The butterfly is a flying flower, The flower a tethered butterfly

Monday, 31 December 2007

New year ... new dawn ... new beginning ..

"I dream of peace on Earth ...."

I dream of everlasting peace on mother earth ...

Of peace and prosperity for Britain,

Of peace and prosperity for all the juniors applying in 2008 and beyond,

And of peace and prosperity for all the good people who visit me here.

Happy New year :-)

Peace has to be created, in order to be maintained. It is the product of Faith, Strength, Energy, Will, Sympathy, Justice, Imagination, and the triumph of principle. It will never be achieved by passivity and quietism.

Sunday, 30 December 2007

Shattering! ....

“Future shock [is] the shattering stress and disorientation that we induce in individuals by subjecting them to too much change in too short a time.”

Professor Sir John Tooke has made an amendment to page 99 of his interim report, 'aspiring to excellence.' He now recommends that the F1 year should be linked to medical school and be the right of all UK medical graduates. No guarantee for UK graduates beyond this point. I remember he spoke about this at the HSC meeting and his reasoning for such a move was because UK graduates will not be able to register with the GMC without this first year as junior doctors and that if UK graduates are not guaranteed the F1 year, this may lead to legal problems and possible litigations because medical schools would not have fulfilled their promise to educate a young person and equip them to become practicing doctors. Of course this is a welcome move because it guarantees something, anything, however small, to UK graduates .. so, it is one very small step in the right direction. ... But look at this on the MMC website about the effect on UK graduates by those applying from 'outside' the NHS in 2008.

Foundation doctors will be well placed to get their first speciality post. They will be in competition with more experienced doctors who are changing specialty. There is significant headroom for doctors changing specialty. Most Foundation doctors should secure a post if they are flexible about where they apply and to which specialty. Unsuccessful Foundation doctors will get counselling to change career and/or be supported for a further year of training to try again in 2009 ... :-(

Career termination! Goodness me! Why?! If those young doctors successfully finish their 2 foundation years, why should their career in medicine be terminated?! What would be the excuse for such cruelty? .. to give the place to someone else from Europe or abroad?! Someone we know absolutely 'nothing' about! ...

This is an act way beyond cruelty; to break a young doctor and their families in this way!

I would urge the DoH not to allow such an act to happen to any junior and to save every British doctor who has successfully passed their medical finals, and has successfully registered with the GMC and has successfully completed the F1 and F2 years. Isn't that what MMC all about? Variety, extended opportunities and flexibility?! Otherwise, if just ONE F2 doctor is terminated in 2008, this will mean that MMC has completely failed the purpose for which it was devised!

How can 'people' who make such decisions sleep at night?!

And Sir Tooke, what is the point of registering with the GMC only to be executed one year latter?! If a young doctor can not use their GMC registration to gain employment in the UK, unless s/he works for the NHS but can not find work because of the lack of posts and the fierce competition from outside the UK, coupled with absolutely no protection, why should 'they' rather than those who were the cause of this mess, face career termination?! IMO this too would probably lead to litigation as those doctors question the legality of being terminated this way!

Then again, why prolong the agony by guaranteeing the F1 year only, if career termination is on the cards anyway?! Of course, from a parent point of view, this should not about legalities only but should be about 'humanity' too, which is much more important IMO. The only reasonable solution Sir, would be to guarantee British graduates employment until they can work in the NHS, either through specialty training or the 'career grade' pathway and providing the latter will be de-stigmatised, properly rewarded, will allow doctors apply for specialty training, then this would be the least to do. Hence, core training must also be guaranteed for British graduates so that they can be spared this unfair probability of career termination through no fault of their own.

Professor Tooke, save our junior doctors, 'recommend' that no junior career be terminated in this inhumane fashion.

This constant bad new is causing constant fear and this is beginning to bite even higher up the ranks. Already, some of the 2007 ST/FTSTA doctors who 'had' to accept jobs in specialties they do not like or in far away regions, away from families, friends and loved ones just to save their careers, still do not feel secure and some say the quality of training is poor, if any at all in some rotations. They also feel isolated, desperate and miserable, they are seriously considering leaving medicine altogether and some are already applying to non medical jobs with a real view to leave if suited. It seems that this notion of leaving medicine is common talk now amongst the juniors who either feel trapped, unappreciated and/or feel it is time to leave medicine as nurses take over and bullying reaches unbearable levels. ... To say that morale is low is an understatement! .... It's below rock bottom!

Try anything and everything,
This is an 'amulet' to protect all juniors and for good luck in 2008

Friday, 28 December 2007

The Brits were 'commissioned!'

“It is a very sobering feeling to be up in space and realize that one's safety factor was determined by the lowest bidder on a government contract”

Made to order .... Hand selected and picked, then 'commissioned' to enter medical school, and providing they pass all necessary exams, to be employed as doctors in the NHS. Well, our junior doctors did just that; achieved straight As and applied to medical school, were better than the fierce competition at interview and were, on government orders, admitted into medical school, were taught to study their hardest to absorb and master all the 'made to measure' syllabus, for six years, then pass the most notorious of finals to graduate. And graduate they did, the 'order' is ready for collection now Gov! "Oh ... Sorry, changed my mind, tell them to disappear, just go!" ...

Had this been a commercial transaction, say, you commissioned a painting of yourself, can you just tell the artist that you have changed your mind when he finishes the portrait?! What would happen in this case if it goes to court?

Surely then, British junior doctors have the 'right' to the 'promised' job; since they were 'made to order?!' .. This far, at no stage were British graduates warned; before applying to medical school, which is what should have happened but did not, that they would graduate to be thrown to the skip a little after, not because they have lost the ability to do the job, but because there are 'others' in their place! That their jobs would go to those from overseas who 'were not' commissioned to be in these jobs! ...


Priority 'must' be for the Brits first and foremost because it is their 'right' as commissioned by the NHS! The juniors fulfilled their part of the 'contract', time the government fulfilled their part. For the juniors, this was a dream they worked hard to make it come true, it was not a fantasy. For both the juniors and the government, this was a contract!

“Society is indeed a contract. It is a partnership in all science; a partnership in all art; a partnership in every virtue, and in all perfection. As the ends of such a partnership cannot be obtained in many generations, it becomes a partnership not only between those who are living, but between those who are living, those who are dead, and those who are to be born.”

Thursday, 27 December 2007

Grosse injustice!

“One never dives into the water to save a drowning man more eagerly than when there are others present who dare not take the risk.”

Up to19:1 ratios predicted for surgical applicants, if not much more!:

This year there were 15,600 training places available and about 29,000 applicants. Next year there will be about 9,000 posts with the same number of candidates.

A letter to junior doctors from Bernard Ribeiro, the president of the Royal College of Surgeons, warned: "These competition ratios will mean a lot of very capable doctors will be frozen out of training.

"There is the potential to severely hamper fair play. The proposed arrangements risk damaging and indeed ending the careers of some of our best junior doctors."

Some of our graduates will definately now be forced to face a career termination in medicine while the 'open doors' policy continues! ....

Why isn't anyone helping?! .... Someone out there needs to do something to preseve, not only British talent, but the thousands of good families that will greatly suffer as a direct result of this grosse injustice! ...

Save our junior doctors; save British medicine .... Save the future!

“The rain is famous for falling on the just and unjust alike, but if I had the management of such affairs I would rain softly and sweetly on the just, but if I caught a sample of the unjust out doors I would drown him”

Monday, 24 December 2007

Best wishes for a Merry Christmas

“Reach high, for stars lie hidden in your soul. Dream deep, for every dream precedes the goal.”

“Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world.”

Sunday, 23 December 2007

Pay to match status!

“Money is the barometer of a society's virtue.”

How can you justify to an F1 doctor that some colleagues who are also F1 doctors earn more than them because some jobs are 'banded' while others are not?! That, after six hard years hard study and total dedication to the work they love, their pay will probably equal that of a McDonalds sales assistant? Most of all, how can a nurse of the same age and much lesser qualifications be earning more than doctors?! Who has also been earning for three years, and getting paid on the way while studying too, while the juniors are still at university accumulating loans and huge debts as well as 'striving for excellence?!'

Why are some F1 jobs 'banded' and pays more while others are 'unbanded' and pay less?! Why are nurses banded while some doctors are not?! Rumour also has it that F2 jobs will suffer the same discrimination in 2008! Sir Tooke rightly wants the 'role of doctors in training' be redefined to reflect their 'knowledge, abilities and attributes'. He also said that doctors in training ARE doctors; fully qualified professionals providing a vital service to the NHS.

Well then, comrades .......

Shouldn't pay reflect status in any civilized society?!

In redefining the role of doctors in training to reflect their scientific knowledge, qualifications, attributes and the responsibilities, please redefine and adjust their pay to reflect same too ..... Again, this would be ...

Doing the right thing .... :-)

ey is like a sixth sense - and you can't make use of the other five without it”

Saturday, 22 December 2007

A step in the right direction

All UK graduates will be matched to a 2 year foundation programme ... :-)

Good news,

let's hope all UK graduates either left out by the 2007 shambles or applying for the first time, will also be matched to a specialty training programme in 2008 and beyond.

I call this ...

'Doing the right thing' ... :-)

Friday, 21 December 2007

Chained and shackled by MMC

“A fox may steal your hens, sir, / . . . If lawyer's hand is fee'd sir, / He steals your whole estate.”

Reflecting again on the second HSC meeting attended by Sir Tooke, Remedy and Fidelio (Prof Brown was there too, look right at the end of the video :-) Dr Richard Marks, a medical educator with the London Deanery for 15 years was present with Remedy UK and Fidelio represented by Professor Steve O'reilly. Dr Marks told the panel that the original idea of MMC was to 'modernise' the SHO grade, the so called 'lost tribe' because some SHOs spent most of their time filling out forms and not getting adequate training and/or supervision, but MMC did not change this; the main goal it was supposed to achieve! Professor Steve O'reilly of Fidelio added that the majority of SHOs had structured training and that the problem was mainly more to do with 'some' surgical SHOs who were going round and round in the system and getting nowhere. However, MMC, rather than modernise the SHO grade, which he believed was easy to do, by using some components from the American residency system to restructure the training programme with clear entry and exit points, it had another much more sinister aim:

Professor O'Reilly said that the process became an opportunity as a 'way in' to restructure the whole profession, an ambition that 'over arched itself.' ... Meaning; the government sneaked in 'through the back door' while everybody was 'asleep' and hit hard at the lot, but rather than achieve the desired outcome, the whole thing turned into a spectacular mess and Chaos ensued! ...

A whole generation of young doctors were harmed as a direct result of this unanticipated attack, the SHOs who were lost in the system are victims because they did not fail but the system failed them. Professor O'reilly said there were around 500 of them going round and round, applying to specialise every year without success! How did anybody judge whether they were good or bad if they were not given a proper training opportunity to prove themselves?! A stigma became attached to them simply because they kept applying and not getting through! ... Great injustice.

Then again, those who were the first batch of the MMC foundation programme, seperated only by birth date from their SHO colleagues are suffering too. MMC planted the seeds of sour grapes between both groups when the foundation programme doctors were seen by their SHO colleagues to 'have their cake and eat it' while the SHOs endured the injustice of MMC! But the reality is, both groups suffered as a direct result of the chaos as nearly half of the foundation doctors are also being forced into dead end traps. Without the chance of a fair opportunity to prove their abilities, despite MMC's promises of 'milk and honey for all of them!' Both groups were victimized by MTAS 2007's white box culture!

white boxes may work for selecting other professionals but not for medicine; they do not prove the attributes and abilities of doctors; those entrusted with people's lives in their hands! For those, qualifications, experience and a 'face to face' interview is the ONLY way to proper selection.

Hence, the responsibility put on Sir Tooke's shoulders to find ways to fix this mess is huge; a mammoth task. Part of his duty IMO, is to ensure that no young doctor will suffer the results of this debacle, either now or in the future. In his interim report, he recommends a period of three years assigned to core training rotations of six month each before embarking on higher specialty specific training, while current F1/F2 doctors spend only 4 months per rotation, I heard from some of f1/2 doctors that they thought 4 months were not enough to get a good feel of any specialty, let alone those more challenging like A&E. That said, the 2007 run-through cohort will be allowed to keep the promise of this run-through but ....

How will the training of the 2007 cohort relate in it's content value to that which Sir Tooke recommends? In say, in 5-7 years time, when the 2007 applicants fully qualify as specialists, will they be penalised by employers for just that? Being the 2007 applicants who do not have as rigorous core training as those who pre/proceeded them?

“So long as the people do not care to exercise their freedom, those who wish to tyrannize will do so; for tyrants are active and ardent, and will devote themselves in the name of any number of gods, religious and otherwise, to put shackles upon sleepi”

Wednesday, 19 December 2007

Who dunnit it!

“Power without responsibility - the prerogative of the harlot throughout the ages”

I had no idea there was going to be a third meeting for the HSC attended by Prof Shelly, Prof Crockard, the BMA and Bapio. Now that I watched this session too, my overall feeling is that everybody, in all three sessions, is just trying to cover their backs, no solutions, no accountabilities, just cover your back and pass the buck! Except for Remedy and Fidelio of course.

In the first session, the CMO defends his 'unfinished business' and says that the Tooke review commended the principles behind MMC but Prof Tooke did not of course. Shelley believes in her foundation years because she was main architect for that while Crockard supports MMC as a whole because he was involved from very early on. Of course the BMA defend their actions all the way; still not recognising the grave mistakes they made along the way, right from the very beginning to the end! It was surprising to find out that originally MTAS was going to allow only one job application per candidate and straight to round 2 if not suited. IMO, this would've been fairer and there would've been substantial opportunities left for round 2 had this happened, but it was the BMA who insisted on four choices knowing this may cause a number of doctors not to get any interviews at all and most probably also responsible for the many unsuitable jobs the juniors had to accept to save their careers. This, however did not stop the BMA to still demand the four choices per candidate and insisting on them! I can't remember who said, in the second HSC session, that a decision was made NOT to tell the applicants the likely consequences of the 4 choices!

Isn't it also amazing that, when the scale of the foul up began to surface, that the ONLY two practicing Medical staff just resigned, leaving the MMC board without medical representation?! They just abandoned ship and left it to sink with whoever and whatever was in it, the juniors affected; a third of the total or around 11,000 young doctors! No real ship 'captain' would ever do that for obvious reasons!

Isn't it an irony that 'communication skills' as well as 'team work' are goal posts for MMC and the 'white boxes' of MTAS, yet, doesn't it blow your mind that those in charge of the whole project at any level and up to the highest level know absolutely 'nothing' about both concepts, leading to a total breakdown of communication resulting in the 2007 disaster?! Shouldn't they practice what the preach?! Nobody knew what the other was doing nor even who to report to when needed! This beggars belief!

Would the initiators, the implementors and the programme and operational directors have been able to win their jobs back if they were made to apply to MTAS?! White boxes and all?! Give them their own medicine and let's see how they do! ...

Time the juniors gave the seniors a good education; not just on team work and communication skills but, most important of all, on taking responsibility for one's own actions ... :-(

We all await to see the HSC report soon and find out about all those accountable for the agony of 2007, 2008, 2009 ... etc, etc! .... Of course, there were many others tooo .... but one name always springs to mind! ....

“People think responsibility is hard to bear. It's not. I think that sometimes it is the absence of responsibility that is harder to bear. You have a great feeling of impotence.”

Monday, 17 December 2007

Opportunity in fascinating India!

Amazing picture, click it to enlarge :-)

I found this article in the Times online. Apparently, many doctors of Indian origin have chosen to leave the 'dirty' NHS to work in one of the many new 'clean' top notch hospitals springing up everywhere in the fast up and coming subcontinent of India. Some of them, although trained in the NHS, have decided to leave on their own accord, a few years ago before the MTAS/MMC circus started 'the show!'

From the article:
"Although salaries are usually lower in India, doctors are finding that their standard of living is better. Kishore said he lived in a bigger house with a driver, cleaner, cook, nanny and watchman to look after him, his wife and two young children."

I wonder how many top British consultants have this entourage within their households? Of course service staff is cheap in the third world in general and you do live like a king if you are moderately well-off by UK standards. From the comments on the article, it seems also that training is catching up fast in India with one comment claiming that surgery is of the same standard as here in Britain, well, maybe. The Indians are hard working, intelligent people who have a long tradition of medical education that attracts students from the surrounding countries including the Gulf states. So, as the economy prospers further, medicine, of course, will also follow suit.

It makes me wonder, why do doctors have to take one exam to practice in the UK, another for the USA, a third for Australia, fourth for Canada .. etc?! ... Since standards are rising everywhere in the world and since there is rapid change in people's movement around the globe, why doesn't the WHO; World Health Organisation, for example, involve itself in a project aimed at setting the standards for ONE International exam for all, one 'universal standard for excellence', an exam that would allow all doctors to practice anywhere in the world they wish after successful completion of same? Maybe Britain can initiate this idea :-)

Meanwhile, with 'Medical outsourcing' and 'Medical tourism', will we see India providing a range of paid specialty training opportunities to foreigners soon?

The song: O mari sanam from the legendary film Sangam with Raj Kapoor. I wish I could understand what the song says :-)

“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Sunday, 16 December 2007

Aspiring to excellence

"may each day bring you bright, happy hours that stay with you all the year long."

I think I have become addicted to the last HSC meeting; the more I watch it, the more I understand things that I once found puzzling. Of course, this particular meeting was like an open book; you skim the surface first but the more you concentrate, the more it gives you! .. And the more I watch it, the more I have respect for Sir Tooke, both; the professional and the man. I have come to admire this man because he is truthful, honest, courageous and because he really wants what is best for the juniors and for the profession. I very much believe he will be the knight in shinning armour who will slay 'the dragon' and his MMC and rescue all those affected because of this sorry mess.

Apart from the urgent issue of redefining the role of a doctor, uncoupling F1 from F2 the way he recommends is not a bad idea, although, I wonder why not just integrate the F1 year into core training and move the competitive point to the end of this core training? At least this way British graduates can be protected from outside competition and you'd still have one competitive point. Thus, all British graduates would, at least, secure the right to registration and training thereafter, be prepared for either the higher part to specialist level in the specialty they choose or change to another? Or even be better prepared for a proper role in a better defined service post, if this is what they choose and prefer to do, or, indeed, if still not prepared enough to enter higher training and wish to compete again at a later stage?

So, I think core training followed by competitive entry into specialist training is good despite what those who prefer run through may say. Those want run through because they want one entry and one exit as a finished product; no more competing. However, core training is an open door, you enter but you can also exit; if you do not like the specialty or want to do some research then return .. etc. There is also the opportunity to say, take a year or more out for more academic qualifications, etc, and providing the system allows you to come in again, then surely, it is better than 'galloping through' training in a straight jacket.

One of the problems facing many 2007 doctors is like this left by a junior on Remedy's today. He says that he got an ST1 post far away from home, his family and friends but now feels lonely and isolated and wants to apply for GP this year but he was advised (By whom?) that he must resign first before he can apply in 2008. I know more doctors trapped in this same situation; accepted unsuitable posts out of fear for their career. They accepted posts either far away or in a specialty they would have never considered but for MMC and MTAS! Of course there are also those who have wives and children but had to leave and live far away because of the job, not forgetting the others who fled the country in search of the opportunity they should have found here at 'home.' Uncoupling core training from the more senior level would, I think, solve this problem but one has to still bear in mind that uncoupling may not guarantee this outcome because the number of posts remain very low. That said, I wonder if Sir Tooke will address the problems of those trapped in 2007 in his final report? I sincerely hope he does.

Sir Tooke also said that he was asked to be on the board implementing his recommendations but he refused :-( and prefers to 'monitor' from far away and act as an adviser when needed. I hope he will change his mind and be in charge of the implementation himself just in case things get 'lost in the post' ... happens a lot these days ;-)

If Sir Tooke himself takes the driving seat, I very much trust that British Medicine's 'life in his hands' .. will be safe

Let's hope for a clear and bright future ...

It's the festive season so, from one eternal optimist to another, this is for you Sir Tooke with my very best wishes .... :-)

I hope the 'rain' disappears so that this song can come true ... ;-)

“Star Light, Star Bright First star I see tonight. I wish I may, I wish I might Have the wish I wish tonight.” ;-)

Saturday, 15 December 2007

Memories ........

When can their glory fade?

O the wild charge they made!

All the world wonder’d.

Honour the charge they made!

Honour the Light Brigade,

Noble twelve thousand! ......

.... Please give our junior doctors their rightful opportunity to the future, give a training post to each doctor who wants one ...

Spare the juniors and their families the agony of 2007

Give to every human being every right that you claim for yourself.

Friday, 14 December 2007

Don't kill 'innocence' in the nest!

“May the dreams of your past be the reality of your future”

This last Health Select Committee meeting was full of information that one needs to reflect upon. One of which was when a panel member asked Sir Tooke whether intake into medical schools should be reduced; 'turn off the tap' because of the 'bulge' situation. Sir Tooke replied to the effect that we do not need a 'knee jerk reaction' and that decisions such as these need to be thought through so maybe this will not happen for a while if at all?

Of course whatever decisions are made, they will not impact on future would be medics lives in any way similar to this below:

Sir Tooke said (Not exact words): 'there was a sense drift to the right (because of the EWTD reducing time and hours of training), That there needs to be a 'pull back' regarding the acquisition of skills and responsibilities and that medical schools would have to make sure that current standards are even better and that they are putting people out there into F1 jobs who are 'skilled up'

So, Sir Tooke is recommending that practical experience and expertise should now be geared at medical school as well. Sir Tooke did not give any indication as to when he thinks this 'shift to the left' should be implemented, will this take immediate effect? How will this impact on current medical students? Would this in effect make life much harder for current medical students to pass their now even more 'toughened up' finals?!

Already, some Medical schools held meetings with all students end of the last academic year and warned them about the reality of the current job situation. One 'new' school even told its students that the 'GMC' visited and commented that 'the school was not failing enough people!' That day, the school of Pharmacy were outside distributing leaflets to entice medics to switch to Pharmacy school and leave medicine! Already, morale at medical schools is rock bottom, especially amongst more senior medics! Now, with this above! .... Worrying to say the least :-(

Although I trust that Sir Tooke has very good intentions, I feel that this particular bit maybe used by 'others' to reduce graduate numbers in the near future by making the final exams much harder 'kill them in the nest' sort of thing! ... Terrifying!

This would be grossly unfair to the current medics who have already invested effort, time and money studying medicine and aspiring to be doctors. I sincerely hope this will not happen.

Policy makers:

Turn off the tap if you must, but don't kill 'innocence' in the nest for this would be a great atrocity!

“Once social change begins, it cannot be reversed. You cannot uneducate the person who has learned to read. You cannot humiliate the person who feels pride. You cannot oppress the people who are not afraid anymore. We have seen the future, and the future is ours.”

Wednesday, 12 December 2007

A pedigree way above the competition!

“A pint of sweat will save a gallon of blood.”

With the number of posts released by the DoH being so low; 8,800 inclusive of FTSTAs who maybe half, if not more of the total number of posts! And since there are, at least, 25,000 applicants; assuming only 1000 European applicants which is probably an impossibility as I think there will be much, much more than this now that MTAS has announced to the world that the Brits are not protected in any way, that anyone can apply to British specialty training ... for free ... and get paid on the way too! Even the Germans are coming or so I hear!

This year, if training posts are not increased, there will be around 17,000 disappointed doctors in Britain! With around 6000-7000 being British graduates; 4000 from the 2007 plus those who will be displaced in 2008!

What does the government intend to do with all the doctors who do not secure training this year?! What do you do with 'untrained' doctors?! Why is the government pushing thousands of bright and very expensive to the British taxpayer doctors into dead end careers when they can aspire and reach excellence?!

While I was watching the HSC's last meeting again, I noticed that one panel member said that Malaysia was wondering how did Britain get itself into this situation and that Malaysia has now decided not to send its brightest to learn Medicine in Britain anymore! I don't blame them! How did Britain get itself into such foul-up?! In only a few month we went from a country with steeped tradition in medicine to one that should be completely avoided!

This hurts .... a lot! We had worldwide reputation for excellence in medicine and medical innovation only a few months ago. Other countries lined up to send their brightest and most promising to Britain to get a taste of this excellence and bring it back home ... but no more :-(

In only a few months we managed to destroy centuries of tradition and all the hard work of those who built British medicine to 'world class', to a class way above the competition. The world is watching with dropped jaws as we seem to be on a mission to self-destruct and, judging by Malaysia's comments, Sadly, it also seems that we are succeeding at that! Shame!

It's like having a pedigree horse who can win time and time again, but, rather than nourish it to prosper, you shoot it in the head and kill for absolutely no reason! Crazy!

In an effort to protect British graduates, the government is seeking legal advice on whether it can charge fees when overseas graduates come and train in Britain. I think this is a very good idea and I suggested this myself before. Not only because this will protect our graduates but also because all other courses in our universities do charge so, why not medicine? Common sense. Charging will probably allow the creation of new specialty training posts specially for overseas doctors coming to learn in Britain and, if the price is right, the fees charged will also contribute towards the cost of creating more training posts for our graduates.

Let's reverse the bad trend, we can return British medicine to lead again, just allow our doctors the opportunity to 'aspire to excellence' again, to return British medicine to the position it always had and still very much deserve ... to lead the world with 'World class' golden standards.

It's British doctors that made British medicine the best in the world and they can do it again .....

British doctors ARE the best

.... Let them!

Save British junior doctors; Save British Medicine

“What difference is there between us, save a restless dream that follows my soul but fears to come near you?”

Sunday, 9 December 2007

Talking numbers ...

“Anarchy! Revolution, Justice, Screaming For Solutions, Forcing Changes, Risk, and Danger, Making Noise and Making Pleas!”

The DoH has now released its 'guidance' re the specialty training for 2008. The MMC website will open mid December with more guidance and confirmation of number of posts, there was no mention of overall number of applicants.

The majority of places are at ST1 level but anything above looks bleak to say the least. There is no limit on how many applications an applicant can make or any restrictions on regions. Uncoupling is being introduced in some specialties while others will remain as run through. Unlike in 2007, there is also no restriction on 'experience'; ie, no upper limit as in 2007

The document emphasizes the fact that the DoH is working with all representative bodies to ensure the application process runs 'smoother' than in 2007. I sincerely hope they succeed in doing this as 2007 was 'torture' that must never be repeated.

There are 5800 ST1 training posts and 5000 foundation doctors but it is anticipated that competition from more experienced doctors wanting to change specialty will push the competition ratios for these and other posts higher of course.

It seems therefore that the 3:1 prediction is somewhat reserved even at this level as there are not many opportunities available at higher levels. With 600 places only at ST3 as well as only 2000 at ST2, there will probably be more than anticipated applications from those who want to get on the training ladder even if this means starting from the bottom at ST1. There is only 8,800 places in all as per this document in the link above, Inclusive of FTSTAs. However, the dept stresses that these are only indicative figueres and that the final figures will appear on the MMC site. It also says that there will be more opportunties throughout the year especially for ST3 doctors. No indication to those numbers was mentioned. I hope these will not be similar to the 'substantial' opportunities that Ms Hewitt announced for round 2 in 2007!

How many applicants are applying in all this year? We know that 14,000 from last year will apply in 2008. The department states that 5000 foundation doctors will also be eligible to apply as well. This is a total of 19,000. There is no mention of the number of other applicants who may have not applied in 2007 but will apply this year either from within the UK or from abroad.

Even if the numbers are similar to 2007, meaning, around 34,000 in all, then the competition ratios are already higher than 3:1, actually nearer to 4:1 and this is only an average! This ratio will be much higher the higher the level of application because all positions are already occupied by the 2007 intake.

With regards to the process of applying itself being so open and unlimited, if you bear in mind the psychological effect on all applicants knowing that the number of posts is this low, then expect them to apply everywhere and to all levels possible. 2008 will most probably see hundreds of applications per applicant and per post?! How can the logistics for this be managed 'smoothly?!'

Well, NACT, the National Association for Clinical Tutors is proposing a lottery to select every tenth applicant for interview! Funny that, since NACT's logo is, "supporting excellence in medical education" ... and this is one way to ensure 'excellence' of course, isn't it?!

The DoH says it will instruct all deaneries to 'forbid' such practice (As suggested by NACT.) Great!... How will this be done then? What measures have been/will be put in place to ensure 'fairness' ?! Is it possible?

The DoH also states that it will need lots more doctors (Career posts)in 2008, could that possibly be because there will be a 'shortage' from the beginning of Feb 08 to August as discussed in the HSC's last meeting?

This above, is expected to run 'smoothly', right!

Lets wait and see ...

Meanwhile, can someone explain the meaning of these two words to me please:

, Carnage

Thank you

Enjoy, it's the season to be merry .... and the season before January 08 too ....

“Things fall apart; the center cannot hold; Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned; The best lack all conviction, while the worst Are full of passionate intensity”

Saturday, 8 December 2007

Wakey, wakey ...

Remedy UK giving the BMA a wake up call?

Just wondering, why didn't the BMA attend the Health Select Committee meeting and I think, not the first one either! A bit strange, isn't it?! Since both were very important meetings, the decisions of which will probably help decide the future of medicine in this country!

One panel member at the Select Health Committee asked Matt of Remedy UK the reason why their organisation was formed and of course, we all know why; Because the BMA did not stand by and fight enough for the thousands of junior doctors who were discarded by MTAS. Even when Remedy was formed to play this much needed role, rather than encourage and help, there was still not enough support for the affected juniors. Of course, no one will ever forget how the BMA then sided with the government against the juniors during the judicial review.Thousands resigned from the BMA because of all this and joined Remedy instead.

Recently, the BMA denied Remedy the chance to advertise in the BMJ, despite the fact that Remedy played a very important role during the 2007 debacle. Of course Remedy would not have existed had the BMA provided enough support for the juniors.

IMO, The BMA is in deep sleep inside its 'chic' and rich quarters. Why doesn't the BMA realize that times are changing and that they too have to change if they are to keep all their members. If medicine is being modernised, why doesn't the BMA modernise too? The BMA is a rich organisation with £155,000,000 in assets and around 140,000 members, while Remedy started from nothing, they now have 15,000 juniors on their books, a little office and some IKEA furniture plus £50,000 in the bank, all achieved in a few months. The BMA should remember that "from a little acorn grows a mighty oak" and Remedy, this is probably the best furniture sale Ikea has ever made :-)

As a doctor's union, why does the BMA's logo say "caring for the NHS" rather than "caring for doctors?"

It seems that Remedy is the bird that is giving the giant bear a big wake up call but, will the giant bear wake up?

“Some people dream of success while others wake up and work hard at it.”

Friday, 7 December 2007

Celebrate achievement ... reward 'excellence'

“Innovation is the whim of an elite before it becomes a need of the public.”

In his review, Professor Tooke, stresses the importance of striving to excellence, hence, called his interim report just that. He was probed about the use of the word 'excellence' for a good few minutes at the Health Select Committee meeting. He took the opportunity to explain that British medicine must strive to excellence, that competence is not enough but must lead to proficiency and this can only be achieved by aspiring to excellence. He stopped short of saying the truth as it really is; that the whole 'initiative' of MTAS and MMC 'stink!' Big mistake, the lot!

MTAS 'despised' excellence and MMC aspires to mere 'competence' through the tick box culture, so, if adopted, Britain would lose it's place as a 'center of excellence' for teaching medicine and medical innovation, ie, British medicine will go from being the 'best' to probably the 'worst' in the world .... Who is responsible?!

No, no, STOP MMC and return British medicine to its 'former' glory.

The panel members took this further in the second half of the session attended by Remedy and Fidelio. Professor Steven (surname?) representing Fidelio was asked whether having a first class degree and higher academic qualifications ensured a good doctor and straight away, he firmly said:

"YES!" ...
"From my experience with my trainees, there is strong correlation between achievement and a good doctor, those who strive to achieve also strive to do their best for their patients ... (not exact words but something similar) ..."

.... and the panel member agreed and commented this was his own experience too! ...

Recently, the mere mention of the word 'elite' was 'taboo'; the word nearly became a swear word! Hush, hush, don't use this word. Because it was perceived to be the domain of the aristocracy and the very rich only and those are perceived to be somewhat separate from the norm. But, in my mind, anything done to 'outstanding' standard is 'elite'; an Olympics athlete is 'elite', an outstanding artist or writer is elite, academic excellence is elite and so is clinical excellence, so, yes; doctors 'are' elite and must remain so if we are to put 'our lives in their hands!' We must never allow anyone to put our lives into the hands of anyone who is below 'elite' standards .... right? ;-)

I salute you for this stand Sir Tooke, Prof Steven and that panel member. Let's celebrate achievement, recognise and reward excellence. Let's all 'aspire to excellence' ... in any thing we do; not only in academia but in all walks of life, in dealing together, with others, with the state, the state with us ....

This is how great nations are made and .... this is how they last!

Sir Tooke recommends that the role of a doctor in training should be redefined within the team, to reflect their abilities and attributes. We need to do just that if only for the sake of the patients who need to trust that they are in 'good, capable' hands. Redefine the role of other health professionals too so that they can go back to what they were trained to do best rather than meddle with doctor duties as this will only cause harm. Let's not blur roles as this only leads to loss of accountability, loss of resources as well as loss of good standards, of safety leading to the filth we see in our hospitals today. .... Elite is 'cost effective.'

Let's revive the concept of 'elite' ... elite is good, let's not shy away from using the word, being proud of reaching high standards and celebrating it too!

... spread the word :-)

“Each honest calling, each walk of life, has its own elite, its own aristocracy based on excellence of performance.”

Wednesday, 5 December 2007

Remedy gives evidence today

“Always do right. This will gratify some people and astonish the rest.”

Remedy UK has now published it's second Podcast, again by Professor pounder. It is entitled 'the medical production line' This is a 'must read' piece because it explains current and future junior doctors numbers, what the future holds and why Remedy UK is taking its current stand re IMGs as well as the options available to solve the problems.

As for Remedy's stance re IMGs. Professor Pounder says, there are roughly 10,000 IMGs currently in the system at different stages of training. If they apply according to the existing ratios of 60% hospital medicine and 40% Gp, then 6,000 will apply to hospital medicine at all levels; ie, 2000 to ST1, 2000 ST2, 2000 ST3 and above. Same goes for the 4000 applying to GP training. Professor Pounder takes the same view as Remedy that this is a small number that can be absorbed and does not greatly impact on the total numbers applying in 2008 and beyond. Remedy UK supports that no more IMGs should come to the UK in the future.

My own understanding of the above is, if the same patten of 2007 repeats itself again in 2008, then, I can see where Remedy and Prof Pounder are coming from. In 2007 when competition for posts nationally averaged 2:1, roughly 15,000 IMGs applied to specialty training, of those, around 5000 were successful and 10,000 were not, ie, their competition ratios was actually 3:1. So, if the trend continues to 2008, it means that only 30% of the current 10,000 may be be successful; roughly 3,000, or 1000 per level of training (ST1,2,3) 650-700 for hospital medicine and roughly half that for GP. But that would probably be the maximum if you consider that since competition ratios this year are predicted to be 3:1, then one assumes that theirs will be higher by 1-2 denominator points, ie, 1:4 or even 1:5, given the impact of the media coverage on the 2007 selection. With the 1:4 ratio, this will mean 2,500 in all stages of training, divided 60/40 as in 2007 or 1,500 for hospital medicine, roughly 500 at st1, 500 ST2 and 500 ST3 and beyond plus 1,000 Gp divided at 333 posts at each stage. Since they have won their appeal, it is illegal to exclude them from training but as they are only predicted to secure a small number of posts and their numbers will phase out when they graduate training anyway within a decade, this is probably why Remedy has taken its current stance even from before the result of Bapio's appeal.

I am still of the opinion that, given the current climate, maximizing opportunity for British graduate must remain a priority. Thus protecting our graduates should not be left to chance, therefore, rules should be put in place to as soon as possible to ensure this protection. After all, we also have no idea how the Europeans will behave in the future, or indeed, what the future itself holds.

In the remainder of the Podcast, Professor Pounder gives a good analysis of the 'production line' from medical school to specialist level and the impact of the greater numbers graduating from our schools on the next decade. He explains that with the increasing numbers of graduates, there are three solutions:

  • 1- Make the surplus redundant; ......... no, no!
  • 2-Introduce a middle grade, .... careers will stagnate, again no, no!
  • 3- Aim for a 'specialist delivered' NHS; all trainees are given the opportunity to train until fully qualified as consultant or GP then work for the NHS, where medical decisions will only taken by fully qualified doctors who are also working in rotas to satisfy the requirements of EWTD.

Option 3 is what Remedy is fighting for. From the above, it seems to be the only viable option; given the current mess. Of course Remedy is trying to save the day the best way possible. they will attend the Health Select Committee's session tomorrow 6 December 2007 at 11.15am to reply to the 'CMO's' evidence, presented to same last week.

Go for it Remedy heroes, you have 'right' on both your sides, you can do it .... Just bite where you stand and the giant will come tumbling down.

“What you need to know about the past is that no matter what has happened, it has all worked together to bring you to this very moment. And this is the moment you can choose to make everything right. Right now.”

God bless you Remedy

As thick as a brick!

In a time when 4000 of our medical graduates were denied specialty training in 2007 because work force planners miscalculated the numbers we need then went ahead and invited huge numbers from overseas, while at the same time increase the number of new intake into medical schools, as well as shortening training time and changing the training system AND giving junior doctor traditional duties to nurses and reform the whole NHS ... etc, etc!

Does anyone have any idea who was the 'genius' who thought the above was not enough to achieve the desired magnitude of the 'cockup!' 'They' nonetheless went ahead and decided to also make 'some' F1 doctors apply for their F2 posts in January 2008? Allowing yet more people to come from all over Europe to be in direct competition with our poor graduates?!

E-mails to that effect have already been sent to those F1 doctors. As far as I understand, it is predicted that some of them will not secure an F2 posts this year...... Because More European graduates than anticipated have decided to apply, hence, some of ours may be displaced in the process! Those in the know' say that it would be illegal not to allow doctors from Europe to come and train here but what they don't say is that, had 'they' guaranteed the affected doctors their F2 posts, the Europeans would come 'only' if places were available!

You know, when I tell the story of what is happening to UK medicine to doctors abroad, they do not believe me, they don't believe things can go that wrong, can be that 'messed' up in BRITAIN, no less! .... and the saga continues ....!

As no one group can be so stupid, it makes you wonder, are 'they' 'dumb' or 'devious' ?!

Politicians and decision makers at work

Any idea what to do next to get us out of this trap?!

It seems that I have made a mistake as not all F1s are having to apply for their F2 posts in 2008. I have now amended this post.

Thanks to Levans who posted a comment to draw my attention to this.

“See how the sacred old flamingoes come,

Painting with shadow all the marble steps:

Aged and wise, they seek their wonted perches

Within the temple, devious walking, made

To wander by their melancholy minds.”

Tuesday, 4 December 2007

Remedy's reply to the CMO's evidence

“God places the heaviest burden on those who can carry its weight.”

I've just received Remedy UK's "The script" Very important read because the 'mess' is much bigger and beyond the wildest of imaginations! A proper nightmare! The reason I include this bit here is for every one to watch out for Remedy's reply to the health select committee, details of when and where below.

'Liam Donaldson, Chief Medical Officer, gave verbal evidence to the Health Select Committee on MMC. From the public viewing area one could see the beads of sweat on his forehead as he came under the MPs spotlight.
Commenting on MTAS he said that it had been "very, very distressing experience for all the junior doctors concerned, and for those of us who care about people". When asked if it had been rushed, he answered that "With the benefit of hindsight, I think probably one thing that should have been done was that the implementation should have been phased or staggered over a period of time". He deflected a question on FTSTAs by saying these jobs would "prepare a doctor very well, I think, for entering the training rotations which are the longer term posts". To some questions he more evasive answers. To the question "Do you accept that recent workforce planning in the NHS has been "disastrous"? If so, who is responsible for this?" he replied "Perhaps I could ask Ms Chapman to come in on that, as the Director of Workforce." Finally Sandra Gidley MP tried to put the boot in. "Is an apology enough? Seeing as you were the architect of the MMC reforms and also the person ultimately responsible for overseeing their implementation, should you not have actually resigned?" Sir Liam replied "The principles and the policy were commended in the Tooke Report and by others, so I do not think the question of criticism of the policy arises. As I indicated to you, accountability did not rest only with me, it was spread quite widely, and I have already given a pretty full analysis of that in response to an earlier question. Policy in relation to the two factors that made the biggest difference, I think, in the crisis were on international medical graduates and on the design of the application form, and those were not matters where I had overall or sole responsibility."

Next week Remedy will have their opportunity to tell the MPs our side of the story. We are giving evidence along with Sir John Tooke to the Select Committee on
Thursday 6th December. The session starts at 10.00 and we will be appearing at 11.15. The session is open to Press and Public and is being held in Portcullis House, adjacent to Westminster tube station. It will also be broadcast on the Parliament website.'

... Go for it Remedy UK and
........GOOD LUCK .... our hearts are with you

“A leader is one who knows the way, goes the way, and shows the way.”

Sunday, 2 December 2007

The doctor of tomorrow

I think Lord Darzi is 47, right? Yet he looks much younger than this. Of course success is nice. When you are successful, expertise leads to confidence, coupled with achievement and financial stability, gives you that distinguished 'eminent' look, you're powerful and bright and it shows, there is this very special aura surrounding you; it is your very own 'body guard', you are 'untouchable!' Its because you feel satisfied with yourself which leads to looking and feeling that good. You had and still have opportunities to better yourself and reach the sky, and you took them and with hard work, you reached your dream, and look so radiant for it too. His is the look of inner satisfaction because life has been fulfilling, so good. No one is standing in his way, no one wants to steele his dream ...

But, this is the doctor of today who 'had' opportunities and used them well. Would life turn the same way had 'he' been the doctor of tomorrow?

Not if he is the product of the 'tick box' , the 'no hoper' of tomorrow thanks to MMC! The doctor of tomorrow will be bored, stressed, depressed and very frustrated, he will age well before his years. A conveyor belt operator who is not allowed to have a brain; 'tick box', tick box, tick, tick, tick ... everyday and every year .. forever! No opportunities open to him; you know before hand that your limit is in the middle, a sub-consultant subservient 'worker' in a center for 'bring'm in, churn'm out' 'people' with disease. Probably no longer called patients but 'clients!' But you don't really care because you're so frustrated to care and because your 'small' part is all you need to learn then do. Someone else will take over from you, so, let them do the worrying. It has been defined and ' tested and tested', so, you are very 'competent' in your little part. End of the month, you get your miser pay and disappear till the following day and so on, ... and so on, .... and so on ...eternally! . You have nothing else and no opportunity to 'know' anything else, after all, they do not want you to! This is why your firsts and your PhDs don't count! Now, back to your tick, tick, tick, tick ... tick .... stagnate, tick, tick, tick ... forever, rhyme with it or die! The doctor of tomorrow will look like picture 2 above probably by the age of 35. He won't be able to afford this suit, shirt and tie either nor join a golf club! ... Lucky you Lord Darzi, you're the doctor of today and not of tomorrow.

This is frightening ...

When devising MMC, did anybody think about what will the doctor of tomorrow do with his/her brains?! since MMC requires them only to tick, tick?!

Strange, medical schools still select the creme de la creme of brains in this country! Why then?! Why aren't medical schools selecting more suitable candidates; the dumb, instead, to suit the tomorrow's doctor role and lifestyle, to suit MMC?!

Will tomorrow's doctor be really safe for patients in his care if MMC is allowed to continue?!

STOP MMC! The 'real 'no hoper!'

“When life demands more of people than they demand of life, what results is a resentment of life almost as deep-seated as the fear of death”