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Radical rethink of training and roles “essential”

A different kind of doctor will be required in future to deliver high quality healthcare for women, a royal college report finds.

A Royal College of Obstetricians and Gynaecologists (RCOG) working party calls for a radical rethink of training and the role of the specialist doctor.

The working party’s report, called Tomorrow’s Specialist and chaired by Baroness Julia Cumberlege and Sir Cyril Chantler, concludes that specialists will need to work more flexibly and in different locations, not only in hospitals but in the community. Training should also continue throughout a doctor’s professional life.

It’s a response to the RCOG’s recommendations in High Quality Women’s Health Care published last year, which called for women to be at the centre of care.

Tomorrow’s Specialist says all changes to education and training should lead to improving the care, treatment and health for women.

When in hospital and in the community patients should have access to qualified obstetricians and gynaecologists at all times. This should include during the day, night time and at weekends.  This will require an expansion in the number of qualified specialists.

Specialists should work in teams and provide care where it is needed, locally and or in hospitals.

Newly appointed specialists should have formal mentoring and commit to lifelong learning. And the training curriculum should reflect both the professional and personal development needs of doctors.

The recommendations would lead to different clinical systems. With more care being provided out of hospitals and in the community, there will be fewer acute obstetric units handling the more complicated cases. For women at low-risk it will mean care closer to home and more choice about where they want to have their baby.

Furthermore, more consultants delivering round-the-clock care will enable doctors still in training to focus more on learning rather than on delivering routine care.

Baroness Cumberlege, chair of the working party, said: “Women want to see qualified doctors as much as possible and a specialist workforce is needed to provide good quality care. Tomorrow’s Specialist builds on from the previous working party report and puts many of the concepts into reality. The previous report emphasised the importance of a new approach to women’s healthcare, promoting wellbeing throughout a woman’s life, and the importance of health teams working together in networks.

“The way services are organised is no longer affordable or appropriate and as services change so must those who work in them. Women need access to doctors round-the-clock. They should receive the same care if they need medical help at night or in the daytime. The focus of this report is to improve the quality of women’s healthcare through highly skilled, adaptable doctors.”

The report sought evidence and views from a wide range of people, including women and patient groups, qualified specialists, specialists in training, midwives, nurses and NHS managers.

Wendy Reid, vice-president for education at the RCOG, added: “As healthcare and medicine advance, so must the clinicians working in our intense and demanding specialty. This report provides an exciting blueprint for future O&G specialists amidst the challenges posed by the current NHS reform agenda. Trainees need more time to learn and undertake intensive training so they can build skills and gain competencies. They should have formal mentoring provided by experienced staff.  Clinical support from a senior colleague is invaluable in such a high-pressure environment.

“For too long, we have relied too much on our trainees.  What we are proposing is an entirely new way of working that is fairer for all doctors and better for the women we serve.”

Dean Royles, director of the NHS Employers, welcomed the report saying it would help “address the crucial need to change the way doctors work and the training they receive, to improve the way we provide services”.

He added: “I’m sure we will see other medical specialities proposing solutions in the building discourse about the need for change.

“Current working arrangements seem to prevent doctors from operating in a flexible way that best supports patient care. High quality patient care depends on more joined up working between doctors and other health care professionals…and on formally accredited learning programmes as well as doctor revalidation to improve their individual development.”

Read the full report.

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