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

Friday, 29 February 2008

No one was impressed!

“Who in the world am I? Ah, that's the great puzzle.”

The DoH agreed unconditionally to some of the recommendations and kept some on hold, either for Darzi to decide upon or for the government to give more consideration 'sometime' in the future. Why will Darzi be given this extra task is unclear, since Darzi would seek the help of his advisers who can not possibly be any better than the totally independent Sir Tooke anyway! Can Darzi achieve an overall 87% agreement from across the medical profession?

Sir Tooke did not comment on this particular bit in his response but, you could tell from he wasn't really impressed by the government's response even after meeting with The Secretary of State to discuss same despite being given 'some' open ended assurances, including:

"deal fairly and effectively with the bulge in would-be specialist trainees"

How? No mention. But, if Remedy is stating there will only be 300 more posts, how is this fair and effective for 12,000 affected doctors? The government's response does not explain what it intends to do to ensure that those doctors will be dealt with effectively and fairly. Of course, the Lords are meeting today to consider the government's appeal against Bapio's win but even if it wins at The Lords, what other measures are in place to ensure fairness? None mentioned.

Prof Ian Gilmore commented:

"The profession remains extremely anxious about resolving the considerable residual issues from the disaster of the implementation of MMC and MTAS in 2007. There is an impatience to move on with these crucial Inquiry recommendations, some of which are now subject to further process. All are agreed that through these changes, the ultimate goal is to improve standards of patient care."

While The Royal College of Surgeons said:

"The college also supports the measures put in place to rescue those trainees who have been caught up in MTAS, but the numbers of training places and extra posts is paltry. Surgical trainees this year are facing competition ratios far in excess of ten to one which means that many of those who would have gone on to specialist training in previous years now face the untimely end of their surgical careers, a huge loss to the NHS. This College has warned successive Secretaries of State about the scale of the problem and this is too little, too late."

So, why didn't anybody do anything about this then? Like stop the flaw of IMGs when the problem of increased competition was known as far back as ' successive Secretaries of State?' What will become of all those trainees midway through their training?

In section 5 'workforce planning' of the response, the government elaborates on its ongoing efforts to give priority to the Brits before considering IMGs but will this alone help? ... not unless there are currently 9 IMGs of the 10 applicants per surgical post on offer, for example. Which is not the case, so, even if you give all the available posts to the Brits, there will still be a large percentage of disappointed excellent trainees! Apart from the trust grade, what other alternatives are there for the disappointed doctors?

"The Inquiry noted the need for consistent policies for the workforce and for those policies to embrace a long-term vision for its size and structure. The vision should be linked to service objectives and to the other roles doctors undertake, including those in management, education and research and overseas work."

Does this mean the government, with regard to doctors, encourages the brain drain out of Britain?

As for redefining the role of the doctor, well, this was vague and extremely open ended:

"Current trends in the health system, including changing demand patterns, more care delivered closer to home, the introduction of new technologies and increasing managerial complexity, will require changes to the ways in which clinicians deliver healthcare in the future."

Oh, look! The Auzies have a problem with their increase in medical school intake and specialty training numbers too! ...

Spoooooky! ;-)

“I am looking at you,
You at him,
How to solve
This puzzle--
You, he, and I?”

Thursday, 28 February 2008

DoH response, general view

“Right is right, even if everyone is against it; and wrong is wrong, even if everyone is for it”

Everybody has been waiting for the government's response to the Tooke review which finally came out today .. and everybody was 'cautiously' hoping that since the government commissioned the review in the first place ... and since Tooke and his team were totally independent ... and since the whole of the medical profession welcomed the final report nearly in its entirety, that the DoH would announce it would be implementing same, almost in its entirety and as soon as possible ... but, this was not the case.

In the introduction to the response, Alan Johnson said:

"Sir John's report marks a significant step forward in ensuring excellence and high achievement remain at the heart of medical education and training in this country."

Ok, very encouraging, that The Secretary of State for Health acknowledges the fact that excellence and high achievement are a vital factor for best training to maintain the excellent British standards. Of course, one can only thank him for finally deciding to protect British graduates so that they can have a real opportunity away from unfair competition to aspire and achieve excellence .. as habitual. But, even Mr Johnson has acknowledged that this protection came late and is unlikely to affect the 2008 or even the 2009 recruitment! This then begs the question; since you believe in ensuring excellence Mr Johnson, why are you allowing the current mess to discard thousands of the brightest brains in this country in 2008 and 2009 and beyond when 70% more graduate our schools? Besides going to The Lords in an attempt to overturn Bapio's win, what is your plan B to save those capable of ensuring excellence but will lose out because there is not enough posts and not through a fault of their own? Surely, if you believe in the importance of ensuring excellence then you believe that those 'must' be saved?!

I have not finished reading the full response yet but from Remedy UK's response, it seems that Mr Johnson is only offering only 300 more posts or only 3% of the number of posts needed to save 'everyone' affected; 12,000 juniors. The figure includes the IMGs who may lose out but even if you exclude those ... according to the DoH figures, between 1,500 and 2,000 Brits will be displaced this year ... If we assume that all of those extra 300 posts will go to them, then this is still only around 15%. Hence, 1700 aspiring to excellence doctors will still be displaced? How is that 'ensuring' excellence Mr Johnson?

Of course these figures do not take into account those with FTSTA posts who will also lose out if not suited either this year or in future years or when the only option available to them will be to take employment in dead end trust grades. What a waste of talent! Especially that the DoH knows fully that those doctors include a large number of top achievers who's only fault is/was applying for highly competitive posts because they know they deserve them .. and they do, but there was not enough! ... their only fault was to aspire and hope to achieve excellence , as habitual to them!

Do those 'high achievers' who are fully capable of 'ensuring' excellence deserve to be thrown to the trust grade lions?!

No, hence Remedy's response through Dr Chris McCullough:

"To attempt to spin government inaction in this area is insulting in the extreme. To offer posts to as little as 3% of these doctors is offensive. This is not a ’transition bulge’ it is the lives of junior doctors with families to support and dreams to fulfill. These are our friends and colleagues who are being offered little chance of pursuing their lifetime dream. These doctors should not be forced to pay the price of failed Government reforms. The Secretary of State for Health has failed to provide any hope for the profession. These doctors will not work in dead-end jobs with no hope of a career. Unless this is addressed now, we will lose a great deal of talent, and ultimately patient care will suffer. "

Remedy is mass lobbying Parliament on 18 March 2007

.... to be continued ....

“Stand with anybody that stands right, stand with him while he is right and part with him when he goes wrong.”

DoH response to Tooke

Government responds to independent review of Modernising Medical Careers

"The Department of Health today published its formal response to Sir John Tooke's independent review of Modernising Medical Careers (MMC).

The former Health Secretary, Patricia Hewitt, announced the review in April last year in response to difficulties with specialty training recruitment in 2007. The review was tasked with examining a number of areas, including the extent to which MMC engaged the medical profession, as well as making recommendations to ensure MMC had the support of the medical profession in the future.

Sir John published his interim findings in October 2007. He then published his final, more substantial report Aspiring for Excellence on January 8th 2008. This included 47 individual recommendations and the Department's response has considered how best to move forward on these. Many recommendations have received a direct response, while others require further consideration.

Health Secretary Alan Johnson said:

"Sir John's report marks a significant step forward in ensuring excellence and high achievement remain at the heart of medical education and training in this country.

"We are accepting most of his recommendations in full and have already acted to clarify our policy of self-sufficiency by introducing new immigration rules to restrict overseas doctors who wish to train in the UK.

"Some of the more substantial recommendations, such as proposals for an independent body to oversee medical education and training, require further careful consideration. This will take time, particularly if we are to meet Sir John's own tests that policy should be evidence-based, carefully tested and taken forward in consultation with the profession. We must not repeat old mistakes."

DoH Response to the independent inquiry into Modernising Medical Careers (in full)

Sir Tooke's response

BMA's response

RCS statement on the government response to the Tooke Report

RCP response

RemedyUK: Johnson plays politics with junior doctors training crisis

Wednesday, 27 February 2008

Choose and block!

"Conceit is the weirdest disease in the world. It makes everyone sick except the one who has it.”

"Hospitals across England are stopping patients booking advance appointments in an attempt to meet a Government target, it was claimed on Tuesday."

What do you know?! Wasn't it less than a month ago the media reported this was happening in 'a few' hospitals? ... Now that all the hospitals in England found the way, through the media, they are all now doing it! And ... the whole scandal is now being reported through the same media! Hospitals are blocking patients from making appointments so that they can 'pretend' to meet the very unrealistic imposed targets! 'Patient led health service' indeed! It's a 'target led health service' and since the target is impossible to achieve, the hospitals have found the way ... ! Very normal human behaviour; when presented with the impossible, go round rather than straight through! Policy is training decision makers in English hospitals on the fine art of cheating! .. and they've perfected it .. well done!

The health service in the country was a cherished treasure envied by the whole wide world when it 'was' professionally lead, when it was a 'consultant led health service.' But, for some reason, someone decided that this excellence was too much, too expensive, so, what to do? Let the sick and the needy lead! No one stopped to consider the logic behind the strange thought! The fact that the sick are in no position to lead!, because they themselves need to 'be led' back to good health!

A 'patient led health service' is a very 'sick' health service, is a dying health service that needs to be saved .... It well never survive in its current sick shape .. and the above is proof!

And .....

will prove to be the most expensive exercise the NHS has ever encountered

because it is a mess!

A 'Doctor led health service' is logic, professional, safer for patients and staff and, above all, most cost effective.

Why should Wales have a 'consultant led health service and we in England don't?!

Watch the Welsh video ... Watch for Dr Sharon Blackford stating that Wales is investing in a consultant led service

“The sick soon come to understand that they live in a different world from that of the well and that the two cannot communicate”

Friday, 22 February 2008

London Deanery needs you ...

"Can you help us develop a better shortlisting process for Core Medical Training?"

The London Deanery will be e-mailing all applicants in an effort to improve it's shortlisting process. Have a look ...

Good idea London Deanery ... :-)

Also, interviews have already started in some deaneries ... Good luck all

Tuesday, 19 February 2008

Hospital 'accommodation' for doctors


This is the only right description for what is called 'hospital accommodation for doctors.' Although I have been told, on many occasions, by my son and his friends, who all work in different locations and different cities around the country, that the accommodation was really bad, I have never expected what I have seen for the first time yesterday! Here is the 'story' :

As I have a people's carrier, I am used to the 'children' ... and their friends, asking me to remove the back seats and use the car as a van to move whatever stuff they need moved from one place to another. I usually lend them the car but, on this occasion, I went with a friend to help her son move out of the hospital accommodation into a newly rented flat because there was no one else available. This city is around 2 hours drive away from London and the young doctor needed to vacate the accommodation and move into his new flat yesterday. As this is a good friend of mine and I was free yesterday ... why not so, off we went together.

The doctor's accommodation is located in blocks of flats on the hospital grounds and actually looks quite decent from the outside and so were the staircase and corridors inside, but nothing prepared me once we stepped inside the actual flat!

As soon as you enter, the corridor was gloomy, the walls were marked everywhere and the walls had bits of fallen plaster that were just painted over for camouflage. All the walls were painted in either grey or beige but I couldn't honestly tell which 'original' colour was used many years back. There was also a really dirty and dusty old teak two shelve empty shoe unit left in no particular place to one side of the corridor.

At the end of this long, dark corridor, you come to what can only be described as a 'filthy' old kitchen with the most basic of units that were not even enough for the 3 doctors per flat accommodation. Those units were long past their sell by date, they were swollen everywhere and the edges were showing the chipped wood inside which was black due to the accumulated dirt and grease. There were only 2 of these units on the wall while the bottom just had a sink unit and space for the free standing appliances, which must have all been bought for pennies at a junk shop or gotten for free at a rubbish recycling center somewhere. The work tops were truly disgusting; burned or with gaps heavily touched with sealants everywhere, either in an attempt to hide knife or burn marks, or just to force them to meet where there were gaps. The 'style' came complete with an ancient, well marked sink and a pair of high taps covered in hard green 'substances!' .... you should have seen the ancient electric cooker or the hospital style vynil floor!

The bathroom was not any better either. It had an old scarred bath tub with grease marks all over, I thought the hospital accommodation officer should have put a sign up to advise anyone using it to wear rubber slippers before attempting to use the shower above and 'never' to actually sit in this bath as, I am sure, is unhygienic! There was also an old sink and this was it in this room! The toilet was separate and had no sink ... and was painted really sickly yellow! .... Was it on purpose that all pipes had to show everywhere?! Even the electrics were inside pipes stuck to the ceiling! ..... Awful!

The flat had a reasonable size yellow living room (The sickly colour) and the 'theme' continued with the mismatch of old junk furniture with an ancient wood and purple two seater suite with one damaged cushion, a well trodden red and blue carpet, A teak unit with 2 dusty black TVs on top; one hardly works while the other does not work at all but was just left there when the 'new' one arrived, a 'washing machine!' ... and, of course, the pipes everywhere 'designer style' continued with all the pipes, either around the skirting board or on the ceiling!

But all the above doesn't prepare you for the doctor's bedroom itself! I honestly have never seen it's like before! Surely, this couldn't be Britain! Perhaps a really poor third world country in the depth of Africa ... but then, they do value their doctors, I don't think it is fair for me to describe the room like that. What was most striking was the bed, a single old hospital metal bed complete with hospital edition old mattress wrapped, as usual, with polystyrene .... YUK! It seems that when the hospital was done using those beds for patients and when it probably became illegal to use them anymore, they were put in the doctor's accommodation! .. Horrible thought but,

I wonder how many people died on those beds?!

... No need to describe the rest of the room as the original 'theme' continues with the mismatch of junk everywhere ... Oh, one wall had painted over or stuck Evostick patches everywhere to finish the designer effect! This must have been done years and years ago because the paint, where painted, was old. They must have also used bits of left over paint back then because each wall was painted with a different colour and, if this was not enough, they painted over anything and everything they met on the way, screws, bits of freshly laid plasterboard that does not meet properly, all the pipes of course and even some of the bits of the carpets or vynil where they met with the skirting board! they even painted on the bits of food stuck everywhere in the kitchen! .... Horrible!

While moving, the young doctor told me that the rent for this accommodation got automatically deducted every month from his wages! I was also told that they did actually have a cleaner who 'cleaned' the common parts once a week but that you could hardly tell when they have been around!

How disgusting is that and where are the hospital health inspectors?!

How can anyone expect young doctors, or anybody else to live like this?! And charge them for it too! Now that, thanks to MMC and MTAS, junior doctors do not have much choice of where they work, the majority will probably have to live in the hospital accommodation if their new job is away from home. Some will not be able to rent outside, either because they can't afford the high rents or because their 4 months rotations are geographically too far apart. Sometimes even in different cities!

Renting outside is not easy either because the young doctors will either not be able to sign contracts for the minimum 6 months rents required by law or be forced to lose money if they had to leave for two months early to live close to the next rotation!

No wonder this young doctor was feeling depressed. He had to move, regardless of cost. As the hospital is not in a safe area, his new flat is now around a half an hour away by car and the rent is quite expensive.

Had this 'doctor' accommodation been 'animal' accommodation, I would have called the RSPCA!

One young doctor was 'rescued' yesterday. What about the rest?!

Not actual pictures above and below but similar IMO to what I saw yesterday.

I can't remember where I read it but, weren't prison cells modernised not too long ago?! Of course, prisoners would riot ... young doctors don't ...

Friday, 15 February 2008

I'm so flexy, it hurts! ...

“Blessed are the flexible, for they can tie themselves into knots”

MMC on progressing from ST2/CT2 to ST3 :

"If you do not accept the first offer from your local deanery, you will be deemed to have resigned from run-through training. This would mean relinquishing your national training number and your entitlement to continue to CCT (subject to satisfactory progress).

We would strongly advise that you consult your supervising consultant or clinical tutor before taking such as step. Current projections indicate that opportunities to enter training at ST3 level and above will be severely limited in 2009."

Phase 1 – Local selection (mid January –mid March 2008)
You will be asked to state your preferences from a list of ST3 programmes available in your local deanery. Your deanery will assess your skills, consider your preferences and allocate you to one of these ST3 programmes.
The post you are offered may or may not be your preferred option. You should accept this offer provisionally and then consider the opportunity to apply for other ST3 posts that will be advertised as part of the national open competition in phase 2.”

Not too bad then, opportunity for the 'trapped' however small since there aren't many jobs to go round anyway ... How about some more ST3 posts ... please :-)

The London Deanery extends the ST3 application deadline because ....

"the person specification for Trauma & Orthopaedics ST3 on the London Deanery website differed from the national person specification on the MMC website. In particular, “4 Months A&E experience” was included in the essential criteria in the “Career Progression” section of the person specification on the London Deanery website. The person specification on the London Deanery website has been withdrawn and the shortlisting scoresheet has been amended to reflect the national person specification.

And the BMA has kindly given guidance and referred applicants to the London Deanery re:

22/2/08 Information for London KSS run-through trainees:

Click Here for the Link

Well, they're only 'human' after all ....aren't they? ...

“I might not this believe

Without the sensible and true avouch

Of mine own eyes.”

The Brits are not afraid of China!

“A master can tell you what he expects of you. A teacher, though, awakens your own expectations.”

Since the results of MTAS were known in 2007, I have campaigned with some other parents for the Brits right to speciality training before considering doctors from overseas. This wasn't because we are right wing or have a 'special' agenda or hold any grudge against others here or anywhere but because we look at things from a parent's point of view. For a parent, protecting the 'off spring' comes natural and for the majority, it is the number one duty of parenthood. So, in a way, Britain has decided to protect her children ... fair and just ... this is what parenthood is all about, isn't it?

Very early on in 2007, as soon as the shortlisting results were known, we parents knew there was a problem with numbers because they didn't add up. We were aware of the lack of posts in 2005, then in 2006 when juniors sent hundreds of applications only to be disappointed at the end. We all then realised that British graduates lost out because the doors were wide open to overseas applications. This is when it became obvious that unless the Brits were protected somehow, the situation will go from bad to worse , even spiral out of control, which it did and still is.

Now that the Brits will be protected and most likely be granted priority to British training when the case is presented by the DoH to The House of Lords end of this month, It is probably time to say that had these measures not been taken by the government, both groups; the Brits as well as the IMGs would have pulled each other down a merciless black hole with no one saved at the end. At least this way, everyone know where they stand, the Brits know there is still competition because of the current mess and the looming increase in those graduating British medical schools and overseas doctors know that there is not enough posts to go round now in Britain. Hence, those are now at liberty to make a well informed decision either come to 'work' in Britain to fill gaps, or decide to go to other countries to train.

Everyone benefits and everyone has a better choice.

This was a hard decision that 'had' to be made to save our sons and daughters for our future. This is only fair, natural and is the right thing any good parent would be expected to do.

So, there was no racisim, no discrimination or anything sinister at all. All countries favour their own citizens and Britain should have done that a long time ago when she decided to be self-suffecient. Had this happened then, the agony of 2007 would have been avoided and the anticipated agony of 2008 and beyond would have been unthinkable.

That said, the problem of numbers remain unsolved and the dilemma is, we are now short by a number equal to those jobs awarded to overseas doctors in 2007! The Brits need 3700 jobs just to break even. Otherewise, this loss will always be carried forward year on year. The Chief medical Officer said, on many occasions, that we need more doctors. Last year, he also said that more training posts to match the increased numbers of graduates will be created. Where are those posts? Planners and employers starkly contradict the CMO! Makes you wonder, who is in charge of what? There is no solution so far nor is the DoH attempting to create more jobs to save the situation this year as per the CMO's promise last year! Unfair, since someone, somewhere must have known that you can't keep the door wide open while implementing a policy of self-suffeciency. It is just unbelievable that 'Britain' of all countries could have over looked something so fundemental; simple mathematics; adding up numbers!

There has been rumours that the government is flooding the market to drive down wages, this has even been suggested by the Health Select Committe panel during the fifth session and the question was evaded by the employers and the planners. I personally can not believe that Britain would do that to her children; sacrifice them for money.

There has also been rumours that we might be afraid of the rise of the might of China and India but, IMO, the Brits need not fear them. the Brits have always aspired and achieved excellence, since the industrial revolution and up till now. We have a worldwide reputation that well reflects British ability. Let them buy polyester from Taiwan and 'best' pure wool from the Shetlands. The Brits will always have their market and this will never be in polyester. We do have the true and unrivalled reputation for the best in engineering, the best in industry and, of course, the best in medicine, medical treatment and innovation that is unrivalled anywhere else in the world. It would be such a shame to dismantle this great heritage because we want to face up to the rising of China and India!

Britain is 'quality' ...

... The Brits are 'not' afraid of China!

Protect the whole of this new generation, our sons and daughters ... teach them the way and they will protect our future. Give them the tools then the opportunity, then hand them the torch lighting bright .. and, teacher ... sit back and watch our sons and daughters keep Britain's head high, as their parents and grandparents did for many centuries before them ...

The Brits 'do' reach heights others can only dream of reaching ... the trend 'will' contine

I very much believe this ... because it IS very true ...

Let's maintain our excellent standards and teach the world, including India and China ... as we have always done!

“Teachers teach more by what they are than by what they say.”

Tuesday, 12 February 2008

Medicine IS for life ...

“Dreams are like may never touch them, but if you follow them they will lead you to your destiny.”

Around a decade ago, the BBC made a documentary about 10 young medics whom it followed right from when they first began medical school and until they graduated and started their first jobs. The BBC then went back again a few years later to see where they were and what they were doing a few years after graduation ...

What I remember most was the 'apprentice' medical education the medics followed. A consultant going round the wards followed by his entourage of very eager to learn young medics who took every opportunity to engage with the patients and respond to their teacher's instructions with great interest . An able teacher who wanted his students to excel and reach their maximum potential. To learn and properly through his careful and very precise instruction , then demonstrate their acquisition of knowledge to him, which he then corrected, added to and built upon for them. The young medics were always under his microscope, not only academically or clinically but also their person. The good teacher insisted on good communication amongst them as well as with the patients and other staff. He wanted clear abilities to communicate using proper written language as well as proper spoken language, no umms or slang was allowed, the teaching was to perfection. The hours were very long, the work was tough and the study was endless .... Not many complaints though, you could tell they loved it, even wanted more and more.

The consultant was a capable, hence, a confident person who wanted his students to be the same. To him, knowledge lead to confidence, so he pushed his young medics to excel and they did. A beautiful sight on graduation day, young confident doctors properly trained to be entrusted with people's lives, to be entrusted with healing the sick, but to also fully realise their limitations and don't shy away from calling for help. Throughout the programme, the medic's strive to learn was outstanding, absolutely amazing. There were smiles and their were tears but they all done it at the end and passed the toughest of finals ... the happiness, the joy ... and very well done too. The teacher was happy to teach and the apprentice was happier to learn . perfection!

When the programme went back again a few years later, the majority were still in postgraduate training but, I remember that one of them had already qualified as a GP. The documentary ended with this young GP saying .. "Here dad, I got my job, for life!"

My eldest son wanted to apply to medicine so, we used to watch together every week. I suppose this programme was a factor in his final decision because he became fully convinced that medicine was the only thing he wanted to do despite the fact that he was and still is brilliant at economics and would have excelled at this too but, .... medicine was his destiny ... and still is, despite the heartache of 2007 and despite the uncertainty of the future.

I am not a medic so, I can't understand when I hear some doctors say, oh, please don't say we want 'easy' lifelong jobs because people don't like to hear that ...

But, who said medicine was ever easy?! Medicine is a life long commitment, lifelong learning, Lifelong hard work, life long dedication and lifelong total surrender of one's self! Medicine, of all professions, can not just be discarded on order or be swapped for something else! It's about helping people get over their weaknesses, about healing! .... almost holy ...

How can you discard that?! How can you tell someone they can no longer be what they have aspired all their young lives to be and do?! Not possible, not now, not when they have fully qualified as juniors and have the ability to save and heal! ... and heal their own selves on the way?!

The government says that 1200 junior doctors were displaced last year. That a similar number will be displaced this year .. and next year ... and the next ... and the next .... and on, and on ...

Those young doctors will know of their fate soon. How very sad and what a terrible waste! Don't decision makers know that medicine is for life?! That medicine is their life?!

Medicine IS a 'calling', it's 'destiny' .... you can't just walk away from that ...

Decision makers, please save our young doctors ....

“Watch your thoughts, for they become words.
Watch your words, for they become actions.
Watch your actions, for they become habits.
Watch your habits, for they become character.
Watch your character, for it becomes your destiny.”

Sunday, 10 February 2008

Priority for the Brits

“Believe nothing, no matter where you read it, or who said it, no matter if I have said it, unless it agrees with your own reason and your own common sense.”

The government has started a consultation aiming to find the best way of managing graduates from outside the EU and wish to train in the NHS. The consultation was published on the MMC website on 6 February and runs until 6 May 2008. The government has distributed copies to all organisations who maybe interested and/or affected by the final decision once this is made. A list of all interested parties is included in the consultation document. It is also encouraging individual participation and has included a form for this purpose.

The government has throughly considered 'most' options as you can see in the document but prefers the option of giving priority for training to certain catagories, including British graduates first, then consider those from outside the EU only if suitable candidates were not found.

For the purpose of the consultation, postgraduate medical training is defined as:

" A medical post or programme, or a group of medical posts or programmes, recruited to as part of an individual recruitment episode offered by the NHS which has been approved by the Postgraduate Medical Education and Training Board as a training programme or post."

The Department’s preferred option aims to restrict those who do not fall into the following catagories from applying in direct competition:

Applicants who have completed a medical degree in the UK and who have been granted leave to enter or remain in the UK

UK Nationals

Applicants with indefinite leave to remain in or indefinite leave to enter the UK (EU)

Spouses or Civil Partners of persons settled and present in the UK.

Applicants with the right of abode in the UK • EEA and Swiss Nationals

A family member of an EEA national (residing in the UK) with a valid UK resident document

Dependents of non-EEA nationals with indefinite leave to remain or indefinite leave to enter the UK


In addition to the above;

"It is important to note that refugees and migrant doctors who have trained in a medical school in the UK will be exempt from the general restriction. Also that the guidance will not prevent migrant doctors who are not in the categories listed above from working in a service post in the NHS or from filling a training post in a shortage area or specialty."

I think this is the best proposal too. I also think it is very generous, given that 'relatives' and 'civil partners' will also be allowed to compete. Of course I do not know the definition of those for home office and residency purposes.

IMO, in addition to giving priority to those detailed above, one option that was 'not' considered is; since we now have enough doctors,

why not stop the 'creep' of other health care professionals on traditional junior doctors duties and use the 'proper' professional doctors we have trained at great expense instead?

The juniors proper roles, the juniors proper right!

British patients deserve the best; doctors in doctor's roles and nurses in nursing roles!

Makes sense, doesn't it?

“I do not feel obliged to believe that the same God who has endowed us with sense, reason, and intellect has intended us to forgo their use.”

Thursday, 7 February 2008

The impact

“Power is no blessing in itself, except when it is used to protect the innocent.”

The announcement made by Alan Johnson yesterday to tighten immigration rules to protect British graduates is a long awaited and a welcomed step after the agony the junior doctors faced in 2007 and the agony that will ensue soon when the results of the first round 2008 recruitment are known in around three month time.

In 2007, around 4.500 speciality training posts went to applicants from overseas resulting in the total displacement of 1200 British junior doctors. This does not take into account the doctors who accepted dead end or very short appoinments to save their careers. Those are estimated to be in their thousands, so, in reality, against the 4.500 jobs secured by overseas doctors, there is roughly the same number of British graduates who unfairly suffered as a result. With competition ratios of 3:1 and half of all the 23,000 applicants coming from overseas, the situation is much worse in 2008 especially because the 9000 jobs on offer this year are far too low and not enough even for the Brits alone. As it stands the announcement to protect British graduates will only help those applying in 2009 as it will reduce the pool of applicants by 3 - 5 thousand but will not have any effect on the very worrying situation this year.

The government is therefore, seeking approval from The House of Lords to overturn Bapio's appeal win to compete head on with British graduates lasst year. But the result of this move will not be known until May 2008. I am optimistic. This of course means that the round one recruitment of 2008, where the majority of the 9000 posts will be filled, is a lost case unless deaneries themselves do as much as they can to select as many British applicants as possible in round 1.

To limit the number of posts lost and save as many British graduates as possible, why not divide the 9000 posts equally between round 1 and round 2 which starts on June the 1st?

For those who will say that the time between June and August, when the juniors start in the new posts is too short, please remember that in 2007, round 2 took only 3 weeks to manage and implement with hardly any adverse effect on patient care.

Of course, protecting the Brits, although a temporary measure, is a good move but will not have a massive effect beyond 2009 when the production line from the new British schools start rolling. This will of course impact on the number of applicantions starting from 2009 itself, when medics from the new 4 schools, who decided not to intercalate a BSc year graduate to compete with the existing numbers. Add to this, is the numbers who will not be suited this year, either British graduates or those from overseas, unless the government succeeds in the House of Lords to stop them applying.

But, regardless of the outcome of The House of Lords appeal, the situation will worsen again when the full impact of the increased numbers graduating from British medical schools start in 2010 .. and beyond. As on top of those graduating in a particular year, there will always be an X number that is being carried out from the previous year/s, even without any IMGs being in the equation. Of course, unless training numbers are increased to correlate with the increase in numbers of British graduates, the X factor will always increase year on year and the result will be more and more disappointed Brits.

Hence, as Mr Alan Johnson announced, this latest restrictions on immigration rules to protect the Brits are temporary until a more permanent solution that insures 'self sufficiency' is found.

In this case, the notion of 'self sufficiency' needs to be defined. Is the government after total 'self sufficiency', meaning British graduates filling both training as well as non training posts? Or it means to be self-sufficient in fully trained doctors but continue to fill non training jobs from abroad? With the current low numbers of training posts available and the projection for future numbers, the situation remains difficult.

Tooke's recommendation of redefining the role of the doctor also become an essential part of protecting British graduates because if this is not fully cleared, British junior doctors will not only displace each other due to the increase in their future numbers, but will also be dangerously displaced by nurses and other health care professionals creeping on traditional junior doctor roles. and this, in turn, will cause more displacement to the juniors. It may even be a bigger threat of unfair competition than what the IMGs ever posed.

This is why Remedy UK' role has now become much bigger, Remedy needs to grow fast to fight for the rights of the juniors and to cope with future challenges which will be many! The young but very active as well as sincere organisation is now already taking the practical view of the need to protect the Brits first and foremost and IMO is now ready for the much bigger role that it was destined for.

From the DoH press release:

Because of the high numbers of potential IMG applicants that will be exempt from the Home Office regulations - currently estimated at around 10,000 - without further action on top of the new immigration rules the Department estimates around 700 to 1,100 UK doctors will be displaced and unable to secure a training place in 2009, 2010 and beyond. Therefore, the Department is today beginning a consultation setting out proposals for managing applications to the foundation and specialty training programmes from Highly Skilled Migrant doctors with leave to remain in the UK. Our preferred option is to implement guidance stating that IMGs should be considered for post-graduate and specialty training posts in the NHS only if there are no suitable UK or European Economic Area (EEA) applicants.

The need for more training posts, the need for a consultant led health service, the need for implementing Tooke's recommendations ... is now more urgent than ever.

Forward Remedy UK -------> Always .... :-)

“We know that when we protect our oceans we're protecting our future.”

Wednesday, 6 February 2008

Thank you Alan


A man who does not talk much but quietly comes up with the deeds .... Thank you Alan

I am a bit emotional now so, won't write much but I have the greatest respect and admiration for you .... :-)

Still a lot to be done to fix and heal Alan, keep up the hard work and ... Thank you



On behalf of the 'struggling' for justice parents of junior doctors ...
( Even though I don't have the authority but I am sure they feel the same ... :)

“In the love of a brave and faithful man there is always a strain of maternal tenderness; he gives out again those beams of protecting fondness which were shed on him as he lay on his mother's knee”

Too late!

“The cure for disorder is more liberty, not suppression.”

I just found this on the BMA website:

It is an 'undated' and, hence, I have no idea when it was posted, frequently asked questions information page to help the 2008 applicants. Of interest is this part in particular:

"Can I hold onto an allocation whilst I apply elsewhere? If you are already in a run-through post you are able, like everyone else, to reapply in 2008 for a different specialty training programme. If you are already in a run-through post you can also apply, if you wish, to a specialty that has a national (as opposed to local) selection process e.g. O&G, GP, plastic surgery."

When was this decided? And, why is it 'not' on the MMC website? Unless it is there but so hidden, I can't find it!

This would have helped many of the juniors trapped in 2007 ... Not only the junior in the link, but all those trapped and let of steam on the net or amongst their families and friends, were under the impression they had to resign their current post before they can apply elsewhere! Of course, given that 2008 is tougher than 2007, they could not chance losing their current posts to run after what is pretty much, a mirage!

But, had they known the above, some of them would have probably been successful in finding more suitable posts rather than being trapped for 7 of the best years in their lives. There would have also been no harm to the 2008 applicants because those juniors would have released their current NTN's instead of the new ones they accept.

very late now!

“As to the injustice which results from a censorship, it is impossible to measure it, for it is impossible to tell where it ends.”

Tuesday, 5 February 2008

Number surfing!

“We have to choose between a global market driven only by calculations of short-term profit, and one which has a human face.”

The workforce planners deny any wrong doing. That if it weren't for the IMG bulge, their workforce predictions would have been as near accurate as possible, since , in work force planning terms, a 100% accuracy is not achievable as it is based on predictions and not real numbers. True and fair enough!

The question that remains unanswered despite all the investigations, reviews and 5 sessions of HSC meetings is, it it was not the planners fault, how did this bulge come about?!

The DoH said that it was not able to convince the home office to revise it's rules on the Skilled Migrants programme to stop overseas doctors from coming in through this route. If this was the case, why didn't the DoH inform the planners to reduce intake into medical schools? Indeed, build 3 new medical schools and increase the overall intake by 70% instead? Surely, whoever was negotiating with the home office at the time knew this would be a problem! Yet they went ahead nonetheless and built the schools and filled them to the brim with hand selected aspiring medics! ... Then kept quiet all this time?! ... and no one noticed?!

So, the situation now is as follows:-

We have the right number of British graduates to fill the available number of posts, but, the 'bulge' will be allowed to compete for these posts, thus many Brits will definitely be displaced so long as this is allowed to continue. There is no indication that it will be stopped for those already here.

The government intends to charge for training in the future and, of course, that will put off the majority of overseas doctors in the future. But, will this help?

Not really because by then, the conveyor belt of our own schools would have produced it's own 'bulge' who will just displace each other since the number of posts is unlikely to increase.

So, for now, IMGs will be displacing British graduates but, in the future, British graduates will displace British graduates!

Therefore, there is a constant factor here; a constant 'bulge' causing 'displacement' ... this is on the cards whatever happens! Actually, when you examine the numbers closely, you notice clear correlation between the numbers of Brits in relation to the current bulge and the number of Brits in relation to the future 'bulge' created by the 70% increase in intake of British medical schools! ... You also notice that this relation is almost in straight parallel lines! And, in relation to the number of posts available now or predicted for the future, there seems to be an amazingly 'unintentional' constant ratios of 3:1 per post!

Does this mean that there really was a mistake in workforce planning? .. I don't know ..

Prof Tooke was asked at the HSC meeting (3) if Britain should turn down the tap on future recruitment into our medical schools but his reply was that 'we musn't have a knee jerk reaction.' Remedy UK was asked the same question and Matt said that we should if need be.

I think Professor Tooke's opinion is based on all his recommendations being fully implemented, especially the recommendations re redefining the role of a doctor and ring fencing training monies and putting that with the new MEE. In which case, there will, of course, be more provision for more training posts. But, even if his recommendations were implemented in full and more posts were created, will they be enough? ... Not unless the government stirred away from it's current policy of a 'patient led health service' to the long promised 'consultant led health service.'

What is the chance of this happening? ...

Not much, as per the work force planners and NHS employers in the second half of the HSC session (5)

In that session, the workforce planners stated clearly that despite the EWTD, there would be no increase in the number of doctors to cover the bigger rotas. Instead, 'other' means would be used instead. meaning more and more HCPs of course.

This was like music to the ears of the NHS employers, who, of course, gladly agreed and added that they would also like to see more competition post core training and even more post CCT, because " NHS employers want to be seen to be employing the 'best' including international consultants in their hospitals." Strange for them to say that! Don't they know there is a 'bulge'? That this is unlikely to go away?

They do! But, the NHS employers say that, like any global market, any industry, there are competition ratios of 2/3:1 and that this was a 'good thing.' That even a 2:1 ratios would not ensure selecting good applicants. So, this means that the NHS employers want the bulge. But the HSC panel quickly pointed out that this was ok for these global industries but that the picture was different in health because of the 'commission' aspect of it. The NHS employers then had to reluctantly agree that the Brits should then be protected up to the end of core training. It wasn't easy for the NHS employers because they clearly want a 'global' market here in Britain regardless of the fact that the Brits were 'commissioned.' Ms Thomas even said that many of her employers would not agree with the statement she made re agreeing to protect the Brits up to the end of core training! So, she obviously does not want protection for the Brits .. it was the panel who twisted her arm!

Now, let's return to the constant 'bulge' numbers. They will ensure the 'global' preferred model of 3:1 competition ratios for the number of posts available up to end of core training ... starting from 2008. This ratio will remain constant, either now because of the IMG bulge, or in the future because of the increased intake in British medical school recruitment ... strange ... because it does look like we had to have a 'bulge' right now, for some reason.

Of course, the introduction of 'global' competition post core training and up to CCT level will probably match the current ratios of up to 19:1 per post, if not more in the future. So, the 2:1 ratios of 2007 where just to get the profession gradually introduced to the new global model.

And now that completion of training no longer guarantees a consultant post, according to what NHS employers want, the competition for post CCT will be ... well, the sky is the limit! Worrying if you also consider the fact that our CCT holders will also be of a lesser 'quality' to those from abroad because of the impact of MMC and the EWTD! ..

It seems the 'plan' is, wer're going 'global' folks! ... With a 'commissioned' but less qualified medical work force .... as planned? Do we have a 'bulge' to ensure that the 3:1 global competition ratios are maintained?

I am no longer looking for the DoH's announcement at the end of this month .... It is unlikely it will make any difference IMO ... not so long as we are stood against the might of 'globalisation' in this puzzling way. It seems, nobody want 'excellence!'

What I am looking forward to see now, is how many of Tooke's recommendations will be implemented, apart from the introduction of core training ...

What do you think? ...

Does anyone have any idea why is this happening as well?

“National markets are held together by shared values and confidence in certain minimum standards. But in the new global market, people do not yet have that confidence.” .... Kofi Annan

Monday, 4 February 2008

A New idea!

I have just started this blog here because I feel many juniors and their families will need to talk soon when interviews, results start or come out. You do not need to log in or register and those who come just to view do not need to register or log in either ... ;-)

a true e cafe that is open 24/7 ... :-)

Please click on it and tell me what you think. Suggestions are very welcomed. You can ask me to include anything you want; links to medical bloggers, to the Royal Colleges, to any site/s, keep or remove the 'News reel' section ... anything .... :-)

This blog is intended for 'your' use so it is your space not mine, except that someone had to start it. I will just be an administrator unless you address me and want me to comment. The idea is self explanatory so please have a look and leave a comment 'there' to tell me what you think.

I am open to all suggestions and will even delete the new blog if you don't like the idea ...

But ... I hope you do like it and will use it .... :-)

Sunday, 3 February 2008

Good on you Bernie .... ...

"for those currently in FTSTA2, the prospect of becoming the new ‘lost tribe’ if new training opportunities do not emerge at ST3 is real" .... Ribeiro

Mr Bernard Ribeiro, president of the Royal College of Surgeons has been fighting for his surgical trainees since before the debacle of 2007. He knew matters would get from bad to worse. I can't remember who said or where but last year, while attending a lecture at the Royal College of Surgeons, a trainee asked for his advice on what to do next, to which Mr Ribeiro replied: "I'd prepare my passport if I were you!"

He was the first heads of a Royal College to show his firm disapproval by withdrawing from the MMC Review Board on 25 May 2007, Here is the letter in full:

Professor Neil Douglas
President of the Royal College of Physicians of Edinburgh
9 Queen Street
Edinburgh EH2 1JQ
Friday, 25 May 2007

Dear Neil

Review of MTAS and MMC

I am writing with regret to inform you that I am withdrawing from the current and ongoing discussions abo
ut the selection and appointment arrangements for junior doctors’ training.

Over my period of two years as President of this College, there have been two particular matters that have been of central concern. First, I have repeatedly, and at length, emphasised to Ministers and policy officials at the Department of Health (DH) the essential need to make adequate transitional arrangements for a large number of well- trained, experienced and committed senior house officers who are in danger of being lost to the NHS. Their career prospects and their opportunity to contribute to the care of the next generation of surgical patients are being severely compromised.

At my first scheduled meeting with Patricia Hewitt, Secretary of State for Health, on 11 October 2005, I made her aware of the difficulties that would arise in 2007 with unprecedented competition for a limited number of national training numbers between the first doctors to complete foundation training and 3,500 or more senior house officers with some years of surgical experience. I put to her the possible solution of expanding progressively national training numbers for a fixed period of time. This would safeguard the future for this group of trainees
and enable pump priming of consultant expansion over coming years to underpin DH’s plans for service delivery. Patricia Hewitt acknowledged that there was a major problem and stated she had no wish to see trained doctors out of work or without a reasonable opportunity of progressing in their chosen specialty. She was happy to seek a solution to this impending problem.

At the time of writing, almost two years after first raising my concerns, there is still no recognition whatsoever by DH of the scale of this problem or its profound implications, far less the prospect of an acceptable solution in terms of a temporary expansion of national training numbers. Only a few days ago, DH appeared to indicate that there would be a significant expansion of surgical training posts at ST3 level with an assurance from Postgraduate Deans that such training would meet the required standards. However, following yesterday’s meeting of the Review Group, DH has again failed to confirm a specific commitment to surgery. The announcement of 200 additional training posts, unspecified in terms of medical specialty or location, can at best be described as obfuscation. There has been in my view a scandalous failure of duty to address this issue. We have all, as taxpayers, rightly invested in training this talented generation of young surgeons. It is my duty to ensure that this is not squ

My second concern relates to the arrangements for selection of junior doctors into run- through surgical training programmes. Surgery has unique requirements in terms of recruitment - the criteria for selection include diagnostic skills, clinical judgement and manual dexterity. It is neither practical, nor indeed safe, to select junior doctors with a view to a career in surgery without the opportunity of assessing whether they have the full mix of professional skills required. The view within surgery, amongst consultants and trainees and across all specialties, is that selection must take place at ST3 level when trainees have had two years to acquire basic skills under supervision in the operating theatre. This is essential to ensure that the next generation of specialist trainees will be able to provide a safe service for patients. I am dismayed that DH has sought clinical engagement on this issue of selection and again failed to accept unequivocal professional advice.

It is with the greatest reluctance, therefore, that I am dissociating myself and my College from any further involvement in the Review Group that you have been chairing.

Yours sincerely

Mr Bernard Ribeiro CBE


The Royal College of Surgeons of England

Mr Rineiro has never given up on his commitment to his trainees and was the best prepared with the most convincing answers at the Health Select Committee meeting (4)
He even prepared a full dossier to leave for the panel to help them fully understand the situation. He also took the opportunity to say that, in his opinion, IMG's should take some training in Britain then go back to serve their own communities. Mr Ribeiro is originally from Ghana.

In the current News letter of the Royal college of surgeons, Mr Ribeiro says:

The decision (By Tooke) to uncouple the foundation years (F1/F2) was made on employment grounds to ensure that medical students were guaranteed their first job as provisionally registered doctors. Ideally, qualified doctors should also be guaranteed access to core specialist training, for without such a guarantee UK graduates cannot access specialist training or staff grade posts .....

I wonder what will happen to UK grduates if this guarantee is not given to them? What is the point of guaranteeing the F1 year only to be thrown to the skip as soon as it ends? What hope has many of them got if the government does not guarantee them the opportunity to, at least, make a living out of the vocation they trained for 7 years? Especially now that it seems the government will not be able to achieve much to safe the applicants of 2008!

I wonder where is the first part of the HSC session 5 attended by Prof Douglas and Prof Rubin?

Keep talking Bernie ....

"The unified voice of the medical profession has overwhelmingly endorsed these recommendations (Tooke's) and this cannot be ignored." ... Ribeiro

Friday, 1 February 2008

Burkas ....

“The heart has reasons that reason does not understand.”
It's a strange feeling when you decide to quit blogging and advertise same only to return a few days later :-) I must say, I have missed not talking for those few days, so, maybe I am not the one for stopping the habit when it has already become an addiction.

So, I thought, why not discuss other topics for a while and return to my original theme on junior doctors if and when I have a need to voice my opinion again? And ... here I am .... :-)

Since I left, I have been visiting other blogs and came upon this on Dr Crippen's site. A person made a comment about muslims and included women in burka's in it. So, what about burkas?

Of course, burka's are not a religious requirement for the women who wear them. The majority who do choose to wear them themselves. They are not forced to by anybody, unless of course they live in Saudi Arabia where the wearing of burkas that provides 'full' face cover is compulsory. But, will this be changing soon? Saudi Arabian women living in Saudi Arabia are also thus far not allowed to drive but, through international pressure from those campaigning for human rights, this will hopefully be changing as close as the end of 2008 because I can't myself see how women can safely drive while completely covering their faces. So, will we see the end of the burka soon? The majority of Saudi women living in Britain choose not wear their burkas here.

Wearing a face cover is 'not' specified in Islam. A woman has the right to show her face and hands but cover the rest of her body. This of course is a requirement by other faiths including Christianity and Judaism. Like followers of those religions, some women choose to follow the scripture and some don't, Muslim women included. In all other Arab countries, those who wear the face cover choose to do so themselves and are not forced to by their male members of their families. In some countries, like Egypt for example, where the wearing of burkas is a novelty practiced by very few women, those married to or are members of the families of army or police personnel are not allowed entry to police or army social facilities with their face covered because they are deemed to pose a security risk. Hence, some choose to uncover their faces while attending such places and some decide not to visit at all. The state can not impose a law to prevent the wearing of burkas so as not to offend extreme opinion which may then cause a backlash.

I can't see why women are not stopped from wearing total face cover in Britain? Cover your body including your head all you like but if showing your face is a requirement for issuing a passport, then it should also be a requirement for walking in the street IMO.

I know I am not a very popular blogger but hope to hear some views on this, including that from women who do wear total face cover.

“What I conclude is that it has nothing to do with religion or reason but with deep and irrational needs”