Implementation
MTAS
In 2007 appointment to this level of training was facilitated using the Medical Training Application Service. Due to several system failures and political pressure, this was abandoned partway during the process. In 2008, following significant pressure from junior doctors, [7] the MMC Programme Board for England came to an agreement to revert to a local application process determined by deaneries and specialties.[ citation needed ] Agreement was made that no further attempts would be made to introduce new selection methodologies without piloting, academic evaluation and professional buy-in.[ citation needed ]
| Old System | New System (Modernising Medical Careers) | |||
| Year 1: | Pre-registration House Officer (PRHO) 1 year | Foundation Programme: 2 years | ||
| Year 2: | Senior House Officer (SHO) a minimum of 2 years, although often more. | |||
| Year 3: | Specialty Registrar (StR) in a hospital specialty: 5–8 years | Specialty Registrar (StR) in general practice: 3 years | ||
| Year 4: | Specialist Registrar: 4–6 years | GP Registrar: 1 year | ||
| Year 5: | General Practitioner total time in training: 4 years | |||
| Years 6-8: | General Practitioner total time in training: 5 years | |||
| Year 9: | Consultant total time in training: minimum 7—9 years | Consultant total time in training: 7—10 years* | ||
| Optional | Training may be extended by pursuing medical research (usually two-three years), usually with clinical duties as well | Training may be extended by obtaining an Academic Clinical Fellowship for research, or a Clinical Fellowship for sub-specialisation. *due to competition for consultant posts, it may take longer than 8 years to gain Consultant status . | ||
Concerns have been expressed by Remedy UK, [8] in the Lancet, [9] and by the British Medical Association, [10] among others that the reforms have not been fully thought through, may worsen the training situation for many junior doctors, and may be part of a covert plan to create "a permanent subclass" of cheap, undertrained subspecialists. [9]
Criticisms
A number of criticisms have been made about the new MMC system, and it was perceived sufficiently poorly within the medical profession that its implementation was ultimately boycotted by senior doctors around the country. [11] [12] [13]
The transition to the new system and the Medical Training Application Service (MTAS) have been particularly criticised. In order to implement MMC, all trainees not appointed to specialist registrar posts for 1 August 2007 were required to apply for posts on the new MMC curriculum, with far fewer posts than applicants[ citation needed ]. However, the application process has had technical problems, [14] and was criticised over the weighting and marking of the applications, [15] [16] with one London training school calling it "unfair and ineffective" in resigning from the process. [12]
There were also concerns expressed over the number of training posts available and the subsequent risk that trained doctors would be forced to emigrate or leave the profession as they would be unable to find jobs in the UK. Government claims that there were 23,000 posts for 32,000 applicants [17] were revealed by subsequent work to be 4,500 out, with the actual number appearing to be 18,500. [18]
On 17 March 2007 doctors marched in mass protest orchestrated by Remedy UK against the system in London and Glasgow. [19]
Resignations
On 30 March 2007, Professor Alan Crockard resigned as national director of Modernising Medical Careers. In his letter of resignation to Prof Sir Liam Donaldson the chief medical officer for England, Professor Crockard stated that he was increasingly aware that he had "responsibility, but less and less authority" [20] and that "the overriding message coming back from the profession is that it has lost confidence in the current recruitment system". Professor Crockard asked that this be urgently addressed "in the interest of the most important people in the whole process, the junior doctors". [21]
On 31 March 2007, Alex Liakos, one of the student advisers to MMC, also resigned, citing widespread misgivings about MMC as a whole and "tokenistic" involvement of doctors in the process. [22]
On 5 April 2007 Professor Shelley Heard resigned as MMC National Clinical Advisor, expressing her support for MMC in principle but citing the major problems with the recruitment process and concerns over the conclusions of the Department of Health's Review Group. [23]
The MTAS affair was swiftly followed by a purge of the remaining members of MMC, and by mid or late 2007 all of the senior members of MMC had been replaced, effectively forming a new organization.
Department of Health response
The Department of Health launched a full review of the recruitment process for specialty training on 9 March 2007. On 22 March 2007 the Review Group issued a statement building on the recommendations they had made and guaranteeing interviews to all long-listable applicants. [24] These recommendations were not found acceptable by the British Medical Association's junior doctors committee and they pulled out from the negotiations with the government on 23 March. [25]
Secretary of State's apologies
On 3 April 2007, during an interview on BBC Radio 4's Today programme, the Health Secretary Patricia Hewitt apologised to junior doctors over the crisis, saying that the application scheme had caused "needless anxiety and distress". The BMA welcomed the government's acknowledgement of the problem but stated that "an apology isn't enough". [26] Patricia Hewitt's apology was repeated to parliament on 16 April 2007, in which she stated that "the problems that have arisen relate in the main to the implementation process and not to the underlying principles of Modernising Medical Careers.". [27] This was later disputed in the independent inquiry into MMC by Sir John Tooke. [1]
Later that month Shadow Health Secretary Andrew Lansley accused Ms Hewitt of failing to express genuine regret over the situation. [28]
On 1 May 2007 Ms Hewitt made another apology in the House of Commons after the suspension of the MTAS website due to security breaches that she described as "utterly deplorable". [29]
MTAS website taken offline
The MTAS website was suspended on 26 April 2007 after a Channel 4 News report stated that applicants had been able to see each other's files by changing two digits in the personalised web address given to each individual. [30] At that point the Department of Health announced that this was a temporary suspension. [31]
On 15 May 2007 MTAS was shelved by ministers due to security breaches. Patricia Hewitt said that after the first round of recruitment, the system would only fulfil a monitoring role that year. [32]
Judicial review
A judicial review of MTAS was requested by pressure group Remedy UK, who demanded that the appointments process should be scrapped altogether. The case was heard in the High Court from 16 to 17 May 2007. On Wednesday 23 May 2007 Mr Justice Goldring ruled against Remedy UK, stating that "although far from ideal", the Review Group's decision on amending the appointments process after the first round of interviews was "within the range of reasonable responses", and that the Review Group was "entitled to reach the decision it did given the circumstances facing it at the time". Although he ruled against invalidating the interviews that had already taken place, Mr Justice Goldring added that this judgement did not imply that junior doctors were not entitled to feel aggrieved, as "the premature introduction of MTAS has had disastrous consequences". Remedy UK have said they will not appeal the verdict, in order to avoid further uncertainty for junior doctors. [33] [34] [35]
Aftermath
For the 2008 specialty recruitment, deaneries and Royal Colleges were asked to arrange the recruitment for all specialities themselves, with particular deaneries or Colleges handling national recruitment for particular disciplines. [36] Although the intention was to have a new version of MTAS operations for the 2009 recruitment process, again this is being handed over the colleges and deaneries. [37]
