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England needs a new body to oversee and champion postgraduate medical education to overcome the “many deficiencies” of the Modernising Medical Careers (MMC) programme, recommends the inquiry into the failed attempt to reform junior doctors’ training.
A new body would be key to ensuring that specialist training in England gets back on track, says the report. It should be “rapidly formed to redefine the guiding principles that should govern the nature and conduct of postgraduate medical education and training in the future”—something that MMC lacked, it says.
The final report of John Tooke’s inquiry says that the new body, which would be called NHS Medical Education England, should have ringfenced funding and be outside the control of the Department of Health.
The inquiry was ordered in April 2007 by the then health secretary, Patricia Hewitt, after one of the programme’s main components—the centralised electronic recruitment system called the medical training applications service (MTAS)—collapsed in chaos. On top of this, some 30000 junior doctors were left chasing after some 20000 training posts.
The final report makes 47 recommendations on how the attempt to reform postgraduate medical education can be saved.
It blames “weak DH [Department of Health] policy development, implementation, and governance together with poor inter- and intra-Departmental links” and the medical profession’s “ineffective involvement” for the failure of MMC.
Most of the recommendations in the final report from Sir John, dean of the Peninsula Medical School in Plymouth, were outlined in his interim report published in October (BMJ 2007;335:737 doi: 10.1136/bmj.39363.596273.59). These included calls for MTAS to be scrapped. The interim report also recommended that the General Medical Council take over the work of the Postgraduate Medical Education Training Board and called for better definition of the roles of doctors at different stages of their careers, both of which are retained in the final report.
A six week consultation period elicited 39850 email responses, of which 87% agreed or strongly agreed with the interim report’s recommendations.
The final report has two additional recommendations, one for a national body for England and one for a “more flexible” approach to implementing the European Working Time Directive, which comes into force in full next year. It says that the Department of Health should explore contractual solutions that would prevent any further reductions in the time that junior doctors spend gaining clinical experience—for example, by separating service and educational contracts.
The report concludes, “The Inquiry has charted a way forward and received a strong professional mandate. The Recommendations and the aspiration to excellence they represent must not be lost in translation. [NHS Medical Education England] will help assure their implementation.”
The strongest criticism in the interim report related to the proposals to change the foundation programme. The final report says that the two years of the foundation programme need to be split to clear the legal barriers that currently prevent UK medical graduates from being guaranteed a preregistration post. Year 2 of the foundation programme should be abolished and its best elements integrated into three years of “core training.” Candidates for core training will be selected by means of local interviews, not—as originally proposed—by taking an examination, Sir John told the BMJ in an interview (www.bmj.com/audio/index.dtl).
Aspiring to Excellence: Final Report of the Independent Inquiry into Modernising Medical Careers is available at www.mmcinquiry.org.uk.
For further comments see News doi: 10.1136/bmj.39455.523090.DB. See also Editorial doi: 10.1136/bmj.39455.385868.80. You can listen to the BMJ’s interview with John Tooke at www.bmj.com/audio/index.dtl.