Hospital Dr News

Cohort face entrapment in subconsultant grade

Training reforms which recommend awarding a CST (Certificate of Specialty Training) at the end of a training period shortened by two years will trap a whole cohort of doctors in a subconsultant grade, the BMA has warned.

The proposals, outlined in the Greenaway Shape of Training Report, were condemned as “not fit for purpose” by the BMA’s annual representatives meeting.

Dr Tom Dolphin, a London specialty trainee in anaesthetics, described the idea as “an egregious assault” on the standards of medical training.

“This is about the timing of the end point of training. It very clearly proposes a subconsultant grade, awarding a CST sooner, and with a lower standard, than is done so at present.”

He said he was also concerned that the top up credentials that could be gained after the award of the CST, would crucially be in the gift of the employer.

The proposals challenged the profession’s deeply held belief of what a consultant was and did. “There is no point selecting the brightest and best, training them up at great expense for a role and then not letting them meet expectations.

“Who is going to do all the service development, research and training etc if they are not in a role that allows these things to happen? We all know that employers treat the junior consultant grade as a service delivery workhorse,” said Dolphin.

Mersey consultant urological surgeon, Derek Machin, said in conjunction with these training reforms the Department of Health was negotiating for a lower starting salary for consultants and to make salary progression much more difficult.

He also warned: “Credentialing would be wholly at the whim of the trust that employed you. And if they decided that they didn’t need somebody working at a higher level you wouldn’t be funded or given the time to obtain those credentials. The result will be consultants stranded on low fixed salaries – essentially indentured labour,” he declared.

Oxford GP trainee, Dr Amar Latif, said there was no mention of who would quality assure post-CST training. “How will this lead to better patient care – we know that having expert consultants involved early in patient cases leads to better outcomes and so it is absolutely about patient outcomes that we must say that the CST idea is something we need to reject.”

The Shape of Training review is sponsored by organisations including the GMC and the Academy of Medical Royal Colleges, and chaired by Nottingham University vice-chancellor David Greenaway.

In another debate the meeting also rejected proposals to award juniors full registration on graduation from medical school. Representatives agreed that junior doctors might not have the necessary supervised training to allow them to practise safely.

They were also concerned that moving the point of registration could open the Foundation Programme up to competition from EU doctors who might take the jobs of UK medical graduates.

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