Surgeons have bigger balls?

The president of the Royal College of Surgeons has written to his members:

"To Members and Fellows of The Royal College of Surgeons of England

The review Group met again on Wednesday 25th April and I am writing to give you an update on the present position.

You will recall that I put to an earlier meeting, a proposed scheme to enable those who are able, but are not successful in securing a ST3 post this time around, to continue their training in what I called ‘transitional training posts’. During the opposition Day Debate on the 24th April the Secretary of State for Health, Rt. Hon Patricia Hewitt MP, agreed the need for additional training posts.

“As part of the review, we are working urgently with the royal medical colleges and the NHS to establish the need for additional training posts—which will of course have to be approved by PMETB—including one-year placements and more senior posts. We are also considering how we can provide more effective training support for doctors in service posts—that is, non-training posts—to maximise their development opportunities. That is the issue on which Professor Douglas’s review group is now focusing, having dealt with earlier problems involving the application process, and it will make a full statement—as will I, to the House—on the support that will be available very shortly.”

Since I last wrote to you, I have discussed my plans with the Senate (with representatives of all the surgical colleges and specialist associations), ASGBI and ASIT. In the light of all of this feedback, I have refined the plans for additional training posts, in England, which have the support of all of these bodies and which I think will offer the best career prospects for as many of our able trainees as possible.

The plans are currently with a working party of the Review Group to consider the detail.

In essence, selection for specialty training should be at the ST3 level for the next three years and the number of run-through training posts at ST3 level should be expanded. There should be a concomitant decrease in the number of training posts available at ST1 in 2008 and in both ST1 and ST2 in 2009. The numbers at ST1 and ST2, for this year however, will remain unchanged.

All ST1 posts should be FTSTA’s. There are c.760 ST1 posts for surgery in England (910 for the UK)
All ST2 posts should be FTSTA’s. There are c.808 posts in England (1043 for the UK)
There should be an expansion in ST3 numbers over a transitional period of three years from 2007 to 2009.

The case for expansion at ST3 is to meet the College’s stated policy in relation to the future workforce required to provide an acceptable quality of service and to continue to ensure patient safety.

You may be aware of the Independent Review into MMC, announced earlier this week by the Health Secretary to be chaired by Professor Sir John Tooke. I am attaching the terms of reference for information. He telephoned me several days ago and I had the opportunity to discuss the review with him. I have written to him today, expressing my concern that there is no specific mention of the role of PMETB in the terms of reference. I have asked him to confirm that PMETB’s involvement to date and its future is addressed in this review. I will expect changes to be made before we can offer our support.

Terms of Reference for Independent Review
(full terms of reference then follow)"

It seems that the goalposts have been shifted yet again, how on earth are candidates meant to keep up with these almost weekly changes and how stressful is this never ending mess? The proposed amendments essentially mean that the President has no faith in MTAS to select the right candidates as there will be no run through training posts at the lower levels of ST1 and ST2. These proposals are an improvement however it is yet another example of how unfair the process has become. Clearly there are some candidates who would have applied for ST3 rather than ST2, if they had been aware of these conditions.

It is excellent that he has asked for a definitive answer as to PMETB's role and future, an eye must be kept on this area; PMETB are now in the spotlight and will not be allowed to creep in via the back door.

In my opinion balls of steel would be demonstrated by the President if he were advising a scrapping of MTAS, walking from the review group and proposing an immediate return to local applications. He may have demonstrated tougher balls than the RCP President, but that doesn't say much does it?