Further supplementary evidence submitted
by British Medical Association (WP 59B)
The BMA's Junior Doctors Committee (JDC) looks
after all matters affecting doctors engaged in hospital practice
in the training grades. It does this by promoting the interests
of junior doctors, improving the quality of their working lives
and seeking to influence the direction of the medical profession
as a whole. It represents all junior doctors, whether or not they
are members of the BMA. The BMA is pleased to contribute this
further evidence following our earlier submission to the Committee
on 16 March 2006. This evidence specifically focuses on the transitional
problems of Modernising Medical Careers (MMC) and junior doctor
unemployment.
The BMA is extremely concerned that at least
11,500 junior doctors could be unemployed next summer under the
MMC plans for specialty training. The MMC initiative seeks to
reform postgraduate medical training and as part of MMC, the Department
of Health announced on 5 June 2006 that there would be a minimum
of 9,500 specialist training posts in England. Next year, existing
Senior House Officer (SHO) posts will all be phased out and replaced
by these 9500 specialist training posts.
However, the group of doctors applying for the
specialist posts in England is likely to number around 21,000,
which include SHOs, doctors emerging from new foundation programmes,
and international medical graduates. With only 9,500 specialist
training places that would leave a possible 11,500 doctors out
of post in England next summer.
TRANSITION TO
MODERNISING MEDICAL
CAREERS AND
THE SHORTAGE
OF TRAINING
POSTS
It is likely that SHOs who have not been able
to secure a specialist training post under the previous system
by August 2007 will find themselves in competition with those
emerging from the foundation training programme for entry into
the new specialist training programmes, and there may then be
no training posts available for those who are unsuccessful. How
many of these displaced doctors will be affected? What measures
has the Department of Health taken to take account of these displaced
doctors? The government has not confirmed what will happen to
the remaining 11,500 doctors.
In short, the current number of SHO posts does
not match the number of specialist registrar posts. Therefore,
what is needed are more of the new style specialist training posts
to mop up the excess. The reason for this shortage of training
posts is poor workforce planning and transition management as
the Department of Health has known that the SHO workforce would
need to be reconfigured to fit into the new training system for
some time. We are told that the Department of Health team charged
with implementing the training reforms does not have the power
to create more posts. It is up to trust chief executives locally
who and how many they decide to employ. Recruitment will begin
at the end of the year but it is still not clear where everyone
is going to go.
Some may have the option to move into "non-training"
posts, where their development is essentially put on hold. However,
a BMA survey last year indicated that most junior doctors would
prefer to continue their training overseas than to take up a non-training
post. Australian authorities have already come to the UK to recruit
doctors.
Given that it costs about £250,000 to train
a doctor, the prospect of thousands of doctors becoming unemployed
seems a waste and a great loss to the NHS. The BMA has been calling
for a temporary increase in the number of national training numbers
(NTNs) so that as many existing SHOs as possible can progress
to higher specialist training before having to compete for a limited
number of new run-through training with those emerging from F2
posts in 2007. Unfortunately, even educationally sound trust grade
posts are not recognised for training purposes and this is causing
a further delay to SHOs' eligibility to apply for Specialist Registrar
posts. The BMA is therefore calling for the Postgraduate Medical
Education and Training Board (PMETB) to arrange retrospective
training recognition of appropriate posts.
Before the Home Office/Department of Health
made their sudden announcement that postgraduate doctors would
no longer be eligible for work permit-free training, the BMA in
conjunction with the British International Doctors' Association
(BIDA) proposed a single-point of entry applications process to
foundation year 2 posts for international medical graduates (IMGs)
which, if based on good workforce planning, would enable IMGs
to be matched to available headroom, rather than contributing
to the over-supply of junior doctors in the UK.
In the long term, the number of UK graduates
expected over the next few years has increased beyond the planned
expansion due to over-recruitment by medical schools. Although
the Department seems to have put funding in place for a headroom
of 12% for foundation programmes to accommodate the as yet unknown
demand for places from the newly expanded EEA, it is thought that
this may reduce to as little as 7% or lower from as soon as 2006
onwards. The BMA has not been informed of any expansion of post-foundation
training posts.
Modernising Medical Careers could bring major
benefits to both doctors and patients, but its implementation
needs to be properly planned and funded. However, the BMA is extremely
concerned about the lack of planning and the speed with which
the service is being re-organised and its effect on the existing
workforce. Inadequate financial management and cuts to funding
also threaten to undermine the training of doctors. The BMA is
therefore calling for a delay in the implementation of MMC until
enough posts are confirmed. It is vital that carefully thought-out
solutions are put in place over the coming years or workforce
problems will worsen.
Jo Hilborne
Chairman, Junior Doctors Committee
British Medical Association
17 July 2006
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