Releases Saturday 25 October 2003
No 7421 Volume 327
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(1) TIME TO STOP EXPLOITING TRUST DOCTORS
(2) GP TRAINING SHOULD BE EXTENDED
(3)
FOUNDATION TRUSTS THREATEN CORE NHS
PRINCIPLES
(1) TIME TO STOP EXPLOITING TRUST DOCTORS
(Recruitment of doctors to non-standard
career grades
in the NHS: analysis of job advertisements
and survey of
advertisers)
http://bmj.com/cgi/content/full/327/7421/961
(Editorial: The rise of trust doctors)
http://bmj.com/cgi/content/full/327/7421/943
Almost a quarter of non-consultant doctors
in the UK
are being recruited to posts that do not
conform to
recognised NHS grades, leaving them unsupported
and
exploited, finds a study in this week's
BMJ.
In a special issue of Career Focus in BMJ
Careers,
which accompanies the study, editor Rhona
MacDonald
argues that such posts are unfair, unethical,
and should
be replaced by a grade that does not exploit
doctors or
leave the NHS under resourced.
Researchers investigated the proportion
of
advertisements for non-standard grade
(or trust grade)
posts in eight random issues of BMJ Careers,
which
publishes 95% of hospital jobs. They also
surveyed
advertisers to find out why these posts
exist, who fills
them, and what the doctors in these jobs
do.
Just under a quarter of non-consultant
advertisements
were for non-standard grade posts. Half
of these posts
are created to keep the NHS going when
there is no
more funding for recognised training posts,
and most are
expected to be filled by overseas doctors.
More than two thirds of the doctors filling
these posts
are required to do on-call work, and a
quarter are on
call for 24 hours every five days and
one in five
weekends, or more, breaching the European
Working
Time Directive.
Several individuals make it very clear
how unjust they
think such posts are. Paul Miller, chairman
of the BMA's
Central Consultants' and Specialist Committee
believes
that these posts are to be condemned as
potentially
exploitative of the doctors and misleading
for patients.
Simon Eccles, chairman of the BMA's Junior
Doctors'
Committee argues that regardless of level
achieved, all
doctors below consultant level should
have their
experience and competence recognised.
The Department of Health admit there are
significant
problems with the current arrangements,
but say that the
consultation paper Choice and Opportunity
will address
this, while Postgraduate Dean, William
Burr, outlines
steps to reform and improve conditions
of service for
trust doctors. He estimates that the number
of trust
doctors from developing countries may
be as high as
3500-4000. To have trained this number
of doctors in
the UK would have cost around £600m.
Contact:
Rhona MacDonald, Editor, Career Focus,
BMJ,
London, UK
Email: rmacdonald{at}bmj.com
(2) GP TRAINING SHOULD BE EXTENDED
(Evaluation of extended training
for general practice in
Northern Ireland: qualitative study)
http://bmj.com/cgi/content/full/327/7421/971
General practitioner training in the UK
should be
extended from 12 to 18 months to ensure
that doctors
have the necessary competencies and confidence
to
practice, suggest researchers in this
week's BMJ.
They used focus groups to examine the views
of 13
general practitioner registrars, six of
whom had
undertaken an extra six months' training
beyond the
standard 12 month course.
Participants reported that the 12 month
course was
generally positive, but was too pressurised
and focused
on exams. Individuals reported training
gaps, leaving
them lacking in confidence and averse
to continuing
lifelong learning.
In contrast, the additional training focused
more on
patient care and promoted self-directed
learning.
Participants reported increased confidence
and feeling
better prepared for life as a principle
or locum.
However, it did not fill all the training
gaps and they still
reported not being "100%" confident.
Although extending training in general
practice by six
months remedies some deficiencies, it
is not the whole
answer, say the authors.
With the development of primary care organisations,
a
new GP contract, and considerable new
funding for the
NHS, a real opportunity exists to design
vocational
training capable of producing the "fit
for purpose" general
practitioner required for the new NHS,
they conclude.
Contacts:
Caryl Sibbett, Lecturer, Graduate School
of Education,
Queen's University, Belfast
Email: c.sibbett{at}qub.ac.uk
Agnes McKnight, Director / Maureen Crawford,
Associate Director, Northern Ireland Council
for
Postgraduate Medical and Dental Education,
Belfast
Email: agnes.mcknight{at}nicpmde.gov.uk/
maureen.crawford{at}nicpmde.gov.uk
(3) FOUNDATION
TRUSTS THREATEN CORE NHS
PRINCIPLES
(NHS and the Health and Social Care
Bill: end of
Bevan's vision?)
http://bmj.com/cgi/content/full/327/7421/982
The creation of foundation trusts by the
UK government
endanger one of the founding principles
of the NHS - to
provide equal care for equal need, argue
doctors in this
week's BMJ.
The new Health and Social Care Bill abolishes
government control of NHS trusts by turning
them into
foundation trusts - competing independent
corporations
with powers to generate income.
These powers threaten to widen inequalities,
write
Professor Allyson Pollock and colleagues,
while
safeguards to ensure that equal care is
available to
everyone who needs it are insufficient.
For instance, there are no duties on either
foundation
trusts or the independent regulator to
safeguard the
principles of universality and equity.
Moreover, it will be
the independent regulator, and not local
people, who will
be responsible for deciding which services
are provided
where and how.
Foundation trusts will be able to subcontract
clinical
services and staff to commercial companies.
They will
also be able to enter into joint ventures
with companies
for the sale of health care and other
services including
health insurance. Their new freedoms include
the power
to buy and sell NHS land and assets and
retain the
proceeds from land sales.
Foundation trusts will compete against
each other for
scarce NHS revenue on the basis of price,
and will find
themselves driven to select patients,
treatments, and
services on the basis of financial risk
rather than
healthcare needs, say the authors.
The bill will lead to multiple systems
of care in England
with access to and the quality of NHS
provision
increasingly dependent on the wealth and
resources of
local communities.
Contact:
Professor Allyson Pollock, Public Health
Policy Unit,
School of Public Policy, University College
London, UK
Email: allyson.pollock{at}ucl.ac.uk
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Advancement of Science
(http://www.eurekalert.org)
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