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Training cuts could harm patients, doctors warn

Proposals to shorten in-job training for qualified doctors in the UK could seriously compromise patient care and safety, leading doctors have warned.

They say there is a lack of evidence for the plans, which could see the time it takes to reach consultant level cut by two years.

They have called on the government to “pause” the training review.

A Department of Health spokesman said changes would only take place if they were in the best interests of patients.

Currently doctors spend the first two years after graduation rotating between about half a dozen different areas of medicine, such as obstetrics or A&E.

Many then specialise and stay within that area until they reach consultant level. Depending on which area they choose to focus on, that can take between eight to 10 years.

‘Broader knowledge’

The Shape of Training review into specialist doctor training was chaired by Prof Sir David Greenaway of the University of Nottingham.

The report made 19 recommendations in 2013 for changes to medical training.

The wide-ranging review involved many leading medical organisations, including the General Medical Council (GMC), and other bodies overseeing medical education.

One proposal was to shorten consultant training to between six and eight years. Another was to allow doctors to be fully registered to practise when they left medical school, rather than waiting a year as they do now.

Sir David’s report suggests an argument for changing the structure of training is that there are more patients with a complex mixture of conditions.

This means doctors need to have a greater breadth of knowledge, rather than specialising early in their careers, it says.

But leading doctors are worried these changes could mean they will be allowed to practise fully autonomously before they have gained all the skills they need.

The proposal would “result in people finishing training and being labelled as a consultant much earlier on, when in fact they are not reaching the same standard that patients have come to expect”, Dr Tom Dolphin of the British Medical Association (BMA) junior doctors’ committee told the BBC.

The BMA has called for a “pause” in policy development while safety concerns are addressed and said any changes should be piloted in small studies before being rolled out more widely.

The Royal College of Physicians has also raised concerns, saying shortening doctors’ training would “compromise both quality of patient care and patient safety”.

A Department of Health spokesman said no decision had been taken to shorten consultant training or change doctors’ registration, adding that any changes would only take place if they were in the “best interests of patients and following appropriate consultation”.

Tribunal ruling

Meanwhile documents seen by the BBC have also raised questions about the transparency and political independence of the review.

An 18-month battle to reveal minutes of undocumented meetings between senior civil servants, politicians and the report’s chairman concluded in court last month.

The GMC, which sponsored the review and provided administrative support, was forced to publish the details of numerous meetings with ministers and officials.

Notes from one meeting between Prof Greenaway and a Department of Health representative said they were eager the report would provide “an opportunity for ministers to be radical”.

Minutes from another meeting, which involved other senior civil servants from the department, noted that: “Ministers [are] setting strategic direction and feeling happy”.

Neither of these meetings, which took place during the review’s call for evidence in 2013, was referred to in the final report.

The GMC said the notes were an informal record of the conversations, and the issues were raised to help “inform our thinking”.

But the tribunal ruled against the GMC, saying: “We are satisfied that it is strongly in the public interest that these proposals are made on the basis of sound criteria and any political influence or otherwise needs to be transparent.

“There should be transparency relating to the process that led to the conclusions.”
‘Potentially harmful’

Ben Dean, a junior doctor who made Freedom of Information requests to reveal the content of the review, said the idea of shortening the training time for hospital consultants could be dangerous for patients.

“Generally trainees just want to become properly trained consultants, so they can actually practise with a degree of autonomy and not feel uncomfortable and out of their depth.

“Without doing anything to improve training quality, cutting training time is potentially harmful, particularly if you devalue what it means to be a consultant.

“The consultants do train the trainees so if your consultants are less skilled then there may be a knock-on effect.”

A Department of Health spokesman said: “There was nothing other than routine engagement with Sir David Greenaway’s independent report from anyone at the Department of Health.”

Niall Dickson, the GMC’s chief executive, said: “The independent review was established by the four governments of the UK to look at the changing needs of patients and the type of doctors that will be needed to provide high quality care in the future.

“There are recommendations made in the review that could require changes to postgraduate training and everyone accepts that more work needs to be done to understand the benefits and impact of such changes.”

He added: “It is highly unlikely that there will be agreement about all of the issues but it is clear that work will be undertaken to look at the key issues.”

Source BBC News