Posts Tagged ‘Training’

New proposals for approval for medical trainers

By Mike Broad - 9th January 2012 8:05 pm

The GMC is consulting on new arrangements for the recognition and approval of medical trainers.

The proposals are designed to improve the quality and consistency of medical training across the UK, the GMC says, by clarifying the roles and responsibilities of those who deliver training as well as the parts played by the regulator, postgraduate deaneries and medical schools.

Local education providers such as NHS trusts would have to use a new system for showing how they identify, train and appraise trainers.

Postgraduate deaneries and medical schools would be responsible for holding the names of all recognised non-GP trainers and showing the GMC what local arrangements are in place to maintain standards.

This would include named educational supervisors, named clinical supervisors, lead coordinators of undergraduate training and making doctors responsible for overseeing students’ educational progress.

The GMC will use its existing standards structured into seven areas. Local education providers such as hospitals and general practices would use the seven areas to show how they develop trainers.

The new system is designed to help raise the profile of trainers, ensuring they are supported and subject to effective and fair appraisal. The standards trainers will be expected to meet are already set out in Tomorrow’s Doctors (2009) for undergraduate training and The Trainee Doctor (2011) for postgraduate training.

It follows the success of approving GP trainers - GP trainees have the highest satisfaction scores (87%) of all medical trainees (74.6 to 83.7%), according to GMC figures.

Niall Dickson, the chief executive of the GMC, said: “Doctors who train other doctors are absolutely critical to developing and improving standards of care - they help to shape the next generation of doctors and are important role models for medical students and trainee doctors. We want to give this formal recognition by identifying and recognising the contribution they make to improving standards and protecting patients.

“We would need new legal powers to approve non-GP trainers on an official basis, until then, we believe the proposed recognition system will ensure that more formal arrangements are in place.”

Respond to the consultation.

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How can we meet the demand for medical generalism?

By Mike Broad - 23rd November 2011 10:34 am

The career aspiration of most young doctors is to become a specialist.

From the day they walk into medical school they are largely taught by consultants with impressive job titles who have spent most of their career becoming super-specialised in their particular field.

In addition to being culturally groomed for specialisation, rapid advances in medical science and health technology have driven the growth of sub-specialisation. Depth rather than breadth has become the medical paradigm. Specialism holds the key to professional acclaim, prominence and esteem.

Conversely, generalism has bordered on extinction in many of the larger hospitals.

Dr Laurence Buckman, chair of the BMA’s GP committee, comments that “generalism in hospital has largely disappeared - and I am not suggesting that this is a good thing - but I think that the era of the general physician with an interest in something has largely gone. That is not necessarily in the best interests of patients, but it is so”.

The Association of Surgeons goes further saying the term generalist is now “pejorative” and this will not improve unless the general surgeon, general physician and GP are rewarded for their holistic approach to medical care.

The irony of the decline of generalism’s standing is that in hospital medicine - not just primary care - it’s needed now more than ever.

The UK’s ageing population has profound implications for the NHS. Almost 45% of all hospital in-patient treatments in 2009-10 involved people aged 60 or over, and patients aged 60-74 stayed an average seven days in hospital in 2009-10 - 11 if they were aged 75 or over. This compares to an overall average of 5.6 days.

Six out of ten older people are now thought to be living with at least one long-term condition, many of whom have two or more.

Complex needs do not fit neatly into one specialty, and a clear need for doctors who can competently deal with the whole patient begins to emerge.

This mismatch between patient need and doctors’ career aspirations prompted the Royal College of GPs and the Health Foundation to set up high profile commission to review medical generalism with a view to its future development.

The review suggests that the new demographics - 18 million people living with a long-term condition within 20 years - demand a fundamental reappraisal of how medical students are taught to think about illness and disease.

In order to learn how to deal with far greater degrees of complexity and uncertainty than their predecessors would have faced, trainee doctors will need to dwell much less on narrow disease silos and to focus much more on the breadth of possible permutations of co-morbidity.

Professor Sir John Tooke, vice provost (Health) of University College, London, says: “Part of the way of dealing with this is to stop trying to think of medical education as a series of systems or disciplines; it is really thinking of it as a more holistic process and series of care pathways which will involve a range of conditions which happen to present in different ways.

“It is re-thinking how you package the experience.”

A pragmatic first step, however, would be to build more emphasis on generalist skills into the training regime. As the Royal College of Physicians commented, increasing generalist skills in hospitals will complement - not challenge - excellent specialist skills and help to improve patient care overall.

The other significant driver behind the resurgence of medial generalism in hospitals is the demand for increasingly consultant-led, round-the-clock, high quality care. To achieve this, a more equal balance between generalism and specialism will be required.

The commission’s review calls for closer integration between generalist and specialist working. Well-trained staff are most effective in well-designed models of care, it says. To capitalise on the skills and approach of the generalist in either community-based or hospital-based services, models of shared care are needed so that the additional expertise of specialists can be embedded in a predictable and robust way.

But the commission also calls on generalists in both primary and secondary settings to be able to demonstrate the value of what they do and take pride in their professional and public profile. Above all, there is insufficient robust and up-to-date research to be able to evaluate and inform adequately all aspects of generalist practice and its relationship to specialist services, the review concludes.

Other recommendations of note include appraisal systems including assessments of the relationship between generalist and specialist services; development of quality indicators to measure performance over a broader range of patient outcomes; and, a care payment system that recognises the whole person rather than promoting piecemeal treatment.

The Royal College of Physicians called the review “timely” and said it’s crucial to consider whether the medical workforce has the right mix of skills to deliver the highest standard of care to patients.

College president Sir Richard Thompson said: “Patients need doctors with the skills, knowledge and expertise to make rapid diagnoses, find new and innovative ways of treating diseases, and provide holistic, high quality care both in hospitals and the community.

“Patients are increasingly likely to have complex needs that do not fit within one speciality, for almost two-thirds of hospital beds are occupied by people over 65. More doctors must be better placed to respond to these patients’ needs. Whereas specialist care delivers the best outcomes for those with well-demarcated clinical syndromes, we believe that increasing generalist skills in hospitals will complement excellent specialist skills and help to improve the overall care of patients.

“Excellent generalist care must be valued as much as specialist treatment, with doctors encouraged to gain experience in a range of care settings in order to develop a broad base of skills.”

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Stop giving educational funds to private firms

By Bob Bury - 1st November 2011 12:16 pm

As the Editor points out, revalidation isn’t going to go away, and it’s difficult to argue against the need for some demonstration of continuing fitness to practise in a job like ours. But our masters do seem to be going out of their way to screw up the implementation of the scheme.

For a start, if revalidation is genuinely about avoiding problems before they occur, and ensuring that we all keep up-to-date with developments in practice, then postgraduate education (PGE) and continuing professional development (CPD) is clearly the key to success. So you would think that the Department of Health would ensure that the systems for delivering PGE were in robust good health, wouldn’t you? You would, of course, be wrong. The deaneries are doing a headless chicken act to rival that of the SHAs and PCTs - all thrown into disarray by the disaster in waiting that is the Health and Social Care Bill.

You might also think that PGE funding would need a bit of a boost, if we are to start taking CPD seriously? Not a bit of it. The government are, instead, throwing the current education budget down the commercial drain in order to make their ill-conceived changes to commissioning a reality. The Hansard report of the Lords’ debate on the Health and Social Care Bill is illuminating. In his contribution on 11 October, Lord Rea, in pointing out that the Bill was likely to increase rather than reduce costs,  stated:

“Clinicians in the proposed clinical commissioning groups will find that commissioning is a highly complex task. They will need the assistance of experienced administrators, statisticians and public health specialists, as well as competent clerical support… A freedom of information request revealed a list of 40 organisations, most of them private, which have been invited to bid for contracts to train GP consortia, now clinical commissioning groups. For this role, in London alone, £7 million has been allocated for the initial phase, taken from funds originally allocated for postgraduate education.”

In other words, public funds earmarked for medical postgraduate education are being diverted into the pockets of an array of private companies in order to train the new commissioning groups, despite the the fact that the people who have actually been doing the commissioning via the PCTs and SHAs are currently in limbo, wondering how much longer they will have a job.

All the necessary expertise is there, but the government are insisting on giving the money that should be funding our PGE to their mates in the private sector.

This, in microcosm, tells us what to expect across the health service if the Bill passes, as services are fragmented and unnecessarily duplicated. The only winners will be the entrepreneurs, further evidence, were any needed, that a free-for-all in healthcare provision leads to inefficiency and waste. The royal colleges tell us that they are fighting to maintain their leading role in medical education. I would be more convinced if I heard them making a fuss about this misappropriation of the education budget.

I’m going to try to avoid mentioning the GMC this time, I don’t want to get boring on the subject.

Except to say (sorry), that Hospital Dr’s Editor sees “scant evidence that the GMC is winning the profession’s hearts and minds”. That’s an understatement on a par with Socrates’ dying comment that the wine tasted “a bit off”. And since I’ve started, I’ll just mention the fact that, having asked the public whether they thought the private lives of doctors were any concern of patients or the GMC, and been told by 94% of respondents that the answer was “no” (see previous blogs), our regulator has decided to ignore the result. This was apparently an ‘informal’ consultation (utilizing Facebook, if I remember correctly), and they now tell us: “given the very large response to this question, the GMC have decided to ask a specific question about doctors’ lives outside medicine in its formal consultation”.

In other words, they’ll just keep asking the question until they get the answer they want. And the really depressing thing in all of this? I can’t remember the last time I wrote a humorous contribution to these columns.

Bugger.

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Juniors question feedback and supervision

By Mike Broad - 11:24 am

Nearly a quarter of trainee doctors report that on a regular basis they are forced to cope with challenges for which they feel inadequately prepared, a survey reveals.

The annual survey of junior doctors, by the GMC, which provides a comprehensive picture of the views and experiences of 46,000 trainees across the UK, suggests there’s a need for improved supervision and feedback by consultants.

Twenty eight per cent of trainees report that they rarely or never receive feedback from senior colleagues.

Respondents continue to raise concerns about the Working Time Regulations, which were introduced in the summer of 2009. Almost two-thirds say they regularly work more than the limit of 48 hours a week, while nearly a third claim it’s taking them longer to meet the competences they need in their training.

The GMC is calling on senior doctors, managers and medical educators to help tackle these concerns as a priority. It is consulting on proposals for the approval and recognition of trainers to help strengthen arrangements for support and supervision.

The GMC does point out, however, that most training is meeting its standards. Overall satisfaction with training among juniors is continuing to increase, with 79% of doctors rating their training as excellent.

Niall Dickson, chief executive of the GMC, said: “Overall, trainees continue to be very satisfied with their training, but the concerns they have raised need to be urgently addressed by all those with responsibility for supporting doctors. In these difficult financial times for the health service throughout the UK, it is vital the education and training are protected and that these young doctors are given the support they need not only to provide good care now but to develop into great leaders for the future.”

The research reveals that a quarter of newly qualified doctors did not feel ready to take the next step in their careers.

Dickson added: “The trainee survey is a vital part of our work to support improvements in medical training and to make sure it meets the standards we require. Together with the postgraduate deans we will use these results to support inspections and to provide feedback to those responsible for providing education.”

Dr Tom Dolphin, chair of the BMA’s Junior Doctor Committee, said: “The GMC’s survey reveals some serious concerns about the level of supervision some doctors receive. In the current economic environment training is a soft target. We are concerned that, in an effort to save money, the time consultants can dedicate to training is being squeezed. We must ensure that trainers are given the time to train and supervise.

“We cannot afford to be complacent about the quality of training and supervision as it will have direct impact on the quality of healthcare that can be delivered to patients in the future.”

Ben Dean, an orthopaedic registrar, who carried out a survey on training for Remedy UK earlier this year, commented: “The issue with supervision is very complex. The supervision of training is something that has been affected by reduced hours and the consequent shift systems, hence reduced continuity of both patient care and training.

“Certainly increasing hours would help as it would improve supervisor training continuity and increase the experience gained by trainees. But people also need to regulate training properly.”

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Part 1: Young GPs can’t diagnose for toffee

By Mike Broad - 4th October 2011 12:05 pm

Oh dear. Dr Martyn Lobley, a GP in South-East London and one of the authors of Dr Tony Copperfield’s Sick Notes, has made himself rather unpopular with the rest of the profession - well, the younger members anyway.

He’s written an opinion piece in the Daily Mail suggesting that young doctors are not sufficiently skilled, and in doing so has become public enemy number one in the online fora for doctors.

Here’s a taster from his article: “Say ‘99’ out loud. Go on, you can trust me. When I trained as a doctor 20 years ago, this ritual was a crucial part of a chest examination. It provided a clever way for doctors to figure out whether someone had pneumonia, or a simple tickly cough.

“You’d listen to the sound of the patient’s voice, then rest a hand on their chest to pick up the vibrations as the patient repeated the mantra over and over again.

“If they had pneumonia, and therefore fluid on the lungs, the voice would sound high-pitched, and the vibrations would be reduced. Maybe not infallible, but pretty slick, right?

“These days you’ll only hear a doctor ask a patient to say ‘99’ on re-runs of sitcoms such as Doctor In The House. But does it really matter?

“Well to grumpy old doctors like me, it does - we still persist with the prehistoric idea that it’s possible to make a diagnosis simply by listening to a patient and examining them carefully.

“However, this seems to be a dying art.”

Dr Lobley goes on criticise young doctors’ dependency on scanning.

He writes: “A reliance on scans means that your fresh-faced GP lacks the basic knowledge to make an initial diagnosis without sending a patient to be X-rayed.

“Special investigations such as CT scans, MRI scans, echocardiograms and biopsies are designed to confirm or rule out a probable diagnosis, not to be part of a diagnostic fishing trip.

“This is a constant frustration for old fogeys such as me. So what’s going wrong?

“Today, medical students are being taught how to be, for want of a better word, fluffy. They spend so many hours being told how to be ‘rilly, rilly nice’ doctors that there’s no time left in the curriculum for boring stuff such as cardiology and dermatology.”

He suggests that juniors “might have enviable communication skills, but they often aren’t au fait with the bread-and-butter topics such as diagnosing and prescribing. And without this knowledge, you could be delaying a crucial diagnosis.

“The first time you hear a classic heart murmur and get the diagnosis right, or recognise a malignant melanoma early enough to give the patient a fighting chance of survival are the times that put a spring in your step.”

He then concludes: “On the day the machines go down, hopefully, I’ll not be rendered completely useless.”

The online fora for doctors, such as DNUK and Doc to Doc, have been buzzing with condemnation.

Lobley has made a crass generalisation befitting of the paper he was writing in (and skimmed over some pretty significant improvements in training), but there’s no doubt he is voicing the opinion of many doctors of a certain generation who feel medical education and training have been dumbed down and that juniors lack all-important ‘experience’. It’s a valid debate that should extend beyond personal condemnation and the protective walls of closed fora.

Those who are up in arms are the self-same doctors who are only too willing to savage all ‘noctors’, and in turn laugh uncontrollably at Tony Copperfield’s savaging of all patients.

The message from the overreaction to this article is don’t debate the more controversial professional issues in public in your own name. And I find that depressing.

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Part 2: Young GPs can’t diagnose for toffee

By Ben Molyneux, deputy chair of the BMA's Junior Doctor Committee - 12:04 pm

Last week, I had the misfortune to be sent an article by Dr Martyn Lobley published in the Daily Mail, criticising young GPs. Carrying the headline, “They are very caring but young GPs can’t diagnose for toffee” it was filled with anecdotes about yesteryear and how the medical profession has declined since the golden days of Dr Lobley’s training.

Fighting the futility of the exercise, I wrote a letter to the Daily Mail in response - they are yet to publish it. I think the most frustrating aspect of the article is that it made no attempt to acknowledge the transformation in training that has taken place in the last 30 years.

GP training, and indeed specialty training for all doctors, has been transformed completely since Dr Lobley’s day. We now have standardised curricula; quality assurance by the GMC, the Care Quality Commission monitoring the quality of our care and a continuing professional development requirement - to name a few improvements.

At this year’s BMA Annual Representative Meeting both Hamish Meldrum, chair of BMA council and Tom Dolphin, chair of JDC, uttered the words “put up, or shut up” following a debate on the issue of the quality of today’s junior doctors. I think Dr Lobley may have missed this as his article has no evidence to support his claims, and it only serves to damage our professional reputation. I think he may also have missed the GMC’s guidance on treating colleagues with professional respect.

If he is so concerned about the quality of care provided by young GPs, I wonder if he has taken it upon himself to address the issue, or even to highlight the problems he has seen. Perhaps he has become a GP trainer? Perhaps he has contributed to the curriculum via the College? Perhaps he has even reported poor treatment to the GMC or CQC?

Or perhaps this is a cynical exercise to deliberately court controversy with the aim of publicising a book he has recently written.

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“Doctors need to be better equipped to deal with change”

By Mike Broad - 19th September 2011 8:32 pm

A new GMC report draws a picture of the medical profession in the UK and seeks to identify some of the challenges that persist.

In the report, called The State of Medical Education and Practice, the GMC acknowledges it has to be a more proactive regulator. Its aim in publishing the report is to promote discussion and debate on issues and trends that require attention or further analysis.

The following is a summary of the report’s findings and conclusions:

Key findings

The profession is diverse and changing:

1. There is an increasing number and proportion of female doctors.

2. Most commonly, doctors are in their early 30s.

3. More than a third of registered doctors completed their primary medical qualification outside the UK.

4. The medical profession is ethnically diverse compared with the UK’s general population.

5. The medical specialties in which doctors work vary enormously in size and are not always aligned to service needs.

Medical education’s importance in supporting good medical practice

1. Medical education and training need to be more responsive to changes in healthcare needs, the organisation and delivery of care, and the shifting expectations of patients.

2. There is a tension between service delivery and protected time for education and training, and this has been exacerbated by the Working Time Regulations.

3. Trainee doctors need high quality supervision and positive role models with strong leadership skills. Yet there is variation in trainees’ experiences of supervision.

Unacceptable variation in the standards of medical practice

1. In 2010 we assessed around 1 in 70 of all registered doctors - although many concerns were subsequently unproven.

2. The GMC receives proportionately more complaints about male doctors, older doctors and GPs.

3. In 2010 the top three types of concerns were about: clinical investigations or treatment; respect for patients; and communication with patients.

4. A small number of doctors are falling seriously short of the standards expected of them. Almost 1 in 3,000 registered doctors were struck off.

Achieving better medical practice

The report suggests that the medical profession is changing, the world in which doctors practise is evolving, and that standards of training and of practice vary.

Doctors today are training and practising in a complex and changing environment. Political devolution has led to greater differences in the way healthcare is organised and delivered in the four parts of the UK, it says.

Ongoing reform, especially major structural change in England, has created further uncertainty both about the future shape of healthcare and its capacity to meet future demand, the report says.

Equally important, healthcare in the UK, as in other developed countries, faces significant funding constraints. After ten years of unparalleled spending growth, the healthcare systems are now struggling to deliver what is expected from them with the resources they have. Given the wider difficult economic environment, it seems certain that tight and constrained budgets will be a feature for the foreseeable future.

In recent years, the policy focus has been on improving quality in healthcare. There must now be real concern about how funding constraints could affect the quality of care, including the delivery of education and training for doctors. There needs to be greater transparency in the way in which medical education and training is funded. If medical education and training, including CPD, is to maintain and improve standards it needs to be protected.

There also remains an ongoing debate about how to address the impact of the WTR, both on delivery of care and medical education and training. The GMC and others will continue to monitor the impact of reduced working hours.

Alongside these changes, the practice of medicine itself is becoming more complicated and technically demanding. In turn, that changes the way in which individual doctors exercise their responsibilities. Today’s doctors cannot master the vast expansion of knowledge and innovation that is driving forward the boundaries of medical science each day, the report claims. But they are expected to keep up-to-date and to know how and when to access information and advice to practise safely and effectively.

Their role goes beyond the application of knowledge - they need to be able to synthesise conflicting and incomplete information, deal with uncertainty and manage and communicate risk. In many cases, they need to do this knowing that they must accept ultimate responsibility for the patient in their care.

The report identifies six areas where the GMC believes there is a need for further debate and action:

1. Professionalism and leadership are crucial to good medical practice. Revalidation, when introduced, will help by bringing every conversation about a doctor’s practice back to the standards set out in Good Medical Practice.

2. Regulatory bodies need to redefine how they work. The GMC needs to proactively encourage good practice as well as take action when problems arise. And professional and system regulators need to work more closely together.

3. Doctors must take responsibility for raising concerns and need to be supported to do so. There needs to be a culture change around this. The GMC will support this, but there are actions for employers too.

4. Overseas qualified doctors need better support. They need to be properly inducted to UK practice and employers need to be confident they can speak and understand English to a good enough standard.

5. Doctors need to be equipped to deal with changing healthcare needs. We believe postgraduate training should be reviewed to ensure it is flexible enough to allow doctors to move between specialties. Doctors also need a higher level of core competence than training programmes currently allow.

6. We need to improve our understanding of medical education. In particular we need better outcomes data so that we can be assured that medical students are entering the workforce with consistent, and the right, skills and knowledge. In 2013, we will evaluate the impact of our updated standards for undergraduate education, Tomorrow’s Doctors (2009).

The GMC plans to publish The State of Medical Education and Practice annually and support it with further data and discussion.

Read the full report.

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‘New’ doctors should receive a proper induction

By Mike Broad - 16th September 2011 5:15 pm

Doctors entering the NHS for the first time either as new doctors or from overseas require better support in order to practise safely, a GMC report finds.

The report, called the State of Medical Education and Practice, recommends that all doctors new to the NHS should complete an induction programme.

Overseas doctors in particular need a better understanding of the ethical and professional standards they will be expected to meet in the NHS and become familiar with how medicine is practised in the UK.

Every year about 12,000 doctors start working in the NHS for the first time. While the report identifies some good local schemes for supporting doctors who are new to practice, there is evidence of many undertaking clinical practice with little or no preparation and locums taking on duties for which they have not been appropriately trained.

The GMC says it will work with doctors’ employers and professional organisations to develop a basic induction programme for all doctors.

Niall Dickson, chief executive of the GMC, said: “We must do more to make sure that all doctors understand the standards expected of them. Developing an induction programme for all doctors new to our register will give them the support they need to practise safely and to conform to UK standards. This will provide greater assurance to patients that the doctor treating them is ready to start work on day one.”

The report identifies a number of current challenges for the NHS including the tension between a health service that must deliver care with constrained funding and within European working time rules and the need to protect time for education and training.

More information is needed on the output of medical education to make sure medical students have the right skills and knowledge when they start work, it says.

And doctors need to be equipped to deal with changing healthcare needs. Postgraduate training should be flexible enough to allow doctors to be able to move between specialties, it concludes.

Sir Richard Thompson, president of the Royal College of Physicians, said: “The report draws on a wealth of authoritative evidence including that from the RCP about implications of the changing structure of the medical workforce and the negative impact of the inflexible application EWTD on training and service.

“The RCP has long championed developing medical professionalism to the needs of modern healthcare, but this must be supported by an environment that encourages an open approach to matters of clinical safety rather than a culture of secrecy and blame.”

The report also says that regulatory bodies need to redefine how they work, with professional regulators such as the GMC and systems regulators such as the Care Quality Commission working more closely together.

It also calls for a culture change to encourage doctors to raise concerns; the GMC, professional bodies and employers all have a role to play to make this happen, it says.

MDU medico-legal adviser, Dr Emma Cuzner commented: “Patient safety incidents are devastating for everyone involved, from the patient to the doctor who is overseeing their treatment but few are wholly due to individual error. More often than not, there are a number of contributory factors, from the hectic environment in which doctors are working, to a breakdown in communication between colleagues.

“We strongly believe the response to incidents should emphasise the need to improve systems or protocols, rather than directing inappropriate blame at individuals. We are pleased that the GMC recognises this important point.”

Read more on the report’s findings.

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Doctors want to reschedule trainees change

By Mike Broad - 18th August 2011 8:38 am

Nine out of ten doctors believe patient safety is compromised in August when juniors start their new training posts on the same day.

A survey by the Royal College of Physicians of Edinburgh and the Society of Acute Medicine reveals that 58% believe it damages their training, and 90% say it compromises patient safety.

Traditionally trainees change their jobs on the Wednesday in August and there has been growing concern that this causes instability, poor safety and reduced patient care. Evidence is emerging that patients admitted at this time also have a higher early death rate than at other times.

The negative effects on all aspects of care and training were found to last for up to one month.

A number of potential solutions were tested in the survey and over 80% of respondents believed that this situation could be greatly improved by moving away from the current national changeover on a single day to a staggered transition by grade, occurring over a period of over a month.

It was also suggested, in the report in Clinical Medicine, that it would be better to move the changeover period to a different time of year in order to eliminate conflict with the holiday period.

Dr Louella Vaughan, honorary consultant physician in acute medicine, and lead author of the study, said: “The results of this survey add to the emerging evidence base which indicates that the current August changeover system increases a number of risks for patients, including an increased early death rate for patients admitted to hospital at this time.

“When this survey is considered along with other related evidence it is clear that the current system is in urgent need of reform. The doctors surveyed have indicated that not only is there an appetite for change, but the desire to enthusiastically lead and support it. All that is lacking now is the political will”.

The survey received 763 responses.

Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said: “For many years doctors have been aware of practical problems caused by this annual changeover. Formal evidence in support of our concerns has, however, been limited, but is now increasing and has reached the level where it should not be ignored.”

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Lack of detail on training reforms worries juniors

By Francesca Robinson - 12th July 2011 1:41 pm

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.

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