Sunday, 16 March 2008

Reinventing the turd

It appears that policy moves in rather illogical and long winded circles, and we often return to from where we initially started, yet this occurs after numerous 'brilliant' government reforms, begging the rather obvious question: if these reforms are so great, then why do we always end up back at square one having spent a rather significant amount of time and money chasing our own tails?

Either we are not back at square one, or these so called 'reforms' are politically motivated garbage of little meaningful content. I would go for the latter as you might guess.

Calman's report of 1993 lead to the reform of the old Senior Registrar grade (SR grade), and there was certainly plenty of debate at the time about how training should be reformed, the BMA were also not happy with the delays in implementing the Calman report (almost as Tooke is currently being delayed by HMG).

To cut a long story short, the SR grade did the majority of the NHS service work while the consultants slunk off to do their lucrative private work; these consultants were obviously keen to restrict the number of future consultants as this would impact upon their private income. Overall far too many doctors spent far too many years being abused as SRs, while the consultants ate the cake. There was also the problem that training doctors were frequently inadequately supervised and left to crack on.

The Calman report led to the specialist register being established, along with the introduction of the certificate of completion of specialist training (CCST), it promised that the days of sub-consultants would be long gone and that a massive consultant expansion would lead to the end of all our problems.

Alas, Modernising Medical Careers came along not long after Calman, so before things could settle down, training had to be rehashed again. The European Working Time Directive (EWTD) had also reared it's ugly head, starting to have a massive impact upon the hours worked by doctors in training from the late nineties. This meant that the new consultants produced by Calman's system with their shiny CCSTs would never be the equivalent of their consultants of old, they simply wouldn't have the experience that was obtained in days of old.

The gimmicky and cynical MMC was a dishonest con from the start, based on Sir Liam Donaldson's 'Unfinished Business', it set out to solve problems that were not present, while creating many more problems that have still not yet be addressed. Tooke's analysis of MMC was spot on, pointing out the vague meaningless principles and poor implementation that have plagued this politically motivated fudge from the start.

We have now come full circle. The current post-CCST fellows are the exact equivalent of the old SR grade, they have finished their formal training but there is no organised and fair route by which they can continue their training to become an independently practising autonomous consultant. The post-CCT fellow and the old SR grade are the exploited underclass of the future and the past respectively. The new system sees doctors struggling to get adequate amounts of experience throughout their training, and then potentially stuck at a miserable sub consultant grade, in which the forced terms and conditions of service may be rather poor, and the chances of career progression may be extremely limited.

Unhappy demoralised doctors who are treated shabbily by their employer, while having their hope for the future crushed, do not make productive and enthusiastic employees. It is good common sense to treat your employees well and fairly to keep them happy, and consequently get the best out of them. This government is treating doctors like shit and this is not a good thing for patients, but then the government cares not for patients, it cares only for its own self preservation and this is a great shame for the vast majority of us.

1 comment:

Fat Lazy Male Nurse said...

Welcome to reality.
Nurses have been treated like shit by successive governments for as long as I can remember. No guarantee, or even a hint, of jobs at the end of basic training. No cash for further training. Abolition of study leave. Working beyond contracted hours for no extra cash - just the promise of time off in lieu - and then no opportunity to take it.
I also read today that SHAs have been raiding the training budgets - that's money to train new doctors and nurses - to ensure they finish the year 'in surplus'.
I've yet to meet a health service manager who whinges about the lack of training, or the lack of funds to attend shitty conferences where they can conspire to fuck us clinicians up!
We're being shafted, royally, and we can't do much about it - that really pisses me off.