Monday, April 23, 2007

Doctors Mass Lobby the Government Tomorrow


Tomorrow will make history when thousands of doctors will lobby the Government about propsed plans to reform medical training that will put patient care at risk. Some Cambridge medics have sent me some of the points they will be raising with their MP tomorrow:

"Patient care is set to suffer under current proposed government changes to medical training. The controversial Modernising Medical Careers programme (MMC) is being implemented by the government on August 1st 2007, despite vehement opposition from the majority of doctors and the Royal Colleges. Patricia Hewitt has already “unreservedly apologised” for the shambolic national application scheme (MTAS), which has prompted two independent reviews. She has yet, however, to acknowledge the detrimental impact that the proposed major changes in training will have on patient care.

On Tuesday 24 April, doctors from all over the country will come together to exercise their right to lobby MPs in Parliament. The mass lobby, co-ordinated by Remedy UK (www.remedyuk.org, an independent representative group for medics), aims to raise awareness of the impact MMC will have on patient care. They argue that the changes proposed by MMC can not be allowed to go through if patient safety and the quality of medical training is to be maintained. An immediate, comprehensive and genuinely independent review of changes in training must be undertaken.

Current medical training consists of “preregistration years” followed by several years at Senior House Officer (SHO) level, during which doctors broaden their medical knowledge and take professional exams to become members of the appropriate Royal College. Once these century-old, internationally recognised and respected exams had been passed, doctors apply for Registrar posts in their chosen speciality and continue training for 5-7 years before being able to become consultants.

The reforms being implemented by the government do away with both SHO/Registrar training, and the collegiate exams and replace them with “run-though” training programmes of 4-5 years. This shortens the period of training, removes any flexibility from the system ( for example, the option to gain furrther training abroad, work in a related speciality, or indeed to take time out to have children), and requires doctors to choose a speciality early in their careers, before knowing what might best suit them. In addition, there are insufficient training posts for the number of doctors currently educated in this country.

Changes to training as a consequence of MMC, will result in a reduction in the length of training for doctors in many specialties – at the same time as the average working week is reducing from 56 to 48 hours, in line with the European Working Time Directive. Inevitably, this will result in doctors who do not have the necessary experience to provide safe practice. For example, it is thought that training time for surgeons to become consultants will be effectively be cut from 21,000 hours to just 6,000 hours.

The MMC programme’s requirement to select a specialty at a significantly earlier stage in a doctors’ career, does not equip a doctor with the skills necessary to identify and treat complications or patients with multiple medical problems. Due to the ageing population in Britain, patients with multiple coexisting illnesses are becoming increasingly common ,meaning a broader knowledge base is required, which seems contrary to MMC implementation.

“Modernising Medical Careers will result in poorly trained doctors working in specialities in which they have little interest,” said Dr Jane Graham, a Remedy UK spokesperson for SE England. An overwhelming majority of doctors believe that the new programme will be detrimental to patient care throughout all specialities of hospital medicine. At the national meeting of the Association of British Neurologists in Cambridge on 13 April, 350 physicians voted against the motion ‘MMC is good for patients, trainees and the Practice of Neurology’. Only 4 votes were passed in favour.

The most immediate victims of the government’s ill-thought through “reforms” are those Senior House Officers with with the most clinical experience and knowledge who are loosing out to more junior doctors to ensure that the governments proposed training reforms can be implemented. In a leaked memo on the impending employment crisis for junior doctors from Sian Thomas, director of the NHS Employers Organisation, it stated that of those 10,000 doctors unemployed from August, the Department of Health plans to prioritise finding posts for only the most junior and inexperienced doctors. Those more experienced doctors, who currently provide the back bone of NHS medical care, will effectively be removed from practising, thus putting patients at serious risk.

The health service is already being put under considerable strain as junior doctors currently have to travel to interviews around the country, leaving wards dangerously understaffed. No one can predict the scale of the disruption to service that will follow when the new scheme if introduced this August. The government propose to simultaneously uproot overnight 18,000 doctors, to start work in what for many will be a new hospital, with a new team, in a new speciality. Previously, the transition between junior doctors’ contracts have always been staggered to ensure continuity of patient care and patient safety.

The Royal Colleges have been in charge of medical training since the 16th century, but their grave concerns have been dismissed. There is growing alarm that the quality and level of patient care will suffer both in the short and long term because of the government-driven change. It is of the utmost importance that those in power listen to the concerns raised, and that the public is aware of the dangers, if these serious issues are not addressed immediately."

9 comments:

Anonymous said...

Hope it goes well tomorrow

Dr Michelle Tempest said...

Thanks!

jmb said...

Thanks Michelle for that very instructive explanation of the situation, current and proposed.
As usual,it's all about money and control.
Good luck for tomorrow.
regards
jmb

Dr Michelle Tempest said...

Thanks jmb - you are a star. The piece was written by a group of medics who will be lobbying their MP tomorrow. One of the authors is the doctor in the picture who also joined that march in March. The government need to be aware of the dangers they are placing the general public under.
Thanks again jmb.
Michelle

David Anthony said...

it is thought that training time for surgeons to become consultants will be effectively be cut from 21,000 hours to just 6,000 hours

How can this be useful to anyone; patient or consultant?

Good luck tomorrow.

QUASAR9 said...

replace them with “run-though” training programmes of 4-5 years. This shortens the period of training, removes any flexibility from the system ( for example, the option to gain furrther training abroad, work in a related speciality, or indeed to take time out to have children), and requires doctors to choose a speciality early in their careers, before knowing what might best suit them. In addition, there are insufficient training posts for the number of doctors currently educated in this country.

Changes to training as a consequence of MMC, will result in a reduction in the length of training for doctors in many specialties – at the same time as the average working week is reducing from 56 to 48 hours, in line with the European Working Time Directive. Inevitably, this will result in doctors who do not have the necessary experience to provide safe practice. For example, it is thought that training time for surgeons to become consultants will be effectively be cut from 21,000 hours to just 6,000 hours.

Hi Michelle,
1) I agrre with you we need flexibility and a Modular System in any Training (doctors or other).

There are transferrable Modules whatever field or branch of medicine one chooses, and they should be able to allow for change in direction (annually or per semester)
And of course women should continue to be allowed to take time out to have babies - and rejoin their education or training - by law!

The EU work directive safeguards best practice, a tired human working long hours is more likely to make mistakes.

But I do agree reducing Medical Training from seven years to five or four (and the duration of other degrees from five to four & three) does mean we have a higher output of watered down degrees.
Mind you it also reduces the size and debt of student loans and personal debt (does it not)

But despair not, the answer in the US (and Cambridge) is to still award higher Masters degrees, or students to do secon degrees and Phds - to secure higher paid employment.

Alas, the imperfect pyramidal society we live in.

I support the shorter working week (for less pay or annual salary) as a legitimate way to create more posts - more hands on patient care is what we need - from fresh hands, not tired people doing a 70 hour week (to earn overtime).

And I support flexibility in training as stated above, but also more scholarships. The worst thing we can do is create another generation of doctors who are doctors because they (or daddy) can pay or get huge loans and debt.

Better to give access to more people, and judge them on their medical skills rather than ability to pay - else we create a culture where medicine is justified and dispensed according to ability to pay - rather than according to patient need.

Dr Michelle Tempest said...

Thanks David - I'll let you know how tomorrow goes!
Quasar9 - Thanks for your comments and thoughts on the issue. I agree that the idea of having qualified doctors working humane hours, means that we need more doctors. Hence, the idea of reducing doctor numbers does not seem to be safe for patients or doctor health.
As far as student debt goes - I think all doctors know they will have debt to pay back after medical school. Student debt is another blog! Thanks again for the comments and for joining in the constructive debate.
Thanks
Michelle

Ellee Seymour said...

The last thing these doctors want to do is lobby, I'm sure they would much prefer to be able to do their job.

Good luck tomorrow, you are a star. (just noticed to said the same to jmb, who is also a star, so you have a little galaxy of bloggers here ;-).

Dr Michelle Tempest said...

Hi Ellee - I agree, but the lobby is necessary and the public have a right to know what is happening within the NHS.
All I can do is report upon the story. I thank all my readers very kindly fo taking such an interest.
Thanks again
Michelle