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Executive Summary
Professor Sir John Tooke published his report on Modernising Medical Careers ( MMC) "Aspiring to Excellence" on 8 January 2008. This report suggests a reworking of many aspects of postgraduate medical education ( PGME) and contains detailed recommendations (full details available at www.mmcinquiry.org.uk). In Scotland, the Scottish Government recognise that some of the recommendations made by Sir John will need further discussion on a UK basis.
In January 2008 the Scottish Government issued the consultation paper Aspiring to Excellence- Scottish Government Consultation on Professor Sir John Tooke's Recommendations to consultees and stakeholders as part of the process of taking this discussion forward. Respondents were asked to comment on a range of issues and proposals. The nature of these issues, and a summary of the responses received, are given in the following sections.
Governance
Whether the governance arrangements within the MMC organisational structure in Scotland are sufficiently robust?
What work can be done by Scotland at UK level to meet the recommendation made by Sir Tooke to "Redefine and reassert principles underpinning postgraduate medical education" to ensure UK consistency, where appropriate?
Suggestions of other work to improve the organisational structure of postgraduate medical education and the career framework in Scotland?
- Ten respondents expressed the view that the governance arrangements in Scotland were sufficiently robust. In contrast, eight expressed the view that they were not. Many respondents, including those who answered positively, made suggestions as to improvements that could be made to the governance arrangements. The two issues that were most frequently raised in this respect were communication and representation. A number of respondents thought that communication within the governance arrangements needed to be significantly improved, whilst a number of respondents made suggestions as to whom they believed should be better represented within these arrangements.
- A commonly expressed view by respondents was that consistency at UK level was required in PGME so as not to reduce opportunities for trainees or to risk the movement of trainees within the UK.
The role of the doctor
Whether the role of the doctor needs reviewed; the role taken by doctors in service delivery during training; whether all services need a judgement safe/ unsupervised doctor; and the approach towards defining the role of a trained doctor taken by the Scottish Government.
- All respondents who answered this question agreed that there was a need to review the role of the doctor before it would be possible to move to a healthcare system delivered by trained doctors, although a number of respondents stressed the urgency of this work.
- A majority of those who responded to this question, eighteen respondents, disagreed with the proposal that doctors in training should be " supernumerary to service requirement", arguing that service provision was in fact central to training.
- A majority of respondents agreed that a 'judgment safe'/ 'unsupervised' doctor was needed for all services, although a number questioned these actual concepts.
- The majority of respondents agreed with the Scottish Government's approach towards defining the role of a trained doctor.
Medical workforce planning
Who should determine medical training numbers in Scotland?
Whether Scotland should be trying to align the number of training places with the number of trained doctors required by National Health Service ( NHS) Scotland?
- The majority of respondents agreed that it was appropriate for the Scottish Government to determine the level of controlled medical training numbers.
- There was no consensus with respect to whether Scotland should try to align the number of training places with the number of trained doctors required by NHS Scotland, with a range of views being expressed.
Role of the Scottish Advisory Committee on the Medical Workforce
Whether the remaining roles of the Scottish Advisory Committee on Medical Workforce ( SACMW) could be remitted to NHS Boards?
- A majority of respondents disagreed with the suggestion that the remaining roles of the Scottish Advisory Committee on the Medical Workforce could be remitted to NHS Boards, with a number of respondents stressing the importance of central scrutiny and/or national responsibility for these posts.
Commissioning and management of PGME
Whether the development of Directors of Medical Education ( DMEs) and flexibilities around regional arrangements will add value and clarity to responsibilities for postgraduate medical education at service level?
The proposed role for NHS Education for Scotland ( NES).
- The majority of respondents agreed that the development of DMEs and flexibilities around regional arrangements will add value and clarity to responsibilities for postgraduate medical education at service level.
- The majority of respondents expressed support for the proposed role of NES.
Streamlining regulation
The proposed merging of the General Medical Council ( GMC) and the Postgraduate Medical Education Training Board ( PMETB).
The majority view was in favour of merging the GMC and PMETB but some concerns were expressed about this.
The structure of PGME
Changes to the structure of postgraduate medical training whilst further discussions are ongoing.
The majority of respondents agreed with the proposal that changes to the structure of postgraduate medical training should await further discussion on the future shape of the medical workforce and that change should be minimised until that is clearer.
GP Training
The length of general practice training.
A majority of respondents agreed with RCGP's proposal to work towards an extension of mandatory training for GPs from 3 years to 5 years. The view was expressed that changes to the complexity of GP practice in recent years necessitated such an extension to this training period
Equality issues
The implications of all proposals for equality groups.
Most respondents did not feel that the proposals would raise specific issues for equality groups.
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