MTAS- frankly DoH your suggestions stink

Several organisations have fed back their views on the MMC board's proposals for the medical application process for 2008. It seems that there is a recurring theme in all the following responses from the BMA, Remedy Uk and Fidelio: it appears that the suggestions for MTAS 2008 offered by the government were to put it plainly, rubbish.



It appears that the vast majority of people want to revert to the old tried and tested process that was used before 2007, and that they want local applications and short listing with smaller units of application. I think that quite a few of us have been saying this for a very long time.



It was embarrassing that the MMC board's suggestions were so leading and stilted that it gave no opportunity for the process to be completely discarded, a complete scrapping of the MTAS process would seem sensible and could not be seen as 'throwing the baby out with the bath water', as there is nothing other than dirty water in the bath.

This letter does the GPs' talking

The following letter from an esteemed GP to his MP reveals the truth behind the government's dishonest and cynical propaganda campaign against General Practitioners, the letter really does all the talking:

"Patrick,

For your information and feel free to forward this to Andrew Lansley some facts about the GP pay deal and its "overperformance". (Okay I accept that I may be biased! But here are some facts, from one who actually knows the deal because I helped negotiate it!

I was one of the 8 doctors who negotiated the whole of that deal. Not only was I present in the room but asked the killer question of what happens if there was to be overperformance. Answer from Mike Farrar, the NHS team lead "The NHS Bank will bank roll it". We spent a WHOLE day telling them it would overperform. They checked back with ministers including The Treasury and the rest is history there are just 2 doctors left of that team of 8, myself plus Dr Laurence Buckman the GPC Chairman. There are NONE of the core NHSE team and NONE of the DoH core team still around and active on this work who negotiated the whole deal start to finish, so what the quality of advice to ministers is I don't know but from other interactions there is huge misunderstanding and misconception about the GPs first ever written contract!

Both sides adopted the principles of a "wise agreement" through principled negotiation backed by facts. All of my team and many of the NHS/DoH core team were all trained by the same negotiator training consultancy. There was almost no positional bargaining and little horse trading.

There has been a concerted government and probably No. 10 inspired campaign for several months about access to GPs, extended hours opening, and out of hours services. They are 3 different things but the government is trying to coalesce them. Part of the campaign has been to smear GPs by constant reference to their performance related pay earnings which are referred to a net earnings. Such net earnings are NOT take home pay but Net of practice expenses BEFORE tax, national insurance, sick pay insurance and surgery mortgage capital repayments.

At no stage during the current media onslaught against GPs has the government in the shape of No.10, The DoH or ministers contacted the General Practitioners Committee of the BMA - the body with whom the deal was done- about extended hours of service. We have received not one phone call, no letter, no email no communication about extended hours. This could be the subject of difficult PQ if Mr Lansley wishes? None of the negotiating team, nor my chairman has even had any informal approaches concerning extended hours from senior civil servants nor ministers in our day to day business including when paths have crossed. All that we have had is megaphone defamation from a government which governs by assent from the baying crowd whipped up by spinmeisters feeding the chatterati via the media.

Out of hours services( Services outside M-F 0800-1830)

Out of Hours are the responsibility of PCTs and have been since 2004. The NHSE, Treasury and DoH underestimated the cost and complexity of a service which GPs had provided at an uneconomic cost and a massive personal price since the inception of the NHS in 1948. For years the DoH officials had been denying the GPs assertions about the burden and the costs. Quite how my practice went from 7 out of hours call per week average with 2 out of bed calls when I joined in 1985 to 60+ calls per week and out of bed 1-2 times per night (despite dropping obstetrics) in 2004 beats me. It was in fact the rise of consumerism coupled with a belief that there was 24 hour general practice. There never was 24 hour general practice and still isn't...just an out of hours service for emergencies and urgencies. What is more Saturday morning surgeries were never for routine matters as we did not have full services or staff available. Even now privately and also in a letter from DoH to one of my "constituents" the DoH concedes that GPs and their staff are entitled to proper work life balance.

The out of hours services horror stories occur because the PCTs wont commission sufficient cover and are using Eastern European doctors whose command of idiomatic English and knowledge of the system makes them slow. (I know what this means to patients, my own mother in law died because of the new arrangements when NYED failed). GPs in Derbyshire myself included work for the service (which is a good one) and actually there are fewer sessions than we are prepared to work as some of the work is being skill mixed to variable effect.

GPs have NOT stopped doing out of hours; they have ceased to be the body responsible for making that provision. GPs still work in significant numbers on the service and there are fewer doctor shifts than takers

Extended hours is about the provision of NORMAL General Practice into the evenings and weekends.

As you are fully aware modern General Practice requires receptionists,phlebotomists, Health Care assistants, practice nurses, district nurses, pathology and X-ray facilities (and the ability to discuss findings with a consultant), access to social services etc. Rough calculations indicate that to keep open my practice at HALF staffing for 2 evening per week to 9pm and for 3 hours on Saturday morning would cost in the order of £100K per annum and there would be no district nursing district nurses, pathology and X-ray facilities (and the ability to discuss findings with a consultant), or access to social services at that figure. With the new contract we took on 52.5 hours of opening based on 37.5 hours of staffing and funded the difference from our "overperformance". PCTs have always been free to commission extended hours and some GPs (my practice included) are prepared to provide it IF COMMISSIONED at a commercially acceptable price. We are NOT prepared to simply be a "GP with a prescription pad" working alone with patients having to return to complete the consultation just so that the government can have a soundbite

I have asked my staff if they would (for pay obviously) be prepared to work extended hours and to a man/woman said not at any price. In any event in order not to breach the EWTD we would have to take on and train yet more staff something which would take considerable time and resource. As they pointed out the evening bus service is dire, they would have difficulty getting home and patients would have transport difficulties in getting to the surgery. (Buses, for example, after 1800 hours to Cromford are at 1900 and 2100 only and their are none to the outlying villages)

Access.
This is about the ease with which patients can make and obtain an appointment. A survey has been done and there is a satisfaction rate of 84% (The London Evening Standard [deliberately?] got it the wrong way around on Thursday. (Analysis of this survey results in politically difficult messages Most of the 16% are practices of a particular type, in a particular geographical locations, serving a particular type of population,with services delivered by a doctor qualified from particular parts of the world). I know of many leading edge practices where they refuse to try to meet the 48 hour target (and forgo the resources) where the urgent and emergent are dealt with today but a routine appointment is 15-17 working days away.

My optician [as opposed to the local spectacle supermarket] is booking 5 weeks ahead, my dentist 14 weeks, my solicitor 5 weeks, and my accountant 4 weeks. The Derbyshire Building Society wanted me to make an appointment to deposit a significant sum last week and yesterday PC World couldn't touch my computer for 3 weeks.

As you know from your formal visit to the practice in December 2005 (?) Doctors have always struggled with their appointments systems we are now on the 8th version since i joined the practice and much of the problem concerns workforce resources and increasingly surgery space! The de facto moratorium on practice premises funding (unless you are in a Labour area LIFT scheme) means that we cannot increase our staffing as we are hot desking already! We have always seen anyone with a clinical priority the same day and a clinical emergency on an immediate basis. Mr Blair's interference over the 48 hour access target (which we by and large meet) has meant that we cannot forward book significant chunks of the appointment book. I DO recognise the problems which working people especially those who commute have in gaining access, but they are the very same people who do not want taxes to rise! Of course I could operate (and actually would take pride in) an 0700-2200 ROUTINE service 6 days per week (provided nobody was required to work compulsorily more than a 40 hour working week) but that is neither affordable nor cost effective and even if we have the resource the staffing is impossible on current workforce.

GPs are tired of the "banks and supermarkets opening argument". The longer banks and supermarkets open the greater their profits. What is more it takes at least 5 years to train any of my professional staff to work independently and a year for my non professional staff. Shelf stackers, and checkout operatives take a matter of weeks to train and the operation of the store does not require the continuous shop floor presence of the board of directors. The only people banks employ are sales people and money counters and again take little real training. Indeed medicine, dentistry and veterinary medicine are the only professions where nothing can happen without the actual presence of the most highly skilled and trained part of the team individual working on the shop floor or immediately available to do so.

The ultimate insult has been the appointment of Ara Darzi to review General Practice. What does a TERTIARY world class surgeon know about general practice or primary care?

The crude attempt to blacken GPs for the political prize of 16 hours per day general practice even if does mean a return to paid slavery for GPs personally is despicable. To blame the GPs for the NHS deficit is deceit. Irrespective of the financial facts the government have conveniently forgotten the long term health gains already accruing from tha performance related practice resource deal - the Quality and Outcomes framework. Doing this by means of public envy and disapproval our earnings is beneath contempt and is hypocritical. ministers conveniently omit the facts in addition that GPS still have to provide a service for a 40% longer working week than the norm. GPs still exceed the EWTD. GPs only have to adjust their individual referral patterns by 1 referral per day to double waiting lists. 40% of GP income is Performance related pay. GPs are stunning value for money. It is fascinating to note that the new accession states in the Baltic have adopted the British primary care system becasue of its cost effectiveness.

The new GP contract was negotiated and agreed with the knowledge,influence and intervention of No.10, HM Treasury as well as all 4 Departments of Health. It was further endorsed by the independent Doctors and Dentists Pay Review Body whose recommendation was not amended by the Prime Minister or the Chancellor at the time and they did not see fit to interfere with its findings! Gordon Brown and Tony Blair therefore had at least two opportunities to veto this deal if they felt that it had been too generous. The GP pay rise was deliberately substantial in return for substantial extra work and to correct the massive workforce crisis in General Practice. It was designed to correct 15 years of pay drift from repeated interference with DDRB reports Remember that GPs were only required by Ken Clarke's contract to do 26 hours over 42 weeks per annum, you now get 52.5 of responsibility with an actual average of 44. The fact that out of hours was priced by the independent DDRB as late as 1997 at only a few thousand pounds meant that the loss of it could only cost us a few thousand pounds.

Patrick, you need to know that the massive relentless adverse and unfair media onslaught of the past few months against GPs has demoralised them hugely. Cheesing off GP will damage the NHS because of the corrosive effect it has on morale. We have a massive GP retirement bulge looming in the next few years and the UK needs as many GPs as it can find. The government assertions border on lies, they are distorting the truth in a manner which if I indulged in my practice I would be struck off.

I hope that this information helps to inform debate and I am happy to elaborate"

This letter explains pretty much everything there is to know about the GP out of hours debate and it does not make the government look very trustworthy or competent, in fact in makes the government look like a rather disorganised and dishonest bunch of bullies.

Deep clean, but still up to our necks in bullshit

Our gormless gawping prime minister Gordon Brown seems to have learnt a lot from his predecessor Tony Blair, he is continuing with the same gimmicky superficial policies that make it appear he is doing something important, when in fact his ideas are nothing more than half arsed turd polishing. It is most amazing that so many people are educationally challenged enough to fall for this hollow sham.

"NHS hospitals are to be ordered by Prime Minister Gordon Brown to conduct a "deep clean" to tackle the spread of infections such as "superbug" MRSA."

I have heard of better ideas from a filleted herring. The media has never really got to grips with the issues surrounding hospital acquired infection, or in the words of the Daily Mail 'super bugs'. The squeeze on the number of front line beds available has been rather notable in recent New Labour years, strangely it is not mentioned in the media and it has rather important implications for infection control:

"1999/2000 135,080
2000/1 135,794
2001/2 136,583
2002/3 136,679
2003/4 137,247
2004/5 136,184
2005/6 133,033"

If we choose to look at the actual science and evidence, as opposed to the illiterate squealing in our domestic media, then it becomes rather obvious that Gordon Brown's big clean is nothing more than a massive publicity stunt which will do absolutely bugger all to combat hospital acquired infection.

The Dutch have been pretty good at containing MRSA, methicillin resistant staphyococcus aureus, and it hasn't been related to 'deep cleans'. Their policy revolves around:

isolating and screening high-risk patient groups

screening low-risk groups
strict isolation of carriers
treatment of people carrying MRSA

This brings us back to the over stretched NHS front line and the shrinking number of beds available, as this has rather significant knock on effects on our ability to 'isolate high risk groups' and to 'isolate carriers'. Most people working on the front line will tell you that it is routine in many hospitals for known MRSA carriers to be nursed in open wards with patients who are known not to be MRSA carriers, it is therefore no wonder that MRSA is not being contained in the UK. The excessive pressure to move patients from ward to ward far too quickly without infection control being respected is arguably the biggest reason for MRSA's success in the UK, and the government continues to make this situation worse with more and more targets.

"However, the main cause of community-acquired MRSA is still selective antibiotic pressure. Patients and parents still pressure physicians to give an antibiotic when it isn't an appropriate choice,"

The unfair pressure put on doctors by patients to prescribe antibiotics is also another reason for MRSA's successful spread, this is rarely mentioned in the media though. In this way an all round clinical approach to halt the spread of MRSA is ignored, as short sighted political pressures drive the target-based system.

In conclusion we are now left with a completely haphazard uncoordinated approach towards hospital acquired infection that is doomed to fail. There is a massive over-emphasis on unproven quackery from infection control fascists, while basic steps that are proven to contain MRSA are not taken. Gordon Brown and his cronies continue to ramble on about superificial gimmicks like 'deep cleans' and 'matrons', without stopping to think what the root cause of these problems is.

It's no coincidence that there's an election coming up, El Gordo wants to move attention away from the government's centralised profligacy, he doesn't want you to know that over 25% of the NHS' budget is spent coming up with more useless glossy gimmicks. It just goes to show how damaging it is for the NHS to be the subject of ridiculous political whims. The politicians should realise that a good health care system must rise above the pandering to short term political objectives, it must be driven by long term holistic thinking based on solid evidence.

If Gordon Brown wasn't a greedy power hungry maniac then there would be a small chance that politicians would stop tinkering with the health service in this short sighted manner, unfortunately he is and he intends to fight the election on health. What a record New Labour have on health, it's a bit like fighting the election on Iraq, PFI/CFISSA/ISTC/WIC/PBC/C&B/NPfIT/MMC/MTAS, need I go on?

Labour limbo - new depths scaled

Just when it seemed that New Labour could get no sleazier, they have sunk lower than ever before as Dr Ray reports here. The cynics amongst us already knew that Prof Sir Darzi was yet another New Labour stooge dressed up in the clothes of an objective neutral, Dr Ray's observations prove that the consultation on NHS reform is nothing more than a corrupt dishonest scam:

"The location of the meeting was kept secret until three days before the event and when this consultant was eventually told the location and turned up in Birmingham for the "Citizens Jury" it turned out that medical staff were outnumbered 2:1 by laypeople specifically chosen by an agency to attend the event. The media were present and had obviously been invited to publicise the event."

Not only were NHS staff prevented from attending, but there were 'minders' present to advise those members of the public (that did conveniently manage to get invitations- were they on a Labour party mailing list I wonder?) precisely how to vote, a mysterious 75 pounds was also strangely donated to the New Labour 'yes' men, of course this could not be construed as a bribe:

"Following the "consultation" the medical delegates were told to leave but the other 2/3 of the audience were kept back and each given an envelope. My colleague was intrigued by this and managed to catch one of the "chosen ones" and ask about the contents. Each envelope contained £75 in cash!"

Dr Rant and DK have followed up on Dr Ray's excellent undercover work. This is the kind of behaviour from the state that one would expect to hear of in a country run by a vicious dictatorship, this should not be acceptable in modern day Britain. Sadly it is rapidly becoming the norm as our country slowly begins to resemble a banana republic. The Darzi review is a dishonest sham, it is designed to force through more cost cutting dumbing down reform that will result in the closure of many excellent specialist medical services up and down the country.

Patients will die from this dishonesty. I hope Gordon Brown and Sir Ara are happy with their achievements thus far.

Leslie Ash- celebrity bullshitter?

Leslie Ash just can't keep her whinging out of the papers, am I the only one getting rather tired of this has-been trying to cash in on bad science and misinformation? The Daily Mail has been serialising what I can only imagine to be one of the world's worst ever books. According to Leslie:

"After breaking two ribs in a freak accident while making love to my husband, Lee Chapman, I had caught MSSA – a close relation of the hospital superbug MRSA – and woken up unable to move."

Broken ribs are a common thing, they can occur after falls or even after being beaten by ones husband. For some reason Leslie Ash required an epidural for pain relief for these accidentally broken ribs. An epidural is very rarely used under these circumstances, most patients would take some oral painkillers or even some intravenous ones; however an epidural seems a bit strange for broken ribs. Possible reasons for this strange decision may be that the patient was unwilling to put up with any pain at all, thus demanding the epidural.

It is well known that epidurals can very occasionally result in spinal abscesses, at a rate of less than 1 in 50,000 patients. Anyone being treated with an epidural would be warned of the common risks and the rarer serious risks associated the epidural. I can only assume that Mrs Ash was warned of the possible complications. The bacterium involved was MSSA, methicillin sensitive staphylococcus aureus, which is in fact a very common skin commensal that many of us have residing on our skins. This is no super-bug, it is a common organism that causes boils and pimples. Developing an infection such as this would not be linked to the hospital being unclean, it most likely was one of Mrs Ash's residents in the first place:

'Do you mean I'm like this because I picked up an infection in a dirty hospital?' I whispered.

'Well, we don't know yet, but I think it is a strong possibility,' the lawyer replied.

This is just one example of the brain dead misinformed scaremongering that appears to be an ever present in Mrs Ash's tedious book. It is indeed unfortunate that she developed such an incapacitating complication, however the way she has reacted and tried to throw blame around has not made her look like a particularly impressive human being.

It could be argued that she is deliberately trying to profit from misinformed scaremongering and selling products of very dubious benefits, such as her 'Matron' handwash. I fear for us all if Mrs Ash sees herself as a spokesperson on MRSA related issues, as from what I have heard she has a grasp of science equivalent to that of a small insect. The media cannot escape blame either, as they continue to print utter rubbush masquerading as proper science. At a minimum they could at least check that their facts do not contradict wikipedia, would that be too much to ask of the poor luvvies? Moronic celebrities such as Mrs Ash end up doing much more harm than good with their negligent misinformation and scaremongering, it is time that they put a cork in it and the media should stop providing their mouthpiece.

Deathly dumbing down

The following story can be applied to the NHS, policing or even the classroom. It demonstrates the same underlying principles of a cost cutting dumbing down that the government has negligently forced upon an unsuspecting public. Tragically a young boy drowned and PCSOs (police community support officers) were called to the scene, unfortunately for the boy and his family the PCSOs were not trained to deal with this kind of 'major incident'.

It is not the fault of the PCSOs as they have not been adequately trained to do things that should be expected of staff that have the very important role of patrolling and policing the streets. It is the government's fault for replacing properly trained staff with less trained staff who are simply not up to the job, this is happening in many different areas of the public sector. Paul Kelly, the chairman of the police federation in Manchester, sums it up well and his logic can be applied across the board:

"The message is clear and unambiguous - it's the government, they are trying to fool the public.

"They take a person and dress him up as a police officer but they just don't have the same powers.

"Every single police officer I trained with left training school with a life-saving certificate of some sort."

He said the PCSOs might not have been able to swim and in that case they should not have risked their lives.

But he added: "People throw themselves into rivers and ponds to save people every day because it's the right thing to do.

"This is an accident waiting to happen again."

Precisely, the government are dishonestly trying to con the public with this shoddy second rate service. They are dressing up the untrained in the clothes of the highly trained and pretending that it will not make a difference, when it blatantly will. There are hundreds of accidents waiting to happen around the country as we speak.

Nurses are being dressed up as Doctors and given roles for which they are inadequately trained. While Health Care Assistants are dressed up as nurses and asked to do tasks for which they are also not properly trained. PCSOs are the example of the dumbing down in the police service, while classroom assistants are given tasks at school that they are simply not adequately trained to do as well as proper teachers.

It is dishonest, it is dangerous and it damn well stinks. Wrapping up a turd in a banana skin does not turn the turd into a banana, and one does not need to taste the turd to find this fact out. How many lives will have to be lost before this negligent dumbing down is stopped? It appears to me that this government cares not for lives.

Plain talking and more of the same

"If you agree with the CBI then you are in the minority, and I would suggest that you look at the underlying motives. Alliance Boots was in fact taken over this year by none other than KKR. It is therefore a strange coincidence that Labour peer Lord Hollick is an adviser to KKR, while the Labour party has received several rather large donations from such private equity firms. These are the very same private equity firms that seem to enjoy profiting from stealing peoples pensions. I am more than a little suspicious that these people do not intend to plough money into health care to provide a better service for patients, I suspect that they want to get their greedy mits on some more easy money and that the government is only too willing to oblige.

If these corrupt profiteers get their way then it will only be bad news for patients. British General Practice is actually a remarkably high quality service that comes at a relatively low cost, one of the things that makes it so precious is the continuity of care that it provides. This will be lost if this short sighted privatising agenda is allowed to continue, catalysed by dishonest pretences at consultation by the illiterate Alan Johnson and the malignant Labour crony Ara Darzi. These big businesses do not care one jot for their workers' health or well being, they are simply intent upon fleecing the tax payer by uniting with a corrupt Labour government that has come to represent the exact opposite of what the Labour party should stand for. Depressingly the way it is going, I fear for the future of British General Practice, and it will not be possible to recreate the brilliant concept of the local doctor who actually knows you when it has been ruthlessly destroyed by this Brownite dictatorship. All we will be able to say is 'I told you so'.

Dr Rant spells how exactly how disingenuous the government in combination with the CBI are being in their drive to privatise primary care. The damage that could potentially be done to the continuity of patient care is very worrying. Dr Grumble has reproduced an excellent piece by Dr Clive Peedell here, it sums up very well just how good we currently have it with General Practice in the UK.

Meanwhile Dr Grumble has saliently pointed out a rather alarming statistic to say the least. Our government is wasting 18 billion pounds a year on centralised budgets, not a small amount in any one's book.

I have also been reliably informed that the lame MTAS format is to be given a kiss of life by the politically correct idiots who seem intent upon destroying the medical profession. Students are to be selected for their first jobs, 'Foundation' year jobs, by using the same 'white space' questions; 'white space' can be translated into 'meaningless waffle' for those in the know. Apparently over half of the marks used for selection will be in the form of this manure maker's fantasy, while the rest of the marks are made up of the student's performance at medical school. Unfortunately this process is so dumb that all medical schools are treated as complete equals, despite the fact that students are rather more able and bright on average at the medical schools with the most competitive entries. This selection process appears nothing more than a cruel joke on medical students.

As if it wasn't bad enough for junior doctors already, having had to endure MTAS 2007, it appears the slide continues. The dumbing down of training gathers apace as Foundation jobs are made up of more and more attachments in which trainees gather no clinical experience. The 'Connecting for Health' Foundation jobs are just one example of this poorly thought out training system, there are many other examples of this around the country with trainees being sent out to work in PCTs for months instead of learning the basic bread and butter. I am sure this system will be good at producing more incompetent self important political medics like Sir Liam Donaldson, people who are so detached from the coal face in their comfy padded chairs that they are completely incapable of doing anything of use. In this way the NHS' cohort of medico political drones will be enlarged, as the emphasis is moved from clinical excellence towards political expedience.

Ringing all the bells

Watching the Panorama involving the blogger PC Copperfield reminded me more than just a little of the NHS. In fact it was quite remarkable to see how the government's stupid target based approach is failing in policing and in health care in the same ways.

The government cares not for protecting the public from crime or from ill health, they have put the emphasis solely on the gathering of meaningless political propaganda at any cost. In this way trivial misdemeanors are criminalised at vast expense, just so that the statistics can be spun. While in the NHS ill thought out blanket targets result in sick patients not being given the priority they deserve, ahead of those with far less urgent and more minor ailments.

The professionals, whether they be doctors or police officers, are treated like idiots by clip-board wielding halfwits who have no idea about the practicalities of doing a good job for the public. Clinical priorities are ignored by our political masters who do not understand the concept of clinical need, while practical policing is ignored at the expense of statistic gathering. The parallels are obvious, the government seems too stubborn to learn from its rather glaring mistakes; and the public are the ones to suffer, as we now have public services that are set up to manufacture propaganda, as opposed to providing a good service for the public who fund them.

MTAS revisited

The ball has been served into play, the MTAS 2008 ball that is, and the MMC Board have produced a document outlining the various options for next year. Here it is.

There are three issues that they are opening up to consultation, and this chance must not be missed: shortlisting, national or local application form and applicant preferences.

Strangely for shortlisting, there is no option of having locally arranged short listing; this is especially strange given that this is the only tried and tested method. I also strongly believe that marked application forms must be binned, only a proper CV that allows individual flair should be accepted by trainees.

As regards the application form, there is simply no need for a CV based form. The form should be locally determined and a CV should be attached, the idea of a CV-based core of an application form is a definite second best to a proper CV.

I feel strongly that more applications should be allowed per candidate and that this should be done 'concurrently' in the words of the MMC board. Their one-strike-and-out philosophy is nothing short of a disgrace.

If you feel strongly about this attempt to water down MTAS and feed it back to more victims, then I suggest you write to mmc.programme@dh.gsi.gov.uk to express you views. I have written a short letter than you may wish to send expressing a concise set of opinions that could not be misinterpreted.

"Dear Sir/Madam,

I am writing to reply to the 'Recruitment to specialty training -Proposals for improvements in 2008'. I have read the document in full and decided upon the following.

1. Shortlisting. This must be done locally and with proper CVs that allow individual creativity.

2. The application form must be determined locally and it must allow CVs to be attached in full.

3. Applicants should be able to apply for unrestricted numbers of jobs concurrently.

Kind regards,

Witch hunt

I choose to stray into a controversial area, away from the world of the government's destruction of the NHS, and into the world of the tabloid media and the McCanns. Whatever one thinks of recent events, I think that one would struggle to defend the pathetic behaviour of the media throughout. SJHoward points out just one example of the rank hypocrisy and lack of logic shown by the media, in this case the BBC.

The McCann story is a great case study in how the modern media operates, and how sensationalist and dumbed down current affairs coverage has become. The media jumped on the story, milked it and has now started to turn on the McCanns in their rather typically incoherent and inconsistent manner.

The media has continued to set people such a bad example in a way that condones the judging of others, without even being sure of any facts or any details of the complex situation that is being judged so righteously. The continuous speculation shows a complete lack of respect to those involved in this sad affair, and could be argued to be downright rude at times.

As a human being I believe we should always give the benefit of any doubt to people that are accused of anything. It is also not fair to speculate on their innocence or guilt unless one is well informed on the facts; in the McCann case I would argue that no one in the media is anywhere near the facts, so they should firmly put a sock in it and show some damn respect. Our legal system means that people have to be proven guilty, and there is a very sensible reason behind this that some people would do very well to remember.

Whatever the ins and out of events, there is absolutely no doubt that the media have shown their true, and rather shabby colours in the last couple of weeks.

Our NHS our future, my derriere Darzi!

The government is most likely trying to shut down health services near you, in a rather cynical attempt to save money by denying patients decent local medical care. A new 'consultation' exercise has begun which will undoubtedly stay true to the government's unique interpretation of the word 'consultation'.

I have set up my own consultation exercise here, so please feel free to add your comments regarding the NHS, its future, Sir Darzi or anything else you feel like commenting on. I will ensure that Sir Darzi is informed of my consultation exercise, it will be imperative that he listens to our voice, however judging on his past record he is more likely to be listening to big Gordon's voice.

I don't want to see the NHS reconfigured in a way that compromises patient care by replacing excellent specialist units at District General Hospitals with dumbed down polyclinics. The government wants to save money by continuing its antidemocratic privatisation program and by cutting services left, right and centre.

This is not good enough. I am fed up to the back teeth with our tax payer's cash being spent on endless disingenuous consultation exercises in which public opinion is ignored time and time again. I want to see less money wasted on targets, spin, centralised control freakery, the internal market and propaganda. I want to see more money going on front line services so that patient care can be genuinely improved. This government has become obsessed with spending money pretending to have a good health service, why not spend this money on the front line, then we would actually have a good health service.

http://ournhs.blogspot.com/

MTAS, the Orwellian nightmare

At last a brilliant piece in the press that sums up MTAS very neatly:

""Modernising Medical Careers" is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service.

The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if not a reactionary. Yet, like all systems of centralised planning,
this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.

Like most outsiders (and many insiders), I find it impossible to understand precisely what has happened, but having a daughter-in-law at the sharp end has helped. The outlines at least are clear. They also offer a classic example of how a government-run monopoly behaves.

What, then, lay behind the fiasco that Modernising Medical Careers
has become? There appear to be three causes.

First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.

Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.

Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.

As always, reasons existed for the shift to central planning: critics complained that the traditional apprentice system was riddled with favouritism; and the European Union's working time directive sharply cut hours for junior doctors, which not only necessitated a greater number of them, but also reduced the experience each would gain from a given period of training.

Some reform was presumably necessary. But this one is an object lesson in what happens when the government introduces a "big bang" shift to a centralised, computer-driven system. A bureaucratic monster replaced what had been a moderately flexible, albeit imperfect, system.

In the old system hospitals hired senior house officers; now they are sent them like a parcel of slaves. In the old system, if doctors did not get a job first time they could keep on applying; in the new system, they were to be given just one chance a year. In the old system, if they made a wrong choice it was relatively easy to change; in the new system, doctors must decide early and are then stuck with the consequences. In the old system, hospitals could change the mix of junior doctors relatively easily; in the new system, nobody knows what flexibility will exist.

Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must really be joking.

To put the point bluntly, these highly trained professionals, on whom you may depend for your lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone so treated?

To make the computerisation manageable, the doctors were allowed only very limited choices - far too few to eliminate random factors. As the chaos mounted, people were offered just one interview each.

The result was that those most likely to fail to get a job were the best, because they made the most desirable options their first choice. To make the computerised system "fair", much of the detail of people's careers and the detailed knowledge of those they worked for were also eliminated.

Centrally planned systems always eliminate latent knowledge, ignore human motivation and destroy flexibility. It was predictable that this Gosplan for the training of doctors would end up just as it has. It could not do anything else. This is a superb example of how the combination of centralisation of power with a belief in rationalistic planning works in the real world.

No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer. But bureaucrats are far too grand to be held accountable. It is doctors whose lives are disposable. Who cares that they have devoted up to a decade to the acquisition of knowledge and experience? Who cares that patients will be worse served? What matters is that the Department of Health is firmly in charge.

So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed."

Very apt.

Dumb me down scotty!

The Scotsman has exposed more government plans to save money by dangerously expanding the roles of the ominously titled 'health care professional'. It seems that the powers that be are considering plans to send out nurses to do the job of GPs due to a worryingly lack of doctors. The logic behind this dumbing down is sadly lacking:

"They are qualified to a degree where they can make an assessment of the patient. And they can call on the advice of a doctor if they need it.

"If it was a complicated problem, the nurse would have the professional knowledge to make a judgment that the patient would require a doctor or hospital."

Unfortunately for patients nurses are not trained as doctors, they are unsurprisingly trained as nurses. This means that they are not trained sufficiently in basic science, clinical medicine, differential diagnosis, pharmacology, medical management and assessing medical problems to be able to safely carry out the job of a GP in visiting unwell patients at home and making tricky clinical decisions.

Nurses are simply not qualified to the degree where they can safely make these kind of tricky clinical decisions, they have no medical degree along with the appropriate experience and training in clinical medicine and decision making. Nursing training and nursing experience does not equip a nurse to become a doctor, a rather obvious fact that the government seems to ignore with ludicrous statements like this:

"It is not a cheap option. It's about delivering a better service for patients and using healthcare professionals in a much smarter and better way."

It is a cheap option. This option is a direct result of a shortage of properly trained staff, therefore replacing the properly trained with those who are inadequately trained is nothing other than a cheap dangerous fix. It is no surprise that a majority of Scotsman readers disagree with the government's plans and want to be seen by properly trained doctors.

The truth is that patients are paying the price for this government's completely inept management of the NHS and in particular primary care services. Dr Rant has neatly summarised the reality of this government incompetence, and the way in which cunning spin is used to try to pin the blame on the GPs when in fact the blame lies solely at the government's door.

The dumbing down as described by the Scotsman is not only occurring in primary care, it is unfortunately putting patients at risk in hospitals up and down the country as nurses are dangerously empowered to do jobs that should only be done by properly trained doctors. This cheap and shoddy dumbing down process is most likely already happening at a hospital near you thanks to a wonderful cost cutting scheme called 'Hospital at Night', I shall leave that for another day though.

Will these idiots ever learn?

It has been revealed that the rather brain dead idiots who dreamt up the woefully inadequate selection process for junior doctors called MTAS want to carry on next year with more of the same brand of politically correct nonsense. The Herald has got hold of a leaked email that reveals just how these morons 'think':

"I expect the absence of a CV to stimulate some heat. I should emphasise that this decision was not an NES one and representations are being made. The justification for this is that it is not possible to anonymise a CV while the generic form has different sections that make this easy."

(Dr Colin Semple, associate postgraduate dean of NHS Education for Scotland (NES) in the west of Scotland, admits in his e-mail that using this system again will prove contentious.)

It seems that some people will never learn their lesson, they should be put out of their misery as they appear destined to never obtain even the smallest quotient of common sense. Colin Semple and his ilk are the kind of moron that have been behind the original MTAS disaster, where standard tried and tested processes were replaced by pscyhobabbling bull of the highest order. Does this breed of politico-educationalist not realise that they are going to sleep walk into another disaster unless they take a long hard look at their own self serving incompetence?

The likes of Colin Semple can stick their anonymized mumbo jumbo where the sun don't shine. Junior doctors must be selected fairly by a tried and tested process that uses the curriculum vitae, unless they can find a better process and conclusively prove it to be better than the old method in the next few months. I rather suspect that there is not enough time to design, test, validate and approve anything other than the old CV based process before the 2008 repeat.

Meanwhile those juniors who were lucky enough to get jobs are experiencing yet more disorganised chaos as regards their bureaucratic competency based training programs. It seems that a rather large number of trainees are being expected to fill in an excessive number of forms, decipher reams of unintelligible waffle, pay large sums for and organise their own training, work out how to use websites that are not yet ready for action over a month behind schedule while providing a service to patients, attending courses and doing exams at the same time. This is the bizarre, complicated and dysfunctional world of MMC's competency based curriculum. Even the programme directors and educational supervisors have been left in the dark with their trainees, as the powers that be appear to be leading us into another pointless and avoidable dark pit of despair. I seem to remember more than a few people mentioning that MMC was being rushed through far too quickly, how correct they were

It also begs the question, just who is actually in charge of this shambles? When MTAS went so horribly wrong, it seemed that everyone wanted to deny responsibility and shift the blame elsewhere. However now the dust has settled, several organisations appear to be behind this nonsensical march into the MMC quagmire that so obviously lacks a direction and a purpose. This complete lack of responsibility and accountability so typifies the approach adopted by many of the failed reforms in the NHS. In my opinion it is about bloody time that someone was held to account for this whole sorry affair. As seems to be the way with the NHS these days, we are more likely to see shiny brochures spew forth from numerous hapless Quangos as the responsibility is spread across even more incompetents. I am sure the government will continue to chatter more meaningless niceties, while in reality they will be railroading through more of the same from behind closed doors.