Thursday, 19 April 2007

More DoH rectal seepage

This is a very lengthy piece, but the fancier has it on very good authority that this document is a very recent product of the DoH:

( the formatted document is here in full now, 22/4/2007)


Doctors at risk

1. There is an excess of applicants for training posts over places (both programmes and fixed-term appointments) by about 10,000. If we are to define more precisely the risk groups and the numbers in them, we need further analysis. In particular, we doubt the accuracy of the free text response on the application form amongst those who said they worked in the NHS. Amongst the 10,000, we will find many on clinical attachments, professional locums, honorary post-holders and those who already have substantive NHS career posts.

2. We believe the most vulnerable group is those Foundation graduates who may not secure ST1s or FTSTA1s. It is difficult to quantify their numbers – there may be some 500-1300 at risk. Our immediate first step is to put in place systems to analyse risk groups more accurately as the recruitment exercise progresses.


3. Since there is a range of doctors at risk, we need a proportionate response to ensure that support is available to those who need it most and those who are more likely to remain in the longer term in the UK labour market. Our concern will be for:

 Priority 1: UK medical graduates and EEA nationals , who:

have made an application to MTAS and

have been in a training post before 5 February 2007 and

have completed a Foundation Programme or equivalent (SHOs) or are unemployed or in a service post as a result of the MMC round 1 and 2 . .

 Priority 2: Other non Uk and EEA nationals with right of residence, unemployed or employed in a service post, since 5 February 2007, registered with MTAS and seeking MMC training.

 Priority 3: non-UK /EEA nationals without employment – registered with the GMC, passed PLAB.

4. We want to offer priority support to UK/EEA trained doctors because of the investment we have made in them. They will get the most help, those further down the list will get some help and those in the last category could have a very limited access. The priorities will need to be checked legally before they are agreed .

5. There is one group (c.500 MTAS applicants) taking time out to do higher research degrees. The Review Group may have a view on their priority and how they might be defined: Held an academic fellowship or equivalent during the period of MTAS recruitment Round 1 – that is, those who have been engaged in research leading towards a recognised higher degree (PhD, MD, MS.) and can demonstrate completion of F2 or equivalent?

6. We expect this overall approach will see a significant reduction from the notional 10,000 at risk. Work has started to develop support packages quickly as more information emerges during Round 1 and Round 2.

Sources of support

7. Initial support and advice to vulnerable doctors who are employed in the NHS will come from their employers with engagement from postgraduate deaneries. NHS Employers are working with trusts to:

 ensure employers know that some of their employees will be in the vulnerable group and that they should offer local support for them

 maximise the number of training and service vacancies available from the end of Round 1 and to ensure that such vacancies are designed with the potentially vulnerable groups in mind. This will include a review of temporary staffing policies and review how we match Locum Appointments for Training to the Priority group. Delivering 18 week waits would be a distinct lever by linking service need with training opportunity

 employers will be asked to consider using career posts vacated, by those moving into training, for those in Priority Group 1

 in the light of known future demand for training we will also review the possibility of advancing the establishment of training posts plan need for 2008.

8. NHS Employers will communicate with trusts regularly to ensure that they can offer initial advice and support locally. Foundation trainees

9. The suitability of Foundation graduates for service posts is a major issue. In some specialties, doctors are not suitable for orthodox career grade posts until ST3/4. Employment for these doctors in the training system may depend on the willingness and ability of local employers to work with deaneries to establish some posts at ST1 level for these graduates. We identify this group as the most vulnerable and in working with trusts and postgraduates deans we must give them a high profile.

10. We are examining how deaneries can utilise empty FP2 slots to offer this group some further experience. While such slots may offer trainees valuable tasters of different specialties they would not offer a long-term job and offer only a limited solution. These limited-term places might be translated into longer-term training posts – either programmes or FTSTAs - though any trainee entering either type of training must be tested against the same standards as any other doctor.

11. Clearly where employers have the capacity to create extra training posts we expect postgraduate deans to maximise the training opportunities available. However, entry into FTSTAs creates a further pool of doctors who have the expectation of entry into ST programmes and future employment as consultants. This expectation is not easy to deliver. Training opportunities must therefore reflect longer-term service needs. It may be that LATs are a more preferable recourse for doctors at this level.

Locum Appointments for Training

12. Trainees at all levels will be suitable for Locum Appointments for Training. These occur regularly and in significant numbers – perhaps 10% of the 15,000 SpR places in any one year. The numbers arising in Specialty Training will also be large and it is our intention to pool the vacancies and make them available in one place. We will work with NHS Professionals to ensure that all such LAT vacancies are advertised en bloc on NHS Jobs. We aim to offer LATs first to Priority 1 doctors but they could also be available to Priority 2 doctors where this would be appropriate.

Other locum appointments

13. We have opened discussions with NHS Professionals who are keen to provide help. They also have a bank of some 80 consultants who can be used as career advisors. NHS professionals can provide good quality service locumships (including longer-term ones matched to individual need). They will also support doctors in securing NHS appraisal. They can offer fast-track access to our Priority 1 doctors. In the last six months NHS Professionals have advertised over 6000 vacancies.

Lessons from the Rural GP scheme in Scotland

14. We know that Scotland runs a GP rural doctors scheme designed to attract doctors to the more remote areas. This is centrally-funded and only open to fully-qualified GPs. It runs for a six-month fellowship. However, subject to funding becoming available, the principle can be adopted in terms of a bursary to accompany trainees especially at post-foundation level. It could be targeted to encourage recruitment into General Practice or more widely but it is not seem a major feature of a support package.

Academic support

15. As well as the support available to other groups we are working with the NHS Institute to identify further academic opportunities in areas that would be of value to the NHS and enhance the career prospects of the doctors concerned.

Overseas placements

16. While it is second order, we have approached VSO to scope the possibilities of placements for some doctors overseas – voluntary service posts. We have received a very positive initial response from VSO. They caution, however, that they are generally looking for doctors whose experience would tend at least to be at the top end of SHO.

Underpinning support

17. Our first concern is to see the NHS itself working with vulnerable individuals and groups. We also believe we can provide some core infrastructure support and we will explore developing a new careers management website that will be in place from July. ( See Annex2)

18. We have invited a proposal for managed `talent pools’ that will offer information on job opportunities on for example NHS Jobs and raise the profile of candidates with potential employers. Elements of this may be widely available but the high-level managed aspect would be reserved for Priority 1 doctors. For them, a talent pool captures key information on candidates and will enable direct communication between registered candidates, deaneries and employers. Deaneries will be able to communicate directly with candidates. Both SHAs and deaneries will have immediate information on the job-seeking pool. Doctors will be able to renew their stay in the pool as long as they need to.

19. We expect deaneries to offer keep in touch facilities to displaced doctors who may be outside the training system but who are seeking to return. We have sought a proposal from one deanery (Annex1) and we will develop it further.


Priority package 1


Access to a managed talent pool
Access to keep in touch scheme
Fast-rack registration with NHS Professionals
Internet careers service
Jobs by emailAppraisal by employer
Access to academic opportunities for researchers
Employers will be asked to consider priority access to service vacancies
Placements with VSO

 Priority package on NHS Jobs
 Notification of vacancies/raised profile with employers
 Training and service vacancies available directly
 Direct communication with deaneries
 Internet support with applications
 Advice on specialty selection
 Priority access to locum appointments for training
 Links with Associate Dean
 Help with portfolio
 Career support from NHS Professionals if necessaryResponsibility:

SHAs, deaneries, individual employers. NHS Professionals, NHS Institute

Priority package 2


Registration with NHS Professionals
Internet Careers Service
Jobs by email from NHS Jobs
Career support and appraisal from employers

 Access to locum opportunities
 Appraisal
NHS P career support
 Internet advice on applications and specialty selection
 Quick alerts from NHS Jobs on vacancies
 Support from employers as necessary.

Responsibility:NHS ProfessionalsDeaneriesNHS JobsEmployers

Priority package 3


Registration with NHS Professionals
Internet Careers Service
Jobs by email from NHS Jobs

 Access to locum opportunities
 Appraisal by NHSP
NHSP career support
 Internet advice on applications and specialty selection
 Alerts from NHS Jobs on vacancies
 Support from employers as necessary.


NHS ProfessionalsDeaneries (for Internet Advice)NHS Jobs

Paper 5 - Annex 1

Process for Support of Doctors (Priority 1 Group) without Training Posts after MTAS Round Two – PROPOSAL FROM WESSEX DEANERY

Most Doctors without Training Posts after MTAS will want to continue to work in this country. They will want to take up posts that will make them better prepared for the appointments procedure in 2008. It is important that these doctors are supported throughout so they have an improved opportunity to enter training in future years.

The unsuccessful applicants will fall into two groups:1) Those who are unemployed2) Those employed but in non-training posts.

Unemployed after MTAS

Although the total number of Doctors unemployed after MTAS could be in the region of 10,000, the Department of Health has identified three “Levels of Priority” support necessary for doctors unsuccessful in the MTAS appointment system. Priority 1 refers to “UK medical Graduates who have completed a Foundation Programme or equivalent (that is, SHOs) with right of residence beyond 1 October 2007. Doctors must be registered with MTAS. They must have been in a training post before 5 February 2007 (when MTAS applications closed). Also EEA Nationals who have successfully completed a Foundation Programme in 2007. They must be unemployed or in a Service Post as a result of the MMC recruitment exercise”.

By registering with the Deanery the doctor will access a managed “Talent Pool”. This group of doctors will be offered a package of support, which is organised at Deanery level. They will have regular and frequent access to the latest job and internet based career information, a career appraisal and access to ring-fenced vacancies in Service or LAT posts. Doctor in Priority levels 2 and 3 will have access to some of these areas.

The Doctor in a Service Post

These doctors have applied through MTAS and, although unsuccessful in obtaining a training post, have found Service Post employment. The options available appear to be a recognised Career post, eg Staff Grade or a non-standardised position such as Trust Grade, Trust registrar, Clinical Fellow or Research Fellow.

A structure needs to be in place to support and assist career progression/development for these doctors. The Deaneries will need to institute and oversee this process. The unsuccessful doctors will still need to register with their local Deanery in what has been termed a “Talent Pool”. The Deanery will have links with local Trusts to identify specific service posts or LAT posts. The links will be through the Director of Medical Education

All Doctors appointed to service posts will need a framework for implementation of Educational Support. The Associate Dean will need to be in direct contact with a Medical Education Lead at each Trust. The College or Specialty Tutors will allocate individual Educational Supervisors whose role it will be to meet with their named doctor and establish a learning needs portfolio appropriate for the individual. This should include keeping an individual logbook, competencies both clinical and non-clinical, use of study leave (needs to include study leave funding) and performing audits. The educational package for these doctors will include access to in-house teaching and subsequent appraisals and a RITA equivalent. In other words the Educational package for these doctors should parallel as closely as possible the STR Educational Package.

For both groups, those employed and unemployed

Special attention will be needed in two areas. The first is Portfolio development. This is to allow better prospects of success at the next round of appointments in 2008. The second area is Career Advice and Career information. This needs to be made available both at Trust and Deanery level. This should include information about alternative specialities, in particular Shortage Specialities, as well as the suitability for the current specialty. (In some situations there may be a possibility of exposure to an alternative speciality.) There are some educational packages that look at doctor’s aptitudes which could be useful in providing career advice.

Although a lot of the work will take place at Trust level, Deanery involvement to support this should ensure overall a higher standard of support for these vulnerable doctors. In particular, the Doctors in Difficulty group that Deaneries run could be expanded to have a role in assessing these doctors as several of their support networks offer some of the necessary skills.


1) The name “MTAS Transition Appointment” should be given to all these posts. This is because many of the titled posts listed above do not come with the package of Educational and Professional support and development we are suggesting with these posts.

2) This is a new direction with new involvement of the Post-Graduate Education Teams. The Deanery will require both Associate Dean lead and significant administrative support. Appropriate funding will be available for this development.

3) The support package would form part of the overall `keep in touch arrangements’.

With these support mechanisms in place and working well, realistic outcomes at the end of the first year for these doctors include competitive appointment to STR Run-through training, possibly FTSTA Year 2, or a successful Change of Speciality.

Paper 5 - Annex 2


Scope of paper

This paper has been prepared in response to the request of the MMC/MTAS Review Group. It details the current web based career tools available and possible future solutions to help deliver more in-depth web presence to support career planning for doctors in training in England. NHS Employers would be happy to discuss what support might be needed by the other three countries separately.

Current tools

NHS Employers already offers, through NHS Careers , information to prospective candidates on training in medicine, entry requirements, benefits of working within the NHS and job vacancies. This is through an internet based web page system which does not require registration .

The NHS Careers web pages have recently been expanded with the input of Deans , specifically to support doctors in years 1 and 2 of the foundation training programme approaching their period of specialist training. These pages bring together the best available information on career structure, skill and aptitude requirements, and advice on applying for training posts. It provides details of each of the broad specialty groups, what is involved in training, overview of the day to day work and the type of professional the doctor will be working with. It is designed to complement existing Deanery information.

Over the next couple of months these pages will be expanded to support newly qualified medical graduates entering foundation training. These additional pages will include an overview of foundation training, what the doctor can expect to do day to day, what the next steps will be and points for consideration to further doctors’ careers.

Web-based Open University Tool

Following feedback from junior doctors and deaneries ,NHS Employers would recommend that the Sci 59 Online tool developed by the Open University is also used. Sci 59 is a specialty choice inventory which covers the training options listed by PMETB and a number of sub-specialties. The programme is a professionally constructed psychometric instrument designed especially for selection of medical careers. It matches an individual's personal and professional characteristics and aspirations to appropriate specialty choices and provides the user with suggestions for further research and information gathering. Sci59 Online can be used to help individuals at any level of training to reflect on, or make, their own career choices; and does not make the choice for them.Some deaneries have already started using this tool and it has been well received .

Careers In Medicine Career Planning Programme

The Association of Medical Educators (ASME) Careers In Medicine programme includes a web based tool developed by the Association of American Medical Colleges (AAMC), This could be adapted for use by medical students to help them choose their career pathways and medical specialties within the UK medical context. Some Deans have already commenced discussions about how the UK could take forward this model and have been positive about the potential it has.

The Careers in Medicine™ is a career planning program designed to choose the medical specialty as well as selection and application to a specialty training programme. It is a four-phase process which provides guidance through the elements of career planning, including self-understanding, exploration of a variety of medical careers, and finally the choosing of a specialty to meet career objectives. It is designed to be a more “managed” system of support for candidates. "

Overall it seems the DoH could not organise a piss up in a brewery. There is lots of chatter about help and support for unsuccessful applicants, but there is really very little concrete here to reassure people. They are openly admitting that their reforms will leave over 10,000 unemployed, this seems to run against a lot of their previous propaganda.

"The hon. Gentleman refers to the prospect or the possibility of unemployment among junior doctors. Although he did not fall into this trap, let me take the opportunity to refer to the thoroughly misleading statements made in recent weeks about the prospect of thousands of junior doctors finding themselves without work. That is complete nonsense. As I said in response to points made by the hon. Member for South Cambridgeshire (Mr. Lansley), the great majority of eligible applicants are already working in the service."

This quote from Hewitt can be seen as nothing other than a lie. It is therefore quite clear that Patricia Hewitt has lied to parliament.

One of the last chunks talks of 'Web-based Open University Tool'. It is pathetic that part of their solution is this useless psychobabbling speciality selection tool with no evidence behind it. Those unemployed will be so happy when they are told to fill in some online questions that will tell them which specialty they should be working in, if only they had a job!

This document makes the DoH look like a bunch of utter incompetents. It is their enforced reform that has created all these problems in the first place, and these sticky plaster measures do absolutely nothing to remedy the root causes of this mess.

The reform of medical training in MMC and MTAS was ill concieved from the start. A far superior old system has been cast aside and replaced with an ideological hunk of turd that will leave thousands of excellent doctors unemployed while wasting billions of tax payers cash. This disaster was eminently preventable, a far better solution would have been to slowly tinker with the old system to improve it; why on earth did the powers that be see the need to rush through such drastic reform so quickly?

The DoH's sticky plaster will not do. MMC and MTAS must be scrapped as they are downright useless. There is simply no other decent way forward.


Anonymous said...

This could be a great blog, but most people will never know as it is just so looooooooooooong...

KISS - Keep It Short and Simple.
Concise sentences and articles pack a punch. The nature of a blog makes it very difficult to present things as paragraphs or bullet points - you need to slim things down for us - people are lazy and they will just not bother to get to the nitty-gritty.

Doc said...

Anon 19:20. Those of us affected, nay blighted, by MTAS have digested every dastardly word. Thanks Ferret Fancier. Time to emigrate.

Garth Marenghi said...

I do appreciate your point, however my decision to show the whole thing is because I want those who are stuck in this mess to be able to read the whole thing

I know lay people will not be interested enough to read the whole thing, but it's not just about bums on seats.

Brum_medic said...

Completely support you decision to put the whole document on - if that is how it was leaked, that is how it should be read!

So, the whole 'lost tribe' thing was just a load of crap. Its the same system - people can still be stuck in LAT posts, or 'MTAS transitional posts' (!). But now, the decision over who gets a training number is decided (seemingly) completely at random.