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BMA warns against Brexit proposal to shorten training for doctors

The British Medical Association (BMA) has today written to health minister Stephen Barclay warning against his idea to reduce the length of training for doctors to help plug workforce gaps in the wake of Brexit.

Speaking to the Telegraph this week, Mr Barclay said that one idea being considered by ministers is to bring forward the “point of registration” – the point at which a doctor gains full registration with the UK’s medical regulator, the General Medical Council (GMC). This proposal would provide all UK graduates with full GMC registration as soon as they leave medical school. This is currently granted after a year of working successfully as a junior doctor (FY1) during which time they hold provisional registration.

In a letter to the minister the BMA warned against this. The letter states that:

“It is vital that the quality of medical education and training and standards of patient care are maintained post Brexit. The BMA firmly believes that moving the point of a doctor’s full registration with the GMC (General Medical Council) would seriously dilute the quality of our current training programmes – such a move would be a mistake.

“In terms of time, to deliver the GMC’s required outcomes for graduates, UK medical school undergraduate programmes currently go beyond the minimum requirements set out in the European Union directive on the mutual recognition of professional qualifications (MRPQ). In addition, under provisional registration, the first year of the foundation programme provides vital opportunities for medical graduates to participate in and to provide diagnoses and treatment under close supervision. This cannot be matched by current clinical placements in medical school. It allows graduates to learn through experience and to increase their confidence in their abilities. It also creates significant opportunities for trainers to identify and support trainees who may be struggling with their clinical responsibilities.

“Doctors undertake some of their most intensive and useful learning during this year. The pressure of responsibility helps them to obtain crucial skills relating to real decision making, working under pressure and leading a clinical team. It is unrealistic to expect that changes to the undergraduate curriculum could offer an adequate substitute for this vital experience.”

Commenting on the proposals, Dr Anthea Mowat, BMA representative body chair, said:

“This proposal just looks like ministers are willing to put medical training and patient safety at risk just so they can claim a win on Brexit.

“Training doctors takes time and experience. Patients want to be seen by a doctor who can provide them with the best possible care. Reducing their training time so that junior doctors have less expertise and less support than the current system provides will not achieve this.

“Ministers should focus on providing clarity on what the future holds for EU citizens and their families living in the UK so they don’t leave the NHS, instead of hashing together an ill thought out scheme to plug the workforce gaps that Brexit could worsen.”

ENDS

Notes to editors

The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

  1. For media enquiries, please contact [email protected] or call 0207 383 6448.
  2. A BMA survey of EEA (European Economic Area) doctors working in the UK found that almost half were considering leaving following the EU referendum result, with almost one in five having already made solid plans to relocate elsewhere. You can read more about this here.
  3. You can read the BMA’s policy briefings on Brexit and health here.
  4. Full text of the letter is below:

Dear Minister,

I am writing in response to your reported comments (2nd August) regarding Brexit and medical education. Specifically, on reducing the length of medical training to address NHS staffing shortages by moving the point of full registration of doctors from the end of foundation year one, to the end of medical school.

It is vital that the quality of medical education and training and standards of patient care are maintained post Brexit. The BMA firmly believes that moving the point of a doctor’s full registration with the GMC (General Medical Council) would seriously dilute the quality of our current training programmes – such a move would be a mistake.

In terms of time, to deliver the GMC’s required outcomes for graduates, UK medical school undergraduate programmes currently go beyond the minimum requirements set out in the European Union directive on the mutual recognition of professional qualifications (MRPQ). In addition, under provisional registration, the first year of the foundation programme provides vital opportunities for medical graduates to participate in and to provide diagnoses and treatment under close supervision. This cannot be matched by current clinical placements in medical school. It allows graduates to learn through experience and to increase their confidence in their abilities. It also creates significant opportunities for trainers to identify and support trainees who may be struggling with their clinical responsibilities.

Doctors undertake some of their most intensive and useful learning during this year. The pressure of responsibility helps them to obtain crucial skills relating to real decision making, working under pressure and leading a clinical team. It is unrealistic to expect that changes to the undergraduate curriculum could offer an adequate substitute for this vital experience.

The transition from medical school to medical practice is one of the most challenging stages of a doctor’s career. It is likely that, if provisional registration were scrapped and the point of full registration moved to graduation, this transition would become even more difficult and patient safety would be put at risk. We do not, therefore, support any proposal to move the point of full registration to the point of graduation from medical school.

Training doctors takes time and experience. Patients want, and expect, to be seen by a doctor who can provide them with the best possible care, and doctors want the confidence of robust training behind them as they go in to an extremely challenging role. Shortening training time and having junior doctors working with a lower level of expertise and without the level of support the current system provides will not achieve this.

The BMA believes that Brexit will exacerbate current workforce problems and shortages, not provide opportunities. More than 12,000 doctors in our health service – that’s around eight per cent of the NHS workforce in England - gained their primary medical qualification in the EEA. We are aware from our own survey work that this vital group of the workforce feel a great amount of uncertainty about the future, with many strongly considering leaving. We have considerable concerns about the NHS’ ability to recruit from Europe in the future, post Brexit.

With regard to creating pathways for other health professionals to enter the medical profession, we remain unconvinced that there is any substitute for the current doctors training curriculum. Physiotherapy training, for example, which is a three-year BSc, is obviously very different to medical training. If the standards that patients deserve are not to deteriorate, we believe that there is no substitute for the current five-year undergraduate or four-year postgraduate medical curriculum for those wanting to become doctors.

I would be very happy to meet with you to discuss these issues in more detail.

Yours sincerely,

Dr Anthea Mowat

Chair, BMA representative body

For further information please contact:

British Medical Association, BMA House, Tavistock Square, London, WC1H 9JP
Telephone: 020 7383 6448 
Email: [email protected]
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