Unfinished
Business: what do you know about
it?
Unfinished
Business: Proposals for the Reform of Senior House Officer Grade
was published by the Department of Health on 21 August 2002 as a
consultation document. The report has a wider brief than just reforming
the senior house officer grade and strays into reform of the
non-training non-consultant grade and into restructuring
the certificate of completion of specialist training years. This will
affect all practising doctors and medical students future
careers if it is approved and
implemented.
Within
Unfinished Business there are
attractive recommendations
The puzzling thing is that the journals that are read
by trainees and medical students show little interest. Speaking to the
preregistration house officers at my trust in the middle of October, I
learnt that none of the 15 present (almost all of them recent UK
graduates), had heard of the
document.
I work in a
busy district general hospital with an active academic centre. There
are lots of trainees who generally get a good education and jobs are
gradually becoming compliant with the new deal, with the help of a
cohort of non-training non-consultant grade doctors. The
average doctor seems to have limited levels of political curiosity and
activity. These reforms are relevant and important. The new deal has
created new perceived boundaries about working hours
and its maybe the case that political fatigue sets in at 56
hours. Trainees do have much to consider; exams are usually looming and
often lack of tenure, particularly at senior house officer level, means
time allocated for “medical” matters are taken
up with mere survival and less with political
development.
Undergraduates
receive practically no training in management issues, and the doctors
in training are woefully ignorant of the ways of the NHS. Initiatives
such as Managing Life in the NHS are developing but take up much study
leave time and may best suit those who have passed their specialty
examinations. The lack of awareness, possibly deviously nurtured, leads
to a generally compliant workforce whose heads are down working for
their patients. As new generations of doctors are tarred with this same
historical brush, nothing will really change until a set of doctors
arrive who have some political awareness that will not see
all change as a surprise or an
inevitability.
Within
Unfinished Business are attractive recommendations. From
qualification, there is a radical rethink of the work in the first two
years, with a broadly based and closely supervised clinical programme.
In the years after, the report promises structured training (formal
entry requirements, a curriculum base, required record of in-training
assessment appraisal, and time capping of positions to prevent blocking
posts or programmes) and the consequent security of employment at this
level, removing much of the bother, expense and worry of
often six monthly interviews. For most, this will mean a
clear progression to achieve their professional aims
in a secured way. All postgraduate examinations are under review and
the intention is to make them more linked to progress throughout the
training, rather than the random use seen at present. The report makes
many important observations, allowing for trainees who wish to or have
to take longer to get their postgraduate qualifications. Doctors coming
from overseas are discussed in
detail.
This
document will affect medical
students future careers if it is approved
and implemented
Unfinished Business recognises the impact it and
the Working Time Directive will have on non-consultant
non-training grades and recommends a broad and urgent review of
the role, professional development and career opportunities in this
group, who have not always done well in recent developments. It moves
to the consultant grade and recommends three years at specialist
registrar grade to become qualified at a generalist level. Quality
within the training and quality in the assessment is stressed. Now all
this seems important to
consider.
The ideas are the result
of much broad consultation and seem good on the whole but will require
a lot of adjustment for doctors even in training now. What will be the
impact of the new deal and the Working Time Directive on it? How can
educational standards be kept up? Where will the management structure
come from? Will different specialties have different needs? Hospital
Doctor (www.hospital-doctor.net 5 September and 3 October
2002) reported a variety of reactions to the report. Go back to your
workplaces and start talking about it, and start talking about talking.
