Friday, 18 August 2017

The dampest squib - Shape of Training outcome

So the Shape of Training Steering Group have published their final report and I think it's fair to say it's a massive improvement on Professor Greenaway's disastrous first draft.  My summary article in the BMJ from 2015 summarises the huge problems with the initial report and the rather dubious political influence upon the review that was taking place off the public record.

The most dangerous and misguided ideas from the initial report have unsurprisingly been shelved, one wonders how much the pressure of certain militant individuals and various representative trainee organisations influenced this rather obvious u-turn.  The moving of full GMC registration has been deemed outside of the review's remit, while the certificate of completion of training (CCT) remains and is not to be replaced with a a certificate of specialty training (CST).  

The only real change is the introduction of post CST 'credentialing' and in reality credentialing is here already in practice, even if not by name.  The devil will be in the detail of how exactly credentialing is defined and setup in the future.  It has the potential to be positive if it can be used as a lever to ensure that post CST training achieves certain outcomes.

Overall the bottom line is that the Shape of Training represents a humungus missed opportunity in terms of assessing the current problems in UK medical training and addressing them.  I would argue that the deep entrenched bias in the way in which the review was conducted involving the hidden political meddling meant this review never objectively analysed the current state of UK training, and as a result it has largely been a total waste of time and money.  The government wanted to dumb down training standards and make training cheaper, so the real quality issues in current training were totally ignored and as a result, the review has suggested little that will make any positive contribution to training quality.

The way in which training is regulated and funded need sensible reform urgently.  It is utterly crazy that some trainees get really substandard training at the expense of being abused as rota fodder by Trusts.  The system needs to be more responsive with homeostatic mechanisms in place which result in poor training posts being canned.  The big elephant in the room here is NHS funding.  In order to improve training quality trainees need to be far more supernumerary in their role, so that they can be free to get the best training exposure and so that they can be pulled instantly if their training needs are not being met.  Sadly as things stand too many poor training posts exist and the system is not responsive enough to eradicate these failures, and the Shape of Training review completely missed the point.


Anonymous said...

"Reforms" to medical training are politically-driven. Make no mistake, the devil will be in the detail, and the government will get what they want-US style attendings.

Credentialling will be good news for the royal colleges and it will appeal to a minority of "badge collector" medics, who think it will enhance their status/earning potential. Others will see it as a chance to kick the ladder away, consigning younger medics to a pool of doctors, who'll work shifts in "major acutes". The latter is nearer the reality.

The government have no respect for well-rounded clinicians, they just want cheap, affordable medics, who'll work like dogs, processing the acutely unwell, in under-resourced acute hospitals, which they'll have to fund.

The BMA have made a mistake calling for more medics. That plays into Hunts hands. The reason for the shortage of doctors is the hellish conditions we have to work in-sensible young medics are walking. The correct solution would be to reverse government policies, but, it suits their purpose to churn out more medics-with massive student debt-some of who will stay to prop up acute care and the newly-privatised privately-owned services that will provide elective care.

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