal colleges are bidding for a greater stronger role in the proposed new structures.
In its submission to the Future Forum the Royal College of Surgeons of England suggested that HEE should be responsible for developing and enforcing the education contract with the skills networks which would be required to meet standards set by the profession through approved curricula.
It proposed that the college, through its national standard setting bodies and regionally based Schools of Surgery, could provide a national perspective and also act as agents of HEE at local level to ensure that providers meet the educational requirements of the contract.
The current deanery functions could be split in two. The administration of training and employment of doctors would be handled by local skills networks and the organisation, assessment, monitoring and quality assurance of training would become the responsibility of colleges or professional bodies at a regional level.
The Royal College of Physicians (RCP) in its response to the NHS Listening Exercise also recommended that there should be national planning of all postgraduate medical education led by HEE closely working with the royal colleges.
This would mean setting the number of trainee placements for specialties at national levels with some scope for flexibility in local implementation. Local skills networks would have to be accountable to HEE.
The RCP suggested that deaneries should be made accountable to HEE. Following the abolition of SHAs deaneries could be hosted at a local level either within universities, trusts or “sub national” HEE structures.
It recommended the setting up of local pilots for increased provider involvement.
But following publication of the Future Forum report RCP president Sir Richard Thompson warned: “Without a fundamental review the government’s current proposals for reform of medical education and training, the next generation of doctors’ training is at risk and patient safety could be jeopardised.”
Dr Richard Marks of the campaign group Remedy says deaneries have always been compromised by a conflict between their educational goals and the demands of their SHA paymasters.
“The question that has to be resolved is who should deaneries be accountable to? We also need to look at the individual functions of deaneries and decide who needs to be managing them,” he says.
Remedy told the Future Forum that it expected to see a lessening of the role of deaneries and that the royal colleges should be given a stronger voice in maintaining professional standards.
Marks suggests that there should be regional organisations responsible for standards of training in their areas. He hopes that the reforms will be an a opportunity to introduce some flexibility and individuality into training so that trainees can dip in and out of programmes and specialties and change careers more easily.
“They have got to come up with something and then they have got to sell it to everyone which is going to be the hard thing because not everyone is going to agree on what the answer should be.
“They can’t leave it too long because staff are haemorrhaging from deaneries and people want answers - they don’t want this to become the Achilles heel of the NHS reforms,” says Marks.
The Department of Health says it will publish its revised proposals for medical education in the autumn.