There are also issues affecting our income such as the reforms of the NHS pension scheme and interminable pay freeze both of which will have a bigger impact on junior doctors as we will be still be working in the NHS when today’s consultants and GPs are long retired.

It is easy to feel powerless, especially when you are too busy to think beyond the next shift or set of exams, but it is possible for junior doctors to get their voices heard – by getting involved with the BMA. If you are the sort of person who finds yourself shouting at Andrew Lansley on Newsnight from the comfort of your armchair or explaining to your friend exactly why the Daily Mail article about young doctors of today being rubbish is a pile of tosh then perhaps you should consider getting more involved in medical politics.

Getting involved is easier than you think. The BMA’s junior doctor committee operates a visitor scheme

that allows you to get a taste of the cut and thrust of medical politics without making a commitment to attend further meetings. It will show you how decisions are made and how the views of ordinary junior doctors can be used to solve problems ranging from banding appeals through to the government’s reforms of education and training. If after attending your first Junior Doctors Committee meeting you feel you have something to contribute then the next step would be to get involved with your regional junior doctors committee and stand for election to JDC

If you harbour serious ambitions to become a medico-political leader then you may want to consider standing for election to BMA Council. This is the main decision making body of the BMA and offers an opportunity to influence the direction of the whole association. Details of the elections can be found on the BMA website – you will have to be quick though as nominations have to be in by Friday 10th of February.

The BMA often polarises opinion amongst junior doctors, but whatever your opinion is, the only way to ensure your voice is heard is to get involved. So, if you are angry about the Health and Social Care Bill, apoplectic about the changes to the NHS pension scheme or frustrated at the way junior doctors are being treated in your own hospital – why not get involved with the BMA and make a difference.

Fighting the futility of the exercise, I wrote a letter to the Daily Mail in response -they are yet to publish it. I think the most frustrating aspect of the article is that it made no attempt to acknowledge the transformation in training that has taken place in the last 30 years.

GP training, and indeed specialty training for all doctors, has been transformed completely since Dr Lobley’s day. We now have standardised curricula; quality assurance by the GMC, the Care Quality Commission monitoring the quality of our care and a continuing professional development requirement –to name a few improvements.

At this year’s BMA Annual Representative Meeting both Hamish Meldrum (Chair of BMA Council) and Tom Dolphin (Chair of JDC) uttered the words ‘put up, or shut up’ following a debate on the issue of the quality of today’s junior doctors. I think Dr Lobley may have missed this as his article has no evidence to support his claims, and it only serves to damage our professional reputation. I think he may also have missed the GMC’s guidance on treating colleagues with professional respect.

If he is so concerned about the quality of care provided by young GPs, I wonder if he has taken it upon himself to address the issue, or even to highlight the problems he has seen. Perhaps he has become a GP trainer? Perhaps he has contributed to the curriculum via the College? Perhaps he has even reported poor treatment to the GMC or CQC?

Or perhaps this is a cynical exercise to deliberately court controversy with the aim of publicising a book he has recently written.

NHS reform has hit the headlines again this week as the Future Forum delivered its recommendations on the the Government’s NHS reform plans (and more importantly, Government responded with what they’re going to do). Less well reported was that they also gave their verdict on the reforms for medical education and training.

In my speech to the JDC conference last month, I highlighted three major changes to the reforms that would be needed to protect medical education and training. Firstly, I challenged the government to learn the lessons of MMC and ensure that any reforms are fully tested before implementation. Secondly, I suggested an alternative way forward; instead of replacing deaneries with poorly thought out plans for skills networks, we should build on their strengths. And finally, I made the point that we need a UK-wide approach to workforce planning rather than leaving it to the whim of local healthcare providers.

So did they listen? Well, there seems to have been a clear acknowledgement that the pace of change in the original proposals was over ambitious. The government’s response to the Future Forum report talks about taking “time to develop the proposals, working with our health and care partners through further consultation.” The decision to retain deaneries, in the short term at least, should help see off the meltdown of the specialty training recruitment process. That was looking like a real possibility if deaneries had been hurriedly replaced by untested “Provider Skills Networks”. But we cannot be complacent – there is still much to do ahead of the 2012 recruitment process, and little time to do it all in. Our priority is to make sure that the expertise in Deaneries gained over the years is retained, to safeguard the mechanics of specialty recruitment.

It seems like deaneries have been given a stay of execution, rather than the pardon we had hoped for. The plan to house them in trusts following the demise of Strategic Health Authorities seems to be the first step in their transition to Local NHS education and Training Boards (the organisations formerly known as “Provider Skills Networks“).

I still worry that pushing education and training into trusts which are focussed on short term goals in order to achieve efficiency savings is the wrong approach. I remain unconvinced that they are the best organisations to deliver our education and training as they will lack the independent oversight crucial to maintaining our standards of training. Can we really expect a trust-based training board to withdraw trainees from work if training is deemed substandard?

The Future Forum also acknowledged the concerns we raised about workforce planning being a UK issue and has suggested liaison between England and the devolved administrations to ensure there is adequate UK provision for small volume specialties. However, I think there is much more to do to ensure these reforms will maintain the consistency of training standards across the UK.

Whilst there is still much in the plans that concerns me, the Future Forum has made it  clear that there needs to be much more detailed work done by the NHS and the Department of Health to get things right. Getting governments to change their minds is never easy, but the listening exercise has at least provided a way for doctors to articulate their concerns about the government’s reforms. We must build on the spirit of the listening exercise to solve the challenges these NHS reforms present to the provision of medical education and training, ultimately to protect patients.

The BMA, along with many other concerned organisations have submitted their views on the government reforms to the listening exercise. The Junior Doctors Committee also wrote to Steve Field, the Chairman of NHS Future Forum outlining our views on their plans to change the structures that deliver medical education and training. Our concerns focused on the fate of deaneries, highlighting the importance of maintaining the current levels of expertise. We cannot afford for deaneries to go the way of PCTs which are being run down before the legislation has even been through parliament.

The proposals to break up the functions of deaneries and deal them out to different parts of the NHS are a disaster waiting to happen. In the short term disruption to the recruitment to training programs will be inevitable. With just four months before key decisions will have to be made on recruitment for 2012 the uncertainty that surrounds the fate of deaneries could throw the whole process into chaos.

In the long term there will be serious disruption to the supply of fully trained specialists. The removal of the regional oversight of deaneries, leaving local trust-led skills networks responsible for training will result in the divergence of quality standards. Workforce planning can not be left to chance – we need dialogue between all four UK nations to ensure the all patients are seen by well trained doctors wherever they live.

The government reforms have ignored the hard work that has gone into improving the recruitment process since the massive failure of the Medical Training Application Service (MTAS). Deaneries do not need to be abolished simply because SHAs are going. They could be rehoused in educational institutions or made into special health authorities.

It is a shame Lansley and Co did not seek the advice of the medical profession. They must now face up to the fact that they are out of their depth on this ill conceived reconstruction project and listen to the experts.

We all know friends who have failed, one or more, parts of the MRCP and many of us have wondered what the pass rates really are. Well, data from the Royal College of Physicians (RCP) shows that an average trainee will take 4.4 attempts to pass all 3 parts of the exam.  In other words trainees can expect to fail one and a half times.

So, say, you are an average trainee and fail one and a half times, how much does that cost?

Part 1: £391 (written paper)

Part 1: retake £391 (written paper)

Part 2: £391 (written paper)

PACES: £613 (practical)

PACES: retake £613 (practical)

Total cost: £2,399

And that’s before you consider the costs of revision courses.

What’s even worse than forking out over £2000 is that, as a result of recent changes to medical recruitment rules, CMT trainees will now have to complete all three parts by the first week of May 2012 before being able to accept an offer of a ST3 post starting August 2012.

The timescale is therefore pretty punishing for those medics already in post. To get everything ready in time, the last opportunity to sit your exams comes as early as October 2011(if you need to sit part 2) or December 2011 (if you need to sit PACES).

The news gets even worse, the College suggest that to mitigate this punishing timetable trainees take exams during the Foundation Programme despite the fact that the advice from the UK Foundation Programme Office is that no exams should be taken in the foundation years. This is also little help for those trainees already in the CMT programme.

Pass rates for PACES before CT2 are miniscule as trainees don’t have enough clinical experience to pass and so one has to wonder at the motives of the College in encouraging multiple exam attempts.

JDC aren’t happy about this and we have raised the issue with the RCP and with the Joint Royal Colleges of Physicians’ Training Board. The response by the Medical Programme Board has not been as vociferous as we would like and we will continue to press on this matter, it is simply not fair for trainees to suffer due to constant changes inflicted upon them.

We would definitely like to hear your views on the issue, especially if this change will affect you personally.

The NHS feels a little bit like a ship trying to traverse a stormy sea of financial austerity whilst the government is taking pot shots with a range of structural reforms. My worry is that the NHS will sink before it can be put back together or the impact of the reforms will be so great that when the NHS reaches its destination it will be unrecognisable.

The reforms are so fundamental that they seem to leach into everything. Take a typical day from my diary, last week, I met with the GMC to discuss revalidation in the light of the workforce white paper (Developing the Healthcare Workforce) which has left a hole in the original plan. Deaneries, which were central to the process, face an uncertain future with proposals to create “skills networks” that will potentially take on the powers of deaneries, PCTs and SHAs. All this change is causing a lot of head scratching for the GMC. They still think revalidation for junior doctors will be implemented by 2012 but, I was left asking myself if the process will be sunk by the complexity and speed of the healthcare reforms

The same day, I attended a meeting at Medical Education England – which is set to be completely transformed and restructured by the bill. A new body, Health Education England, looking more broadly at education and training will replace it. Another major revamp to the structure of our training and education looks set to occur, but the questions remains, what will the changes cost? Should we have any faith that the reforms will improve our training? It doesn’t seem likely from here.

To round off the day I met with the Shadow Health Secretary, John Healey to discuss, guess what? – the bill. It was a great opportunity to discuss some of our concerns about the impact of the reforms on training. I put it to him simply – we are worried that these reforms threaten the training of doctors and could seriously jeopardise the future of patient care.

The Government’s health reforms will have a massive influence on our working lives. Tell us what you think at our evening debate “Education and training – is it just an after thought?” You can submit questions or comments in advance to JDCchair@bma.org.uk or email the same address to attend the event.

The event will be webcast on Tuesday 15 February 2011 at 6.30pm – 8pm visit the BMA website for further details. I look forward to hearing your questions.

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.

The quick guide to recruitment in 2011 was published in October 2010 by the Department of Health’s Medical Education and Training Programme team; yet less than 6 weeks later they have been forced into a U-turn and have abandoned the plan to use a single online system in the forthcoming 2011 recruitment process.

When I heard about this volte-face I wanted to know how my colleagues viewed this decision and last week I took the time to discuss the latest changes with doctors from a whole host of specialities. A fair few seemed happy that a national online application system is not going to be used. It would seem that a certain four letter word looms large in the collective conscious, and it wasn’t long before our discussion of online applications turned into a dissection of MTAS. It was of course an online system which was at the heart of the MTAS fiasco and no-one wants to return to those dark days!

What concerns me most is that changes are being made to the system so late in the day; for this year’s application process to be fair and transparent it is crucial that trainees who use it are clear on how the system works, and eleventh hour changes will undoubtedly cause confusion.

From a pragmatic perspective, the decision to abandon the system is probably a wise one. Better to drop a system that doesn’t work properly than to carry on regardless – we all know what lies down that road. It now looks like the application process will remain much the same as it was in 2010, with applications taking place through local or national recruitment processes (depending on specialty) but with one crucial difference: unlike previous years the 2011 recruitment process will feature a coordinated offers period, meaning that for the first time trainees who have applied for training posts in multiple specialities will be allowed to hold an offer while waiting for their preferred post to get back to them. No longer will trainees be blighted by the stick or twist dilemma and will not be expected to make a decision to accept or reject a job offer without knowing whether other preferred applications have been successful.

To maximise the chance of getting the job you want, it is critical that everyone ensures they understand the process for 2011. The Medical Specialty Training England website (the website formally known as MMC) and Deanery websites are the main resources, although posts may also be advertised via BMJ Careers and NHS jobs. If you encounter problems during the recruitment process – contact the BMA on 0300 123 1233 so that we can put pressure on those responsible. Let’s hope that work will continue so that 2012 recruitment can deliver effectively where 2011 could not.

I recently attended the launch for the Collins report on the Foundation Programme, and I’m pleased to see that the concerns many of us have are recognised. The GMC has some clear directives from the report to look at trainee supervision and the resultant impact on patient safety.

The overwhelming sentiment of the review is about two things: patient safety, and trainee supervision.

I recently attended the launch for the Collins report on the Foundation Programme, and I’m pleased to see that the concerns many of us have are recognised. The GMC has some clear directives from the report to look at trainee supervision and the resultant impact on patient safety.

The overwhelming sentiment of the review is about two things: patient safety, and trainee supervision.  The fault does not lie with consultants – their workload is increasing, particularly out of hours – and the evidence is that they are taking on a greater front-line role.

But there are plenty of systemic problems -  the patchy pastoral care we receive; the highly variable careers advice out there (that leaves thousands of trainees with a desire to do surgery when there are clearly not enough jobs); and the lack of flexibility in choosing F2 posts are all covered in the report.
In fact, rather a lot finds its way into the Collins report.

Another recommendation by Prof Collins is that foundation posts should reflect the medical workforce – basically more community placements (GP, paediatrics and psychology) and less surgery. Currently 65% of foundation doctors do a surgical job whilst only 16% can do a GP job in F2. This doesn’t compare favourably when 50% of trainees go on to be General Practitioners and only 8% to be surgeons.

It’s not all doom and gloom, the report recognises that overall the FP is doing pretty well. The national curriculum is praised, as is the Academic Foundation Programme which is seen as a real success.

Overall, the FP is delivering a solid, broad education to junior doctors bridging the gap between medical school and specialty training. However, there are serious concerns and clear messages emerging from the report that Medical Education England will have to act on in the coming months.

Rota design can be quite intimidating but I have found that getting involved with medical personnel to put forward the educational and training needs of the doctors on my rota is an effective way of improving access to training. It does, however, rely on someone to volunteer. Ideally you want someone with good negotiating skills and a thick skin.

So, how do you design a rota? The first step should be to look at the BMA’s guidance on rota design. Top tips include planning the rota well ahead (perhaps three months in advance), critically analysing the previous rota to see what worked and what didn’t, and separating popular holidays and exam periods out from the body of the rota. Finding out what trainees’ agreed training priorities are and what they are competent to do independently also helps when allocating people to different shifts.

A rolling rota may well be the easiest to implement, or a weekly rota which is team-based. Getting the rota out well in advance is always a bonus, and making sure it’s finalised before release is important to avoid making colleagues angry. Telling someone they have to cancel their holiday because changes have to be made to the rota will not make you popular.

Finally, make sure that annual and study leave is requested as early as possible and speak to your consultant’s secretaries to find out if clinics or theatre lists are cancelled when they are away so that you know what manpower is available to manage the service requirements.

Organising the rota involves a lot of wheeling and dealing with your colleagues, but it can be very rewarding when you are in charge of your own training. Remember to listen to feedback your colleagues and accommodate individual requests where possible. Above all, remain flexible and compassionate – as one day you too may be facing similar circumstances.