“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.”