Nigel Hawkes, Health Editor
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The running of doctors’ training must be taken out of the hands of the Department of Health after its chaotic mismanagement of funding and job applications, an influential report will say today.
The report by Sir John Tooke, ordered last year after thousands of highly qualified junior doctors were left without training posts, recommends that the Government be stripped of control of postgraduate medical training.
Instead, it recommends that the cash needed to train the next generation of specialists should be ring-fenced to prevent the NHS from spending it on something else, and managed by a new body, to be called NHS Medical Education England.
The recommendations, seen by The Times, are expected to be made today by the inquiry, which was set up by the department last year after a series of failures. Incidents included thousands more doctors applying for posts than were available, and problems with a computer system designed to shortlist applicants, which resulted in severely underqualified doctors turning up for job interviews.
Sir John Tooke, Dean of the Peninsula School of Medicine in Plymouth, was asked to chair an inquiry into what to do next. His interim report was published in October, and has been overwhelmingly backed by doctors. His final report, out today, is a stunning vote of no confidence in the department. Last year’s crisis “could and should” have been predicted, he told The Times yesterday. The appointments system that failed was “rushed and poorly planned”.
There are two important changes to the interim report’s recommendations. One is the formation of NHS Medical Education England, which Sir John and his colleagues say will be able to articulate the principles of postgraduate training and implement it successfully — something that the department “is in no way capable of doing”, he said. The report also gives warning that training could suffer when the European Working Time Directive comes fully into force next year.
The limit on doctors’ working hours will mean that there is not enough time to train them to the skill levels needed, he cautioned. A way needs to be found in which doctors can continue to work legally more than 48 hours a week — perhaps by separating work on the wards from training time.
But the most urgent problem is one that Sir John cannot solve — making sure that last year’s debacle over training appointments, when 30,000 junior doctors applied for 20,000 posts, is not repeated. The evidence is that the pressure on places will be more intense this year, with about three applicants for every training place, and 20 to 1 in the more popular specialties.
Sir John said that the Government had failed to reconcile two of its policies: expanding medical school places in Britain and the “open door” policy towards graduates from overseas. Unless further training places were made available this year, he said, British graduates would be disadvantaged compared with those of earlier years.
There will be a bulge in applications for higher training, caused by a growing number of British graduates, applications from those who won only a one-year post last year, and the uncontrolled number of applicants from abroad.
Last week, the British Medical Association gave warning that the process could go as badly as it did last year. Applications opened on Saturday for training posts in England that start in August this year.
Ram Moorthy, chairman of the BMA junior doctors committee, said: “Our concern is that without adequate planning, the levels of competition could result in a lottery.”
Sir John said that unless changes were made to protect the rights of British-trained doctors to at least one year of postgraduate training, a situation could arise in which students graduate from medical school but could not practise as doctors because they had not completed their year in hospital.
What went wrong
— The computer designed to shortlist applicants failed
— Consultants asked to interview applicants walked out because many of those whom they saw were unfit to be shortlisted
— At least 10,000 overseas doctors applied for posts, even though the Government had expanded medical schools in Britain to make the country self-sufficient in doctors
— Attempts by the Government to stanch the foreign applications failed in court
— The computer failure made personal details of doctors’ applications, including in some cases sexual orientation, accessible to outsiders
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Tooke review is good in recommending that power should be taken away from DoH in planning the postgraduate training for doctors. DoH is cutting the budget for doctors in training and spent it on PFI and ISTC, which i find unnecessary. This created more burden into the budget and hence, there is cut in budget for doctors in training. DoH had spent millions on MTAS system, which has failed. This is unfair to doctors in training because of the poor planning from DoH. Doctors in training work hard to get into higher training but is deprieved the chance because the lack of funding.
Besides, I think that government should restrict overseas applicants for training posts excluding those that graduated in UK. This is because taxpayer has invested lot in their training. The first priority should be given to UK graduates irrespective of their nationality. I hope that the Tooke recommendations will be implemented soon.
Kim W Chan, Blackburn, United Kingdom
Prof Sir Tooke's final report is a breath of fresh air after the dire MTAS experience and the resulting chaos. He wants the role of doctors redefined within the health team whose roles will also be redefined to acknowledge the doctor status as head of such team. He stresses that this redefinition should also reflect the doctor's abilities, knowledge and attributes. I hope that his recommendations in this regard are implemented asap to end the current blurring of roles that only harms the patients on the recieving end. This means the end of the current 'noctors' or nurse practioners and other quangos who claim superiority over doctors after attending six week training 'courses.' An end to doctor bullying by the new army of noctors?
However, the report does not address the problems of the 2007 doctors who had to accept unsuitable or far away from families jobs to save their careers but are now miserable and will remain so for 7 years unless a solution to their predicament is found.
Yaya, Doncaster, England
Training places, should, primarily be given to British born doctors, and only awarded to applicants from abroad once this obligation has been met.
It is becoming more difficult by the day, for British people to find jobs, it's outrageous.
This principle should be applied throughout the Kingdom.
Clive Burghard , LANCING, ENGLAND
Tooke has done well, he has correctly analysed postgraduate medical training in the UK. He has conducted an enquiry of incredible thoroughness and highlighted the need for better management of training, the need to aim for excellence not adequacy and the desirability of taking junior doctors training out of the political arena.
He correctly points out that some roles will forever remain the job of doctors ("The doctorâs role as diagnostician and the handler of clinical uncertainty and ambiguity requires a profound educational base in science and evidence") and only medical training fits someone for that role, contradicting a thread running through the NHS that anyone can take on any role with enough development.
A late addition to the report is an aim to square the circle of restricted hours of work with the need to spend many hours training to achieve excellence.
It is easy to see Tooke as working for doctors, but in aiming for excellence he is working for all patients as well.
Andrew Skinner, Sedgefield, Co Durham
Liam Donaldson is still in office, thats the most galling fact for me following this fiasco. There will remain "Unfinished Business" until you are fired Sir Liam.
Doctor P45, Glasgow, Annoyed
Beware "independent bodies". They're an excuse for empire building. No doubt this report will be accepted, and then yet another part of government will be stripped out to a parallel organisation which will seek remorselessly to expand its funding, powers and influence. Our "expert classes" seek to govern at the expense of the taxpayers without democractic oversight- as they already do in so many "agencies" and quangos. The fault here is that the NHS is a failed socialist system that can never work; that is the fundamental problem that needs addressing. Creating yet another autonomous tax-funded body is not the way forward.
Ian B, Northampton, England
Sir John Tooke is to be congratulated for speaking common sense and with some common sense solutions. How ludicrous to spend hundreds of millions of pounds training doctors and then having to let them go elsewhere to find work. Perversely, we could be faced with an acute shortage in an economic downturn as a weak pound encourages foreign doctors to return to their homelands.
Steve Marchant, Torquay, UK
What with this and the MRSA business, time to rename it ...
MINISTRY of FILTH
Sean Shalor, coventry, uk
Excellent report - but does anyone think the Government will accept it and act upon it?
Alison, Ludlow, England