More than 50,000 NHS jobs will be lost because of government spending cuts, a new anti-cuts campaign group says.
Trades Union Congress-backed False Economy said its study showed that NHS trusts were planning to cut 53,000 staff over the next five years - more than double previous union estimates.
It used replies to freedom of information requests to produce its picture of cuts across the UK.
But the government has accused the unions of “scaremongering”.
Read more on BBC Health.
NHS managers in London have demanded the budget for trainee doctors be cut and at least 140 posts.
The NHS in London is already under financial pressure and a leaked email from the London deanery has revealed that junior doctors’ training is now under threat.
Funding for 140 posts will be withdrawn from April next year and experts have warned it could be ‘devastating’, especially for small hospitals.
Jeremy Levy, head of medical specialties at the London deanery, said NHS London is asking trusts to cut 35 specialist registrars, the most senior doctors still in training, by 2010/11, alongside 30 posts for doctors with three years’ postgraduate experience.
A further 75 posts will disappear between 2012 and 2014.
The cuts are all being made in medical specialties, including cardiology, diabetes and cancer services.
There are around 12,000 training jobs in London and the posts will be deleted as the doctors move on to the next stage of their career.
The email said there was a need to reduce the doctors’ training budget “as dictated by the Department of Health”. He added that there was a lack of consultant posts for junior doctors to take up when they complete their training.
Read more at the Telegraph.
The government has been accused of “promoting privatisation” of the NHS after a surprise announcement of sell-off plans for an agency which provides thousands of nurses and other health workers to hospitals across the country.
The department of health said it would explore options for private sector investment in the state-owned NHS Professionals, which has 50,000 workers on its books and places staff for two million shifts a year at 77 health trusts.
Unions were furious over the sell-off. Karen Jennings, UNISON Head of Health, said that “the whole reason that NHS Professionals was set up was because private agencies were ripping off hospitals by charging them outrageous fees for recruiting or finding staff for shifts.
Read more at The Guardian.
Deaneries around the country are drawing up plans to cut specialist trainee posts over the next three years.
Health authorities describe a 15% reduction in the national training budget - a loss of £650 million a year - between now and 2014, the Sunday Telegraph claims.
In some parts of the country, this could translate into the number of training places for surgery, trauma and orthopaedics falling by a third.
The official line is that the cuts are necessary to avoid unemployment in future and to try to ensure deaneries are training doctors in appropriate specialties to meet NHS requirements. But many suspect it is about cost cutting.
While some fear there is oversupply in the surgical specialties, others believe that the demands of the Working Time Directive mean that doctor numbers must be maintained.
Mr David Mahon, a surgeon working in Musgrove Park NHS hospital in Taunton, told BMJ Careers that the South West Deanery was facing a 14% reduction in the budget for trainees. He believes the cuts will fall disproportionately on some of the larger specialties, such as medicine and surgery, where there is greater room for manoeuvre.
“This is unprecedented,” said Mr Mahon. “Trainee numbers have increased year on year for as long as I can remember. My specialty is going to be harder hit than many other specialties.”
He also warned that a loss of trainees would lead to hospital staffing problems and would mean “either spreading the remaining doctors more thinly, which is potentially dangerous; using consultants, possibly unnecessary and definitely expensive; or using non-training grade doctors or non-medical staff”.
Papers drawn up by the strategic health authority NHS East of England describe a net loss of more than 500 clinical training posts, suggesting that nationally the cuts could amount to more than 5,000 jobs.
The SHA which covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk warns that the public sector is moving into a period of sustained economic recession, with “significant implications” for the NHS workforce.
There are 6,800 training posts available for doctors graduating from medical school this year - a significant increase on previous years. In future, GP numbers are set to grow at the expense of hospital doctor roles.
The Department of Health confirmed it has been reviewing specialty training and specialist numbers to ensure they are appropriate for future demand.
It follows Conservative claims that significant numbers of clinical posts are to be cut.
Campaigning group Remedy recently forced the government, following a legal challenge, to delay their plans to exempt deaneries from employment agency legislation.
This is of significance to any doctor involved in the recruitment process, who would have been deprived of many employment rights by these proposals. The legislation governing the conduct of employment agencies was passed by Parliament in order to give protection to vulnerable workers.
A government consultation, in early 2009, stated that they ‘consider that [Deaneries] operate as employment agencies within the definition contained in the Act’ and that they wished to introduce an exemption. Their reasons for doing so were unclear. Remedy’s legal team postponed the introduction of the exemption, possibly indefinitely.
Following this, Remedy has prepared a briefing document which they suggest all applicants for training jobs read. Here’s a summary:
Do you know your rights?
Employment agency legislation may protect doctors in many areas - in particular around confidentiality, ’stick-or-twist’ and your right to information before accepting a post.
Employment agency legislation offers significant protection to work seekers. Here’s a simple guide to it.
What is an employment agency?
Section 13 of the 1973 Employment Agencies Act defines them as being: the business (whether or not carried on with a view to profit and whether or not carried on in conjunction with any other business) of providing services (whether by the provision of information or otherwise) for the purpose of finding [persons] employment with employers or of supplying employers with [persons] for employment by them.
There are three important parts of the Act Remedy highlights:
• Information given to work seekers.
• The twist and stick dilemma.
• Maintaining your confidentiality.
The legislation requires that sufficient information is given to work-seekers, including the place of work, the nature of the work and the duration of employment. This information needs to be provided to the work-seeker by the employment agency at the time that the offer is made, or in any event within three business days.
The second is the statutory requirement under Section 6 of the 2003 Act that prevents employment agencies from: subjecting or threatening to subject a relevant work-seeker to any detriment on the ground that -
(i) the relevant work-seeker has terminated or given notice to terminate any contract between the work-seeker and the agency or employment business; or
(ii) in the case of an employment business, the relevant work-seeker has taken up or proposes to take up employment with any other person; or
(iii) require the relevant work-seeker to notify the agency or the employment business, or any person with whom it is connected, of the identity of any future employer of the relevant work-seeker.
Remedy believes that this requirement affects the ability of an employment agency to compel applicants to withdraw their other applications when they receive an offer.
Your confidentiality is protected by Section 28 of the Act.
1. Neither an agency nor an employment business may disclose information relating to a work-seeker, without the prior consent of that work-seeker, except -
(a) for the purpose of providing work-finding services to that work-seeker;
(b) for the purposes of any legal proceedings (including arbitration); or
(c) in the case of a work-seeker who is a member of a professional body, to the professional body of which he is a member.
2. Without prejudice to the generality of paragraph 1, an agency shall not disclose information relating to a work-seeker to any current employer of that work-seeker without that work-seeker’s prior consent, which has not by the time of such disclosure been withdrawn, and shall not make the provision of any services to that work-seeker conditional upon such consent being given or not withdrawn.
Why don’t deaneries admit they are employment agencies?
Strangely, legislation requires that employment agencies mention their status in every advertisement. This is important so that work-seekers know what sort of organisation they are dealing with. Remedy will be writing to BERR shortly asking why this is not enforced.
Training programmes and contracts of employment
A contract of employment is a binding agreement between employer and employee, governed by employment law, which sets out the rights and duties of the two parties.
A training contract is a separate type of agreement between trainer and trainee. It is important that you check which type of contract - employment or training - you have signed.
If I withdraw from a job will the GMC be interested?
The threat to refer doctors to the GMC might appear to be covered under Section 6 of the 2003 Act (see above).
We recognise that the provision of safe levels of patient care is essential, that it would be irresponsible for doctors to pull out of a job that they had agreed to do at short notice, and that once you have accepted a firm offer of employment then you must honour that commitment. The GMC itself has issued guidance on this subject.
If you find yourself in this predicament then there are two important aspects to consider. Firstly there is the nature of the contract - employment or training - that you have signed. Paragraph 49 of Good Medical Practice refers solely to a ‘post you have formally accepted’.
Secondly you must consider what would be a reasonable period of notice to give if you were to withdraw. Three months is the usual notice period for Specialty Trainee jobs.
I have been offered a place on one training programme, but haven’t heard yet from the one I prefer. What should I do?
Despite the provisions of employment agency legislation, Remedy is getting reports from doctors who have been asked to sign agreements that run contrary to Section 6 of the 2003 Act.
If you intend to withdraw from all other training programmes that you have applied for then we would encourage you to let the deaneries know this. However you might still consider that their letter compelling you to do this contains a threat that breaches Section 6 of the Act, and you might wish to let BERR know. You can do this anonymously.
If you do not intend to withdraw from all other training programmes then you should let the deanery know this, and you should also state your reasons. You should never deliberately mislead them of your intentions or give false or incorrect information.
I think a deanery has breached the regulations. What should I do?
You can let BERR know this by writing to them directly.
For more visit the Remedy website.
A legal challenge has been issued to the government over decisions it has made which deprive junior doctors of key labour protection rights.
Lawyers employed by the campaign group Remedy are questioning the propriety of a consultation carried out earlier this year on whether to exempt deaneries from employment agency legislation.
Remedy has opposed the move because it claims that it deprives juniors of key employment protection rights.
Abuses include failing to inform junior doctors seeking work through deaneries of which rotation jobs they will be assigned to when they apply; being forced to ’stick or twist’ on jobs; and not knowing where they will be two weeks before a job starts.
Remedy’s lawyers have sent a legal ‘letter before action’ to Lord Mandelson, the business secretary, in a bid to persuade him to withdraw his decision and to start the consultation process again.
They have highlighted the way the Department for BIS justified the exemption on “potential consequences” and “evidence” - the details of which were not revealed.
They argue that the consultation came to the conclusion that the only group who could be affected by the proposed changes to the law would be the deaneries themselves. They also point out that there was no consideration of the impact this action would have on the doctor.
Remedy’s head of policy Richard Marks said: “In the short term this legal action will delay any changes which will be to the benefit of those currently going through the system. But our long-term aim is to campaign for better and fairer controls of the ways that deaneries conduct recruitment.
“We want to see the levels of protection for doctors increased, not reduced. The distant promise of a code of conduct with very uncertain powers is simply not good enough.”
In return for exempting deaneries from employment legislation the Department for BIS has proposed establishing a code of conduct to govern future recruitment and training arrangements for junior doctors.
But Dr Shree Datta, chair of the BMA’s junior doctors’ committee said they were concerned about how much teeth the code would have and whether it would be enforceable.
“We will await with interest the progress that Remedy make on this issue. Meanwhile were are putting pressure on deaneries to make sure they are aware of the feeling among junior doctors on this issue,” she said.
A Department for Business spokesperson said: “I can confirm that we have received a letter from Remedy and are in the process of considering it.”
Read a blog on the issue.
Can you imagine a job advert that doesn’t tell you where you will be working, the hours of work, what you will be paid, when you need to start or the length of the employment? Furthermore, when you call up to ask these questions your prospective employer refuses to give you an answer…
Well many of us don’t have to imagine, we just have to be junior doctors. Everybody from office temps to fruit pickers has the basic right to this information but, it seems, not junior doctors.
In 2008, the BMA challenged the Employment Agency Standards Inspectorate (EASI), the organisation responsible for regulating employment agencies, to find out whether deaneries were employment agencies in the eyes of the law. If they were, deaneries would have to comply with the requirements of the Employment Agencies Act and supply all the basic details about their jobs before they start.
Much to our satisfaction EASI confirmed that postgraduate medical deaneries appear to be employment agencies and as such would be required to comply with the requirements of the Employment Agencies Act. The BMA immediately began notifying EASI of deaneries failure to comply with the legislation.
Sadly, the costs of getting deaneries to provide junior doctors with the same basic rights as other workers caused the government machine to whirr into action and in
In May 2009, the Department of Business and Skills (BIS) published a consultation which detailed their intention to exempt deaneries from the employment agency regulations.
The BMA responded strongly to this consultation stating that deaneries should not be exempted. If BIS chooses to ignore the views of junior doctors and exempt deaneries then we must start the hard work of getting deaneries to sign up to a code of practice that raises standards.
Junior doctors are united on this issue and the JDC will do everything in its power to get what are basic employment rights for junior doctors. Should we not be satisfied with the terms of the code of practice for UK junior doctors, we will not be able to agree to them.
Our aim is to ensure that junior doctors are merely afforded the same rights to any other work seeker - no less. We will have a better idea of the direction of the code of practice early next year, so watch this space.
In the meantime, do get in touch with the deaneries and the BMA if you have trouble with applications for specialty training.
December is traditionally the time of year that most people get ready for Christmas.
Many junior doctors also face the additional pressure of applying for new jobs. But, with all the distractions of the festive season, it is important that everyone understands the recruitment process to maximise their chances of getting the training post they want.
Recruitment for specialty training officially began on the 4 December. And whilst the ill-conceived MTAS has been confined to the dustbin of history; we cannot be complacent.
There were glitches in the some of the application systems last year, but thankfully these were sorted out before any junior doctors were disadvantaged. However, they reminded us of the need to stay vigilant and proactive rather than reactive.
The principles of the Tooke Report should still be ringing in the ears of those responsible for recruitment. Change, although not unwelcome, must be evidence based. We must have robust piloting to find out how new systems operate in the real world and critically new computer systems must be rigorously tested.
The cost of getting selection for specialty training wrong is high, not merely financially, but in terms of affecting the public services our patients receive and the careers of individual doctors.
We have concerns over changes that may be on the horizon. There has been talk of introducing another knowledge-based test for specialty recruitment. The rationale for knowledge-based selection tests is not clear and the BMA has been critical of these tests as there is little evidence that they are a good way of selecting the best candidates.
Machine marked testing (MMT) is also looming. It has been mooted as a way of addressing the inconsistency of assessments which has caused problems for deaneries in national recruitment and has frustrated applicants.
Unless planned thoroughly, dissected microscopically and piloted, MMT will receive a hostile reception from junior doctors which it may not survive.
To maximise the chance of getting the job we want, it is critical that all applicants ensure they are familiar the process for 2010. The MMC website and Deanery websites are the main resources, although posts may also be advertised via BMJ Careers and NHS jobs.
If applicants encounter problems during the recruitment process they should contact the BMA on 0300 123 1233 so that we can put pressure on those responsible.
Doing your research thoroughly prior to applying or accepting a post is crucial as there are regional variations in the content of training programmes. Study leave and relocation allowances can also vary and the best way to find out what’s available is to speak to those in post currently.
This is the only way to avoid the Nightmare before Christmas. Good luck!
The first step for a doctor to get a new job is to write a strong CV. A doctor’s CV will often have less than a minute to convince a recruiter of their suitability for a role in a competitive specialty. A doctor’s CV must be concise, well designed and easy to skim read in search of important information.
Application forms
Increasingly electronic application forms are requested for NHS job applications. These do not replace the well written CV and it is standard pratice for doctors applying for a role to send a CV in advance, or bring a CV with them when visiting the hospital prior to interview. Standardised application forms include all the usual sub-headings of a CV but will also include interview-type questions on leadership, management, personal strengths and weaknesses.
Medical CV structure
1. Title page: name and qualifications only.
2. Personal identity (full name, date of birth, nationality, sex).
3. Professional memberships (GMC, royal medical college, NTN, CCT date, indemnity number).
4. Contact details (postal address, telephone, email).
5. Qualifications (dates, institution, location).
6. Education (dates, institution, course, prizes, other achievements).
7. Prizes and presentations.
8. Current position.
9. Work history (date, position, employer, supervising consultant, duties and achievements – all in reverse chronology).
10. Summary of skills and achievements.
11. Courses and conferences attended.
12. Research.
13. Publications (original papers, reviews, chapters and abstracts in that order).
14. Teaching (training and experience).
15. Audit (training and experience).
16. Management (training and experience).
17. Leisure interests and activities.
18. Career intentions.
19. Referees – names and contact details of three people.
Common mistakes made by doctors in their CVs
At the top of the list of CV mistakes is poor spelling, grammar and typos. Doctors must spell check their CVs. They should also ask a friend, colleague or mentor to proof read the completed CV.
Doctors should also be careful not to make the CV too duty-oriented, at the expense of outlining the individual’s experience and achievements. Applicants should avoid long paragraphs and use concise bullet points instead.
Other problems include inaccurate or missing contact information, poor formatting, long-winded paragraphs and inappropriate personal information.
The doctor should ensure the CV is written in active language and competently printed on white paper. It is unnecessary to have the CV professionally printed on thick paper – the candidate is going to be judged on the words and how they’re presented.
A doctor’s covering letter
The doctor’s covering letter should be tailored to the role. It should convey the doctor’s interest in – and suitability for – the job. It must be both informed and enthusiastic about the role, team and employing organisation. The recruiter must be left in no doubt on what the applicant would bring to the role and how that separates them from others. It should be no longer than one side of A4 paper.
Job interview preparation for doctors
Medical interviews should not be taken lightly. They are demanding at all levels, seeking to assess a doctor’s character, attitudes and flexibility of thought as well as their medical expertise. The panel format (typically eight to 12 people) can also be intimidating for some. Many good doctors have failed to secure the role they wanted because of poor preparation and interview technique. Planning and preparation can significantly improve a doctor’s chances.
Interviewers’ objectives in a medical interview
They are seeking to appoint the right doctor for the role, and a colleague they can envisage working with. To do this they will examine a doctor’s motivations, career aspirations and potential, technical competence, team working abilities and professionalism.
For a consultant interview, the panel will also be looking for a doctor’s ability to work independently, work with managers, lead a team and move the service forward.
Getting prepared for the interview
The formal interview is not the chance to find out more about the job – the doctor should already have done this. Clarity is needed on the following issues:
1. Yourself: a doctor should be clear on their ambitions, priorities, and clinical and outside interests.
2. The role: review the person specification in depth and detail all of the key competencies, personality skills and clinical skills required.
3. The organisation: find out about the department, hospital and trust. Doctors should visit its website and read the annual report or executive summary. They should visit the team in person and ask lots of questions about the role and service, and talk to any contacts who have worked there. Doctors should understand the team’s and organisation’s history, activities, strengths and weaknesses and future direction.
4. The interview panel: the interviewee should find out, if possible, who will sit on the panel. For a consultant interview there will be at least seven members potentially including the trust chair, chief executive, medical director, lead clinician from the team, college representative, academic representative, patient representative and a member of the HR team. It is worth exploring the clinical interests of the medical members.
Candidates for consultant roles should ensure that they meet the chief executive, medical director, clinical director, as well as the current consultants in the relevant team in their visits to the trust. They may also wish to meet allied health professionals as well.
Commonly panel interviews take a structured approach, with each interviewer taking it in turn to ask questions.
5. Specialty issues: read relevant medical journals closely for three to six months preceding the interview, and are aware of any recent NICE or MHRA guidance.
6. Wider NHS issues: read non-clinical magazines, such as HospitalDr.co.uk and BMA News, to understand the current professional debates. Doctors should understand the current change agenda including the modernisation of services, Lord Darzi’s review, revalidation, changes to training and Foundation Trusts.
Practicalities of getting to the medical interview
It’s commonsense to check the employer’s location and travel details well in advance. Also find out where the interview is being held within the building beforehand. On the day of the interview travel early, or even consider the night before, and ensure that you don’t have to ‘cram up’ on information you should already have read.
Doctors’ presentations at interview
Doctors may be asked, in advance, to give a formal presentation as part of the interview process. Check what equipment will be available on the day and prepare appropriately. Make sure it is professional and formally delivered, but with pace and enthusiasm.
Answering questions at interview
There will be several candidates for the job. The applicant who is successful will be the one who is distinctive, enthusiastic, has something interesting to say and shows potential.
Doctors should not simply answer the question. They should also sell themselves. Doctors should populate their answers with real examples from their working life. They should also remember to demonstrate their understanding of the role, team and organisation in their answers.
Be positive wherever you can. Panels like positive people. So when a doctor is asked about changes in the NHS, they should start their answer by stressing why change can be good before being more critical.
Rehearse strong answers on your skills, strengths and weaknesses (finding a positive way to frame your answer), experience and motivations. Draw up a list of other potential questions and think through answers – but don’t sound too pre-rehearsed.
First impressions
Initial impact is important. Doctors should dress smartly and be well groomed – they will never regret buying a plain suit. They should take a deep breath and calm themselves before entering the interview room. Candidates need to be confident. Close the door behind them. Smile. Respond to offered handshakes firmly and sit quietly but alertly for the opening question.
Positive body language is also important. The doctor should be responsive, leaning slightly forward, open arms, nodding. They should listen attentively and keep eye contact.
Style of response
The interviewee should look at the person questioning them and direct answers to them. They should glance around to engage the whole panel. Speaking slightly slower than normal is a good technique, and their voice should show their enthusiasm for medicine and the role.
If they ask you whether you have any questions at the end, either ask a good one or don’t bother. Don’t ask one for the sake of it and avoid ones about terms and conditions. In a consultant interview, you should – from your previous visits – know the service ambitions of the chief executive or senior clinical representative and you could consider asking a more strategic question about those issues. At the end thank the panel for their time and leave in a smooth manner.
Practice makes perfect
Take time to practice. Try your ‘stock’ answers out in the mirror first and then on a colleague or mentor – preferably one involved in recruitment. If you’ve been asked to do a presentation, also run it past a friend or colleague as well. It’s the only way to still be able present yourself to the best of your abilities when you may be suffering from nerves.
Type of questions asked in a doctor’s interview
A search of the web will reveal lists of questions that typically get asked in medical interviews for both juniors and consultants.
Accepting failure and learning from it
If the doctor doesn’t get the job they should ask for feedback. However disappointed a doctor feels they need to learn from the experience and then try again.
