Category Archives: Junior Doctors

Many junior doctors have told me they are aware that their seniors are disengaged from the managerial process, and they often comment that if they focusssed on “significant Events” they could spend all day filling out forms and never seeing a patient.
What hapens to change the altruism which almost all doctors have when they qualify?
How does a MRCP qualified doctor feel about being made to do 6 months medicine in a GP training scheme?
What do they feel about management and the changes ongoing in the NHS?
Why would they go abroad? What is it about the foreign systems and opportunities that appeals?

A&E standards fall – the end game means an opportunity for private A&E and Ambulance services in richer areas

Don’t wait until you are ill, or your next of kin needs emergency care. Try and think ahead to what options you have in your post code. In reality most of us will have no choice, but there may be a choice in the bigger cities. Certainly NHSreality expects market forces to mean private services expand. As A&E standards fall – the end game means an opportunity for private A&E and Ambulance services in richer areas. And its going to get worse…

It is all very well having long waits for access to GP and cold hospital care, but it is quite another when one of the holes in the safety net gets so large that the net has been removed. I can attest to the fall in standards from personal experience with a recent Right hand compartment syndrome that was ignored at first, and then operation was delayed, for a total of 18 hours. The recovery will be longer, and more painful than it might have been, but thank goodness I have kept my hand.

The failure in manpower and forward planning in general, the over supply of doctors who wish to work part time, and under supply of those who wish to work full time, rationing of medical school places, and lack of increased reward for working a shift pattern career are all part of the problem. There is no valuing of what are seen as temporary staff, and it has to get worse…

The Care Quality Commission

Henry Bodkin in the Telegraph 15th October: More than half A&E services failing

More than half of A&Es are now failing because patients who should be treated at home or in clinics are flooding through emergency departments’ “ever-open doors”, inspectors have warned.

The Care Quality Commission said breakdowns in provision for dementia and mental health patients are fueling the deterioration of standards….

ITV News: A&E under tremendous pressure as more departments need improvement (Standards fall)

Shaun Lintern in Health Service Journal: Regulator warns of ‘extraordinary’ winter for A&Es

  • Chief inspector warns of “extraordinary circumstances” for emergency departments this winter
  • Care model failure leaves hospitals overloaded
  • Watchdog warns of deterioration on mental health, learning disability and autism wards

A failure to provide the right models of care is forcing thousands more people to attend emergency departments each day, the Care Quality Commission has said, while warning of a “perfect storm” for the health service this winter……

Dennis Campbell in the Guardian: More than half of A&Es provide substandard care, says watchdog – Hospitals struggling to cope with rising numbers of patients who cannot get help elsewhere

Kaya Burgess in the Times: More than half of A&Es not up to job, says care watchdog

The health watchdog has warned that A&E departments are under “tremendous pressure”, with more than half now deemed inadequate or in need of improvement.

The Care Quality Commission’s annual State of Care ( England only) report also warned of a “perfect storm” across health and social care where people cannot access the services they need or where care is provided too late.

The regulator found that A&E standards had slipped over the past year and that emergency departments were the most likely part of a hospital to be ranked as inadequate.

In 2018-19, 44 per cent of urgent and emergency services were rated as requiring improvement — up from 41 per cent the year before — with a further 8 per cent deemed inadequate, up from 7 per cent the year before.

Inspectors said that A&E departments had not had their usual “breathing space” over the summer months to prepare for the perennial winter pressures.

He said: “We know that it’s a combination of increased demand and challenges around workforce [that] are creating something of a perfect storm and if that perfect storm is allowed to continue we will have a number of problems.”

He said that the 18-week waiting list for planned hospital treatment had grown from about 3 million people to 4.4 million over the past five years.

The CQC also warned of a “serious deterioration” in the quality of inpatient services for people with mental health problems, autism or learning disabilities. About 7 per cent of child and adolescent mental health services were rated inadequate last year, up from 3 per cent the year before.

Mr Trenholm said: “We also know that adult social care remains fragile. We know that the failure to agree a long-term funding solution is driving instability in the sector.”

Sally Warren, director of policy at the King’s Fund health charity, said: “The CQC’s report provides further evidence that staffing is the make-or-break issue across the NHS and social care. Staff are working under enormous strain as services struggle to recruit, train and retain enough staff with the necessary skills.”

Nick Scriven from the Society for Acute Medicine said: “At some point in the near future all these sustained and repeated problems with increasing demand, inadequate workforce that is haemorrhaging senior cover, the pension tax crisis, crumbling estates, insufficient community medical care and community social care in general totally under-provisioned, we will reach a vital tipping point and care will be compromised despite all the heroic efforts by the human side of this, the staff in post.”

An NHS spokesman welcomed the watchdog’s finding that quality standards had remained stable when taken as a whole and said: “While the NHS Long Term Plan set out an extra £4.5 billion to ramp up GP and community care, the CQC rightly highlights the need for a long-term solution to adult social care so that older and vulnerable people get the right care when they need it.”

March 2015 NHSreality: From bad to worse: “NHS medical accidents investigation unit ‘needed’”

Jan 2016 NHSreality: Accident and Emergency – departments understaffed – report suppressed

Doctors let dying patients waste their last days in Accident and Emergency

The Care Quality commission has different standards and reports in different jurisdictions

 

Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

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Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns

Haverfordwest

Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

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Swansea should combine with Hywel Dda, This option is not in the Trusts gift, but is political. And the opportunity afforded by restructuring may be lost if choice and specialist access is not improved…

It is hard to recruit to West Wales. The “little England beyond Wales” is culturally very different from Welsh speaking Carmarthenshire. I used to think Whitland would be near enough, but no longer.

Doctors choose centres of excellence in cities rather than rural areas to work in.

There is an under capacity in diagnostic physicians, and this will remain the case for 10 years.

Reconfiguring West Wales services gives an opportunity to raise standards, reduce infections, accelerate discharge and improve choice.

The medical model is changing, and teams of specialists raise standards fastest.

There has not been the investment in infrastructure that there should have been to speed transport.

Choice for patients needs to be encouraged by the system. A larger Trust ( preferably all of Wales – why not?) will give greater choice.

If a rural area such as Pembrokeshire wishes to recruit consultants and GPs easily, it needs to recognise the drivers for change in the medical profession. New doctors want to have access to new technologies, tests, and treatments. The medical model now involves large teams of specialists raising their standards together. Access to such centres is meant to be “equal” but in effect, especially in Wales, it is dependent on post code. Choice has been restricted to “within your own trust”, and outside referral restricted unless there is no service within your trust. Consultants and their juniors like to have access to specialist investigations, a complete set of treatment options, and research and teaching opportunities.

So why did I move to Pembrokeshire. I enjoy an independent mind-set, and the challenge of working in remote areas. But I saw the possibilities were better where there was a DGH (District General Hospital), a postgraduate centre and teaching opportunities. All these will go if my local hospital closes, or moves outside of the “little England beyond Wales”. I feel cultural affiliation, and when I seek medical care the first language should be one I understand. (English). Consultants arriving in the area were offered subsidised accommodation in a hospital house whilst they looked for a home. New physicians arriving felt they were cared for …

Within GP, the clinical variety and opportunities have reduced, and there is much less room for manoeuvre in todays group practice experience. The shape of the job has changed, and the people in it have changed too. Now it is 80% female reflecting the underperformance of males at age 18 when applying for medical school. It may change even more, because with too few diagnosticians, digital consulting, without an examination may expand, with resultant litigation risk. ( Murray Ellender GPs must embrace digital future – The Times 23rd April 2018 )

The threat to move our hospital outside of our county, and into another tribal area, will not be taken lying down. So we need a solution that allows consultants all the things they want, and our, mainly female, GPs to get what they want. With a 10 year deficit and shortage of diagnostic doctor skills, we have to centralise in some way or other. ( Patients want all services as close as possible, and many would choose local access instead of lower death rates. They will also demand it is all free, for everyone, everywhere, for ever. )

If we take out the hospital we take away part of the culture. House prices will fall further as professionals leave, and choose to live near tertiary care centres. The already dilapidated and sometimes empty heart of the county town will get even more squalid and forgotten. Yes, we can replace one culture with another, more cynical one. People are already disillusioned in the shires, where the vote went against staying in the EU, even though the people there had more to lose. Taking away their hospital without persuading them that it is for the greater good could lead to civil unrest…. and they will also have a Welsh language school they never asked for.

In the end we have to make the new solution attractive to medical applicants, and that means combining Hywel Dda with Swansea so that hospital jobs are rotated, the educational and research opportunities are there for all, and the important services; stents, stroke and radiotherapy are all provided on site. Without Swansea the new hospital needs more money to have the facilities needed to help recruitment and even then it may not be enough.

Dirty surgery such as gut emergencies should be treated in on of the old DGH theatre suites, and the rest of old DGHs become community care recovery centres. The funding must also be changed, so that all the country, patient and professionals, realises that financially, it is founded on a rock rather than sand. This will win hearts and minds.. but it is tough love.

My personal belief is in means related co-payments, scaled and managed centrally. I have some concern about how to deal with citizens who have cash flow poor, but are asset rich, but this can be debated once we agree to ration and use co-payments.

The three options are all reasonable, given the under capacity and recruitment problems described, and NHSreality goes for a new build in Pembrokeshire, along with new roads. If this were done, and/or the trust combined with Swansea, there would be a great improvement in services for West Wales patients. The finances are a different matter, and I expect continued denial all round.

IT – the solution and a problem… Every patient deserves an examination. GPs must not be robots..

Who wants to be a Hywel Dda board member? “Hywel Dda health board looks at hospital closure options”. The obvious solution is to promise a new build at Whitland, and a dualling of roads west.

Hywel Dda under pressure as doctor says ‘Glangwili will not cope’ once Withybush has been downgraded..

A poisoned chalice. Advertisment for Chairman of Hywel Dda…

Hywel Dda Health Board chief executive Trevor Purt to leave his post

Hywel Ddda on the way to the roasting oven of political dissent and civil unrest?

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Official gagging? “…a climate that threatens individuals with criminal sanctions and lets the system off. The hospital hasn’t been held to account.”

This case has been festering, and playing in the minds of many reflective doctors. The principal that we should be completely open in our reflection will not hold water for those doctors who have made mistakes – Is this a form of official gagging? Dr Vaughan’s comment at the end of this report reads: “You can’t learn from errors in  a climate that threatens individuals with criminal sanctions and lets the system off. The hospital hasn’t been held to account.” The Official BMA response (30th Jan 2018) is here.

Chris Smyth reports for the Times, 26th Jan 2018: GMC wins appeal to bar Hadiza Bawa-Garba after boy’s death

A doctor whose career was spared despite being convicted of the manslaughter of a six-year-old boy has been struck off after the General Medical Council won a High Court appeal.

Jeremy Hunt, the health secretary, joined doctors in arguing that the ruling could harm patient safety by making staff scared to admit mistakes.

Doctors accused the regulator of a vindictive campaign to use Hadiza Bawa-Garba as a scapegoat for systemic failings in the NHS. The GMC, however, insisted that patients would lose confidence in doctors if they could be convicted of criminally negligent treatment yet continue to work.

Bawa-Garba, who was 35 and a paediatric registrar, was on duty at the Leicester Royal Infirmary in 2011 when Jack Adcock arrived with diarrhoea and vomiting. She did not follow up on abnormal tests quickly, did not call in a consultant and missed what an expert described as a “barn-door obvious” case of sepsis.

She then told a crash team to stop resuscitation without looking at Jack’s notes because she had mistaken him for another patient after confusing their mothers. Although this did not contribute to Jack’s death, the trial judge said that the “extraordinary” error illustrated how bad her care was. She received a two-year suspended sentence in 2015.

Last year, an independent Medical Practitioners Tribunal Service panel decided not to end her career, citing “the context of wider failures”, such as short-staffing and IT glitches that delayed test results. It suspended her for at least a year, but told her the mistakes were not irredeemable and would not preclude a return to work. The GMC, which won the power to challenge such rulings last year, made an appeal.

Yesterday Mr Justice Ouseley overturned the panel’s verdict, citing a ruling by Lord Bingham that “the reputation of the profession is more important than the fortunes of any individual member”. He ruled that the tribunal had not respected the “true force of the jury’s verdict” that Bawa-Garba’s failings were “truly, exceptionally bad”. He said that a panel had no right to judge her culpability less severely after considering the same issues. “The holes in the patient’s safety net cannot reduce her personal culpability,” the judge wrote, arguing that systemic problems did not cause Bawa-Garba’s errors.

The health secretary said he was “deeply concerned about possibly unintended implications” of the ruling for the process of learning from mistakes. He said he was “totally perplexed” by the GMC decision to pursue the case.

Charlie Massey, chief executive of the GMC, said “doctors should have nothing to fear” from the case as he would not hold an admission of error against them. “People are confusing normal, everyday error with things that are ‘truly, exceptionally bad’.”

Jenny Vaughan, a consultant who has supported Bawa-Garba, said: “You can’t learn from errors in a climate that threatens individuals with criminal sanctions and lets the system off. The hospital hasn’t been held to account.”

Rob Hendry of the Medical Protection Society, which defended Bawa-Garba, said: “This decision may jeopardise an open, learning culture at a time when the profession is already marred by low morale and fear.”

Bawa-Garba may appeal to the Supreme Court.

Back to blame: the Bawa-Garba case and the patient safety agenda. Is there any Dr who will not stop putting any form of patient identifiers in their portfolio now? Medical errors may now be hidden for fear of litigation.

Update 1st Feb 2018: “Junior doctors fear reporting errors” by Kat Lay

Doctors have been warned that they risk disciplinary action if they carry out threats to stop recording mistakes in writing.

They fear that any admissions could be used against them, after a junior doctor was struck off last week for errors that led to the death of a six-year-old boy. Hadiza Bawa-Garba was convicted of manslaughter by gross negligence in 2015 over the death of Jack Adcock from sepsis in 2011.

Her case has provoked anger among thousands of doctors, who believe that she was a scapegoat for systemic failings and may have been the victim of racism. Jack was admitted to Leicester Royal Infirmary in 2011 with diarrhoea and vomiting. Bawa-Garba failed to follow up tests quickly, did not call in a consultant and told a crash team to stop resuscitation after mistaking him for a patient with a “do not resuscitate” order. She was covering the work of two doctors after return from maternity leave, with no induction into the role.

Last year the Medical Practitioners Tribunal Service decided not to strike her off but the General Medical Council appealed and won last week.

Kaanthan Jawahar, a junior doctor specialising in geriatric psychiatry in Nottingham, wrote on Twitter: “Your employer will scapegoat you for systemic failures . . . Your seniors will throw you under the bus.”

Doctors must keep an eportfolio as part of their annual appraisal process, in which they should reflect on how they could improve their practice.

Rob Hendry, medical director at the Medical Protection Society, which represents doctors in legal cases, said: “One particular area of concern has stemmed from reports that Dr Bawa-Garba’s eportfolio reflections were used against her at the criminal trial. In fact, her eportfolio did not form part of the evidence before the court and jury.

“We also advise doctors to bear in mind that not disclosing an incident or reflection during appraisal may lead to a greater risk of allegations of probity and referral to the GMC.”

Terence Stephenson, chairman of the GMC, said that although the court had ruled that the tribunal “had no powers to unpick the criminal conviction”, there was a “critical need” to examine how gross negligence manslaughter cases were initiated and carried out.

A budget should make us all think. We are all lost, and in denial with health care, which depends on jobs, productivity and the economy, all of which are threatened.

Going back to the original roots of the Health Service: NHS ‘birthplace’ Tredegar’s GP services ‘unsustainable’ – why? how?

As your local Health Service safety net corrodes, you might be interested to see the headlines and links in the medical and general media following the budget. Mr Hunt would never want the health service to fall apart…. wouldn’t he? Desperate measures such as “on line” consultations are of no practical use.                 Nick Triggle for the BBC reports: NHS Budget plan not enough, say bosses

Many employees “need to leave” to keep their sanity. Threats to disallow medics and nurses from travelling seem to have been withdrawn. Doctors demanding clarity….Nick Bostock for GPonline)  and then in August in the Mail the government backed down. The Mail also reports on “physician assistants” being poached from North America! Dennis Campbell in the Guardian “Junior doctor Nadia Masood: ‘Hunt’s driven a lot of us out of the NHS’ – Medics felt justified in opposing a new contract and their defeat has left many feeling demoralised, Masood says. Health service is ‘haemorrhaging highly trained, experienced GPs at an alarming rate,’ says top GP. BBC reports on “Thousands of out-of-hours doctor shifts unfilled”, and then on the locum situation Andy Philip in the daily record 13th November reports: GP crisis forces Health Board to pay a whacking £2000 for one (8 hr?) shift.

The Motherwell Times spares no one: GP recruitment has failed and since 1/5th or 20% are from overseas, and many are returning or retiring….. These tend to be working in the less popular areas, and some cities are now appreciating the crisis: David Ottwell for the Manchester Chronicle 18th November – NHS at ‘breaking point’ as GP numbers fall and patients soar in North East

The British Medical Association warns a chronic shortage of doctors is putting patient care at risk

The Belfast Telegraph tells us overseas doctors are crucial….

Whilst management attempt to apply artificial waiting times as “routine”. Henry Bodkin for The Telegraph 13th November offers : “Phantom waiting time branded unethical”. The Sun calls it “Op woe”.

In April atie Foster for the Independent warned us: Almost half of GPs plan to quit NHS due to ‘perilously’ low morale, survey suggests and then in November: Jeremy Hunt’s GP recruitment pledge in tatters as 1000 full-time …

If you cannot register or see a GP then you may not have a local A&E to go and see a medical student or a junior inexperienced Dr for your primary care needs either:  Dennis Campbell in the Guardian: A&E units, GP surgeries and walk-in centres to close as cash crisis bites

NHS bodies have decided in the last four months alone to shut or downgrade 70 services, says campaign group 38 Degrees

The Mirror: Budget pledges extra £1.6 billion for NHS next year but it’s less than half what health service chief asked for – The announcement also included a commitment to fund a pay rise for NHS nurses, midwives and paramedics – but only if negotiations on wider pay reform are successfully concluded.

Promises have been broken and the profession have no faith in discredited politicians. We always knew 5000 instant Drs and GPs was impossible. There are many doctors being trained, of whom 80% undergraduates are women, but the graduate courses are usually 50:50. men to women. Many will take career breaks, or work part time, or go abroad for relevant experience. They may decide to stay!  Chris Smyth in the Times 22nd November: Fewer GPs despite pledge to hire 5,000

GP numbers have fallen again, throwing a key NHS pledge of thousands more doctors into question.

The NHS has 541 fewer family doctors than a year ago. Doctors said they were “gravely concerned” by the figures at a time when patients were waiting ever longer to see a GP.

NHS Digital figures show that there were 41,324 GPs working for the health service in England at the end of September, 240 fewer than in June and 541 fewer than September 2016.

Full-time numbers are down even more as doctors cut back their hours, citing intolerable workloads. The NHS has the equivalent of 33,302 full-time GPs, 1,193 down on a year before.

Jeremy Hunt, the health secretary, has promised to recruit 5,000 more GPs by 2020. However, Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “We need to start seeing some progress, and fast. We understand that change takes time, but we desperately need more family doctors.”

A Department of Health spokeswoman said: “There are more than 3,000 GPs in training and 500 new medical school places will be available in 2018, with a further 1,000 in 2019. We’ve also outlined more flexible working options so we can retain the expertise of more experienced GPs.”

We have rationed medical school places for too long. The country does not deserve to be treated like this. We need honesty and admit that we cannot have “Everything for everyone for ever“.

The facts, What doctors earn – except that GPs are self employed and you wont know their overhead/expenses/debts which will vary by GP and by practice.

BMJ has helpfully published the latest data on GPs (BMJ Aug 30th article by Tom Moberly

Data chart: what doctors earn

Authors: Tom Moberly

Publication date:  30 Aug 2017


In 2016, the mean annual pay for all doctors working full time in the UK was £78 386, according to figures published by the Office for National Statistics (ONS).

The ONS data show that 78% of doctors work full time. For the remaining 22% who work part time, the mean annual pay was £46 277. Across all doctors, working full time or part time, the mean pay was £71 455.

Separate figures on doctors’ earnings are published by NHS Digital, and these figures provide data on the earnings of different sections of the workforce.

These figures show that, in 2014-15 (the latest period for which these data are available), the mean earnings for GPs was £101 500. This figure is for income before tax, but after expenses, for salaried GPs and partners working under either general medical services or personal medical services contracts.

For consultants and other hospital doctors, NHS Digital has published data on earnings in the year up to March 2017. These show that the mean earnings for consultants were £111 563. For specialty and associate specialist doctors they were £69 336, and for all doctors in training, mean earnings were £49 318 (£55 629 for those in higher specialty training, £47 420 for those in core training, and £36 122 for those on the foundation programme).

The ONS data show that, between 1997 and 2016, mean pay across all doctors increased from £36 849 to £71 455.This equates to an average annual increase of 3.5% over that period.

What doctors earn

Consultants £111 563
GPs £101 500
Specialty and associate specialist doctors £69 336
Trainees (higher specialty training) £55 629
Trainees (core training) £47 420
Trainees (foundation programme) £36 122

Source: NHS Digital. Note: GP data are for 2014/15; other data are for 2016/7.

Tom Moberly UK editor BMJ

The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations

A Times leading article alludes (correctly) that undergraduates are less value to the state than graduates who enter medical school. But Zawad Iqbal in “Doctors’ training needs streamlining before it’s too late” does highlight the problem of declining standards, and lowest common denominator medicine. The problem with the new GMC suggestion is that too low a standard may be deemed acceptable in order for us to have enough doctors in the short term. The fact that NHSreality would never have chosen to start from here is omitted. Long term rationing of medical school places, as well as too many undergraduates and too few graduates is to blame. A ten year program of capacity management may be undermined if we admit too many overseas doctors suddenly.. On the other hand, if the bar is set high enough… OK, I forget, nurses can do the job of a GP can’t they? NHSreality feels it is already too late, and it’s going to get worse… (Katie Gibbons reports from Kent: NHS operations postponed to save cash). Decommissioning is going to get worse still.

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In a letter to The Times 3rd Feb 2017 Prof Derrick Wilmot of Sheffield writes: on DOCTORS’ TRAINING..

Sir, A medical licensing assessment for doctors is long overdue (“Doctors face tough new test on basic skills”, Feb 1). There is a similar situation for dentists. A third of the dentists entered each year on the General Dental Council’s register qualified at an overseas university. UK graduates are not tested by a common examination but by the individual university dental schools, which do try, mostly with success, to maintain sufficient quality and commonality. Many of the overseas new dentists entering the UK come from EU countries and cannot be tested. Brexit is the ideal opportunity to introduce a new robust common assessment for all doctors and dentists registering in the UK.

Recent years have seen a frightening increase in medical and dental litigation. Evidence for an association is weak but if a basic clinical education is lacking problems surely lie ahead both for the practitioner and, more worryingly, for the patient.

Emeritus Professor Derrick Willmot of Sheffield University, and past dean, Faculty of Dental Surgery, Royal College of Surgeons: Doctors’ training needs streamlining before it’s too late

The news that thousands of newly qualified doctors aren’t confident enough to perform basic tasks such as taking blood is a real canary in the coal mine moment — a warning sign that the way we teach doctors urgently needs to change.

Part of the problem is that the basic structure of medical training hasn’t changed in more than a hundred years. The General Medical Council sets the standards for undergraduate medical education and supervises the training and education of students. But the content and length of a medical degree varies widely, depending on which institution you attend, and the different medical schools are allowed to set their own criteria for licensing doctors.

There is no common standard to practise in the UK. Doctors from the European Union can work here if they’ve passed relevant exams in their own country. Doctors from other parts of the world are given a separate test, resulting in a confusing system with no overall benchmark.

So it’s a relief that medical regulators now want to introduce a standard test. But that’s still some years away and frankly it’s not enough. We should seize the opportunity to conduct a bigger and more wholesale review of how we train our doctors and whether these decades-old methods are up to scratch.

What doctors needed to know ten years ago is often a world away from what they need to know today. Basic science and clinical science remain the core modules on medical courses but healthcare delivery is becoming ever more important. As well as introducing a common approach to basics such as taking blood samples and performing lumbar punctures, areas such as data analysis, IT skills and interpersonal ability must play a bigger role in medical training.

One of the biggest opportunities being missed is in postgraduate medical education. This is because postgraduate training falls under the NHS rather than a university or medical school. Our doctors need to keep learning new skills if they’re going to give their increasingly well-informed patients the best treatments. The doctor of the future will not necessarily carry a stethoscope around his or her neck but will more likely be one of a specialist team working alongside health technicians, pharmacists and nurses.

Rather than introduce a new standard test for doctors after they have qualified, they and their patients would be better served if medical schools standardised the courses they begin at 18.

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