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In an 11th hour development, a day before a High Court hearing was due to take place on Wednesday, England's health secretary, Patricia Hewitt, announced plans to scrap the flawed medical training application service (MTAS).
But although this has been heralded by some observers as a decision to abandon MTAS—the system for handling junior doctors' applications for training posts—it is clear that the first round of interviews set up through the service and that have already taken place or are due to take place will still be valid.
Ms Hewitt merely announced that, rather than trying to continue with MTAS, local deaneries would notify junior doctors of the outcome of the round one interviews and that selection for the second round would be done by local deaneries, not through MTAS.
“It's old news,” said Matt Jameson-Evans of Remedy UK, the doctors' group that is bringing the legal action against the Department of Health. “We knew round two was going to be done by local deaneries.”
Nearly all the posts would be filled on the first round, he said, which is where Remedy UK claims that the health department has abused its power. Dr Jameson-Evans said that the department's announcement will not affect Remedy UK's case, which was due to be heard on Wednesday, after the BMJ went to press.
In her written statement to the House of Commons Ms Hewitt outlined her concerns at the security breaches that had occurred with the MTAS website and said that these would be reported to the police.
“Given the continuing concerns of junior doctors about MTAS, the system will not be used for matching candidates to training posts but will continue to be used for national monitoring,” she said.
She went on to explain that, subject to the outcome of the current judicial review, the first offers for specialty posts in hospitals in England would be made on or after 21 May 2007 and that all would be made by early June.
Remedy UK is bringing its court action because of the problems associated with the discredited MTAS arrangement (BMJ 2007;334:974, 12 May doi: 10.1136/bmj.39209.730567.BE). When it became apparent earlier this year that its original system was flawed, and there were protests because some doctors had not been offered an interview in round one of the process, the organisers decided that all applicants should be allowed at least one interview.
But those who had been offered more than one interview were told that they had to say which job they wanted, rather than waiting for offers from all the hospitals who had interviewed them, or who were about to interview them.
The judge could order the health department, if it loses the case, to scrap its current plans to push ahead with specialist training appointments from 1 August. Instead it would have to appoint doctors to these posts on a temporary basis only, for a year, and a fairer appointment procedure would then have to be set up for next year.
Remedy UK has instructed Leigh Day and Co, a firm of lawyers that is well known for taking on controversial human rights and medical negligence cases, to fight the case.
“MTAS has been a comprehensive failure,” the lawyers state in their submission to the court. “The result has been a far-reaching loss of confidence, morale and faith by junior doctors and many consultants in the fairness of MTAS and the consequent integrity/fitness of the NHS.”
They argue that the decision by the MTAS review group led by Neil Douglas that all applicants in England should be guaranteed an interview but only for one of their four choices “aggravates the unfairness of the prior MTAS system rather than cures it.”
Some doctors had already had more than one interview before the new rule came in, so they had been unfairly advantaged. The flaws in the modified MTAS arrangements make it an abuse of power, they say.
Applicants for GP posts were told last week whether they had been successful in the first round of interviews. From a potential 3819 posts across all three GP specialist training years some 3000 offers have been made so far.
But the first round of interviews for hospital posts will continue until the beginning of June, as deaneries try frantically to fit in all candidates for an interview for their chosen training post.
Meanwhile the health department is contacting teaching hospitals in England in attempt to identify “staff grade” posts for those doctors who are unable to secure specialist training places. As many as 10000 such posts are needed across the United Kingdom, BMA figures indicate. The BMJ understands that these posts are to be centrally funded. Creating as many as 10000 staff grade posts could cost the government as much as £300m (€440m; $600m) in the first year alone.
A health department spokeswoman said that it had received a response from all strategic health authorities to its request about creating these posts. “Work is ongoing to determine how we proceed with arrangements,” she said.
One hospital internal memo seen by the BMJ says that these staff grade posts—which will not lead to a consultant position—will be on a par with specialist training years 3 and 4 (ST3 and ST4) and will initially be for one or two years. However, the posts would, the memo says, offer the potential for those in them to transfer into a career grade post at a later stage.
Just how many posts will be needed is unlikely to be clear until mid-June, when the first round of interviews is over and posts are allocated. Those who are currently in staff grade jobs and applying for specialist training will be able to continue in their current posts. The new staff grade posts would mainly be for doctors who are currently senior house officers and who are unable to find an ST3 or ST4 place.