Scapegoats

So rumour has it that Prof Crockard, captain of the not-so-good ship MMC, has resigned. This is as yet unconfirmed, but it got me thinking about the state of this sorry mess.

This has all come about as calls for Prof Crockard to be hauled in front of the GMC have increased. A letter has been sent to the Council (it even made this morning's Telegraph) citing failures in management and professionalism, among others.

There seems little doubt that as head of MMC, Prof Crockard is well-placed to be the fall-guy for this fiasco. The MTAS issue has really brought this to light, and with the BMA Junior Doctors Committee walking out of the review talks, the pressure is really on the entire system of Modernising Medical Careers.

But is it right? Yes, the system is a mess. Yes, it fails to provide doctors with a fair application process, acceptable standard of training and decent career pathway. But to single one man out is perhaps not the way to do it. My humble opinion is that it is the Chief Medical Officer who really needs to talk a look at himself. He continues to pander to the whim of the government, and I fail to see how his suggestions of reform can be any good for patients or doctors. Instead, doctors are reduced to working under constant restraint, not wanting to take risks or pioneer controversial improvements, for fear of losing their careers. Whilst paramedics/nurses/pharmacists increase their provision of independently prescribed medicines, regulation of doctors tightens to further strangle their clinical autonomy.

I don't understand why people can't be up front with their intentions. The CMOs report "Good doctors" is no more about creating good doctors than "Creating an Interprofessional Workforce" is about interprofessional collaboration. The latter I shall rant about at a later date, needless to say it should be called "creating a generic, underskilled practitioner". In the same vein, "Good doctors" appears to be more about "controlled doctors" which fits very nicely with the inflexible, deskilling MMC process.

And so perhaps it is not Prof Crockard that should take all the flak for this mess. Some, for sure, but just maybe there are others who should shoulder the burden. And don't get me started on the politicians...

Simple Guide to MMC

Now I must confess, I'm not normally a Daily Mail reader. Today however, I am. A lovely man has written a brilliant article which explains exactly what is going on with MMC and MTAS. This serves as a great summary of some of the key issues with the process, written for non-medical audiences. Well worth a read.

Also essential viewing for anyone considering medicine as a career or currently training and unaware of what is going on!

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=444301&in_page_id=1774&in_page_id=1774

Doing something about MMC

Okay so to follow up from my last one, here's what doctors/students/HCPs can do to help:

Write to your MP
This takes about 5 minutes of your time on www.writetothem.com
Ask them to put pressure on Patricia Hewitt to STOP MMC and fully review it, with grassroots involvement. Ask them to sign the Early Day Motion 737 about MTAS (they'll know how)

Join Remedy UK
With the BMA writing angry letters, an ever-growing group of doctors is starting to take action. Visit www.remedyuk.org and register your support. If not, at least register your views on: http://www.remedyuk.org/GetInvolved/Survey/Survey.html

Petition your seniors
ASK people what they're doing to support you! A number of high profile consultants have spoken our publicly about the state of MMC. Are yours on board?! If not, why not?!

Spread the word
Get on doctors.net.uk and read the forums. They are a wealth of knowledge. Spread the word to colleagues but also to your families and friends to get this scandal publicised.

You can make a huge difference to your careers and the state of healthcare in this country. Thank you.

Mangling Medical Careers

I hope most people are aware of the Medical Training Application Service (MTAS) fiasco. Whilst it has served me reasonably applying to foundation training, the plight of thousands of applicants to specialist training, who have been selected without acknowledgement of skills or experience, or suitability for the individual post, is henious.

But MTAS is just part of the joke that is Modernising Medical Careers (MMC). This government 'project' was designed to reform the medical training process. All well and good. But it has created a monster that has the potential to alter the shape of medicine forever in this country, and not for the better.

The European Working Time Directive (EWTD) has served as a convenient catalyst for many of these changes. By refusing to allow doctors to be exempt from the short working week imposed by EWTD, the government are able to find alternative 'solutions' to fill the service gap. Hospital At Night schemes, which replace juniors overnight, and endless 'practitioners' (anaesthetic care practitioners, emergency care practitioners, nurse practitioners, emergency nurse practitioners, surgical care practitioners etc.) all contribute to the dissolution of skills to professionals outside of medicine. No bad thing in itself necessarily, but part of an erosion of the profession.

The next step in the MMC plan is the sub-consultant specialist grade. Rather than being rewarded for completion of specialist training by consultancy, doctors will be forced to become 'specialists'. This will of course attract less pay and less clinical prowess than the consultant grade. And it will be 'justifiable' because we will have worked about 1/3rd of the hours required by today's consultants, thanks to EWTD. Our clinical skills and experiences will have been limited by fewer hours and the fact that 'practitioners' will be seeing many of the patients with which we would have gained that experience.

There are other flaws in MMC. For example, the rigid process makes it almost impossible for doctors to get experience in alternative specialities and there is no easy way to change speciality mid-way through. Experiences such as a year overseas or aid work will become harder.

This is all before considering the MTAS issue.

MMC arrives conveniently alongside a raft of other changes to the profession. The Chief Medical Officer has decided that doctors accused of professional misconduct will no longer need to be guilty "beyond reasonable doubt", but there will simply need to be a likelihood that guilt is present. Changes to the GMC will see the lay public increase its regulation of doctors - already proven to be a problem with their involvement in the failed MTAS process.

I am categorically not against change. It is a necessary part of progress. But this change is ill-devised, unintelligent and lacks support of anyone other than peerage-hunting, government saps. We've sat on our laurels for too long saying "it won't happen", well now it is, and if we don't start making a fuss, we'll lose out. There has already been talk from the government about "downward pressure" on wages. This has been confirmed by insulting pay rises this year for doctors. Plan announced today discuss walk-in centres and other services "filling gaps" in GP cover - not recruiting more doctors.

As a doctor or medical student you have 2 choices. Sit back and proclaim that it will all work itself out in the end, and end up an ill-treated pawn working for Tesco Health (today's other new initiative). After 5 years hard work, is that REALLY the profession you want to work for??