Saturday, 13 July 2013

The Shape of Privatisation (Training) Review

Anyone involved in medical training should be keeping a very close eye on the GMC's 'independent' review 'The Shape of Training'.  I may turn out to be completely paranoid and misguided on this piece of work, but it does appear to me that the review has already made up its mind and that the 'consultation' is nothing more than a pathetic sham.

It is worth having a read through the 'evidence so far', if one can call it 'evidence' that is.  Sadly the literature review is a biased piece of highly selective cherry picking, and then much of the other 'evidence' (opinion) gathering seems focused on reinforcing the Review's predetermined outcomes.  In life if one asks a silly question, then one gets a silly answer and this is exactly what this review is doing.  The logic of the review is sadly lacking:

"Most participants supported a move towards broader based, general training after the Foundation Programme. As the number of patients with multiple morbidities increases, we will need doctors with sufficient breadth of knowledge to provide appropriate care to these patients."

This is a spurious point as doctors who have been adequately trained for 2 years post registration should not need yet more generic 'broad based' training to be generally competent.  Overall the review ignores the massive failings in training today such as inadequate experience gained due to shoddy regulatory processes, and is proposing a complex solution to a problem that would be better addressed by direct fixation, not the creation of a misleading theme in order to indirectly fudge the problem.

I would be ashamed to produce such a biased 'review'as the Shape of Training review has done, the negative impacts of competency based methods that have been regularly outlines in peer reviewed journals are completely ignored, and the low quality evidence to fit the review's preconceived ideas is cherry picked.  The predetermined goals are highlighted by this kind of biased statement in the review:

"Most agreed that at the end, doctors should receive a Certificate of Generalist Training (CGT), which could
be followed by further generalist or specialty training through credentialing. "

This idea of a CGT is ludicrous.  The review should be addressing the rank inconsistency and inadequacy of Foundation training, so that doctors are generally competent post registration, not creating yet more waste and bureaucracy by pushing through reform to create a service providing monkey post-CGT grade.

The preconceived nature of the review is confirmed when the review states that there are only 3 paths ahead: 1) sub consultant grade of dumbed down post-CGT monkeys 2) slight changes to current system (best option but will clearly be ignored) 3) sub consultant grade of dumbed down post-CGT monkeys with credentialing.  The best option (2) will be ignored because it will make "it more difficult to emphasise the importance of generalists to care in the future" - an incoherent illogical explanation that makes little sense to anyone with half a brain cell.

The Shape of Training review is MMC part 2 - it is clear that the nature of the training reforms have already been decided by those in Whitehall and that the imperative is to create a cheaper dumbed down medical workforce that will be far easier for the new privatised NHS to bully and exploit.  It is a G4S style solution, shiny on the outside but completely devoid of quality on the innards.  The sub consultant grade is coming, the government wants to kill the properly trained consultant grade who are empowered by quality training and a CCT.  It is yet more command and control from the government, aided by the GMC, and it will not be good for doctors or patients.  I fear for medical training when it is being run by those who are prioritising the needs of cowboy profiteers over patients.

1 comment:

Graham said...

Excellent article, thanks.