MMC Third Report 8 May 2008

MODERNISING MEDICAL CAREERS – HEALTH COMMITTEE THIRD REPORT 8 May 2008 – HTML

“We make a number of recommendations for change and improvement in response to the shortcomings which undermined MMC. The Department of Health must address its weaknesses in project and risk management. It should strengthen and increase the independence of the MMC Programme Board and work more effectively with the medical profession on future education policy. A number of improvements to project management and to performance management of Strategic Health Authorities by the Department are also required. Employers and training providers should play a bigger role in decisions about the future of training while partnerships between the health and education sector must be revitalised.

The future structure of the training system itself must above all be made more flexible. This means allowing individual specialties to decide what length and type of training posts they offer, rather than continuing to impose one-size-fits-all solution from the centre. We therefore support the current “mixed economy” of specialty training schemes and recommend that this approach is maintained and extended. We suggest a similarly flexible approach to future recruitment processes and recommend that the Department devolve all responsibility for recruitment and selection to Postgraduate Deaneries and employers.

Devolving these detailed responsibilities to local level will allow the Department of Health to focus on more important policy questions affecting the medical workforce. Most pressing of these is how to restrict access for non-EEA doctors to UK training posts, a necessity in light of the recent expansion of UK medical schools. The Government has comprehensively failed to address this issue to date and its future policy is now reliant on a legal judgement by the House of Lords. The Department of Health and the Home Office must work together to resolve this embarrassing problem as a matter of urgency.

Finally, we recommend that the Department of Health address policy issues relating to the wider medical workforce, one of the unrealised ambitions of MMC. Reform of the SAS grades in particular is vital: the Department should aim to develop SAS posts into a genuine and valuable alternative to the formal training system, rather than the educational backwater in which they currently remain. We also propose the introduction of a hierarchy within the consultant grade. In addition, we call on the Department to resolve the key questions affecting the size and nature of the medical workforce, including whether care is to be consultant-led or consultant-delivered in future.”

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MMC House of Commons Select Committee – Written Evidence

MODERNISING MEDICAL CAREERS – SELECT COMMITTEE – WRITTEN EVIDENCE (HTML)

MODERNISING MEDICAL CAREERS – SELECT COMMITTEE – WRITTEN EVIDENCE (PDF)

“EXECUTIVE SUMMARY

Modernising Medical Careers is a collection of policies to improve the way in which junior doctors are trained and to modernise the Senior House Officer grade. The original principles as set out in Unfinished Business and Modernising Medical Careers aim to do just that and are still valid.

In the main, the implementation of MMC was in line with the original principles. However, the introduction of run-through training, thought by many stakeholders to be a good thing, limited the flexibility inherent in the original principles. The Department is re-introducing flexibility for 2008 and beyond. “

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MMC House of Commons Select Committee – Oral Evidence

THE WITCH DOCTOR’S OFFERING – MMC

MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 15 NOVEMBER 2007

Sir Liam Donaldson KB, Professor Martin Marshall, Ms Clare Chapman, and Mr Nic Greenfield.

“Sir Liam Donaldson: I know that some of this is caught up in language and terminology, but might I just clarify that to begin with. The original programme was not called Modernising Medical Carers. It was, as you rightly say, a reform of the senior house officer grade, which was, in my view, an educational scandal in this country and needed to be remedied. I produced a report, advised by members of an expert committee, which suggested reforms to the SHO grade. The Modernising Medical Careers programme then was a broadening out of that.

MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 6TH DECEMBER 2007

Professor Sir John Tooke and Sir Jonathen Michael

Dr Richard Marks, Mr Matthew Jameson Evans and Professor Steve O’Rahilly

“Professor Sir John Tooke: The Committee will be aware that the distress caused by the selection system known as MTAS in the spring generated a good deal of anxiety within the profession. That ultimately precipitated the then Secretary of State for Health having a telephone conversation with me and inviting me to consider chairing an independent panel to look into the circumstances surrounding that perceived failure.”

MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 13TH DECEMBER 2007

Professor Alan Crockard and Professor Shelley Heard

Dr Jo Hilborne, Dr Ian Wilson and Dr Ramesh Mehta

Mr Mark Johnston

“Professor Crockard: I think the final stage was total frustration, feeling that our views as medical people, and as people with an interest and background in education, was being neglected. I felt that the whole principles of MMC, which I thought were very important, were being subsumed into an attempt to get the workforce running. We saw the situation unfold from fairly well back; I had tried very hard to make this known to the SRO to whom I was accountable in terms of MMC, and to the DCMO.”

MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 17th JANUARY 2008

Professor Dame Carol Black, Mr Bernard Ribeiro and Dr Bill Reith

Professor Elisabeth Paice, Professor David Sowen and Professor Sarah Thomas

“Mr Bernard Ribeiro: Therefore, we supported the initial principles of MMC in Unfinished Business but not what happened subsequently; it was imposed. Many of the comments that our college made were ignored in this situation.”

MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 24th JANUARY 2008

Professor Peter Rubin, Professor Neil Douglas and Professor Sir Nick Wright

Ms Anne Rainsberry, Dr Moira Livingston and Ms Sian Thomas

“Professor Rubin: The timing was largely coincidence. I should qualify that by saying that I was not involved in the establishment of PMETB. I came on the scene somewhat later than the establishment process, which was earlier on. Inquiries and reviews going back to 1970 recommended that postgraduate medical education should be regulated, as undergraduate medical education has been since 1858. The most recent of those reviews was the Bristol heart inquiry and in that review Ian Kennedy very clearly recommended that postgraduate education should be regulated and PMETB was a consequence. MMC was developing in parallel with all that. One of the issues that has been all too apparent to us is that, because the MMC came on the scene at much the same time, there has been a lot of confusion about what the two organisations do.”

MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 18th FEBRUARY 2008

Ms Lorraine Rogerson and Ms Judith MacGregor

Rt Hon Alan Johnson MP, Mr Hugh Taylor, Sir Liam Donaldson and Ms Clare Chapman

“Ms Rogerson: The Department of Health first approached the Home Office in 2005 about using the Immigration Rules to limit further competition for training posts from international medical graduates.”

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