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There is one year above all that inspires difficult, painful but also happy memories. Depending on their age, doctors talk about their time as a house officer, or a PRHO, or an F1, but they are talking about the same first year of working as a doctor - the intensely formative year between graduation and full registration with the GMC.
It can be deeply exposing, and doctors often say they learn more in that year than the previous five at medical school. But the vitally important point is that during that year all aspects of their practice are supervised and trainees have a valuable year gaining experience and confidence.
It also offers significant opportunity to identify, supervise and support struggling trainees. It means that while they may make mistakes – everyone does in a new job – there are strong measures to protect patient safety.
The Government is now consulting on a plan that could see this safety net removed.
Back in 2013, both Health Education England and the Shape of Training review said doctors should become fully registered on graduation.
They gave different reasons, but none were convincing. Shape of Training, which also proposed other sweeping changes to postgraduate training, said it would clarify that postgraduate institutions were responsible for F1 doctors, although this does not require moving the point of GMC registration.
Health Education England said the move, combined with a national exam to enter the foundation programme, would ‘help promote the quality and patient safety agenda’ (a minority view, to say the least) and, even more curiously, that it met the ‘moral obligation’ of providing all UK medical school graduates with full GMC registration.
But full registration is not much use if you cannot find a job. The change would make the foundation programme open for the first time to fully registered medical graduates from 16 European countries. Competition for an already over-subscribed foundation programme would go through the roof.
There is certainly a moral obligation to the trainees who have dedicated years of their lives obtaining a medical degree, but perhaps there is also an obligation to taxpayers, who have made a large contribution to the estimated £250,000 cost of training a doctor. Ensuring the UK trained graduates embark on fulfilling careers in the NHS is clearly the best return on that investment.
The proposal does not come up with any accompanying plan to make the medical degree longer. So extra elements would have to be squeezed into curricula in an attempt to make students safe enough for immediate full registration, while other elements would have to be displaced to postgraduate training.
Health minister Dan Poulter has announced a period of stakeholder engagement until the end of March. Although Dr Poulter is the English minister, this is a UK-wide engagement because if the change went ahead, it would need UK-wide legislation, an amendment to the Medical Act.
Aiming to ensure that all eligible UK medical graduates attain full GMC registration is important to the BMA not just to the government, but we think the Department of Health and HEE need to find a different way than simply moving the date. We will make this point strongly in the stakeholder engagement.
There are no firm educational arguments for moving the point of GMC registration and it does little to address the thorny issue of foundation programme over-subscription.
Whilst provisional registration can certainly be improved upon, simply bestowing full registration on graduates as they step out of medical school simply creates more problems than it solves.
What do you think about moving the point of registration? Use the comments section below