Modernising Medical Careers – reasons for delaying implementation
BMA Junior Doctors Committee
October 2006
Summary
The Annual Representative Meeting (ARM) of the British Medical Association (June 2006) voted to support its Junior Doctors Committee in its call to delay the implementation of run-through grade training. This paper highlights the issues of concern, and suggests how this delay could be implemented. The Academy of Medical Royal Colleges’ Trainee Doctors Group also strongly supports the document.
Current situation
1. In August 2006 the first cohort of F1 doctors progressed to F2 posts. In December 2006 recruitment to the Calman SpR grade will cease, and recruitment to the new run-through specialty training programmes will commence. Applicants will include SHO-level doctors and new F2 cohorts.
2. The Junior Doctors Committee (JDC), supported by the whole British Medical Association at its ARM in June 2006, is calling for a delay in the implementation of the Run-Through Grade (RTG). It is apparent that key elements of the framework and infrastructure are unpublished or incomplete, and neither junior doctor training, the service as a whole, or patients, will benefit from the introduction of under-developed reforms. Another concern is that the information provided to trainees with regard to the new system is inadequate.
3. This monumental reform should not be rushed (to the detriment of junior doctors, the service, and patient care), although it is appreciated that momentum should be maintained where possible and there is no wish to see MMC fail.
Reasons to call for delay
4. The delay in submission of curricula by several Royal Colleges has raised concerns that the information necessary for selection will not be adequate. The PMETB has assured us they will be submitted in time for the application process, but last-minute publication will disadvantage both applicants and those involved in the short-listing process. A year’s delay would allow curricula, competencies and person specifications to be resolved, consulted upon and defined.
5. There is deep concern for the lack of flexibility within the current MMC plans. It seems Royal Colleges and other stakeholders have diverted from the initial intention to make the training pathways flexible, and this is a worrying progression. The development of individual curricula by Royal Colleges is a further obstruction to flexibility. JDC, again supported by the BMA at its ARM, would welcome a cross-specialty database of defined competencies. This would be invaluable to doctors in training when deciding upon which level to enter into a new specialty. It would also clarify transferable competencies and how much of their training would ‘count’ towards their CCT.
6. The MTAS front-end user interface appears to be easy to use, and, as described to JDC, the hardware backing it up should be robust enough to cope with the peak demand as people apply. However, the underlying application process still has a worryingly short timetable as well as very short periods of notice for attending interviews and accepting or rejecting offers made. Also, the application form questions do not seem to be searching enough. This will make it very difficult to discriminate between thousands of candidates who, by definition, are already good enough to be in training posts at that same level.
7. A further reason to support delay is to allow enough time for additional selection tools to be developed, piloted, validated, and for training in their use to be disseminated.
8. Even though Roadshows are taking place to inform HR departments of their involvement, the timescale is very tight and there are concerns that this will not allow enough time to plan for this vast administrative task. It is hoped that the IT infrastructure will be sound, and that no applicant is significantly disadvantaged by this foreseen problem.
9. With fierce competition for places, applicants will need to attend all their interviews within a short period. Simultaneous disruptions to service and clashing interviews do not, as yet, appear to have been taken into consideration. With all the SHO-level juniors being interviewed, and all the consultants interviewing them, the interview period will be difficult for the service. At the same time, with such greatly reduced opportunity to apply for specialty training, failing to accommodate candidates whose interviews clash is not acceptable. These situations must be recognised and provision made in advance.
10. Doctors at this stage in their training are required to make a momentous decision regarding not only their training but their future career. It is feared that the proposed level of careers guidance and counselling will not be sufficient or timely for this year’s recruitment. This means that applicants will not have the necessary information with which to make this crucial choice. The competition ratios currently presented are very difficult to establish as, at present, post numbers remain indicative. By delaying this process, the number of posts will be identified and published in advance of the application procedure and enough time would be provided for the invaluable careers guidance to be implemented.
11. The indicative number of RTG posts and Fixed-Term Specialist Training Appointments (FTSTAs) for the UK has been announced in early October as 22,000 to 23,000, with 17,000 to 18,000 offering "access to run-through training". Firmer figures have been promised in December 2006. This is a substantial improvement on the 9,500 posts for England confirmed earlier, but still leaves a shortfall. The number of estimated applicants in the UK exceeds 28,000 as overseas doctors, those unemployed and others in research posts have not been included in this estimate. A delay would allow negotiations to complete, and extra appropriate posts to be identified and approved.
12. Inadequate workforce planning has lead to uninformed decisions with regards to the number of NTNs available within each specialty. This information must be accurate. If it is not, this could lead to considerable disparities in the consultant workforce in five to eight years’ time. At the same time, consideration has to be given to the number of trainees already part-way through a specialty training curriculum, who mostly want to continue in that specialty up to CCT.
How could delay work?
13. JDC proposes that the same transition recruitment process should be put back by exactly one year. This involves delaying the abolition of SHO grade to August 2008, and continuing recruitment to the SpR grade up until December 2007. This would allow work to continue on curricula, selection methodology and tools, transferable competencies and programme numbers. F2 cohorts would be able to apply for SHO positions with the vision of joining RTG the following year as SHOs are expected to this year.
14. It is noted that some work may be lost by a delay, specifically the identification of SpRs leaving posts, but this could be repeated. This is a small matter in relation to the potential gains that could be made.
Call for information
15. As a result of the ‘Case for delay’ stakeholders are seriously considering the problems we have highlighted, although we feel that time is still exceptionally short. Unless rapid progress is made on these issues, a delay remains the best way forward. We have therefore considered how to mitigate against any likely problems that could arise whilst pushing ahead without everything in place.
16. A contingency plan is vital in order to deal with any potential disasters. There are concerns that one does not exist and that status quo is the fall back option. As this will affect not only the careers but lives of trainees, this information is crucial.
17. Due to the time constraints surrounding application, legal challenges could be brought forward by disappointed trainees who feel that the application system has failed or that they have been inadvertently discriminated against.
18. JDC therefore calls on the MMC team to share contingency plans with the profession, to include a time specific deadline by which, if certain criteria are not met, the process will be halted and everything would revert to ‘plan B’.