Medical Practitioners Tribunal Service

On Tuesday and Wednesday I was in Manchester for my annual panellist training.  We were reminded that we are no longer GMC panellists, but are in fact MPTS panellists.

The MPTS was launched on 11 June 2012 and the blurb on the front of our training folder describes it succinctly:

We got a useful update on the work of the GMC Standards & Ethics Team.  The Medical Act 1983 (amended) gives the GMC the power – ‘To give advice to the profession on standards of professional conduct, professional performance and on medical ethics, as the Council think fit.’

Some useful new guidance this year includes:

Leadership & management for all doctors

Raising and acting on concerns about patient safety

Protecting children and young people

We also learned that the New Good Medical Practice will be published on 29 March 2013 and will come into effect on 22 April.  It will be shorter and more concise with with 7 headings along with 4 domains to fit with the framework for revalidation.

Of interest amongst the explanatory guidance coming in 2013 was the ‘Doctors’ use of social media’ – the draft of which can be found by clicking the link.  There was also a nice introduction written by the popular medical tweeter Dr Anne-Marie Cunningham (@amcunningham).

How can the GMC influence how doctors use their guidance in practice?  What works to improve adherence to professional standards?

The Medical Workforce Challenge

On Thursday and Friday I had meetings where medical workforce issues were discussed.  This an interesting topic that can lead to spirited discussion.  Over the last number of years we have had vacancies on a number of trainee rotas.  Some of these have been high profile, affecting services or necessitating reconfiguration.  Trusts often have to resort to locums to cover vacancies to the point that the level of spending on locums has attracted the attention of the Public Accounts Committee at Stormont.

So why do we seem to have a shortage of trainees on rotas?  Many might think the answer to this question is simple – four letters – EWTD.  Certainly the EWTD resulted in a loss of man-hours.  This is bound to happen where you have a fairly fixed cohort of workers and you reduce the number of hours each one works.  But in reality it is more complex than that.  Our trainees are now predominantly female and maternity leave is a factor that’s hard to account for.  We don’t know how many female trainees will become pregnant or how many times a trainee will fall pregnant.  That makes maternity leave hard to account for.  Then there’s less than full time training.  An increasing number of trainees wish to balance their work and family lives by training less than full time.

Then there are the long established factors such as trainees taking time out of programme to do research or gain specialist experience outside the UK.  It is also becoming more common for trainees to take time out to gain experience of medical leadership and management as I have done.

So if we have a shortage of trainees why don’t we just recruit more?  There are a couple of key arguments against this.  The first is workforce planning.  To some degree trainee numbers are mapped to the projected need for consultants and GPs in the future.  They are not mapped to current service need.  The second is the ethical argument that it is not fair to recruit more trainees than those needed to meet future consultant need as this could lead to a situation where doctors who have completed specialty training are unable to work as consultants.  Other elements of this argument are the assertion that it is not appropriate to spend a large amount of money to bring a doctor to the end of specialty training if they will not be able to work as a consultant.

Trainee numbers also need to be controlled in order to preserve the quality of training.  Some might argue that this is particularly important in surgical specialties where large numbers of trainees would dilute the amount of experience individual trainees can gain.  Yet conversely, too few trainees on a rota can lead to them being overworked, overly focused on service demands, and unable to attend scheduled teaching sessions.

This brings us to the crux of the problem.  Trainees have traditionally been relied upon to provide a large element of service, especially out-of-hours.  This fitted well with the old apprenticeship model when training was time-based.  But this reliance on trainees for providing service has not kept pace with changes in medical education, trainees’ contracts, and working time regulations.  The result is a gap between service demands and the service contribution available from the trainee workforce.  And over the years there hasn’t been enough focus on filling that gap.

Fortunately Nurses and Allied Health Professionals can be trained to take on roles and responsibilities traditionally held by doctors.  This has the benefit of providing role enhancement, job satisfaction and career progression for these groups of staff while relieving the burden on doctors.  But it is not without its own issues including the increasing burden on these staff groups and the slow pace of change when it comes to changing traditional roles and responsibilities.

Specialty Doctors are a good solution if you need a non-consultant grade doctor to provide service or to support trainee rotas.  But these posts are often hard to recruit to as there isn’t a large enough pool of non-training-grade doctors out there.  The pool of Specialty Doctors predominantly comes from those doctors who opt out of training for personal reasons or because bottlenecks in training have hampered their progression.  So again, the mapping of trainee numbers to future consultant need could be a strong force opposing the development of the Specialty Doctor pool.

Decisions will need to be made now at a policy level as to how the healthcare workforce of the future will look and what will be done to shape that workforce – because by the time we get there (the future) it will be too late.