Hospital Dr News

Consultants reject training reform proposals

Consultants have rejected a proposed overhaul of postgraduate medical training which has been endorsed by the Academy of Medical Royal Colleges and the GMC.

The annual Consultants Conference agreed that the reforms outlined in The Shape of Training Review by economist and Nottingham University Vice Chancellor Professor David Greenaway, were “not fit for purpose”.

“This report is full of good intent but my worry is it’s a Trojan horse – it’s the sub consultant grade but this time straight through the front door,” declared Preston consultant in trauma and orthopaedics Daniel Redfern.

A key recommendation for doctors to be trained to provide general care in broad speciality areas across a range of different settings would result in “generalist specialist oxymorons” being trained, would erode professionalism and would degrade prospective consultants to the level of “rota fodder” he added.

“My worry is that doctors processed in this way will have a severely limited clinical compass, a limitation that would make them vulnerable and compromise their employability both within the UK and abroad.

“Moreover Shape of Training says one thing and then proposes another. It says raise skill levels across the board so that you can deal with complex medical morbidity but by doing that reduce the training time allowed to do so.  If that makes sense then you’re probably an economist or the Sheriff of Nottingham,” he said.

Redfern maintained that all the good ideas in the report were already enshrined in enlightened teaching programmes. “This thing is a bit of a juggernaut. The NHS executive are doing cartwheels over it and I’m concerned that if the BMA doesn’t do anything about opposing those parts of the report which are inadmissible to us as consultants this thing will go through completely.”

Dr Anthea Mowat an associate specialist in anaesthesia and chronic pain at the Pilgrim Hospital, Boston, Lincolnshire, said she was concerned that the reforms provided no clear mechanism to enable those who wished to have a different career pathway, such as  a portfolio career, to re-enter the system.

Greater Manchester consultant psychiatrist Dr Shanu Datta said the review contained some useful ideas the BMA had been campaigning for for some years: “It enhances the woeful lack of careers counselling for career doctors in training,  it proposes to increase flexibility so doctors can carry their competencies with them when they change specialties and increases the flexibility of doctors in academic training to switch to clinical training and vice versa.”

The conference also passed a motion deploring a recommendation in the report to make GMC registration synonymous with passing final medical school exams. Consultants were concerned that this would remove the opportunity to monitor the clinical work of the newly qualified and identify the clinically incompetent, take away the pressure to provide a foundation post for every graduate and would give individuals uncontrolled prescribing rights before they had demonstrated competence in a controlled environment.

Mersey consultant urological surgeon Derek Machin warned that this proposal would be dangerous for patients. “Prescribing produces many errors in hospital. The F1 year is an opportunity to improve a doctor’s prescribing habits supervised by consultants and ward pharmacists.”

The conference also opposed a recommendation by the Shape of Training Review that a certificate of specialty training should replace the certificate of completion of training. The review suggests that some highly specialised skills should move outside the scope of postgraduate medical training. Consultants agreed that a CCT should indicate that a consultant had completed their training

London acute medicine consultant Dr Kevin O’Kane said: “Over the past two years I have been dismayed to see a proliferation of post CCT fellowships…Many of these ‘fellows’ feature on consultant rotas, they undertake the responsibilities of a consultant, they supervise full teams, they take risks as a consultant but are not labelled as such and are not paid as such and these doctors deserve to be recognised as consultants.

“Having a CCT is a requirement to be appointed to a substantive consultant post, it’s a badge of clarity and quality which we must all stand up for.”

Watch a webcast of the conference.

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