So, the future of our education and training is up for grabs once again. Another round of changes to the way junior doctors work and train is just around the corner thanks to the new education and training consultation.
My biggest concern after reading the consultation is that this is a root and branch overhaul of postgraduate medical education to fit a philosophical model of a smaller state and less top down control from the Department of Health. I remain convinced that the reforms highlighted are primarily to fit in with the “Equity and Excellence” ideals and that this paper has been tagged on as an afterthought.
The paper deals in very general terms with issues of recruitment, workforce planning and the training of healthcare professionals.
At times it is unclear which specific groups of healthcare workers are being discussed, and it is not clear which organisational elements in the current training system will remain, and which will cease to be. A good example of this is Deaneries who are barely considered in the document.
There are some useful suggestions – workforce planning has been notoriously poor in the past, and I welcome the news that a comprehensive strategy is being developed. However, I don’t agree fully with the proposals. The paper suggests national oversight from the Centre for Workforce Intelligence, and local workforce planning by employers with no regional input. My worry here is that local providers will always have short term influences that will trump long term workforce planning aims leading to over or undersupply of doctors.
Another key message from the consultation is around the formation of ‘local skills networks.’ These new networks will be allowed to self-determine their size and membership and seem to lack any oversight or governance from the top. They will be a combination of commissioners and providers for education and training, and for services. They will take some functions from deaneries, some elements from PCTs and some elements from SHAs. I am not clear on how junior doctors will benefit from this rehash of existing structures.
Probably the third key message is creation of Health Education England which will build on the good work done by the existing Medical Education England. This advisory body will encompass all training healthcare professionals and will hold the MPET budget. Whilst improved inter-professional working is a good thing, we must however be clear that the voice of medics should not be diluted to a voice in a crowd.
Junior doctors are part of the future of the NHS, and we understand that we must all meet the changing needs of our healthcare system. We need a robust workforce plan and we need security of supply of the workforce. We need to cooperate better outside of our professional silos and these are all sensible messages to come from the consultation. However, these ideals should be the first concern of the government and not an afterthought to facilitate marketisation of the NHS. As we all know, world class training today will lead to world class patient safety in the future.