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Junior Doctors’ Crisis
March 10, 2007 — Aphra Behn
A patients’ guide to Modernising Medical Careers - Volume II - in which we lobby parliament - including an explanation of why - one year on - there are so many doctors out of work and why so many hospitals who can’t fill the rotas.
The Patients’ Guides to Modernising Medical Careers and MTAS - written during 2007, these provide straightforward explanations of the systems of MMC and MTAS.
Discussion, Opinion and Comment 2008:
1st March - Remedy Mass Lobby of Parliament March 18th - in which I admit, grudgingly, that I’ll be spending my annual leave lobbying my MP about the continuing mess and encourage others to do the same
8th January - So what’re you gonna do about it Gordie? - in which I welcome the publication of the Tooke Report on medical training, and wonder if it’ll make a blind bit of difference
7th January - Here we Go Again - in which I admit I’m worn out by the events of 2007, and warn that 2008 will be worse, but more fractured
Discussion, Opinion and Comment 2007:
29th November - The BMA are Blackleg Scum - in which the British Medical Associtation refuses to publish an advertisement invitining Juniors to join Remedy UK
24th November - Now you CD it, now you don’t - in which the MTAS leak is put in perspective as just one of many ways the government plays fast and loose with data about us
13th September - Pop Goes the Weekend - consultation document on MMC available - what it says on the tin.
18th July - Stats Tart - A scatty view of Patricia Hewitt
11th June - An Anatomy of Anger - in which I take stock of the emotional rollercoaster I’ve been through in the first half of 2007
9th June - You can take the Health Secretary out of Andersens - in which the Department of Health don’t shred evidence
8th June - Fuck MTAS - the best search terms are the simplest
27th May - MMC made simple - a video providing a simple, straight-forward and dignified explanation of MMC which deserves a wider audience.
23rd May - Vindictive Fucking Bitch - in which Remedy gets under Ms Hewitt’s skin, and pays heavily for the privilege.
17th May - Ain’t got no algorithm, baby - in which the DoH itself admits that the selection algorithm right at the heart of MTAS could not be relied upon.
16th May - MTAS - The silent “SH” in Department of Health IT - Five out of eight reasons why IT projects fail come down to the the project team failing to understand how the system will be used or what it it should do - MTAS ran depressingly true to form.
13th May - Modernising Medical Careers: On babies, bathwater and early specialisation.
7th May - So why did the MTAS site spring a leak? - I email Mike Clement, the IT Manager responsible for MTAS, with the three most likely explanations which boil down to incompetence, incompetence, incompetence, but get no reply.
2nd May - Incidentally - the MTAS leak in words and pictures - not pretty
26th April - I don’t have the words - to describe how enraged I was by the MTAS leak
18th April - Talking to Patsy - trying of something sensible to ask Ms Patronising Hubris but fail
17th April - If I could ask Tony and Gordon - I’d ask why they don’t both take a flying jump of Blackpool Tower, hand in hand, wearing tutus
5th April - And for their next trick - what next after Patronising Hubris is reshuffled by Gordie? A question debated on Dr Crippen’s blog.
3rd April - Sprinkling fairy dust wherever she goes - an assessment of Patricia Hewitt’s comments on Radio 4 concerning of MMC and MTAS.
31st March - Not in Kansas any more: Alan Crockard’s resignation letter decrypted
30th March - Modernising Medical Careers isn’t Working - with a link to two comments, one about how the UK government has mislead and continues to mislead the International Medical Graduates, and another which challenges assumptions about how the increasing number of women doctors will change the profession.
27th March - Lords, Ladies and Politicos - relevant only because the comments thread is building up into a list of the pitifully few doctors in the House of Lords. They might be worth writing to, if only because adding weight to their postbag might help add weight to the things that they say.
23rd March - “You may already have lost” - the way that the Review may have affected those who were interviewed while the Round 1 interviewers though there would still be a Round 2.
24th March - That Sinking Feeling - why nothing fundamental will change until the architects of MMC and MTAS have resigned.
17th March - What we have here is failure to communicate - a look at the internal compass of doctors, the external compass of administrators and civil servants, why they are so different and why it matters.
15th March - What makes a good doctor anyway?
From 2008:
A patients’ guide to Modernising Medical Careers - Volume II - including an explanation of why one year on there are now so many doctors out of work and why so many hospitals who can’t fill their rotas.
From 2007:
A patients’ guide to Modernising Medical Careers and MTAS - Part 1
Why there are now “too many” doctors in specialist training and how the government has decided to cut their numbers.A patients’ guide to Modernising Medical Careers and MTAS - Part 2
The geographical implications of MTAS - how the lucky doctors and their partners will be forced to relocate (despite the fact that all areas have an equal need for specialists) and how the unlucky ones don’t have the chance of continuing in their speciality and are explicitly prevented from re-applying next year.A patients’ guide to Modernising Medical Careers and MTAS - Part 3
The self assessment competency questionaire that has been used (with examples) and how academic research on the subject shows that this is one of the least valid ways of selecting candidates.A patients’ guide to Modernising Medical Careers and MTAS - Part 4
The kick in the teeth we are giving to the overseas trained doctors, and why we will always need them. The comments which hang off this particular post are depressingly informative.
In their own words:
MMC and MTAS: real stories, real doctors
Exerpts from some of the posts and comments I’ve read elsewhere which show the stoicism, dignity and pain we are putting these guys though as we kick them out of their profession.
Rants:
“Medicine Mismanaged by C**ts” - a brief and emotionally charged summary of Modernising Medical Careers including links to further reading and a plea to sign the Downing Street Petition asking that medical training be returned to the Royal Colleges.
Betjeman and the Medics- a general critique on the way the world is run for the convenience of large organisations which includes a couple of paragraphs about MTAS
March 23, 2007 at 10:54 pm
Hey,
Thanks for stopping by my blog.
You may indeed use the image - I’d be grateful if you could mention my name in small print or link it back to me somehow. She does indeed sum it up nicely!
Nice blog, by the way. I’m a new reader after getting to you through NHS Blog Doctor!
March 24, 2007 at 8:36 am
Could you please note I have started an e-petition to stop the closure and running down of local hospitals and their services. Two of our local hospitals, (Hartlepool and north tees) are under threat of closure, as are many others around the country. The unwanted effect of this will be having to travel much further for services that are available locally at the present time and we will also suffer closure of maternity and a&e. along with the loss of beds and training places for doctors. I would anticipate you are interested in saving local hospitals and would like to think that if all the people who are campaigning at a local level could combine into one united petition it may have some influence on the government to prevent the closure of these much needed hospitals. To vote please click on the link and feel free to distribute it to others,
thanks, r. olaman
http://petitions.pm.gov.uk/SAVE-HOSPITALS/
March 24, 2007 at 10:45 pm
Thank you Cal. I have of course credited and linked to you.
Thanks for dropping by R. Olaman with the link to your petition. I do wonder how politicians think people can get to such non-local hospitals if they don’t have cars. But what does it matter - we’re just the people they govern. Thank you for the link.
Aphra.
April 20, 2007 at 6:53 pm
Please do not blame only the senior managers or the politicians
for killing off the National Health Service.
Senior doctors running the
Royal Colleges, GMC and BMA are as much to blame.
These doctors have always maintained a system
by which the bulk of the work was done
by juniors and a group of non-consultant (NCCG) doctors,
while they themselves spent time
cherry-picking few NHS cases or on their private practice.
They have given in to all the demands
made by the managers and the ministers
as long as their own manner of practice was allowed to continue.
They could not have been concerned for the future of the NHS.
This was the status quo for many many years.
But they did not account for
1. new pay deal for junior doctors
which made them more expensive
than the NCCG doctors with years of experience!
To balance the books, the junior doctors
and registrars working (training) hours were reduced.
2. To meet the job demand,
Nurse practitioner posts mushroomed.
But inadequate training and supervision made them a liability.
They were supposed to learn within six months
what a junior doctor has taken five years.
It was expected that only a fraction
would be capable of delivering the service, and so it is.
3. Immigration restriction of non EU overseas doctors.
These were a group of doctors, some with PG degrees,
with knowledge and skills of years of experience.
The quantity and more importantly the quality
of EU doctors coming to UK is a big disappointment.
A void is being created at a mid to senior level.
4. To fill up that void, doctors in consultant training
are being given the license
to become consultants in shorter time.
Given that these doctors had inadequate training
at a junior and registrar level,
they are disastrously inexperienced as consultants.
But they are accredited to work autonomously!!
They will treat you and me when we are ill?
That frightens me, does it frighten you?
All along the priority has only been the “numbers in posts”
never the quality of service provided.
Do you really believe this could happen
without the co-operation
of the doctors responsible for making the policies?
Finally
5. A demoralised NCCG work force.
Every group of doctors had massive pay increase,
except the group of doctors that matters
that does the real hard work.
For if this group becomes to expensive to employ,
there really is no one else to do the job.
They have to work ‘under the supervision’ of these inexperienced ‘consultants’
and are regular victim of bullying and harassment.
NHS is not dying because of the MMC and MTAS.
These are just the sore on the surface
of a system that has been terminally ill for a while now.
Band-aids and poultices unfortunately no longer covers the open wounds.
Its time to give NHS the last rites.
Too many things have gone wrong;
correction, has been allowed to go wrong.
It now is beyond salvage.
You may not believe me today,
but do remember this post in a couple of years time.
April 21, 2007 at 8:33 am
I think you are right, there has been a certain amount of Pastor Neimueller-ism among the seniors. (”When they came for the Jews I did not protest because I was not a Jew” etc, etc). However, that is - I hope - beginning to change. The West Midland Surgeons are the true heros of MTAS, and I hope that other seniors are beginning to give voice to the concerns they have held privately for a while.
And I do believe you about the seriousness of the position. Everything that I have posted is based on my concern that the consultants in a few years time will not have the experience or the knowledge they - and we - need.
I have no idea if the NHS is past saving, but I do know it is worth fighting for.
Thanks for reading and commenting.
Aphra.
April 21, 2007 at 12:00 pm
Mine is an insider’s interpretation of over 16 years.
April 21, 2007 at 4:53 pm
And mine is an outsider’s - but both have validity. (I analyse systems for a living - in my experience outsiders have perspective and insiders have evidence and both groups need the other if balanced and accurate conclusions are to be reached. I have never yet once met an outsider who didn’t need evidence or an insider who had evenly distributed experience of any substantial system). And, as I’ve already said, I agree with many of your points even though you put them rather bluntly and seem to assume that I don’t.
My objective with the “patients’ guides” was to put something out onto the internet which explained the situation for outsiders because when I wrote them there was nothing at all that did that. There is now a much wider understanding of the situation among the public and the press, and events have overtaken the pieces I wrote. I may still use MTAS and maybe MMC as a case-study for how not to introduce organisational change. If I do that, I’ll have the time to understand it though I’ll still have the challenge of obtaining the access, and if I’m not satisfied with that then I won’t be able to use the situation.
You are banging on an open door here because we agree with each other on the main points though, as I’ve said, I accept that I’ve probably let the senior members of the Royal Colleges off the hook in what I’ve written. And as I said many times, as a patient I worry about the NHS.
Aphra.
April 21, 2007 at 6:10 pm
Am I hallucinating?
Or did you just reword this comment?
I am almost sure you had said something different
to which I was about to reply, but
Brian Lara took a priority.
I am not ‘banging on any doors’.
Neither does it matter if you agree or disagree.
I have only mentioned my understanding of a problem.
I had returned to add something I missed mentioning earlier.
April 22, 2007 at 8:02 am
No, you aren’t hallucinating. I hit post by mistake before I had finished writing it, and continued editing it until I felt that the comment said what I meant. I did hope at the time that it wouldn’t confuse anyone.
I have never and would never edit other people’s comments here, though I have removed the active links from hand-crafted spam and simply rejected mechanical spam.
All the best.
Aphra.