The 'independent' MMC inquiry

Following the recent MTAS shambles and the widely acknowledged farcical whitewash that was presided over by the first 'independent' review panel, Patricia Hewitt has asked John Tooke to lead an 'independent' enquiry into Modernising Medical Careers. The MMC Inquiry website explains how this process will be undertaken in a completely 'transparent' manner.

The Inquiry has its own specific 'terms of reference' that explain how the independent review will examine the framework and processes underlying Modernising Medical Careers (MMC) and make recommendations to inform any improvements for 2008 and beyond. It is strange that there has been no comment as to the exact nature of the discussions between Hewitt and Tooke, and precisely what conditions have been placed on this 'independent' review group. The website is keen to make it clear that the review is 'independent', however it does not explicitly state the conditions under which John Tooke is carrying out the review. What did Patricia Hewitt say to him? Does he really have a completely free reign?

Apparently the panel want to know what we think; it's a great shame that there are no junior doctors on the panel, as it is made up of largely academic committee dwellers and not clinicians on the ground. Anyone can take part in this consultation process; there are several sections including MMC general, selection and workforce issues.

I like to think I have a fairly open mind, however when I perused through the questions I became suspicious that they were leading me in a rather predetermined direction. The MMC section starts with questions that are designed to test one's understanding of MMC, this sounds strange but some of the questions are even stranger:

Do you agree that the principles behind MMC are sound?	Yes No Don’t know

Run-through training means that College exams are no longer allowed	Yes No Don’t know

Run-through training means that doctors can no longer take time out of programme (e.g. to undertake some training overseas)	Yes No Don’t know

The first question is eminently debatable, as arguably the principles are entirely meaningless as they cannot be seen out of the context of the process in its practical context. While the other questions are deceptive as they stray from hinting at the reality of MMC which will mean the dumbing down of College exams and it becoming trickier to go abroad for a bit of extra experience. Then there are questions that are very leading in their nature and which rely on terminology that is very debatable itself:

" Do you support? Q1.12 E : A consultant provided service with a higher ratio of consultant posts to training posts"

what does consultant mean here? (sub consultant)

Then the questions on Foundation training consist of over fifteen question of which NONE are negatively phrased, they are all positively spun in favour of Foundation training. I am no psychologist but it would seem that by asking positive questions means that one is more likely to get positive answers; here are some examples:

Do you agree that Foundation Year 1 has been an improvement on the previous PRHO experience ? Do you agree the assessment processes used in Foundation year 1 are an improvement on previous assessment of PRHOs ?

There are also suggestions for improvements to the Foundation year training, all of which miss the point fundamentally; the problems with foundation training will not be remedied by more educationalist paperwork, juniors need to go back to basics and learn their bread and butter well before embarking on attachments in paediatric neurosurgery.

"better integration with the undergraduate curriculum, clearer educational goals, greater support in confirming the new doctor is putting into practice those skills learned at Medical School, greater exposure to different specialities in the Foundation years"

The next section on selection does have some better worded questions:

"Do you agree that too much emphasis is placed on achievement of competence at the expense of the pursuit of excellence"

It would be unfair of me to claim it is all biased, however there is definitively a deliberate attempt to spin Foundation training in a positive light; while the principles behind MMC seem immune from any scrutiny despite their use as a cynical smokescreen. While there are other questions that are virtually useless:
" Do you agree that in a global market UK graduates should not expect guaranteed employment in the NHS ?"

It is frustrating that it is just another tick box exercise, there is no scope for any input into other important aspects of MMC that are not covered by these questions. I am therefore still sceptical as to how much good can come from this exercise, especially when Patricia Hewitt herself says:

"They must and will be closely involved in the independent review that will be led by Sir John Tooke, which will enable us to learn lessons, to review Modernising Medical Careers, and to ensure that the principles of MMC, for which there remains widespread support, are properly implemented in future, so that junior doctors and patients are looked after."

It is also abundantly clear from the terms of reference that Sir John and his review group cannot question the real motives behind MMC; I therefore fail to see how the dishonest 'principles', that have been used as a deliberate smokescreen, can just be accepted without question. This surely limits any positive that may come from the review, as if certain unquestioned principles are the root cause of our current strife; then the review panel has no scope to address the root cause of the problem.

If the principles of MMC are not overturned, then there is no way of averting the damage that the creation of an incompetent sub consultant grade will cause. As Dr Michael Fitzpatrick puts it:

"For the Academy of Medical Sciences, MTAS is ‘an object lesson in what happens when we take medical education out of the hands of those who value objective academic achievement and put it in the hands of those who wish to create a uniform and biddable workforce unencumbered by the spirit of inquiry needed to challenge dogma and central directives’. The consequences of this lesson are not confined to MTAS, but go back through MMC to Tomorrow’s Doctors, and the wider framework of medical education and training established over the past decade."

Quite. Even if the control of medical education is grabbed back by the medical profession, it is very questionable as to whether the danger of the sub consultant grade can be avoided. There is no room for complacency.