House of Commons Health Committee Modernising Medical Careers Volume II Written evidence Ordered by The House of Commons to be printed 8 November 2007 HC 25-II, Session 2007-08 Published on 14 November 2007 by authority of the House of Commons London: The Stationery Office Limited £20.50 The Health Committee The Health Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health and its associated bodies. Current membership Rt Hon Kevin Barron MP (Labour, Rother Valley) (Chairman) Charlotte Atkins MP (Labour, Staffordshire Moorlands) Mr Ronnie Campbell MP (Labour, Blyth Valley) Jim Dowd MP (Labour, Lewisham West) Sandra Gidley MP (Liberal Democrat, Romsey) Dr Doug Naysmith MP (Labour, Bristol North West) Mike Penning MP (Conservative, Hemel Hempstead) Mr Lee Scott MP (Conservative, Ilford North) Dr Howard Stoate MP (Labour, Dartford) Mr Robert Syms MP (Conservative, Poole) Dr Richard Taylor MP (Independent, Wyre Forest) Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/healthcom Committee staff The current staff of the Committee are Dr David Harrison (Clerk), Adrian Jenner (Second Clerk), Christine Kirkpatrick (Committee Specialist), Ralph Coulbeck (Committee Specialist), Frances Allingham (Committee Assistant), Julie Storey (Secretary) and Jim Hudson (Senior Office Clerk). Contacts All correspondence should be addressed to the Clerk of the Health Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 6182. The Committee’s email address is [email protected]. List of written evidence Page MMC 1 Department of Health Ev 1 2 Dr Pete Jones Ev 43 3 Richard Cove Ev 47 4 Graham Robertson Ev 47 5 Professor David Curtis Ev 48 6 The Royal College of Radiologists Ev 51 7 Diana Morgan Ev 54 8 The Academy of Medical Sciences Ev 54 9 Dr Clive Peedell Ev 58 10 Anna Peek Ev 58 11 Dr Schramm-Gajraj Ev 59 12 Catherine Macdonald Ev 60 13 James Jenkin Ev 61 14 Mums4Medics Ev 62 15 NHS Workforce Review Team Ev 64 16 Yorkshire Deanery Ev 66 17 English Postgraduate Deans Group Ev 71 18 Mersey Deanery Ev 81 19 The Medical Women’s Federation Ev 82 20 North Western Deanery Ev 87 21 Dr Gordon Caldwell Ev 92 22 Association of Surgeons of Great Britain and Ireland Ev 94 23 Queen Victoria Hospital NHS Foundation Trust, East Grinstead Ev 97 24 Penelope Jane Berry Ev 98 25 Alison Matheson Ev 98 26 NACT UK Ev 99 27 Postgraduate Medical Education and Training Board Ev 103 28 Royal College of Paediatrics and Child Health Ev 108 29 The Royal College of Surgeons of England Ev 113 30 Roger Fox Ev 117 31 British Orthopaedic Association and the Specialty Advisory Committee in Trauma and Orthopaedic Surgery Ev 118 32 NHS London and London Deanery Ev 121 33 Professor Alan Crockard Ev 125 34 Committee of General Practice Education Directors and the Society for Academic Primary Care Ev 130 35 British Medical Association Ev 133 36 Dr J L W Parker Ev 137 37 British Orthopaedic Trainees’ Association (BOTA) Ev 138 38 RemedyUK Ev 140 39 Lindsay Cooke Ev 148 40 Margaret Demaine Ev 148 41 Royal College of Physicians of Edinburgh Ev 149 42 Royal College of Physicians Ev 154 43 Royal College of Psychiatrists Ev 162 44 British Geriatrics Society Ev 167 45 NHS Employers Ev 171 46 Georgina Wilson Ev 175 47 Association of Surgeons in Training Ev 175 48 British Society for Rheumatology Ev 182 49 Royal College of General Practitioners Ev 184 50 Fidelio Ev 188 51 Dr Alan Bosley Ev 193 3820961001 Page Type [SO] 09-11-07 21:56:20 Pag Table: COENEW PPSysB Unit: PAG1 Health Committee: Evidence Ev 1 Written evidence Memorandum by the Department of Health (MMC 01) MODERNISING MEDICAL CAREERS (MMC) Executive Summary Modernising Medical Careers is a collection of policies to improve the way in which junior doctors are trained and to modernise the Senior House OYcer grade. The original principles as set out in Unfinished Business and Modernising Medical Careers aim to do just that and are still valid. In the main, the implementation of MMC was in line with the original principles. However, the introduction of run-through training, thought by many stakeholders to be a good thing, limited the flexibility inherent in the original principles. The Department is re-introducing flexibility for 2008 and beyond. The introduction of the Foundation Programme and the changes to GP training and their respective selection processes worked well. The implementation of MMC for hospital specialties has run into diYculties this year mainly because the number of applications, particularly from international medical graduates, was very high. As a result, some UK graduates have been unsuccessful at obtaining a training post. The Department had planned for the high numbers of international medical graduates applicants and issued guidance to consider UK and EEA graduates before those without indefinite leave to remain in the UK. This guidance was taken to a judicial review. The judgment that the guidance was lawful was handed down after recruitment had started and was too late for the guidance to be implemented in 2007. This year’s problems in recruitment were exposed because we changed the training structure, the selection procedure and introduced a national recruitment process all in the same year. The introduction of run- through training and the fact that there would be very few second and third year places in later years meant that this year was seen as the only chance to get into training. The national shortlisting system was criticised because it gave insuYcient weight to academic achievements. This happened despite considerable consultation and evidence that now suggests the shortlisting process did work. Junior doctors and consultants did not understand that many applicants would miss out on interviews in the first round. This suggests that more could have been done to manage their expectations. The IT system lost the confidence of the profession following two security breaches and two times when it ran slowly. The recommendations of the Douglas Review were accepted by the Department. All applicants had at least one interview and the second round of recruitment was managed locally, within a national framework and timetable. The governance structures for MMC evolved over time and were too complex with a lack of clarity about which group would take which decision. There were weaknesses in the project management of recruitment to specialty training. There was a very ambitious timescale for developing and implementing the new selection and recruitment system, leaving insuYcient time for piloting and full testing. The Department has taken onboard the lessons learnt and a new MMC Programme Board with greater professional input has been established. For 2008, recruitment will be locally run with a national timetable. The number of applicants to posts is likely to be higher in 2008. The Department is consulting on proposals for managing applications from medical graduates from outside the European Economic Area. The Department’s preferred option is that doctors from outside the EEA with limited leave to remain in or enter the UK should be considered for post-graduate medical training places in the NHS, only if there is no suitable UK or EEA applicant. For 2009, the Department has welcomed the independent Tooke Inquiry interim report and will consider its recommendations carefully. 1. Overview 1.1 We will start our evidence with a short overview of what went wrong followed by answering each of the questions raised by the committee. 1.2 The IT system Medical Training Application Service (MTAS) was blamed for the diYculties surrounding recruitment to specialist junior doctor training. In fact there were four other issues that were the main causes of the problems experienced this year: — There were a very large number of applicants to posts (roughly two to one). Over 10,000 of these were international medical graduates. This meant that some UK graduates were going to be displaced. This displacement led to an outcry from the displaced UK graduates, their parents and the consultants for whom they worked. 3820961001 Page Type [E] 09-11-07 21:56:20 Pag Table: COENEW PPSysB Unit: PAG1 Ev 2 Health Committee: Evidence — The changeover to the new specialty training scheme happened this year at all Specialty Training (ST) levels (ST1–4). Most posts were for run-through training which meant that a successful applicant at entry level (ST1) would progress through specialty training without further competition (provided they successfully passed their annual assessments). The result would be that, in future years, there would be very few training places open for applications above the first year of training. As a result, applicants felt that 2007 would be their one and only chance to get into training to be a consultant. This increased the anxiety and stress levels in applicants and families. — It is very diYcult to shortlist from an application form for the first level of specialist training (ST1) because the applicants have relatively little experience. It is diYcult to use academic achievement and prizes because schools have varying standards and this may not indicate suitability to become a consultant. The solution used in 2007 was to use white boxes where the candidates could demonstrate the extent to which they met particular competencies.