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."