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Rapid responses on 30 March to the editorial on global health partnerships produced something special: a letter from the chief executive of the Medical Research Council and president of the Academy of Medical Sciences, followed by three letters from coalface workers showing the disastrous effects of Modernising Medical Careers (MMC) as they are experiencing it.1 2 This cluster follows letters from the major UK overseas research institutions,3 all the tropical medicine schools, and Médecins sans Frontières (MSF UK).2
Blakemore and Bell call for mobility between Britain and the rest of the world for clinicians while maintaining their career security, and they cite calls for the same thing from others. But in a giant organisation like the NHS “calling for” counts for nothing, even if the call comes from the prime minister or the chief medical officer. Middle managers spend their days trying to discover what they are being directed to do and then trying to do it, usually with sufficient general awareness to know that this contradicts something else that they are being directed to do.
MMC has arisen from a “call for,” or consultation document, published in 2000.4 That call has now been translated, doubtless via almost uncountable directives through chains of middle managers, into the horror of MMC 2007. The flexibility of the original call is now a depressing rigidity, and mediocrity is the ruling standard throughout. The chief executive of the NHS will just have to follow the call of his predecessor, Lord Crisp, and direct that time spent overseas is always to be counted as a strong asset in promotion or entry to further training, and that any NHS trust that has not made an effort to link with an institution overseas is going to have to explain itself to him.
Competing interests: None declared.