Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Shurely shome mishtake
- William A Parsonage (24 October 2003)
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women resources
- veena bisht (24 October 2003)
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The US option
- Omar Khwaja (24 October 2003)
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Non-standard NHS posts: what's to be done and why
- Edmund J Dunstan (26 October 2003)
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Physician Assistants: A first-class solution to the problem of reduced junior doctors' hours
- Margaret E Allen (26 October 2003)
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First they came for the Jews
- Jean P Fisher (27 October 2003)
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Careers Development for Overseas Doctors
- Raj Khiani, Khiani Raj (28 October 2003)
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Re: Non-standard NHS posts: what's to be done and why
- Sandip Raha (28 October 2003)
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TRUST DOCTORS , NOT ALWAYS EXPLOITED
- P . K. SHIBU, K. MOHANARUBAN (29 October 2003)
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You have to be lucky to get the TD position !
- Amine Braci (31 October 2003)
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Recruitment of doctors to non-standard grade
- Jai Shankar (6 November 2003)
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NCCG doctors employed outside NHS face added challenges
- Suzanne Kite, Fiona Hicks (7 November 2003)
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Non Standard Grades
- Kate Bullen (8 November 2003)
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He that is without sin among you, let him first cast a stone.....(St. John 8:7)
- Shah M Tauzeeh, London N12 OJE (18 November 2003)
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Trust Doctor posts are detrimental to high-quality patient care
- Fiona M Kew (21 November 2003)
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Failure of recruitment websites to give accurate information on change in law re GP training
- Jane H Dammers (2 December 2003)
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What is there in the name?
- Umesh Prabhu (3 December 2003)
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Re: Trust Doctor posts are detrimental to high-quality patient care
- Jay Ilangaratne (3 December 2003)
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William A Parsonage, Consultant Cardiologist Australia
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Having been completely scuppered by the Calman reforms whilst overseas I spent some time in various bogus posts in the late 90's before getting completely hacked off with the NHS and emigrating to Australia. So I've seen a few job titles and filled in a few applications but... 'Non heart beating kidney donor transplantation fellow' you must be kidding!! Sounds like a Monty Python song. In seriousness some of these positions were fruitful. I would suggest that if possible successful applicants make some sort of deal with the local consultants relevant to their interests. I tried 'I'll do your job for 6 months if you teach me to do coronary angiography' and it worked. At least this way, despite lacking formal training recognition, some sort of real world skills are picked up that look good on a CV. Competing interests: None declared |
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veena bisht, SHO Paediatrics Wrexham Maelor Hospital,Wrexham LL13 7TX
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It is not suprising that a quarter and may be even more of non standard grade posts are filled in by doctors from overseas. Given the record no. of GMC registrations this year there is no dearth of unemployed overseas doctors who are willing to take up any job out of desperation and financial hardship.I have known colleauges who have applied for training posts but have been turned down due to not having UK experience or being overqualified for the job but have easily obtained trust grade posts.Iam sure most of them are fully aware of the implications of going into non consultant grade post .It seems to be more a matter of individual neccesity than of choice. The other aspect which the paper has failed to explore is the percentage of women doctors in these jobs especially overseas women doctors.I think the majority of women doctors are compelled to take up these not so ambitious non training posts due to family reasons. Their main efforts are directed in trying to stick together with their partner & children in order to enjoy certain quality of life as they are deprived of the valuable family support system they enjoyed back home. For them it is just a matter of somehow continuing their professional lives while looking after the family. Competing interests: None declared |
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Omar Khwaja, Specialist Registrar Cambridge CB2 4PH
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Sir, Among the common problems non-consultant grade doctors face is lack of access to formal study leave, training and appraisal with Royal College oversight. Added to this is the frank exploitation by NHS trusts with respect to terms and conditions of service. This is discriminatory to these professionals on whom the NHS depends. It is unfair to patients that up to 40% of their doctors have no access to formal continuing education and appraisal. Perhaps one solution for incoming trainees from overseas, is to ensure that all posts are approved for training with equal access to appraisal and study leave. Doctors who enter post-graduate medical training from overseas could however be subject to a 2 year home residency requirement at the end of their approved training, similar to the US J-1 exchange visitor sponsorship program. This would ensure that applicants receive equity in training and allow transfer of skills back to countries in desperate need of them. If and when consultant numbers expand and there is a short-fall in British trainees available to fill new consultant posts, overseas applicants with valid CCSTs, who have fulfilled their home residency requirement, would then be eligible to apply for consultant posts in the UK on a level playing field. Additionally the DOH/NHS executive and/or Academy of Royal Colleges could develop a waiver scheme, where the 2 year home residency requirement is waived for certain specialities where there is an on-going and critical shortage of filled consultant posts. The BMJ could also take a role by insisting that advertised posts in BMJ Classifieds for non-standard grades are headlined clearly as "Non- standard grade NHS post" and do away with misleading "Trust Fellow, Clinical Fellow, Trust Doctor (Specialist Registrar) etc" titles currently used by NHS trusts. Sincerely, Omar Khwaja Competing interests: None declared |
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Edmund J Dunstan, Consultant Geriatrician Selly Oak Hospital B29 6JD
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The proliferation of non-standard NHS medical posts is a consequence not only of working time legislation, but of demands from within the profession. These include shorter, more rigid training programmes, an expectation that nearly everyone should progress to consultant rank, but above all the stranglehold on SHO numbers held by deaneries, and the arbitrary and illogical separation of "training" from "service". To help towards a solution, the NHS should: require all medical posts (including clinical assistants) to include an appropriate element of training or continuing professional development as part of good human resources practice, decide which posts are "training" posts by the quality of the training offered not the source of funding, so that Trusts can create new training posts if they ensure the training is good enough and accept that some variation in speed of progression, and competition, has to be a fact of life. . Our present attempt at (over)-regulating medical training has created as many problems as it has solved, and indeed has created an apartheid between those in approved training posts and others. Only by some loosening-up can equilibrium be restored. Competing interests: None declared |
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Margaret E Allen, Physician Assistant East Palo Alto, California, USA
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There is another US option. Drawn from (often deprived) communities in which they are likely to stay, mature people with previous health care experience are trained to high medical standards in a relatively short time. Their numbers can be fine-tuned to meet evolving needs. They work collegially with physicians, provide continuity of care, are not anxious to move on and out of their community, do not deplete already decreasing numbers of nurses, and are not hired away from developing countries. In America they are known as Physician Assistants. They have helped solve the US time-directive hospital manpower crisis quite quickly. It might be worth considering bringing in some PAs from the US to demonstrate their skills, and start training mid-level providers now! Competing interests: None declared |
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Jean P Fisher, Clinical lecturer Liverpool School of Tropical Medicine, L3 5QA
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Editor, I am heartened to see the responses to the article by Dosani et al1 on the rapid expansion of non-standard, non-regulated posts in the NHS. Working as I do with overseas trained doctors who are trying to enter the NHS, I am all too aware of the danger that they are side-lined into positions which offer little training and no recognition. The profession as a whole must speak out where such exploitation is occurring, if not from consideration of the moral position stance then in consideration that one day we may find ourselves in such a position. "First they came for the Jews and I did not speak out because I was not a Jew. Then they came for the Communists and I did not speak out because I was not a Communist. Then they came for the trade unionists and I did not speak out because I was not a trade unionist. Then they came for me and there was no one left to speak out for me." Pastor Martin Niemöller 1Sabina Dosani, Sara Schroter, Rhona MacDonald, and Jackie Connor Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertisers. BMJ 2003; 327: 961-964 Competing interests: I facilitate a study club for refugee and overseas trained doctors working towards PLAB. |
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Raj Khiani, Wellcome Trust Cardiovascular Fellow South Manchester University Hospital, Khiani Raj
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A large number of overseas doctors enter the UK with the hope of receiving a high standard of clinical training with the UK. Dosani et al have highlighted the large number of service posts currently advertised within the UK. The majority of these posts are filled by overseas doctors. Prior to coming to the UK the majority of oversease doctors have little knowledge about the difficulties of obtaining a training post in the UK. Overseas doctors often have limited access to clear honest careers advice and personal development courses (e.g. developing communication skills), which are aimed at their specific needs. The unique needs of an overseas doctor coming to alien health care system and learning about new pathologies and new working patterns are not being met, by the NHS, indeed they are often left to sink or swim. I am the founder of Medical Careers Development (www.mcd.uk.com) an agency aimed at meeting the specific needs of overseas doctors. We offer honest information, advice and courses aimed at meeting the unique needs of overseas doctors. We offer honest information, advice and courses aimed at meeting the unique needs of overseas doctors. I would encourage overseas doctors to visit our website and offer feedback on the courses and services we offer. Competing interests: Founder of Medical Careers Development |
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Sandip Raha, Associate Specialist, Integrated Medicine Princess Of Wales Hospital, Bridgend, CF31 1RQ
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This paper clearly shows the gap between need for service provision and training in UK NHS hospitals. Our Deanery, Post Graduate education and Royal colleges are completely unaware of the service provision at NHS hospitals and role of non training grade doctors in the Trust enviornment. Department of Health and Govt. sets targets which Trusts have to meet to get or lose Star status and they struggle to provide the service every time a new European directive comes through (working directives, Junior doctor hours etc). It goes on to show the little understanding in Brussels about the health needs and demands at local level in EU and increasing beurocracy EU going through. It would have been a lesson for all law makers concerned, if Trusts and hospitals close their doors to local population because of new working directives of EU and tell politicians to arrange their constituents treatments in Brussels or another European centre or in India. That day is fast approaching like in other fields of service rovisions. EU and UK is at the begining of outsourcing their service provision and jobs!! No wonder so many non-european doctors are in UK in non training and non recognised posts. Competing interests: None declared |
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P . K. SHIBU, Staff Grade Medicine Withybush General Hospital, Haverfordwest, SA 61 2 PZ, K. MOHANARUBAN
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It was interesting to read your paper on the increasing recruitment of mainly overseas doctors to non standard grades in the NHS. It is true that this is due to lack of funding for more standard training posts. Service requirements have been compounded by the legal New Deal and European Working time directives. We do not agree that they are being exploited and their careers always hindered. In reality there has been an unprecedented rise in the number of overseas candidates mainly from the Indian subcontinent passing their PLAB exam and registering with the GMC. Overseas PLAB centres and increasing pass percentages have fuelled this surge. This has not been accompanied by a corresponding rise in trainee posts in basic medical and surgical rotations. Overseas doctors with no previous NHS experience usually fill out hundreds of application forms and have to wait an eternity to get their first job. They go through protracted clinical attachments often paying the trusts for the accomodation and experience.Trust grade doctor posts with relatively lesser competition can act as a portal of entry for actual paid work experience. In our hospital trust , we do appoint Trust grade doctors , but their training is identical to standard SHO posts. They in built study leave arrangements for future exams and regular career appraisals. Most of them get into the regular rotations as well. These posts serve as a useful tool in integrating newly qualified mainly overseas doctors into the NHS mainstream. Having centally collected data would be a good idea and may not necessarily show that they hinder career development as suggested in the paper. Competing interests: None declared |
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Amine Braci, Unemployed citizen PL4 6BW
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I am an a non-EU overseas doctor who have been granted the British Citizenchip recently.I have 5 years as post-qualification experience in my country.After coming to England 3 years ago,i passed my english test, my PLAB1+2 and I did 2 clinical attachments in Plymouth(Derriford Hospital).I got also the ALS in the same hospital. I applied recently in Derriford Hospital (Plymouth) for the famous SHO Trust Doctor Position with the names of two consultants from the same hospital as references on my CV and i have not been even shortlisted, It is sad and ironic! Even the TD position has its price. It is not given to everybody with a smile and a free lunch.I should apply for a district nurse position the next time, i might have a chance. Now,I am living on the state benefit system and i am reading my textbooks till this absurd and anachronistic systems change. In matters of these non grade positions, I hope that the NHS administrators are aware of the Discrimination Acts in the workplace and equal opportunities.This issue could lead to the European Court one day. If the justice is not applied, the decadence will come soon, howevwer we can see its signs these days. We have a proverb saying " i accepted the rubbish but the rubbish did not accept me" Competing interests: None declared |
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Jai Shankar, Retinal ASTO St. George's Hospital & Moorfields Eye Hospital, Blackshaw Road, London SW17 0QT
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I read with great interest the paper by Dosani et al1 on recruitment of doctors to non-standard grade in the NHS. I agree that for many overseas qualified doctors who have recently entered the UK and may be unfamiliar with the system here, may erroneously believe that these are recognised training posts. In the BMJ Careers dated 25th of October, 99 advertisements pertaining to 137 non-standard posts appeared. Of these only 55 advertisements specifically mentioned that this was not a training post. In fact, in one common advertisement for 2 SHO and 4 Trust Doctor posts, the advertisement confirmed that the post has educational approval. If my presumption that this refers only to the SHO posts is true, such advertisements can be most misleading. The BMJ advises that advertisements for junior hospital posts should include “a statement that the placement and / or programme has the required educational and Dean’s approval”. It should perhaps also insist that advertisements for non-standard posts should have an explicit statement that “the post is not recognised for purposes of training”. It should perhaps also insist and a training post and a non-training post cannot be advertised in the same advertisement. I however, do not have any objection to the basic principal of hospital trusts advertising and employing junior staff outside recognised training programmes as they potentially fulfil a very useful purpose. Many post-CCST doctors work in such so-called “non-training” posts to gain valuable sub-speciality training, clinical experience and research opportunities. They are also useful for those doctors who have completed their BST and would like to do a period of research or work in a particular sub-speciality before applying for a Higher Specialist Training post. I would like the authors to clarify whether “ASTO fellowship” mentioned in Box 2 refers to Advanced Sub-speciality Training Opportunities. If my understanding is correct, this is a Deanery approved training post and counts towards CCST. Jai Shankar, Medical Retina ASTO
References: 1. Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertisers. Sabina Dosani, Sara Schroter, Rhona MacDonald, Jackie Connor. BMJ 2003;327:961-4. Competing interests: None declared |
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Suzanne Kite, Consultant in Palliative Medicine Leeds General Infirmary, Leeds Teaching Hospitals Trust, LS1 3EX, Fiona Hicks
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Editor, The problems facing Trust doctors are exacerbated for those holding contracts outside the NHS. Doctors in non-consultant career grades form a significant proportion of the medical work force in palliative care - working largely in the charitable sector. This group of doctors face significant hurdles in identifying, pursuing and recording continuing professional development (CPD) for a variety of reasons including lack of dedicated study time, clinical cover and availability of relevant local educational events. Lack of awareness, or uncertainty, regarding CPD requirewments, appraisal and revalidation is also alarmingly common (CPD survey, Association of Palliative Medicine 2003). Many doctors in non- standard grades may be registered with a College other than with the Royal College of Physicians, which holds the only recognised CPD scheme for Palliative Medicine. Valuable information may, therefore, not be readily accessible. It is a worry that so many doctors are potentially vulnerable with revalidation fast approaching, and mechanisms to ensure CPD requirements and appraisal not yet in place. Recent standards set by the Royal College of Physicians, based on the GMC guidelines, 'Good Medical Practice', are also focused on the roles of consultants and will need to be adapted to meet the needs of other grades. All doctors are personally responsible for their ongoing professional development. However, it is imperative that non-NHS employers understand the professional needs of their medical employees and take steps to ensure that the necessary supports are in place to permit successful CPD, appraisal and revalidation. Competing interests: None declared |
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Kate Bullen, Associate Specialist Frenchay Hospital,BS16 1LE
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As a long-serving member of the BMA Staff and Associate Specialists Committee, I welcome the BMJ's timely and extensive coverage of the plight of doctors employed in non-standard grades in the NHS.However, I was dismayed and disappointed not to find a single reference to or comment from our committee on this issue, which we have always held to be within our specific area of interest. The terms of reference of the SAS committee clearly identify our duty to' consider and act on matters affecting those doctors working in NHS trusts who are not general practitioners, nor in training grades and whose posts do not require their names to be on the Specialist Register'. Both as the Non Consultant Career Grade subcommittee of CCSC and, more recently, as the SAS separate craft committee of the BMA, we have consistenetly and resolutely drawn attention to the exploitative and unfair nature of these posts. We urge Trusts through the Local Negotiating Committees not to establish them and we advise members seeking advice from us not to sign up to them. We have been aware for many years of the difficulties and shortcomings inherent in the contracts of non-standard grades and that, by and large, it is the vulnerable doctor from overseas who is most likely to be a victim of them. Our policy has been unswervingly that only contracts based on nationally agreed terms and conditions of service should be used as employment tools. There has not been an Annual Representative Meeting of the BMA in the last 7 years that has not passed a resolution unanimously condemning the proliferation of non-standard posts, calling for a halt to them, and the continued appearance of advertisements for such posts are under our constant scrutiny. Indeed, the Editor of the BMJ will be well aware that we have repeatedly requested that they cease to appear in the career section of the BMJ itself or, at the very least, are 'black-boxed' to draw attention to their dubious nature. These requests have fallen on deaf ears to date, but I am confident now that, as a result of this recent public exposure and obvious increase in concern on your part, the advertising policy will be adjusted. 'Choice and Opportunity-modernising medical careers for non consultant career grade doctors' was published this summer by the Department of Health and offers the propect of addressing the problems of all non consultant, non training medical staff. This is particularly relevant for those in non standard posts and the BMA SASC is committed to resolving their unsatisfactory status as a priority when negotiations take place on implementing the recommendations. Finally, it comes as no suprise to me that the authors could not find trust grade doctors to talk to them when researching their articles. Perhaps, as in the case of SASC, they were simply not asking the right people. Competing interests: None declared |
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Shah M Tauzeeh, Staff Grade Physician Finchley Memorial Hospital, London N12 OJE
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Thanks to Dosani et al(1) for this article which was long overdue. There is an exponential and unregulated growth of non-standard grade posts. The exploitation is of massive proportion and has been going on for many years amidst conspiracy of silence and quiet approval from all quarters.The fairness is eroded and sacrificed at the alter of NHS and perhaps human rights are at stake too.There is a sense of frustration and everyone including the political parties, medical institutions, BMA and the newly formed SAS Committee are equally responsible and there appears to be a kind of unholy alliance. The expansion of the non-standard grade posts can not be simply explained in terms of supply and demand as claimed(2). The successive Conservative and Labour parties empowered the Trusts to recruit both clinical and non-clinical workforce in their own terms and conditions. This led to the creation of non-standard grade posts in the first place followed by unabating growth. The European Working Times Directive has made a serious impact on the situation. The deans, medical directors and consultants are actively involved with the Trusts in creating non-standard grade posts. There is a likelihood that only a few of the top people in our profession can deny their involvement. The BMA sustained and exacerbated the growth of non-standard grade posts by accepting job advertisements and there is not enough warning to prospective job seekers.According to some BMA officials (personal communication),there is no alternative but to accept these advertisements to keep the membership fee low. I think perhaps the same argument can be used to promote tobacco products in the BMJ. The SAS Committee being a new one can be forgiven for not able to attract non-standard grade post holders and champion their cause. The SAS Committe has a formidable task in bringing the 'lost tribe' in its fold. The SAS Committee need to work hard in the greater interest instead of pursuing one agenda:creation of an alternative route to consultant post. A rejoinder(3) alone may not be enough for this purpose. The current campaign of 'Recognition & Reward' to raise the profile is a welcome step forward. It is pleasing to note that a few contributors in the Rapid Response have highlighted positive aspects and stated the way they were able to take advantage of non-standard grade posts. These native doctors are in possession of special attributes which made this possible. To enhance the career prospects of locally trained doctors is not a sufficient ground for expansion of non- standard grade posts. Way back in July 2001, I requested the BMA NCCG North Thames Regional Committee to carry out an audit of advertisements of non-standard grade posts in the BMJ. The results of this audit are no different from what Dosani et al(1) have found. I also suggested that the offending Trusts should be named and shamed. In the subsequent meetings, we have discussed this issue without progress. Recently the DoH published a document entitled: Choice and Opportunity Modernising Medical Careers for Non-Consultant Career Grade doctors. The consultation period is over now.The document is available on internet only and many NCCG doctors do not have access to computers. The medical newspapers did not publicise this as they expected to report the results of ballott of consultant contract. The time has surely come when a concerted effort is needed by all concerned to alleviate the misery of non-standard grade post holders. It is easier said than done as it happens that the perpretrators are from their own profession. It gets even more difficult when existence of other grade doctors apart from consultants and trainees are not acknowledged(4). 1.Dosani S et al. Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertsers.BMJ2003;327:961-4. 2. Storey S. Non-standard grade(trust grade) doctors: the human resources view. BMJ2003;327:s129. 3. BMA Newsletter 30/08/03 4. Gosney M.Book Review.Age Ageing2003;32:468-9. Competing interests: None declared |
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Fiona M Kew, Specialist Registrar, Obstetrics and Gynaecology University Hospital of North Tees, Hardwick, Stockton
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Sir, The papers on doctors in the non-standard grades in both the BMJ and BMJ careers highlighted several important issues for this group1. However they do not address the crucial issue of the impact of these posts on the quality of patient care. Increasingly, these doctors are being used to prop-up unfeasible rotas that see the most junior and inexperienced doctors providing the vast majority of out of hours care. This is likely to be further exacerbated by the introduction of the European Working Time Directive next August, when junior doctors will be limited to 58 hours in the hospital per week2. In the NHS Plan the government finally recognised that more care should be delivered by fully trained doctors3, yet the article by Loveland4 fails to address this central issue. Until such time as the government is prepared to prohibit the employment of doctors in non- standard grades, care will continue to be provided by the most junior of doctors. Only when this is addressed are we likely to see the levels of consultant expansion that are needed in order to improve the quality of patient care. 1. Dosani S, Schroter S, MacDonald R and Connor J. Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertisers. BMJ. 2003; 327: 961-4 2. Department of Health. Protecting Staff, Delivering Services. Health Services Circular 2003/001. 3. Department of Health. The NHS Plan. 2000 4. Loveland P and Amos D. Non-standard grade – trust grade doctors: the Department of Health’s view. BMJ Classified. 25th Oct 2003. Competing interests: member of BMA Council and JDC |
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Jane H Dammers, Course organiser Northumbria NVTSand member of the NE Programme for the Professional Integration of Northumbria Vocational Training Scheme, Northumbria University, Newcastle upon Tyne NE7 7XA
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On November 3rd 2003 a change in the law widened access to GP training. Doctors eligible for limited registration can now apply. Previously full GMC registration was required for the GP component of the training. On Nov 28 almost 4 weeks after the change in the law and with a late recruitment round in progress, I looked at recruitment information for general practice on the web. I found that of the 17 UK deaneries (excluding the armed forces), only one (Eastern) had a clear accurate statement of the new law on its GP recruitment page. Two sites had out of date and therefore wrong information (Wales and Wessex). Three had some information but not very clear (London, Mersey and Northern), three sites were inaccessible (Kent, Nottingham and Yorkshire) and the remaining eight gave no specific information on eligibility. I found that most sites had links to the GP national recruitment office (gprecruitment.org.uk) and the Joint Commitee on Training for General Practice (jctpgp.org.uk). The national recruitment office had updated its eligibility criteria but not its person specifications; the JCPTGP website had not been updated and had incorrect information. Many overseas and refugee doctors rely heavily on the web for information about all aspects of jobs. Out of date, inaccurate and less than clear information is likely to lead to discrimination. Competing interests: Member of steering group for the North East Programme for the Professional Integration of Refugee Health Workers |
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Umesh Prabhu, consultant paediatrician The Pennine Acute Hospitals Trust BL9 7TD
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Dr. Kew is totally missing the point. The non-standard grade has nothing to do with drop in patient care. The patients who come to our NHS during evening hours and weekend probably do receive poor quality care, as most of these patients are seen by junior doctors irrespective of the fact whether we call them as SHO, trust grade, trust fellow, clinical fellow or by any other names. Just because we call some of these doctors as Trust grade, doesn't drop the quality any further. I still fail to understand why we use different terminology for these doctors who actually do the same job, receive same training, same entitlement for study leave and so on. Only difference is that the SHO tends to be a local graduate and the time he spends is considered as training, where as the trust grade tends to be an overseas qualified doctor and the time he spends is not considered as training! What a travesty of justice! Of course patients must be seen by a trained doctor but the question is who is going to see those patients who come to the NHS during unsocial hours? Will he/she be a consultant, sub-consultant or same old story, non- consultant career grade doctor or SAS as we now call him/her, most of whom happen to be overseas and ethnic minority!. Competing interests: None declared |
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Jay Ilangaratne, Founder Medical-Journals.com
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In hospital medicine,for decades,'junior doctors' have been in the frontline providing out-of-hours care to a reasonably satisfactory standard.Hence,what is the real evidence that Dr Kew has,in order to prop- up her assertion that patients are receiving sub-standard care because 'inexperienced' junior doctors provide the first line of care during out- of-hours? The BMJ study which she refers to,does not provide evidence to support her assertion. Looking at the matter more objectively,even if one looks at the increasing number of reported clinical negligence claims within the NHS, there is hardly any evidence to suggest that bulk of those cases involve mismanagement at junior doctor level, or the alleged events had taken place out-of-hours in the hands of 'inexperienced' junior doctors. Hence, in this era of evidence-based medicine, Dr Kew's sceptic view is neither justified by evidence nor logic.At a time when the BMA has exclusively negotiated a contract for consultants aimed at providing more money,less out of-hours & weekend work--as a council member--Dr Kew should have known better about the realities of her argument to promote consultants to be in the frontline when providing out-of-hours services in the NHS.Ideas inspired by political motives may not always fit in well with practical realities. Competing interests: None declared |
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