Industrial unrest
Is there a secret strategy behind the govt’s recent changes to the NHS?
If so, it isn’t working.
‘Do we say to health professionals, “We will scrap 95 per cent of those targets and the one thing we want you to worry about is whether your users are happy with what you do”?’ said Halpern, who argues that what patients actually say they want most is respect and dignity.
A pro-happiness government might also treat public servants differently. In one of Halpern’s studies doctors asked to make a diagnosis from x-rays did so faster and more creatively when offered sweets while working, which boosted their mood.
Yup, that idea of asking nurses to keep records of the chocolates they received at work was a stunning success. Oh, I forgot, was it not the idea to give them the chocolates?
The fallout from MMC & MTAS continues to cast a shadow over the medical profession with this letter in the Guardian:
Doctors’ training heading for disaster
We wish to voice our strongest concerns over the implementation of the new appointment process to medical postgraduate speciality training. The former local application form and interview has been replaced by a national online process, with doctors limited to making applications for four posts only in the first round. There have been major organisational problems over the implementation of this system, which had not been piloted.
The questions on the application form have to be scored independently of each other (by two consultants or lay assessors). This is carried out without the knowledge of other answers, or of the career progression or experience of the doctor. Although this may seem fair, it is only by putting answers in the context of the doctor’s career progression and previous experience that a logical judgement can be made.The result is that this process appears to have failed to discriminate between candidates, as many of the most capable doctors have not been called for interview. In general, in this hospital, we have high-quality junior doctors and we expect the majority of them to be successful in obtaining higher training. However, over 30% of our trainees have not been called for interview. The anger of the consultants is a reflection of the disillusionment and despair of our talented junior doctors, many of whom are understandably questioning their future in medicine. We urge the secretary of state to urgently review the process and make the widespread changes needed to rescue a disastrous situation.
Katharine Stanley
Consultant in obstetrics and gynaecology
And 93 other consultants at Norfolk and Norwich University hospital
And in the Telegraph, the article that first gave it proper attention continues to receive impassioned comments, over 400 of them at last count. Another story today keeps up the pressure.
A few of the comments from that thread:
I think this should be an open debate but this really isn’t about pay. It’s about enthusiastic, bright, people having their career and livelihood decimated by a system that doesn’t allow them to compete on merit.
Doctors take exams and do courses to improve themselves, their prospect of getting the job they want, and patient care.
Ironically this has been sold as better training for doctors yet currently study budgets have been cut or frozen. Moreover if you get on to ST training what’s the point of taking courses - you’re a made man, if you’re not on ST training what’s the point - you have no career.
As to the government’s claims, when they tell you that 30,000 of us are applying for 20,000 jobs they are being somewhat disingenuous. If you look at the figures released in January there were approximately 20,000 training posts however, 4000 were FTSTAs (i.e. two year dead end jobs with essentially no prospect of a long term future) and 2800 GP posts that had already been filled. Therefore the 30,000 are in fact competing for 12,500 posts. (See MMC web-site)
It is desperately sad that it has come to this. The government have systematically dismantled the medical profession.
Hospitals run because of the good will of the doctors, evidently this has now been shattered and with it patient care. There will be irreparable damage to the working attitudes of doctors. With the NHS in desperate trouble the last thing the government should have done was to demoralise the one group who hold it together.
Posted by Rob Henderson SHO on March 2, 2007 5:43 PM
Could you imagine a system where graduates from the best universities in the country were told the following:
1. Make a choice- are you more committed to being a lawyer/accountant/IT specialist/teacher etc or would you rather choose where you live.
2. If you decide you really want to be a lawyer you have to choose 4 large areas of the country in which you would be prepared to work- These include areas as large as 3 counties or indeed a whole country (Wales/Scotland).
3. If you were born in London, studied there, own a home there, have worked in competitive jobs there and have excelled in your exams and you really want to stay there you can apply to do 4 different jobs in that area (bearing in mind you could be then allocated to work anywhere in the whole of greater London, Kent, Surrey or Sussex if successful).
3. Your application (one of 30,000 x up-to 4 per person), which consists mostly of poorly discriminating 150 words generic essays will need to be rapidly assessed against an unvalidated marking system. This may involve administrative staff. It may involve not being marked at all if the consultant it was sent to was on holiday at half-term. If it was not marked your application will be automatically discounted.
4. You will then be told if you have an interview-there will be no correlation between the quality of the candidate and the interviews awarded.Compare this to the current system- You apply for the individual jobs or rotations you want based on your career intentions and social/lifestyle needs. Your CV is assessed in its entirety and interviews are given to the best candidates.
Everybody is very upset and angry. The government is determined to maintain momentum.
Posted by Dr M Varrier on March 2, 2007 11:40 AM
As a consultant of nearly 20 years, I am shocked to see the devastation brought to our new doctors. I shortlisted applications marking my response to the most banal, non discriminating questions with no idea how good or bad the candidates are. I am now being told the interview questions must be controlled and discussed in advance! I shall ask what I want in a frustrated attempt to bring common-sense to a discredited system . The cause of all this is based on obsessive political correctness, and massive distrust of our profession by this government. It is all part of a control system ( see Lenin’s plan to control the professions in his writing). They hate an independent profession like ours. The only good news is that the protests may break the system and we can all return to a system where hard work and effort is rewarded.
Posted by Andrew Morgan on March 3, 2007 8:07 AM
I am a doctor who has been shortlisted but am still devastated by the system. My boyfriend is also a doctor and has just had his career potentially destroyed. He graduated in 2003, trained in Surgery in good university teaching hospital jobs since then, passed his exams very quickly and has been on more then the required surgical skills training courses. He is very good at his job, his references (from very respected Consultants) for these applications state he is an “exceptional trainee” who will go very far in surgery. He has applied for 4 jobs, (the maximum allowed) and been offered no interviews. Now he can apply in round two where no-one knows if there will be any training jobs left. A non training job may mean he is never a consultant. The results of round two will not be known until the 23rd of June, just over one month before he would be unemployed altogether. It is absolutely disgusting to see him be treated in this way for a job which he loves and is excellent at. I have been offered interviews to train in Oncology, but we are likely to both now move to Australia and leave the NHS which trained us forever. Doctors at our level in training have been sacrificed due to poor work force planning by the government. I am appalled, disgusted and very very upset at the way we have been treated and leave the NHS now with a heavy heart but no choice. Please understand that there are very very good doctors being lost because of this system, surely the public can see that this is not acceptable.
Posted by Kathleen Houston on March 3, 2007 3:13 AM
The MMC initiative is part of a clearly worked out strategy to de-professionalise the medical profession in the UK. GMC changes, dis-empowerment of consultants from service delivery decisions, reduced funding for academic development and the watering down of the Royal Colleges powers to train doctors has all led to the most esteemed of careers turning into a mere job. The ramifications of this will be felt both in the short and long term and correcting the systematic denigration of the medical profession will take decades to fix. The public have no idea how thoroughly demoralised the medical profession as a whole is in this country, though they will soon. The DoH wishes to control supply, training and demand for a profession; this monopoly will only be broken by radical action by doctors and their nursing and other colleagues by leaving the NHS and ’selling back’ their skills on their terms - the government will then have achieved its ultimate aim of being able to dismantle and privatise the NHS and being able to blame doctors for the mess that follows.
Posted by Charles Rathdowne on March 3, 2007 12:10 AM
A consultant’s viewpoint on MMC and MTAS – how the Government and the medical hierarchy have betrayed doctors and the public
(see evidence, quotes from college officials, MMC petition etc for this letter below)
The NHS 2000 promise of a Consultant led service is a sham. The government, aided by the Academy of Medical Royal Colleges and the 4 UK Chief Medical Officers have in reality been planning a sub-consultant led service that will be cheaper to run and easier to manipulate. This has been done behind the backs of grassroots doctors and the public and is another example of the way this government uses stealth tactics to railroad through its policies. The BMA has twice fought off the spectre of a sub-consultant led service in the last 4 years, but to no avail. Through very weak leadership and personal self interest, senior members of the Royal Colleges have betrayed their own profession and the public.
Junior doctors have been treated in the most shambolic way. Training is being shorted and dumbed down and selection for specialist training has been left to an untested and unevidenced computer selection process (Medical Training Application System) (MTAS)) dreamed up by educational psychologists that know nothing about the realities of day to day clinical medicine. Over 30,000 junior doctors have simultaneously been forced to apply for 22,000 training posts leaving the prospect of up-to 8,000 unemployed UK doctors. Worse still, 9,000 of these posts are temporary and will only last for 2 years, therefore leading to even more medical unemployment in the next few years. The whole process has been rushed and forced through by the DH, 4 CMOs and the MMC team despite calls from several quarters (including the BMA JDC and a Doctorsnet petition of over 500 doctors) to delay the process. The selection process is biased against the most experienced junior doctors with the most qualifications who will have to find jobs elsewhere. This is of course ideal for the government who will have a lower salary bill (due to effect of lower seniority payments) thereby helping to reduce their well-publicised NHS deficits. Thousands of young doctors careers are being ruined in the name of saving money and producing a less able “fit for purpose†workforce that will have less influence and power to combat the government’s disastrous NHS reforms. This truly is a national scandal and I am ashamed that senior colleagues in the Royal Colleges have been complicit in this in order to further their own careers and prospects of gongs form the honours system. It comes as no surprise that the government have recently appointed the president of the Academy of Royal Colleges, Dame Professor Carol Black, as the chairwoman of the honours select committee for health service staff.
Please see my article in the BMJ Careers Focus today.
This contains the quotes and references from Professor Sir Alan Craft and Professor Alan Crockard. The quote for Crockard is from personal correspondence that you can have if you want.
Also, here is the Doctors net protest letter signed by 510 doctors published in the Sunday Observer.
Another statement comes from the President of the Royal College of Physicians, Professor Ian Gilmore, in the BMJ (Nov 2006) recently:
“We should learn from the lessons of postgraduate education, where the royal colleges’ oversight has been lost to others. We need to stand up and take responsibility
for demonstrating that patients’ trust in their specialists is justifiedâ€This describes the regret that the colleges have in handing over power for training doctors to the government. A very interesting but galling statement that just about sums up the weaknesses and mistakes of the recent college hierarchy.
Please also see recent posts of mine on Doctorsnet.
Posted by Dr Clive Peedell on March 2, 2007 11:09 AM
I was lucky enough to escape the MMC process late last year, so I have no personal interest, but have followed the introduction of this very closely as a representative of a plastic, reconstructive & burns surgical trainees’ group, over the last 12 months. The DoH’s response that this process was ‘competitive’ would be laughable, if it wasn’t so serious for the thousands of very talented, high-achieving individuals that have been tossed on to the scrap heap. The government’s ‘one-liner’ political retorts are an example of the arrogance and disdain with which they have steamrollered their changes through. And it seems our senior representative bodies have failed to adequately look after trainees’ interests due to either inertia or an inability to envisage or admit that a ‘cull’ would take place. This process has, after all, been going on for a few years now and has culminated in this ‘one-off’, ‘now or never’ selection process.
This new selection system has a number of open-ended questions assessing what would be deemed the ’soft’ competencies for being a surgeon e.g. probity, handling a difficult situation etc. These attributes are best assessed at interview, not with an application form. The selection team (Workforce Psychology Partnership) have provided absolutely no shred of evidence that the new system is valid or reliable, and if they have, it is certainly not in the public domain. Furthermore, we have no evidence that there were any QA checks in place to ensure shortlisting was carried out reliably. The team should be pressed for all this information to prove that this process was fair. There was also significant variation in the outcomes based on which region you applied to - not really an advert for a ‘national’ standardised selection system. On the basis of no evidence for robustness, how can anyone claim that this selection procedure was fair or discriminating between the best candidates for the job? In some cases, selectors were marking 100s of application forms in the space of a couple of days! It was more a game of Russian roulette with a significant risk of terminating your future career in medicine.
High achievers and the innovators of the future, with prizes, distinctions at University, strong academic track records, doctorate research degrees - the pursuit of which was actively encouraged by their seniors- have been discarded; those who can ‘cut and paste’ from the latest GMC Good Medical Practice document have been rewarded. It is a climate of political correctness gone mad - doctors need to be ’seen to be patient-centric’ at all times - but is this best assessed by a written application form ? Or was the application form in reality, a ‘bullshitters’ charter’ (a term used in the media last year to describe the application process for medical students entering MMC)?
The lack of transparency throughout has been nothing short of a disgrace and all representative bodies, but particularly the Government, have let down a whole generation of doctors in training. Where next for these doctors? Abroad? Carving out a management consultancy career in the City? I am sure the industrial and commercial sectors will welcome these high-achievers with ‘open arms’, but at great loss to the NHS. If the tax-payers realised how much money has been thrown down the drain with this process, there would be a public outcry. It is an irony that we have been crying out for more doctors, and toss out a whole generation without a blink.
Posted by Piyush Durani, Chairman Modernising Plastic Surgery Careers Group on March 2, 2007 10:49 AM
I apologise for being one of the lucky ones who has in fact received an interview. I see my peers absolutely defeated and can only imagine the effect this has on efficient health care. I also see a government that signed up to the European Working Time Directive by 2008 (but)that is effectively giving redundancy to a third of junior doctors who are already working on average 60 to 70 hours weeks (too little in my own humble opinion). I would be delighted to know how this is reconcilable.
Posted by Chris Picken on March 2, 2007 7:07 PM
As a consultant, I have had to score e job applications in a system that is banal and inefficient. I feel for this generation of juniors that have been let down by the sheer pig headed incompetence of labour politicians. it will take generations to undo the damage that has been done to the NHS. My advice to juniors - emigrate. My advice to myself - retire as soon as possible. My advice to the electorate - get rid of this nest of vacuous, protocol driven, target riddled bunch of self serving idiots.
Posted by D S Jackson on March 2, 2007 5:44 PM
I am an SHO in psychiatry, and like so many others, am facing a destroyed career. I may be considered lucky compared to some; though I was rejected by London, my current location, and the two deaneries closest to London, I have been shortlisted for another deanery several hundred miles away.
Should I be offered the position, I have a choice: give up medicine, or give up everything else important in my life. Sell my house. Leave my partner. Leave my family. Leave my friends. Leave my entire support network. The government expects us to roll over and accept whatever is offered to us because, let’s face it, we should be so damned grateful for a job that we should value it over everything else.
I understand the process is competitive - medical jobs have always been competitive. What has not been the case before is that every junior doctor in the country is competing for all jobs at the same time, or that there is no choice but to compete in the system.
In some rotations, as many as 80% of doctors have not been shortlisted for the area in which they already work.
On Tuesday the 7th August 2007, all junior doctors will finish their current posts. On Wednesday the 8th August, they will all be expected to start new ones, many of which will be in other parts of the country. All job allocations will be finalised at the end of June. That leaves thousands upon thousands of doctors ONE MONTH in which to uproot their entire lives and relocate.
One month to sell our houses.
One month to find somewhere new to live.
One month for our partners to find new jobs in the same area.
One month to find new schools for our children.
One month to say good-bye to everything and everyone we hold dear.
All whilst working full-time.I would like to know how the government thinks this will be practical, and thinks that patient care will not suffer drastically as a result of such massive upheaval.
Posted by CB on March 2, 2007 4:23 PM
In other news, the BBC reports that this year the Scottish Ambulance Service will report a 12% year-on-year increase, while in the West Midlands and the North East the rise could be as high as 20%. Please refer to previous posts re the sustainability of cuts in services. Also pay attention to the ongoing row about how meal breaks will be handled and the fallout. An update on the Welsh situation.