Priorities for Health: Junior doctors
November 2006
Introduction
In August 2006, BMA Scotland conducted a survey of members to identify their priorities for health. Around 600 doctors from all branches of the profession responded to the survey and their priorities for junior doctors are reflected in this policy briefing.
Background
Junior doctors are the largest single group of doctors in the NHS. There are 5120 (whole time equivalent) doctors in training currently working in Scotland ranging from newly qualified medical graduates to doctors with many years experience and post-graduate qualifications [reference 1].
More than half of the doctors trained in Scotland leave the country, with most choosing to work in England [reference 2]. This is partly explained by the lack of attractive training and long term career opportunities and partly due to the fact that Scottish medical schools have a high percentage of students from England. Research shows that Scottish domiciled students are more than twice as likely to remain in Scotland [reference 3].
Training
Modernising Medical Careers (MMC) is the new training programme for all junior doctors and is currently being introduced across the UK. It aims to reduce the amount of time that junior doctors spend in the training grades whilst protecting the quality of training. MMC is a focussed training programme which will produce consultants in an average of seven years after graduation from medical school, and GPs in five. The current average length of training for consultants is 10 -12 years.
A two-year foundation programme, which replaced the traditional Pre-Registration House Officer and Senior House Officer (1) years, was introduced in 2005 and, as of August 2007, the first cohort of trainees will enter into the run through specialist training grades. At the same time, all other junior doctors (current Senior House Officers) will move into the new training regime at a level determined by their experience and competencies.
Working hours
The European Working Time Directive (EWTD) cut the number of hours a junior doctor can legally work each week. Currently, juniors are restricted to working 56 hours a week under New Deal arrangements. Latest figures show that approximately 97.2% of junior doctors fall within this limit [reference 4]. In 2009, however, the legal working time drops to 48 hours each week.
The European legislation is a health and safety requirement that recognises that reducing the amount of working hours helps improve patient care by ensuring that doctors are rested and fit to treat them. Lack of sleep is associated with memory deficit, impaired social and occupational performance, increased risk of car crashes, lack of energy and motivation [reference 5].
Flexible training
The increasing numbers of female doctors and medical students, as well as changing aspirations of doctors, means that greater numbers of part-time posts will be needed if doctors are not to be lost from the health service.
Currently approximately 61% of medical students are female [reference 6] and research has shown that half the UK's 39,000 junior doctors (including four in ten men) would like to work part-time in future [reference 7]. These changes in the workforce will undoubtedly have an impact on the planning and delivery of NHS services. Flexible training and family friendly working patterns could remove some of the artificial barriers to medicine, widen access and retain doctors in the profession who otherwise might be lost to the NHS because of other commitments. However, despite the fact that in theory, flexible training is available for trainees, the number of places is very limited, primarily because of a lack of funding in Scotland.
Immigration
Following changes to the UK’s immigration rules for postgraduate doctors in April 2006, non-EEA or non-resident doctors need a permit to train in medicine. Health boards must apply for a work permit before employing such a candidate and demonstrate that there are no suitable EEA nationals to take up the post. Non-EEA doctors who have graduated from UK universities are granted two years permit-free training. Without the ability for these graduates to complete their training in the UK, they may look elsewhere to study medicine resulting in medical schools missing out on a large amount of funding and experience from abroad.
Interventions:
There is a lot of uncertainty and confusion among doctors surrounding the implementation of MMC. 95% of doctors surveyed believed that all medical school graduates should be guaranteed foundation training post and nearly 88% believed that it is important that there are sufficient specialists training posts to ensure that all doctors completing Foundation Year 2 and the current SHO grades can continue to train and work in Scotland.
BMA Scotland is working with the MMC Delivery Board, NES Scotland and the Scottish Executive to ensure that the new training programme does not disadvantage current, or future, medical trainees. Furthermore, impending reductions to working hours for junior doctors could cause problems of compliance unless steps are taken now to reduce the possibility of impacting service delivery.
It is important that:
- Training opportunities are attractive to help recruit and retain junior doctors in Scotland.
- Every junior doctor has access to a run through specialist training programme for general practice or a speciality within hospital medicine.
- Effective ways to meet the reduction in working hours under the European Working Time Directive (EWTD) are developed and introduced before 2009.
- Long-term strategic workforce planning is in place to ensure that patients continue to receive high quality care during the transition to streamlined training and further reduction in working hours.
- Flexible training opportunities are improved and increased, with availability of posts across Scotland.
- Doctors who come from overseas, but who graduated from a UK medical school, should be allowed to complete all of their training in the NHS.
1. Scottish Health Statistics. NHS Scotland Workforce Statistics. Doctors in training 2005. (www.isdscotland.org)
2. Hospital Doctor. Regional Spotlight Scotland. Francesca Robinson. 27 January 2005.
3. Calman K. Review of basic medical education in Scotland. June 2004.
4. Scottish Health Statistics. Doctors in training: compliance with New Deal August 2005-January 2006. (www.isdscotland.org)
5. British Medical Association. Effects of Sleep Deprivation. London. 2004. (Go there now)
6. British Medical Association. Demography of medical schools. London. June 2004.
7. British Medical Association. Hospital doctors: flexible training. London. May 2006.
For more information contact:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk