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EDITORIALS: Tony Delamothe Centralised application services for specialist training BMJ 2007; 334: 1285-1286 [Full text]

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Rapid Responses published:

An open appeal to our Royal College presidents: Please stand together for our Juniors

Morris J Brown, Sir Nicholas Wright, Peter Barnes FRS, Stephen O'Rahilly FRS, Mark Pepys FRS and 41 other professors or presidents of specialist societies   (22 June 2007)

A smooth run-through?

Sean P J Lynch   (22 June 2007)

protecting professionalism

J. Martin Dace   (22 June 2007)

Research and the MTAS disaster

Joe Herbert   (23 June 2007)

Of course

David Curtis   (23 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Jonathan Roos   (23 June 2007)

Silent demise of autonomy

Klaus K Witte   (23 June 2007)

Juniors' Jobs

Gordon W Stewart   (23 June 2007)

This is no way to treat entrants to a caring profession

Clive W Richards   (23 June 2007)

MTAS: Make a change

Tony Heagerty, 46 Grafton Street Manchester M13 9NT   (24 June 2007)

Disgust and shame

Matthew J Knight   (24 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Paul N Rogers   (24 June 2007)

shocked

Gursharan l kashyap   (24 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

emma gudgin   (24 June 2007)

Prof Brown is absolutely correct

Nick P Martin   (24 June 2007)

When in a hole stop digging

Jane Deal   (24 June 2007)

Betrayal of a generation - the repurcussions

Waqas Ullah   (24 June 2007)

A debt of gratitude

Steven D Vidgeon   (24 June 2007)

Colleges cannot stick their heads in the sand

Alasdair Miller   (24 June 2007)

Is it too late?

Mark D. Bloomfield   (24 June 2007)

The career lottery.

maitrayee choudhury   (24 June 2007)

Scarp MMC

M Farouk   (24 June 2007)

The failure of representation

Vincent Connolly   (24 June 2007)

An aplication service to flood the medical labour market

Clive Peedell   (24 June 2007)

Did i apply for the wrong level

Manotheethan Jegasothy, SM5 1AA   (24 June 2007)

Abandon MTAS

john roberts   (24 June 2007)

Time for new leadership

Mark R McCartney, Cornwall PL14 5RP   (24 June 2007)

MTAS

Thomas Britton   (24 June 2007)

Defining Moment

Nick J Sarkies   (24 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Nadine S Granger   (24 June 2007)

Support for statement

John M Morgan   (24 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Gordon Caldwell   (24 June 2007)

protecting professionalism

Bates David   (24 June 2007)

Centralised Application Process

Andrew W McCombe   (25 June 2007)

The Royal Colleges must stand up

Daniel P Gale   (25 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Bruce J Finlayson   (25 June 2007)

Please return powers to the Colleges and disband PMETB

j wace   (25 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Adam S Onyett   (25 June 2007)

Royal Colleges must finally speak up for their members and their profession

Amanda J Taffinder   (25 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Dominic P Rogers   (25 June 2007)

Doctors as the Miners of the Middle Class

Christopher M Rayner   (25 June 2007)

A request for support from the Royal College of Physicians

Abhijoy Chakladar   (25 June 2007)

Thanks Prof Brown

Max Priesemann   (25 June 2007)

Illogical

Neil D Citron   (25 June 2007)

MMC Debacle

Paul D McGeoch   (25 June 2007)

Support for Fidelio

Robert A Price   (25 June 2007)

What now?

Yvonne M Cartwright   (25 June 2007)

Medical Royal Colleges need to reclaim authority for postgraduate education and training

David B Hocken MS FRCS   (25 June 2007)

Time for action.

J. David Leopold   (25 June 2007)

All too familiar

Rachel M Nicholson   (25 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Stephen R Ford   (25 June 2007)

blame the game, not the player

Jalil Ahmed   (25 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Chris Chung   (25 June 2007)

Full support to Prof Brown

Tom D Cosker   (25 June 2007)

In support of Morris Brown.

Alan J Carson   (25 June 2007)

Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Paul J Andrews   (25 June 2007)

In support of Prof. Brown

Ally Rooney   (25 June 2007)

Doctors should take back control

Clio Bellenis   (25 June 2007)

We must act now.

Felicity J Meyer   (25 June 2007)

Re: An Open Appeal

Louella Vaughan   (25 June 2007)

Re: Support for statement

Ian F Russell   (25 June 2007)

The current state of play

Christopher Twine   (25 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Michael Douek   (25 June 2007)

total complacency amongst the royal colleges

Katrina L John   (25 June 2007)

MTAS- the other debacle

Graham P WINYARD   (25 June 2007)

Stay united and lobby for more consultant posts

Damian J Kelly   (25 June 2007)

Time for the College Presidents to Act

Richard J Motley   (25 June 2007)

Another victim's perspective

Ben S Clark   (25 June 2007)

Department of Health and the Royal Colleges - Special Relationship?

Boyd Ghosh   (25 June 2007)

Insult after insult

shelley dale Riphagen   (25 June 2007)

Keep the new name, just bring back the old system

Adrian J McKenna   (25 June 2007)

Royal Colleges must stop being so spineless

Jan K Melichar   (25 June 2007)

Please help us

Onkar S Dhillon   (26 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Christopher H Blake   (26 June 2007)

Re: An open appeal to our Royal College presidents: Please stand together for our Juniors

Helena Tabry   (26 June 2007)

Support for Prof Brown and colleagues

Paul A Clarke   (26 June 2007)

More support for Prof Brown

Ben Underwood   (26 June 2007)

I am a moron

Rahul V Bhintade   (26 June 2007)

MMC/MTAS, The BMA and the Royal Colleges

Peter McNamee   (26 June 2007)

MMC

Allan P Corder, HR11SG   (26 June 2007)

Well done Morris Brown et al

Charles P Warlow   (26 June 2007)

Experience of a national recruitment process for general practice

Mayur Lakhani, Simon Plint, GP Dean, COGPED   (26 June 2007)

Disgusting and Demoralising

Chris D Briggs   (26 June 2007)

MTAS Disaster

Lynne Carmen Fryer   (26 June 2007)

The dilemma of through-run MMC training

Michael J. Kelly   (26 June 2007)

Damage limitation

s judd   (27 June 2007)

Accountability and Integrity

Alastair R Deery   (27 June 2007)

Is anyone out there in favour of the current MTAs/MMC system?

mary g harrington   (27 June 2007)

MTAS: A Disaster

Charles N McCollum   (27 June 2007)

What now for the dispossessed?

Glenis K Scadding   (27 June 2007)

MTAS shambles

Allistair Stark   (27 June 2007)

Let's stop being so nicey nice

Louise M Pealing   (27 June 2007)

fomenting poor morale within the profession and hampering change

Dan Harding   (28 June 2007)

Morris Brown speaks for the profession

Ruth M MacInerney   (28 June 2007)

In support of Prof Brown

D Owen   (28 June 2007)

Plan B

Simon T Adams   (29 June 2007)

We have let our Juniors Down

Daniel M Sado   (29 June 2007)

Re: Let's stop being so nicey nice

Tom A Milligan   (29 June 2007)

Re: Support for Prof Brown and colleagues

Catriona Sykes, DG1 4AT   (30 June 2007)

Further support for Prof Brown.

Jamie Peyton   (30 June 2007)

Medical reforms put patients at risk

Jane E Graham   (30 June 2007)

A robust stance is required

Duncan J M Macdonald   (30 June 2007)

cogs in a machine

Iona Heath   (3 July 2007)

Rage Against the Machine

Jasjit K Dhillon   (3 July 2007)

Numerical indicator nonsense

JOHN HUTCHINSON   (4 July 2007)

loss of confidence

Philip J Dawson   (22 July 2007)

An open appeal to our Royal College presidents: Please stand together for our Juniors 22 June 2007
Morris J Brown, Professor of Clinical Pharmacology Addenbrookes Hospital, Cambridge, CB2 2QQ, Sir Nicholas Wright, Peter Barnes FRS, Stephen O'Rahilly FRS, Mark Pepys FRS and 41 other professors or presidents of specialist societies Send response to journal: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	During the current disagreement between the medical profession and Department of Health (DoH) over responsibility for medical training, there is an important role for a pressure group of independent senior doctors. Our role is to speak on behalf of colleagues, in particular our beleaguered juniors, whose views we have sampled in a series of online polls. Shortly after the terrible truth began to dawn on 8th June that the results of MTAS might be even worse than expected, we wrote to the Royal College presidents expressing our fears, and asking for help with a solution to the immediate crisis. Our letter is reproduced below. The presidents – except PRCSEng whose college is pursuing more active intervention – reassured us that, while they shared our concern for the victims of MTAS, the situation would improve by June 22nd; they explained that only candidates considered excellent were to be appointed to run- through grades during the six months of round 1, in order to leave posts for round 2. The presidents have submitted evidence of serious concerns about run-through to the Tooke review, and are optimistic if all parties work together that things will come right for the future. They did not wish however to see publication of their reply, being an inappropriate basis for the online debate we would like to encourage. The final week of our rolling poll of 1523 applicants unfortunately continues to show only 58% with offers, of which 18% are FTSTAs. As we predicted in April and May, the single interview in competitive specialties appears to have caused a selective cull of the best, with 33% of unsuccessful (unlucky) candidates in our poll having a 1st class degree or distinction-in-finals, compared to 26% of the successful (lucky) ones. A majority of both lucky and unlucky candidates would like to see STs and FTSAs free to compete equally for ST3/4 next year – some of the ‘lucky’ because they otherwise face 7 years at the opposite end of the UK from their partner. Polls, we recognise, selectively sample the disadvantaged, and more accurate figures on outcomes will hopefully be published as promised by the DoH next week. Meanwhile Trusts, who were no longer to be trusted under MMC/MTAS with ‘elective’ medical appointments, have been instructed to act as emergency labour exchanges in placing the 30-40% or so of doctors whom the DoH recognise will otherwise be unemployed on 1st August. Catastrophe? Conspiracy? 'Incompetency?' We hope, by publishing our letter, to promote a ‘bottom-up’ discussion of how to affect a ‘top-down’ process when the top is invisible; and of what optimum balance of dialogue and distance should exist between our leaders and those who have caused the current disaster. Wishful thinking is not enough. To the Presidents of the medical Royal Colleges 11th June 2007 Dear Presidents We appreciate and support the efforts that many Royal Colleges are now making to engage with their constituencies and make strong representations to the Tooke enquiry. However, the immediate and urgent problem is the very large numbers of doctors not being offered jobs as a result of the rounds 1a and 1b interviews. Although, officially, re-cycled offers will continue to be made until June 22nd, the expectation among the Juniors is that there will be only a few more after the beginning of this week. It is already clear from feedback to us and others that there have been some very gross miscarriages of justice. We attach just a few anonymised examples, but they are typical. In addition, and in the absence of any official attempt to document and publicise the outcome of the MTAS experiment, we have established another online poll. The responses to date show that the attached examples are but the tip of an iceberg. In addition, numerous respondents document procedures in the round 1interviews which confirm our worst fears, and bring shame upon all those bodies who lent their name to the process. Because any attempt to reverse, and prevent further, miscarriages of justice would need to happen before contracts are issued, we are now writing to all College Presidents to seek your outspoken views while there is still time. We appreciate that the official response will be that further posts are available in round 2. However, given the gulf so far between official promises and disastrous reality, the Juniors can be forgiven for lack of trust in promises, and we ourselves have no confidence – despite the small number of extra posts in a few specialties – that there will be any quality posts available for those unsuccessful in round 1. We regret that our cynicism about DoH involvement in all decision -making processes to date has been fully justified. Given the SoS’s recent statement that the problems are now resolved, casting herself as heroine and saviour, we intend to disabuse publicly her and the next Prime Minister before the new administration takes over. You are in a much stronger position than we to propose the urgent interim solution. Given the overwhelming evidence, confirmed by an independent Judge, of serious deficiencies in the appointments process, our preferred option would be a joint call from the Royal Colleges to PMETB to declare the current round invalid, without regard to the red faces this will cause in Whitehall. All doctors should stay in their current position, with the new generation of FY1s paid for a minimum of six months of shadowing the existing FY1s, or some other useful activity. We doubt whether you or PMETB will be prepared, however, to go down this route. The less satisfactory, compromise option is to demand that either all or at least 50% of posts are offered for one year only, with unsuccessful but eligible candidates remaining in current, paid, posts until they are able to compete in a round 2 for a 1-year FTSTA; the 50% would have to be based crudely on interview scores. All should be given 1- year training recognition. Both these options, and indeed many of the likely Tooke recommendations, will stoke up another numbers mis-match for next year’s exercise. For this reason it is extraordinary that Tooke’s remit does not include consideration of medical manpower, and risks ignoring one of the main sources of this year’s troubles – the need, in kick-starting MMC, to funnel the FY2s and SHOs into the disproportionately small number of training posts. Even if the Royal Colleges were signed up to the principles of MMC – which we doubt – the clear responsibility was to ensure that the inevitable blood-letting competition should be transparent and fair. It is regrettable that continued College participation in the Review Body, after abandonment of short-listing, allowed the DoH to associate the Colleges’ good names with the debacle, without admission of the systemic failures that led the independent Judge to brand the process as flawed and disastrous. Among those concealed failures was the vital matching algorithm of the MTAS computer – now ironically protecting the DoH from the public impact of the chaos to which the failure has contributed. We hope you will press the Review Body to announce urgently its arrangements for collecting and publishing by June 22nd data from Deaneries on the number of successful and unsuccessful applications. We also consider it appalling – and absolutely contrary to the Royal Colleges’ recent campaign for professionalism – that many applicants were not informed by Deaneries of interview dates/times, and that unsuccessful applicants’ only way of discovering their rejection this week is the absence of receipt of an email. What a contrast to another broken promise from the Review Body of counselling for all unsuccessful applicants! While unsure how closely the Royal Colleges are currently working together, we would welcome – as evidence of the belated separation of powers for which we have previously called – a joint statement that endorses the well-publicised request from ourselves and the vast majority of the medical profession that the Chief Medical Officer is called urgently to account. Until or unless there is recognition of failure at the top of the DoH, any compromise between the Profession and government will be in one direction, with the Royal Colleges remaining unwillingly complicit in the DoH agenda. We look forward to your reply, and would be delighted also to meet with you. This week is a crossroads for our profession. After a few days for reflection, therefore, we would like to publish this as an open letter, together with responses if you wish. We are confident that we can unite in this pivotal step of demonstrating and strengthening the profession’s determination to reclaim responsibility for our destiny. Morris Brown, Professor of Clinical Pharmacology, Cambridge Peter Barnes, FRS, Professor of Respiratory Medicine, Imperial College Nicholas Boon, President Cardiovascular Society Nicholas Brooks, Past-President Cardiovascular Society John Camm, Professor of Clinical Cardiology, St George's Hospital Mark Caulfield, Professor of Clinical Pharmacology, Queen Mary London Edwin Chilvers, Professor of Respiratory Medicine, Cambridge Angus Dalgleish, Professor of Oncology, St George’s Hospital Pamela Ewan, CBE, Consultant Physician, Addenbrooke's Hospital Jon Friedland, Professor of Infectious Diseases and Immunity, Imperial College Steve Franks, Professor of Reproductive Endocrinology, Imperial College John Gibson, Professor of Respiratory Medicine, Newcastle Peter Grant, Professor of Vascular Medicine, Leeds University Ashley Grossman, Professor of Endocrinology, Queen Mary London Alistair Hall, Professor of Clinical Cardiology, Leeds George Hart, Professor of Medicine, Liverpool Rod Hay, Head, School of Medicine, Queens University, Belfast Tony Heagerty, Professor of Medicine, Manchester Humphrey Hodgson, Vice-Dean, RFUCMS Juan Carlos Kaski, Professor of Cardiovascular Science, St George's Hospital Christopher Kennard, Vice Principal, Charing Cross Hospital Kay-Tee Khaw, Professor of Clinical Gerontology, Cambridge John Lazarus, Professor of Clinical Endocrinology, Cardiff Stafford Lightman, Professor of Medicine, Bristol Jim McKillop, Professor of Medicine, Glasgow Peter McCollum, Professor of Vascular Surgery, University of Hull John Monson, Professor of Surgery, Hull Steve O’Rahilly FRS, Professor of Clinical Biochemistry & Medicine, Cambridge Mark Pepys FRS, Professor of Medicine, RFUCMS Rodney Phillips, Professor of Clinical Medicine, Oxford Philip Poole-Wilson, Professor of Cardiology, Imperial College Stuart Ralston, Professor of Rheumatology, Edinburgh Jon Rhodes, Professor of Medicine, Liverpool Jim Ritter, Professor of Clinical Pharmacology, Kings College London Brian Rowlands, President of the Association of Surgeons Neil Scolding, Professor of Neurology, Bristol Peter Sleight, Emeritus Professor of Cardiology, Oxford Roger Sturrock, Professor of Rheumatology, Glasgow Robert Sutton, Professor of Surgery, Liverpool Raj Thakker, Professor of Academic Endocrinology, Oxford Douglas Turnbull, Professor of Neurology, Newcastle Hugh Watkins, Professor of Cardiology, Oxford Alistair Watson, Professor of Gastroenterology, Liverpool Robert Wilcox, Professor of Cardiology, Nottingham Mark Wiles, Professor of Neurology, Cardiff Sir Nicholas Wright, Warden, Queen Mary London Competing interests: Several authors are parents of, or otherwise related to, junior doctors, some of whom participated in the MTAS experiment.
A smooth run-through? 22 June 2007
Sean P J Lynch, Honorary Senior Clinical Lecturer, PMS and Consultant Psychiatrist Mental Research Group, Peninsula Medical School , Wonford House Hospital, Dryden Rd, Exeter, EX2 5AF Send response to journal: Re: A smooth run-through?	I have been reading the debate about MTAS and MMC with keen interest and firstly, I would like to express my support for all the junior doctors caught in what is one of our profession's darkest hours. My response is more concerned with the operation of the run-through grade system once applicants are appointed. I can only comment from the perspective of my specialty, psychiatry and there may be different issues affecting other specialties. My main concerns are about the inherent inflexibility of a "perfectly balanced" system. There are many possible challenges to a smooth run- through and I have listed just a few examples. 1. The mechanics of changing to flexible working or part-time working need specific consideration. For example family reasons, work-life balance reasons, illnesses. 2. Colleagues who want to undertake specific experience overseas (not just to obtain academic experience but to develop new clinical expertise)may find the process of taking "time out" 3. Colleagues who have a desire for a specific period of training in another specialty e.g. if you wished to become a neuropsychiatrist and would like relevant medical experience in neurology. I have some suggestions to increase flexibility that hopefully will stimulate more debate 1. Within each Deanery, there is a floating number of flexible slots at each ST stage. These could either be delegated to specific Schools (e.g Psychiatry) or in a larger "pot" for collaborative training 2. Numbers within each scheme should have more inbuilt flexibility within each training stage e.g. 5-10% variation of "ideal numbers" each year. 3. Deaneries should be liberated from the inflexibility of the annual intake, or be at least allowed to appoint to temporary or transition posts (see points 1 and 2) for suitable candidates at who eventually can enter at each year of the training scheme. 4. "Mapping" is needed of potential consultant / specialist grade vacancies two to three years before completion of training i.e end ST4 / start ST4 in psychiatry. This should in my view be a joint Strategic Health Authority / Deanery responsibility. 5. A different type of post to FTSTA to allow for "out of scheme experience" approved by the Deanery School. 6. Clear rights for trainees to move to part-time and flexible working that are parctically translated and not subject to hughe bureaucratic obstacles. In conclusion, the principles behind MMC have much to be admired, but the system will falter unless greater flexibility develops. Competing interests: MRCPsych Course Organiser Clinical Tutor Chair, Curriculum Quality assurance Group, South West Peninsula Deanery These comments reflect my personal views only and may not represent the views of the above bodies with which I am associated.
protecting professionalism 22 June 2007
J. Martin Dace, GP 21 Morden Hill, Lewisham, London SE13 7NN Send response to journal: Re: protecting professionalism	Beyond the current injustice to junior doctors (and the loss of some of the best abroad) lies an intent to destroy medical professionalism in this country. This is being done by removing the independence of the profession in self-regulation, by dumbing down medical education to 'competencies' instead of striving for excellence, by failing to increase, not decrease training to compensate for the European Working Time Directive, by perverting clinical judgement with target driven medicine, by the distortion of clinical priorities by bogus and manipulated waiting times, and by taking every opportunity to damage morale. A full cure would require removing the potentially irreversible canker of political interference from the NHS and from the profession. Competing interests: None declared
Research and the MTAS disaster 23 June 2007
Joe Herbert, Director of Graduate Training, Department of Clinical Neurosciences, University of Cambridge University of Cambridge Send response to journal: Re: Research and the MTAS disaster	It must not be forgotten that, in the midst of the MTAS calamity over jobs, there are serious worries about the ability of young doctors to incorporate research training in their career structure. A small but highly significant number of young doctors have the ability, wish and necessity of pursuing a higher research degree qualification (eg PhD, MD etc). The new scheme makes this almost impossible: indeed, it seems overtly anti-academic. The high standards of British medicine rest on a solid, internationally-recognised excellence in research. Along with all the other idiocies of the MTAS is the failure to recognise that an acceptable national training scheme has to cater for those who want (and are able) to carry out medical research on which not only their careers, but the general health of medicine in this country, so evidently depends. Competing interests: None declared
Of course 23 June 2007
David Curtis, Clinical director, Tower Hamlets Adult Mental Health Service Dept Adult Psychiatry, Royal London Hospital, Whitechapel, London E1 1BB Send response to journal: Re: Of course	Of course I would like to see a more robust response from the Royal Colleges. Or, indeed, anybody. Week after week, day after day, I have witnessed this fiasco unfolding (and yes, this fiasco does unfold) to ever more breathtaking levels of surreality. Day after day, moment after I moment, I find myself confronted with the question of how this has been allowed to happen. Whose fault is it? Who is doing this? Who knows about it? The whole medical profession seems trapped in a fog. If a colleague goes to some central meeting to be updated on the latest developments they come back reporting that nobody knows what is going on. As a clinical director, I would have appreciated being kept in the loop regarding how many doctors were likely to be working in my service in six weeks from now. I would have appreciated being told what an ST4 job description would look like before recruiting seven of them. As an educational supervisor I would have quite liked to have been told about the new training and appraisal arrangements. As a doctor, it would have been a bonus if my junior colleagues had not been subjected to this degree of abuse and if my patients had had the benefit of treatment from medical staff who were in a better position to apply their emotional and intellectual resources to providing care rather than simply surviving. The proposed new training scheme is shrouded in mystery. There are so many obvious questions to ask about it, issues which seem problematic, glaring problems. To date, the position of the powers that be seems to have been, "Trust us, it will all be OK". Well, I have a communication for the powers that be. I don't trust you. Not any more. And, no, it will not all be OK. Of course nobody will listen to me. So: Of course I would like to see a more robust response from the Royal Colleges. Competing interests: I wish to see a functioning health service staffed by skilled and motivated professionals.
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 23 June 2007
Jonathan Roos, MD/PhD student CB2 2QQ Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	It would appear that instead of leading the profession, the Royal colleges are sloshing in ministerial sycophancy, abandoning their duty to already burdened Professors who are now fighting for the very future of our profession. Perhaps on this one occassion Bush's doctrine is right: you are either with the profession or against it. Do the Royal Colleges still not see that they have failed to serve their colleagues and their profession? Is there not a hint of embarrassment? They have asked that their response to Professor Brown et al., not be revealed publicly? Why? Perhaps there is a bit of shame after all, but whom do they believe they should serve? Their opinions are not private, but as representatives of colleagues belong to those colleagues. Prof Brown et al., are owed much thanks from the profession. That in private this group has been criticized by some ministers and College presidents for being hysterical and ‘going too far’ is completely beyond the pale. The solution is simple, one change profession or move abroad- with this sort of system in place the UK cannot expect to be a world leader in biomedical research nor clinical care. I for one dropped out of MTAS and am doing research at Harvard for a year. Perhaps I shall stay. Would the DoH or NHS miss me? Competing interests: None declared
Silent demise of autonomy 23 June 2007
Klaus K Witte, Specialist Registrar in Cardiology Leeds General Infirmary, Leeds, LS1 3EX Send response to journal: Re: Silent demise of autonomy	It is amazing that a profession attracting the brightest and most dedicated individuals has allowed itself to be led to the edge of this cliff. Silently we have sat by while the government, apparently acting in the best interests of OUR patients, has eroded our autonomy to the point that we are close to becoming mere slaves to guidelines, directives and political whim. Independent thought and creativity have been suppressed, our chosen profession is becoming one based on minimal competencies and targets and now many of our brightest junior colleagues will be without a training post. Is it not about time we began to express our disatisfaction with the political interference in the jobs most of us are actually proud to do - not for our government but our patients? For them we also need to protect our training programs and our trainees. Competing interests: None declared
Juniors' Jobs 23 June 2007
Gordon W Stewart, Professor of Medicine University College London WC1E 6JJ Send response to journal: Re: Juniors' Jobs	I think that in the current emergency, all 'training numbers' should just be dropped. Deaneries should be arbitrarily closed. Hospitals should be able to appoint what junior doctors they need on the basis of a cv and interview. Later, an individual's competence to take up his or her next job can be decided on the basis of what experience that individual has. This will give flexibility in a system that has collapsed under the incompetent management of the DoH. Competing interests: None declared
This is no way to treat entrants to a caring profession 23 June 2007
Clive W Richards, Consultant in public health medicine Nottinghamshire County tPCT, Mansfield, NG21 0ER Send response to journal: Re: This is no way to treat entrants to a caring profession	When the fall out of this debacle becomes apparent, who will count the cost of problems caused to personal lives? I know of medical couples forced to take jobs in different parts of the country when previously they would have been able to apply for posts together, or in adjacent trusts, even if that meant compromising on one or other not applying for the job they most wanted. Now all flexibility is lost. It is ironic that at a time when patients are quite rightly demanding to be treated as people by their health service, their junior doctors are being treated like cattle. It is unreasonable to expect junior doctors to become good carers when they have not been shown an example of being treated in a caring way at a critical time in their career. Junior doctor abuse, like child abuse, runs down the generations. Competing interests: None declared
MTAS: Make a change 24 June 2007
Tony Heagerty, Professor of Medicine Faculty of Medical and Human Sciences, 46 Grafton Street Manchester M13 9NT Send response to journal: Re: MTAS: Make a change	As a signatory on all the letters that Morris Brown's Group Fidelio has published, I have signalled my personal dissatisfaction with the appointing process for Junior Doctors. This has been discredited and steps are being taken to review and modify the situation. This is not a time for recrimination. It is irrelevant who got the profession into this, we must deal with the consequences and of immediate priority is our unfairly treated Juniors. Doctors have many leaders. Indeed this is one of our problems because we are represented by a multitude of voices. Recently I heard Lord Hunt applaud senior doctors who have taken a robust stance against more hysterical elements in the profession over this issue. I assume Fidelio is in his cross hairs. But all doctors must be heard. We cannot stand by as thousands are unfairly treated by a flawed process and say we shall do better next year. We must contribute constructively to redesiging MTAS but something must be done now to support a demoralised workforce. We all have a duty to speak out in their defence. Competing interests: None declared
Disgust and shame 24 June 2007
Matthew J Knight, FY2 General Medicine Hastings- TN37 7RD Send response to journal: Re: Disgust and shame	Dear Editor, As a current FY2 having gone through the process of MMC and the MTAS application fiasco I would like to thank a small minority of our profession, such as RemedyUK and the group of senior clinicians lead by Professor M Brown, who have taken a keen interest in defending the rights of junior doctors- whilst at the same time our employer, the secretary of state and, by guilt of omission and disinterest, most of our senior colleagues have left junior doctors out to dry in what has been a devastating and emotionally exhausting year for many in our profession. The whole process of medical recruitment this year has been a farce. The basic fundamental rights of each of us as human beings have been violated. The levels of uncertainty, the stress experienced by many of our young and talented doctors faced with having to suddenly and unexpectedly move across the country or even be faced with unemployment or the effective termination of their careers, is akin to psychological torture. This whole process is in clear violation of articles 23 (section 1), articles 1 and articles 4 of the Universal Declaration of Human Rights, too which this country is a signatory. Despite being lucky enough to secure a job through this system, I have no feelings of accomplishment. I do not feel as if I have competed in a meritocratic process- I feel exhausted and worn out. Many of my close friends and colleagues, talented people who work hard, are as yet without work- they are now engaged in a humiliating process of checking multiple internet sites on a daily basis (often filling in ridiculous application forms which yet again focus on the ability to answer in 150 words or less why you are such a wonderful doctor) and I fear that few of them are focusing on their work. Distressed doctors, often in tears, irritable, upset, do not make good caring professionals- despite their best efforts. I, and many of my colleagues, have a complete and total loss of faith in both the Department of Health and our senior colleagues ability to fairly appoint and manage workforce planing. To restore trust in the system will take an immense amount of effort, which must start here and now. There must be an immediate return to a system where by individual doctors apply for individual jobs at specified hospitals (or rotations) at SHO level, and then in a second wave apply for run through specialist training at the ST3 level. There is nothing wrong with a centralised application system as such, however it allows the mass application to many hundreds of jobs and makes the selection of the best candidates rather difficult. I would like to suggest a computerised and common NHS application form be filled in "online", that a personalised CV be attached to this, however a copy of this should be sent by post (this very slight obstacle is often enough to stop someone applying for a job that they do not really want just because it is easy to do so online and I feel will reduce the number of people applying per job). Candidates apply to specified jobs, with full job descriptions, banding details, and details of childcare, facilities and so on. That shortlisted candidates are interviewed by people they are going to be working for and that offers are made through an online system, which will allow the DOH to manage workforce planning. In the interim it seems as if an awful lot of people are going to have an uncertain time over the next few months. The change over for jobs should be delayed for all until the first Wednesday of September, allowing the overworked deanery officers time to place as many people as possible in jobs, and as far as possible we should all change jobs together. The medical year should run from September to September avoiding the problems experienced every year of change overs whilst senior staff are on holiday. The secretary of state should issue a full response and apology in writing to each and every doctor. All future changes to the system must have widespread consultation of junior doctors and should not be undertaken unless there is widespread support. I am ashamed of the way this country has treated so many people whose primary vocation is that to serve others, I am upset that so many of my friends have felt it necessary to accept jobs in far off lands and I am furious at the level of perfidy demonstrated by so many senior members of our profession. Yours faithfully, Dr Matthew Knight FY2 General Medicine Conquest Hospital Hastings Competing interests: An FY2 with a job offer for ST1 Medicine, exhausted by the whole MMC debacle and thoroughly fed up! Supporter of Remedy. Someone with an iota of common sense and respect for others.
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 24 June 2007
Paul N Rogers, Consultant Surgeon Gartnavel General Hospital, Glasgow G12 0YN Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	The views of Prof Brown and his colleagues reflect accurately the fury that is felt by my colleagues, both senior and junior, at this disgraceful shambles. The apparent inability of our elected representatives in (most of) the Colleges similarly to represent our views calls their competence or motives into quetion. Their "softly, softly" approach has permitted this chaos and their present contention that a similar approach will help to resolve matters is risible. The profession has a duty to take a very robust stance in opposing arrangements that will lead to the destruction of medicine as a profession in this country. Competing interests: None declared
shocked 24 June 2007
Gursharan l kashyap, SHO,psychiatry cold east way,sarisbury green,southampton Send response to journal: Re: shocked	I was shocked when i could not get ST3 and thought that everything is finished, i have a family of a wife and 2 kids,don't have a choice but just be hopeful,which i am surely not,and trying to keep a smiling face for my kids, why i could not get it,i don't know.i have 3 years of training and passed part 1 of MRCPsych. so why ? Ask my consultant who says i m surely appointable and that if it comes to him he is going to give me an excellent reference,and i was deemed untrainable and not given a training job in the only interview which i had in round 1b.ask my staff,my team,my senior colleagues,look at my academic records,and other consultants where i work, they will tell whether i m appointable or not but who is bothered ,we are being forced to follow the dictatorial instructions which don't depend on your credibility butrather on how to save money either by cutting down posts and pays of probaly the most vulnerable and helpless professional group of the modern ages i.e the doctors,where every senior person just seems to sit and look at the undeserved torture of their junior colleagues and ultimately be a party to it,because they also seem to be afraid of the system and don't dare to raise their voice because it can just chew any one and everyone and throw it away like a chewed gum,that is what has ahppened to me. Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 24 June 2007
emma gudgin, SpR haematology Addenbrookes, Cambridge Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	I would like to express my support and thanks for all that Prof Morris Brown has done to promote the interests of junior doctors and patients in this terrible situation, and agree wholeheartedly with his sentiments. As someone who has escaped the whole thing personally, it is so good to see all the senior members of the profession trying to sort it out, as many registrars like myself are not doing enough to support our SHO's. I think that any training numbers that become available now, over the next 12 months should be allowed to be advertised by the individual regions, and appointed to directly, similarly to the old system, but bypassing the incompetent deaneries. Competing interests: None declared
Prof Brown is absolutely correct 24 June 2007
Nick P Martin, GP Faslane,G84 8HL Send response to journal: Re: Prof Brown is absolutely correct	Rarely am I moved to comment, but on this unmitigated disastar I applaul Prof Brown et al in their stance. The BMA and the colleges have acted woefully slowly and inadequately in supporting their most valued assets: the thousands of young doctors who have been comprehensively let down by this shambolic charade. Robust action is needed, and now. Competing interests: None declared
When in a hole stop digging 24 June 2007
Jane Deal, Consultant Paediatric Nephrologist St Mary's NHS Trust, London, W2 1NY Send response to journal: Re: When in a hole stop digging	I whole heartedly support Professor Brown and his colleagues in their call for a stop to the current process. I am sure I am not the only one who keeps thinking "when in a hole stop digging" everytime I read of the latest attempt to resolve the current mess. The Royal Colleges, I'm sure, genuinely feel that they have done their best to work with the process but it is increasingly apparent that appeasement has not worked. The process should therefore be halted and proper time given to reviewing where it has all gone wrong and how to make the future training and recruitment of our most precious resource, juniors doctors, work properly for the benefit of all. Please swallow your pride and go back to square one before it is too late. Competing interests: I supervise junior doctors whose futures I care about, I have a family member caught up in the ST3 debacle and potentially jobless and I will be a patient of the NHS in the future
Betrayal of a generation - the repurcussions 24 June 2007
Waqas Ullah, LAT SpR Cardiology Princess Royal Hospital, Haywards Heath, Sussex, RH16 4EX Send response to journal: Re: Betrayal of a generation - the repurcussions	The government have proceeded to betray a generation of doctors and in so doing the profession as a whole and patients as well. They are succeeding in flooding the labour market with doctors and producing inexperienced junior consultants so glad to have got a job they will compromise on everything. The Royal Colleges and the BMA have been complicit in this mess. They realised too late the scale of this government's nefarious ambition. Some may even have helped in its planning for the sake of knighthoods and other trinkets. So what are we left with? A generation of juniors who will never trust the government and who will look back on this as a time of continuing torture. Many will leave the country and many will leave medicine. Those remaining will see a vocation turned into an MMC-produced shift-centred, tick-box based, insufficiently trained work force where there is no longer any merit to excellence. How motivated will someone now be in their job when it constitutes a lifetime in a specialty they never truly wanted but were forced into, in a location far from friends and family. The NHS and patient care relies on doctors giving more that they are rota'd to - working that extra hour, chasing down that extra goal. Patients do not require tick-box competence in their treatment: they deserve excellence. How motivated will juniors who have been treated like farm animals be to provide this service? Right now, the fear of unemployment is such that juniors just want a job to pay the bills. Is that really what you want from the person treating you? Surely the public should have doctors who are happy in their profession, and in their current employment, who when working are focussed on that moment and not clock watching until they can go home and call their distant loved ones and try to ignore the feeling they have become trapped within a system that victimises them. We are mentally exhausted from the disorganised, Kafka-esque misey that has been waged upon us. We are starting to become numb to the continuing outrages the government inflicts upon us - the laughable the concessions, the rushed elastoplast-type inadequate fixes. The Royal colleges have a duty to step up and represent us adequately - for the sake of our careers, our profession, our mental health and above all our patients. The time to fight has not passed. This great profession, this noble vocation, must not be allowed to slip quietly into the night. Competing interests: One of the so called 'Lost Tribe' who has so far failed to secure a training placement
A debt of gratitude 24 June 2007
Steven D Vidgeon, Specialist Registrar, Anaesthesia Queen Mary's Hospital, Sidcup, DA14 6LT Send response to journal: Re: A debt of gratitude	Yet again the medical profession owes Prof Brown and colleagues a debt of gratitude, for highlighting with clarity. detirmination, and insight, the plight of junior doctors. As a registrar I am not directly affected by the MMC scandal, but have watched helpless whilst highly skilled, well motivated more junior colleagues are torn apart by this government's thinly veiled attack on the profession. Some of those who were lucky enough to get a post in round 1, still do not know where they are to be placed, and must leave their domestic arrangements in limbo, just grateful that they can continue their career. Those without posts are subjected to a drip feed of rumour and speculation, about the availability of round 2 oppotunities, fixed term "training" appointments, or "Trust Grade posts", all of which change on a daily basis. Some are given less than 48 hours to complete and submit further applications in order that they may catch a few crumbs from the top table. It is high time that the Presidents of the Royal Colleges spoke out publicly and made a stand against this government. Either that or appear totally complicit in the emasculation of the profession which has been done in their name. The BMA having not covered itself with glory during the MMC/MTAS debacle, is now spinning frantically, and using our money with which to do so. Both the Royal Colleges and the BMA are reliant on the fees paid by hard working members for their very existence. Those members are rapidly losing confidence. Those of a cynical disposition might be excused for saying that the overlap between the higher echelons of the medical establishment, the government, and the honours system, has not fostered a truely candid debate, on the future of medical training and ultimately the NHS. Competing interests: None declared
Colleges cannot stick their heads in the sand 24 June 2007
Alasdair Miller, SHO General Medicine Westmorland General Medicine, Burton Road, Kendal LA9 7RG Send response to journal: Re: Colleges cannot stick their heads in the sand	The current vogue for abdicating responsibility amongst the medical professions representitive bodies is simply a case of heads in the sand. Defering action until the conclusion of the Tooke inquiry is unacceptable. Firstly, the review, when it concludes, may not have a conclusion that is acceptable to the medical profession, and given the history of recent government inquiry 'white-washes', this must be a possibility. Secondly, it is likely that for a successful recruitment process next year planning should start now, and if even if it did this would be a tight shedule to correct all the mistakes of the current application process. Thirdly, junior doctors careers and lives are suffering now, and our interests can not simply be deferred. Participating in the MMC Inquiry is certainly to be encouraged, but every legitimate course to further the medical professions interests should be used, and clearly this has not, and continues to not be the case. Competing interests: Unsuccesful applicant through MTAS
Is it too late? 24 June 2007
Mark D. Bloomfield, Consultant Orthopaedic Surgeon Windsor SL4 3SJ Send response to journal: Re: Is it too late?	Words fail in describing the depravity or venality of our political and medical 'leaders'. How did it come to this, and how does it come right? What will change to correct the trend? Even if we obtain concessions over the MTAS/MMC debacle, the overall future still looks bleak. What astounds me is the complacency, paralysis or blindness of the many, and the anguish of the few who see clearly into the future. And all the while the band plays on..................... Competing interests: None declared
The career lottery. 24 June 2007
maitrayee choudhury, SHO general medicine Leicester Royal Infirmary , LE2 7GF Send response to journal: Re: The career lottery.	I agree with Tony Delamouth's criticisms of the flaws of MTAS. However, one important outcome from this is that despite the lack of current training posts there continues to be an ever increasing number of graduate doctors. This highlights the increasing control the government will have over future doctors' training, as by having a surplus of junior doctors, it will give them greater power over their career choices and pay, something that modernising medical careers has failed to higlight. Competing interests: None declared
Scarp MMC 24 June 2007
M Farouk, Cons Surgeon Bucks NHS Trust Send response to journal: Re: Scarp MMC	We need to go back to training of surgery as a craft - centralisation should be abandoned, there really was nothing wrong with the old system. The time of trainng should be extended to 8 years to cope with shorter working hours. Future surgeons should be appointed by current experts in the field. Competing interests: None declared
The failure of representation 24 June 2007
Vincent Connolly, Chief of Service, Acute Medicine The James Cook University Hospital, Middlesbrough Send response to journal: Re: The failure of representation	Dear Sir/Madam There have been many mistakes and misjudgements which have culminated in the disintegration of MMC/MTAS. Most of these have been well documented but I would like to add two additional points. Firstly, it is widely accepted that any good management process is developed and delivered by those who work with the process. For MMC/MTAS the opposite has happened; a system has been developed which is owned by no one, which moves the appointees to new employment in different organisations every four months and which disenfranchises the trainer from the trainee. The centralisation of the process inevitably disenfranchises people from the process. Secondly,organisations which are political will demand and expect solutions which deliver political aspirations but medical representatives and institutions must demand solutions which will deliver the best possible medical care for patients. Our organisations the BMA & colleges should conduct an internal review of their decision making and representation with regard to MMC/MTAS and publish it for their members. No individual is singularly responsible for this but there has been an institutional failure among several organisations who should have been developing the best possible appointment and training system but have instead been focussed on delivering short term political goals. It appears that frontline medical staff both junior and senior have become disenfranchised from the development of their own profession. The colleges and BMA need to address this urgently, otherwise their is no justification for the membership fees. There has been an abject failure of medical representation. Yours faithfully Dr Vincent Connolly Competing interests: None declared
An aplication service to flood the medical labour market 24 June 2007
Clive Peedell, Consultamt Clinical Oncologist JCUH Middlesbrough Send response to journal: Re: An aplication service to flood the medical labour market	When this government uses the word "Modernising" it should always be interpreted as "Marketising". The political agenda underlying MMC and MTAS is all about flooding the labour market and providing a cheaper more manageable workforce. The medical profession is being systematically downgraded and disempowered. The aim of the new training system is to produce doctors with "minimum competencies" that allow them to perform certain levels of work "safely". The tick box assessmnets essentially make all doctors look the same on paper. It is very hard to pick out the best. This is of course exactly what the market wants. The other pre-requisite for a cheaper medical workforce is an excess of doctors and that is exactly what we have. Traditionally, Europen trained doctors have found it extremely difficult to compete for specialist training posts without prior experience in the UK, because UK graduates had very high levels of training,experience and brilliant CVs. The new system that is dumbing down and reducing training has now opened up the floodgates to the rest of the World. The labour market is flooded and this is going to be ideal for the private sector to recruit from in the next few years. ISTCs are desperate for staff and flying teams in from abroad on a long term basis is not sustainable considering the workload increases of their contracts. The CCT holders of the future will be appointed as subconsultants with much worse T+Cs. Many will end up in the private sector without the benefits of the NHS pension. NHS Trusts will need to drive down their T+Cs to compete. The UK medical profession is on a slippery slope and the CMO and Royal Colleges keep on squirting the "fairy liquid". An entire generation of junior doctors has been betrayed in the most disgraceful manner. We must fight back soon before it's too late. The first step would be to get Liam Donaldson and Carol Black to stand down. Competing interests: Anti-MMC campaigner
Did i apply for the wrong level 24 June 2007
Manotheethan Jegasothy, SHO in Medicine St Helier Hospital, SM5 1AA Send response to journal: Re: Did i apply for the wrong level	MTAS has currently left me unemployed and with no further training in my chosen career. Did i apply at the right level - well i managed to get 3 interviews. Did the interviewers feel i was inadequate - well 2 of the 3 went fairly well - so i thought. Does the government want to ration training - i think there lies the answer. Cost cutting, in whatever guise has the same result - inaqeduate patient care. Just like the system of hospital clinicians not being allowed to refer to another disipline but rather 'recommend' the GP does so (I bet a significant percentage of these don;t get done - not through the GPs fault but more the fault of the system. How does this affect MMC - we need to return to the past and correct the point when the training pathway sidetracked to this current dimension. What we need is Doc Brown and his De Lorean - or at least active constructive support from our royal colleges - They still are OUR royal colleges - right? Competing interests: None declared
Abandon MTAS 24 June 2007
john roberts, Consultant Physician Royal Hampshire County Hospital Send response to journal: Re: Abandon MTAS	I write to support the stance of Professor Browm. The MTAS plan is ill conceived and poorly executed. The idea that Doctors of all specialties should choose their ultimate specialty within 2 years of qualifying, and then stick to a rigid training programme is not sensible. Tha appointment process is clumsy and can place juniors far from where they prefer to work, very important if they have other family members to consider. This is not about medical training, but about Stalinist central control. MTAS should not be modified, it should be scrapped. The previous system of deanery appointments worked reasonably well. Why change it? Competing interests: None declared
Time for new leadership 24 June 2007
Mark R McCartney, GP Pensilva Health Centre, Cornwall PL14 5RP Send response to journal: Re: Time for new leadership	I cannot understand why the BMA and the Royal Colleges have been so slow to act on this. August approaches and thousands of juniors have no idea if they will have a job or where they will be. This is a disgraceful way to treat our professional colleagues. I believe all those involved should step aside and allow a new team to sort out the mess. The BMA and Colleges should take a firm stand with the Department of Health, and that should involve a change in leadership. I only wish our College Presidents could visit our hospitals and GP Out of Hours services at night to see the effects of the changes in training. Our junior doctors are demoralised by the situation and the loss of role to non-doctors ("noctors"), such as "specialist nurses" and "emergency care practitioners" - at a time when employment and training opportunities for doctors are disappearing. In the middle of this will be our patients who will suffer from the loss of continuity of care and from being treated by inadequately trained or supervised noctors. Qualified medical doctors will have undergone a shorter training period which may not allow them to adequately deal with their patient's problems. Finally a large cohort of talented professionals will leave these shores for a new life in countries that recognise their skills and commitment. Academic medicine in this country will be further eroded by this loss. Competing interests: None declared
MTAS 24 June 2007
Thomas Britton, Consultant Neurologist King's College Hospital, SE5 9RS Send response to journal: Re: MTAS	The size of the debacle from MTAS gets bigger by the day. The short- term costs (both financial and social) are already enormous. If we fail to train the right doctors for the right jobs, the potential long-term costs to society are incalculable. The current MTAS system has clearly failed. Many would have doubts about whether a revised MTAS system would succeed in choosing the right doctors for the right jobs. Rebuilding confidence in the selection process will require a complete review, even if this means considerably higher short-term costs. Professor Brown and his colleagues should be commended for their efforts in publicising the plight of current MTAS applicants and for advocating a complete review of the system. Competing interests: None declared
Defining Moment 24 June 2007
Nick J Sarkies, Consultant Ophthalmologist Addenbrooke's Hospital, Cambridge Send response to journal: Re: Defining Moment	Morris Brown et al have not been alarmist in drawing attention to the many injustices that have been perpetrated by this headlong rush into a new system of training. Many excellent young doctors are so disillusioned we shall lose them permanently. It is a defining moment for the profession. We must wrest control of our training back from PMETB. The Colleges must exercise their right to supervise training and appointments. MTAS and MMC must be buried and not resuscitated in any form. The architects of this disaster should resign forthwith since they have lost our confidence. Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 24 June 2007
Nadine S Granger, SHO E11 Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	As a vanishing SHO in the NHS, I would urge those that criticise the brave individuals at Fidelio to realise that while they have jobs; have had decent training and can be proud about their skills, the depth of despair and loss of faith among future leaders of medicine - current junior doctors with little hope for the future, cannot be underestimated. So many of my colleagues, excellent doctors who have proven themselves in difficult exams and work tirelessly for the NHS are now facing the stark choice: a dumbed-down career in medicine with no hope of going anywhere, or leaving and using their skills to make money for some company in the city. Fidelio are the only senior doctors willing to stand up for juniors and ensure the safety of patients and medical practice in the NHS, heed them, they are the only people juniors trust anymore. Competing interests: None declared
Support for statement 24 June 2007
John M Morgan, consultant cardiologist s016 6yd Send response to journal: Re: Support for statement	I fully endorse the sentiments expressed by Professor Morris and colleagues. The Colleges must now take unprecedented action or they will become irrelevant and the profession will enter a decline from which it will take generations to recover. The Stalinist control features of the current government have done immeasurable harm to the profession and the Health Service. Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 24 June 2007
Gordon Caldwell, Consultant Physician Worthing, BN11 2AA Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	Mr Nicholson the Chief Executive of the NHS, the then Chairman of the BMA Dr J Johnson, and Dame Carol Black, President of the Academy of ROyal Colleges, have all in one way or another criticised me and others who have spoken out in the media about MTAS and MMC. Had the DoH, MMC and COPMED been organisations that listened to well meaning constructive ctiricism and been willing to change, then we would never have had to turn first to MPs for support, then to the media. None of us wanted these discussions held through the pages of newspapers nor on the screens of our TVs. Yet we have had to do this, knowing that "the man in the street" in Britain, is still interested in fairness and excellence. The DoH, MMC and COPMED have come across as a monopoly power that exerts its powers against the interests of doctors committed to teh NHS and care of patients. Well done to Prof Morris-Brown and colleagues for moving reluctantly into the public eye, and doing this with such professionalism! Competing interests: None declared
protecting professionalism 24 June 2007
Bates David, Professor of Clinical Neurology University of Newcastle upon Tyne, NE1 4LP Send response to journal: Re: protecting professionalism	As one who was persuaded into being trained to assess and interview at the advice of the DoH and Colleges on the basis that the process would be "transparent and audited", my own expertence is that it targets and rewards the mediocre who adopt political correctness. Since the Chief Medical Officer no longer seems to accept responsibility, our Colleges must produce a firm response to the Minister to attempt to protect excellence in our young colleagues, reward endeavour and assess fairly rather than "transparently", whatever that means. Competing interests: None declared
Centralised Application Process 25 June 2007
Andrew W McCombe, Consultant ENT Surgeon Frimley Park Hospital, GU16 7UJ Send response to journal: Re: Centralised Application Process	Whilst it may be that centralised application processes have worked in other countries, it certainly hasn't here. This country is crap at doing anything in the public sector. There is too much involvement by too many people who have no idea what is involved at the "coal face". The BMA particularly, and the colleges, have constantly peddalled the idea of a softly, softly approach based on negotiation from inside the camp. This has clearly not worked - as evidenced by the many communications that run along the line of "we pointed this out back in...." Well it still happened and now we all look stupid and are paying the price. It is time to stand up and JUST SAY NO! If they (the people of this country and their duly!? elected leaders?) want the health service, and its selection processes, to run properly then leave it to the people who actually have some understanding of what is involved!! (Come on Fidellio!) And finally - some of the people who are happy to accept the label of senior doctors or leaders of the profession, should learn some humility and find out what those of us who are actually doing the work feel about some of these things before pressing ahead with them. Liam Donaldson where are you and where is your apology? Andrew McCombe GMC 3088375 Competing interests: None declared
The Royal Colleges must stand up 25 June 2007
Daniel P Gale, SpR and Clinical Research Fellow in Renal Medicine Hammersmith Hospital, W12 0NN Send response to journal: Re: The Royal Colleges must stand up	The insipid dogma of the Royal Colleges and BMA has been to 'influence from within' the reforms imposed by a DoH which lacks leadership and flexibility. This policy has failed miserably and their naivety has been laid bare for all to see and lament. It is now self evident that the bodies purporting to represent the medical profession must do exactly that: They must state publicly, unequivocally and emphatically what the medical profession believes to be the best way to recruit, select and train our future specialists and GPs. "If I am not for me, who will be for me? ...If not now, when?" Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 25 June 2007
Bruce J Finlayson, Consultant and Clinical Director, Emergency Medicine Norfolk & Norwich University Hospital NR4 7UY Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	It is outrageous that the current leaders on the groups responsible for this tragedy are still in post. It is also outrageous that the Secretary of State for Health has been allowed to get away with the bland statements that have been made by way of apology for what may well ruin the lives and careers of many promising trainees. Not enough fuss was made when the decision was taken to wrest control of training and career planning from the ownership of the Colleges and drop it into the lap of the politically-motivated PMETB. In my view, the Colleges effectively rolled over. The Government agenda seems to be to fulfil its commitment to have service delivery by "specialists" at all costs. Trouble is, those "specialists" will be the product of a curtailed training programme trained to rather vaguely- defined "competencies"; excellence will be discouraged and aptitude not assessed. Trainees will emerge from a sausage factory designed to produce uniform "specialists" trained to the lowest common denominator. Out of programme experience (e.g. overseas experience or even attempts to seek dual accreditation) will become difficult to achieve The Lost Tribe of no-hope or exploited SHOs that this was partially designed to eliminate will be replaced by a far more worrying Lost Tribe of jobless, unsupported trainees. Return control of training to the experts - the Colleges. Return control of appointments to the Deaneries, at least until the present central application system has been completely re-jigged. If a central application system is to be the way forward, then base it on assessment of training, experience and aptitude, not imagination and literary skill. Competing interests: None declared
Please return powers to the Colleges and disband PMETB 25 June 2007
j wace, consultant anaesthetist Portsmouth Hospitals NHS trust po6 3ly Send response to journal: Re: Please return powers to the Colleges and disband PMETB	Thank you, I agree with the letter and am sad that a cohort of doctors will now never again trust the government. I would urge all the colleges to unite and wrestle back the responsibilities that they relinquished to PMETB. This is the only way the quality agenda can be followed which will safeguard medical standards for the people of the UK. Yours faithfully Jos Wace Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 25 June 2007
Adam S Onyett, GP registrar Winchester SO23 8EF Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	I missed out on the whole road of MMC and MTAS by the skin of my teeth, and every day I thank my lucky stars for this: I have seen the effect this whole demoralising, career destroying, grossly unfair and incompetent process has had on many good friends (and as it happens excellent doctors) who are only a few years behind me. I agree with the above letter and would like to add my voice to the many others in calling the DoH to account and trying to work out some solution acceptable to those doctors - and patients - whose lives will be irrevocably damaged by this whole mess. Competing interests: None declared
Royal Colleges must finally speak up for their members and their profession 25 June 2007
Amanda J Taffinder, SHO Psychiatry Leeds Mental Health Trust, LS15 8ZB Send response to journal: Re: Royal Colleges must finally speak up for their members and their profession	Looking back over the last six months the incompetence of the MMC/MTAS system continues to shock even having experienced it minute by minute and being lucky enough to gain a job. However, what really stands out for me is that Royal Colleges and the BMA have appeared complicit with this throughout. They have been deluged with contacts from trainees with their individual stories and have had ringside seats watching the spectacle unfold. What have they done? I have seen conciliatory press statements that in no way represented the views of their members and watched their participation in a review group and court case that has allowed the government to claim the system is supported by the medical profession. For those who feel that this softly-softly approach is the right one, please look where we are now. There is absolute chaos and uncertainty for many as regards their future. Despite repeated statements from the government that everyone, including the medical profession, believes MMC is a positive step this is not the feeling at grassroots level. As no one listens when I speak, the Royal Colleges must finally come out of the shadows and represent their members. Please stand up against the government and oppose this system. Please defend the juniors' immediate interests as well as the long-term impact on the quality of medical training. Competing interests: MTAS applicant
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 25 June 2007
Dominic P Rogers, SpR Cardiology London Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	Once Prof Brown and colleagues have not let the half-baked compromises stop them fighting for representation of the true feelings of the medical profession. I agree wholeheartedly with their statementsand despite being fortunate enough to have escaped the MMC lottery feel that this the time for us to stand up for the rights and the opinions of doctors. Competing interests: None declared
Doctors as the Miners of the Middle Class 25 June 2007
Christopher M Rayner, GP Principal Elstead Surrey GU6 Send response to journal: Re: Doctors as the Miners of the Middle Class	Older readers will remember the successful miners strikes of the 70s and 80s and their nemesis at the hands of Margaret Thatcher and her administration. During the early part of this period as a profession we were intransigent and stood up for what we saw as the interests of our patients and the service. No doubt this would nowadays be seen as defending producer interests, although I think this is a blinkered economist's view of the position. Since those happy times we have been gradually tamed and house trained so that we follow our political masters' bidding for the most part. Now we are being dealt a fatal blow. The autonomy of the profession is foundering in a sea of directives, guidelines and NICEness. Our freedom of action is curtailed at every turn, and the Chief Medical Officer thinks he can run medicine as if it were the flight deck of a passenger airliner. We may be, I believe, at the brink of a confrontation similar to that engineered to finish off the National Union of Mineworkers. You may remember that they too suffered from a schism with the Democratic Union of Miners who sought to appease the authorities. Both perished. Now such coal as we have comes from cheaper forms of British mining or is imported. The mining industry is more or less defunct here. Medicine will not go the same way, rather the existing rift between private and state medicine will deepen and widen. Already there are specialist surgeons and psychiatrists making independent careers outside the NHS, a state of affairs which was very rare, and more or less confined to Central London 25 years ago. The number of non-essential procedures and treatments not funded by the NHS will continue to expand, and the population indicators of health will deteriorate, despite the intention to put statins in the water supply. Already our maternal and perinatal mortality figures have reached a level below which they will not fall; with the introduction of "choice" of home confinement I confidently expect them to rise again. The medical profession, the BMA, and the Royal Colleges will not be in any position to resist this, as they will have been broken or act as quislings for the government. Competing interests: None declared
A request for support from the Royal College of Physicians 25 June 2007
Abhijoy Chakladar, Medical Senior House Officer Whittington Hospital, London, N19 Send response to journal: Re: A request for support from the Royal College of Physicians	Surely the time for private disagreement must be at an end. We as a profession must take a stand but to be effective we need the help of yourselves, the bastions of our profession. I want my MRCP to count for something, but more importantly I demand a health service of which I am proud and to which I feel safe admitting my family. I gained my membership to the Royal College of Physicians this year. This was a proud moment for my family and myself. We attended the admissions ceremony and had a lovely afternoon enjoying the traditions associated with our honourable profession. In your speech, you did not shy away from the disaster facing us doctors in training and you outlined your letter to the Secretary of State. For the first time in months I felt proud to be a doctor and some optimism for the future of the profession - our Royal College was taking a stand. However, it seems nothing has changed. The reply from Patricia Hewitt was an insult to the College, to its members old and new, and to those who strive to become members. Mrs Hewitt could not even find the time to write an original letter. The third paragraph is a blatant rehash of previous releases telling us nothing that we do not already know. She continues to hail MMC as the saviour of medical training and her comments were a kick in the teeth for every junior without a job, every junior having to relocate, emigrate or change profession. MTAS has failed (as we said it would) and those at the coalface know that MMC will ultimately be the death of our profession. We know that 'tick-box' competency will never replace experience in making a good doctor, neither will a system based on allowing the progression of the lowest common denominator (with no reward for those that excel) ever make for an excellent health service. We at this time are observing the death of our profession by a thousand cuts. The Chief Medical Officer is out of touch and continues to support the government. The quango PMETB has taken control of our medical education with no fight from the Royal Colleges or the Deaneries. The British Medical Association is now obvious in its impotence and had the gall to stand against its own recently. It is no longer an option to wait and see what happens or find who is to blame. We are all complicit; we have none of us done enough. I am one of the lucky few. I have been offered a run through post. The 'system' hopes that as people get job offers the fires of resistance will fizzle. However, I find it difficult to be placated as I can see the long-term implications for the profession. The Royal College of Physicians is world-renowned. Its words hold great weight with physicians and non-physicians alike – words that even politicians cannot publicly spin. Some of our seniors (Fidelo) have taken a reluctant public stand and I implore the Royal College to now find its public voice. It is not enough that we wait to see what happens. MMC must be halted and we must build new plans for next year so that what happened this year has some meaning and wont be repeated, disenfranchising more goos doctors in training - even if this means We SHOs cannot await the outcome of yet another enquiry. Our personal and family loves have joined our careers in limbo and even those of us lucky enough to have been offered jobs have no idea where these will be. Some of us are wondering if the time, sweat, tears and money invested in gaining our exams was worth it? The survival of Royal Colleges are inextricably linked to the survival of a quality profession - a survival that is now in question. We must act. Please help us. Yours faithfully, Abhijoy Chakladar Medical SHO London Competing interests: Applied under MTAS/MMC; disagree in principle with MMC
Thanks Prof Brown 25 June 2007
Max Priesemann, LAT SPR Paediatrics Winchester Send response to journal: Re: Thanks Prof Brown	Thank you very much Prof Brown. The best of MMC/MTAS is really that different pressure groups have arisen like yours and Remedy. I hope we get the goverment's fingers out of organising our training. The training in the UK is internationally well known for its quality and it would be a shame to lose this. Let's go back to the old system and only improve parts as needed. I would favour a system containing a percentage of run through posts plus a remaining part for short term training posts for 6 month - 2 years for instance in each deanery. Stop clinical fellow and trust grade posts! I keep my hope up for myself and the positive future of the NHS and the training system. Competing interests: None declared
Illogical 25 June 2007
Neil D Citron, Consultant St Helier Hospital SM5 1AA Send response to journal: Re: Illogical	The strategy behind MTAS has been to create a totally dependant and malleable workforce , not of doctors but of medically qualified civil servants. The colleges must completely dissociate themselves from the process and its chief architect, Liam Donaldson should resign. The fact that he has not is shameful. In the same issue, Jeffris concludes that the present system is as fair as any other, but neglects to add that at least it is free to applicants unlike the other countries analysed. How can it be fair to young British graduates to have to compete on a level playing field with much more experienced overseas candidates? Surely the duty of this country is first towards those who qualify here and in whom the taxpayer has invested so heavily. Competing interests: None declared
MMC Debacle 25 June 2007
Paul D McGeoch, Clinical Fellow University of California, San Diego Send response to journal: Re: MMC Debacle	I appled for a ST3 post and travelled back from the United States to attend the "interview" for it. I was dismayed by a process which manifestly was much more concerned with such Newspeak nonsense as "certified competencies" than selecting candidates based on their clinical ability. The decision to exclude clinical and research experience from the decision process in an effort to ensure fairness, has had quite the opposite effect. As a result the interview process was not merely bizarre but also negligent. Competing interests: I had the misfortune to take part in the MMC "process".
Support for Fidelio 25 June 2007
Robert A Price, SpR anaesthetics Gloucestershire Royal Hospital GL1 3NN Send response to journal: Re: Support for Fidelio	MMC is politically motivated to force the introduction of sub- consultant specialists who will be the technicians of the NHS, powerless to influence their own working lives. They will be resident shift workers for their entire careers, driven by the targets dreamt up by politicians and NHS managers. This will ultimately do irreparable harm to the profession and to patient care. What is even more appalling is that the colleges have colluded with the department of health in attempting to bring this about. We must unite in our opposition to this and stop the colleges from adding credibilty to this disastrous exercise. I add my support to Professor Brown and his colleagues Competing interests: None declared
What now? 25 June 2007
Yvonne M Cartwright, SHO Oncology Royal Marsden NHS Trust Send response to journal: Re: What now?	As outlined by Professor Brown et al the real question is "What now?" What happens to those who don't get a training job this year? Are we forever condemned to a non-training wilderness? In the light of significant problems with the application system, surely there must be a chance for people to have another go at getting a training post? How many current registrars got an SpR post on their first interview? I can't see how justice for those disadvantaged this year can be equated by fairness to those promised run-through and currently rearranging houses, childcare and relationships to be able to work in whichever part of the country they are placed in. We really need urgent clarification of the way forward, the agony has gone on since February and enough is enough. Competing interests: SHO without training job, applied at ST3
Medical Royal Colleges need to reclaim authority for postgraduate education and training 25 June 2007
David B Hocken MS FRCS, Consultant General and Vascular Surgeon; Honorary Clinical Senior Lecturer Great Western Hospital, Swindon SN3 6BB Send response to journal: Re: Medical Royal Colleges need to reclaim authority for postgraduate education and training	I applaud the continued efforts and concerns of Prof Morris Brown and his coauthors who with the young doctors from Remedy UK have together continued to highlight that the issues regarding MMC and MTAS are not in any way resolved and that the Tooke review has far too limited a remit. It is with considerable dismay that I see the continued reluctance of Dame Carol Black and Sir Liam Donaldson to accept their responsibility. When Prof Alan Crockard resigned he spoke honestly about his long held concerns regarding MMC and the MTAS selection process; and his integrity and honesty highlights the lack of courage and a lack of accountability that has most in common with the series of "New Labour" ministers whose collective failure to accept responsibility should have prepared us for the behaviour of Patricia Hewitt. The most important thing that can come out of this is a reminder of how good the Royal Colleges have been at promoting excellence and how wrong it is to allow the Government to assume "command and control" of medical education through PMETB and the collusion of a small group of self seeking professionals. I really hope that the Royal Colleges look at the mandates that people such as Dame Carol have been given and use this disaster to reassume responsibility for training and supervision of practice. David Hocken MS FRCS Competing interests: None declared
Time for action. 25 June 2007
J. David Leopold, Consultant Physician Swansea SA6 4NL Send response to journal: Re: Time for action.	Dear Sir. The atrocity of MMC which has been visited upon our brightest and best is the Colleges Last Chance. Thier primary function must surely be to maintain standards of training in the UK.. The utter debacle has handed them an unprecedented challenge, and opportunity . I pray they may grasp it..this is the end of Colleges if they falter.. Kind regards David Competing interests: None declared
All too familiar 25 June 2007
Rachel M Nicholson, un-numbered registrar general surgery Hereford County Hospital, HR1 2ER Send response to journal: Re: All too familiar	The responses tell all too many a familiar story. Dozens of quality doctors have been axed and even those who have achieved training positions are exhausted and disillusioned. I am one of the many unsuccessful. I have jumped through a series of hoops (quality training jobs, higher degree and publications, senior posts, un-numbered but in rotation with numbered posts) for a system now considered defunct. Since my student days I have received encouragement and assurances that I would make it as a surgeon. Now these same consultants can only offer tea and sympathy because the people in the best position to judge who might make suitable succesors have been emasculated, by a system determined to discard quality training and propogate a system of government friendly technicians. I am struggling to hold things together for my two toddlers. Ironically, taking maternity leave has been the factor which has caused me to be caught up in this mess. Fortunately it is not my children who are responsible. Competing interests: only my personal disappointment
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 25 June 2007
Stephen R Ford, Anaesthetics SHO Lister Hospital, Stevenage Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	Fidelio and RemedyUK have rapidly evolved into doctors' true advocates, the ecological niche having been vacated by the current professional organisations. The Royal Colleges should take note - they have one chance to rescue the profession from the mess that arose from centralised, ill-considered reform. There were problems with SHO and SpR training, but they were soluble with dull, incremental changes - such as mentoring, guaranteed teaching free of service commitments etc. (Look at post-graduate OT training for an example of this.) They did not require the tearing-up of a system that had evolved into a certain pattern for good reason. Run-through training hampers any attempt to create excellent future consultants: it forces people into premature career decisions (four months as a foundation year is insufficient), and it removes a firm quality safeguard (competition for SpR employment). Furthermore, it substantially reduces experience: six years hence, I hope for appointment as an ICU consultant with both substantial medical and anaesthetic experience (MRCP and FRCA). Those after me will have less diverse training: whom does that benefit? In addition, this year has destroyed the morale of junior doctors, held, as we are, over a barrel by this unscrupulous monopoly employer. I would never advise my friends or family to enter the profession in the UK. We must retain the SHO-SpR split. We must retain control of entry into specialist training and not allow it to be nationalised permanently. The Royal Colleges must be fierce in their advocacy of professional excellence and independence. And in future we must all remember to sup with a long spoon when dining with governmental devils. Competing interests: Successful candidate for run-through training in Anaesthetics
blame the game, not the player 25 June 2007
Jalil Ahmed, FY2 General and Acute Medicine Central Manchester and Manchester Children's University Hospitals Send response to journal: Re: blame the game, not the player	Many doctors will feel very unlucky not to have secured a training rotation or indeed a paid job. They will have been unfairly treated by a system that was implemented in a rush and caused many to make knee-jerk career choices. MTAS/MMC has created a culture of junior doctors playing the percentages and securing rotations that they may not even prefer. As round 2 begins, many doctors will have to fight for jobs. Do you blame the demoralised, depressed and exhausted juniors who may leave this country or medicine altogether because they have had enough of playing this terrible game to secure any job? I agree, seniors must contribute constructively to redesign or change the flawed game that is MMC/MTAS and I applaud and thank those who are trying but is this wishful thinking? Competing interests: Applied via MTAS
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 25 June 2007
Chris Chung, Registrar Medicine ML8 5DY Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	Professor Brown and colleagues are correct that there have been "gross miscarriages of justice". My personal one is being dismissed from a job I got fair and square and by the book and not being given a reason. Whatever steps taken to resolve this situation ought to be done in the open to restore Juniors' confidence. Having an invisible process without Juniors' views being taken into account and having a solution imposed without proper debate or popular approval is tantamount to fascism. The new BMA Chairman was also right to apologise for the Juniors being let down. Let down we have been and a small handful of brave souls that formed Remedy UK deserve a standing ovation. We are voters too, and we have the right to disagree. Competing interests: None declared
Full support to Prof Brown 25 June 2007
Tom D Cosker, Specialist Orthopaedic Registrar Northampton General Hospital NN1 5BD Send response to journal: Re: Full support to Prof Brown	Thank goodness for Professor Morris Brown's measured response to the MTAS debacle - I fully support and indeed applaud a robust response to this dreadful situation - at least to ensure the media remain interested and therefore the situation remains in the public arena. We MUST stick together at this critical time for our juniors. Competing interests: None declared
In support of Morris Brown. 25 June 2007
Alan J Carson, Consultant neuropsychiatrist Royal Edinburgh Hospital Send response to journal: Re: In support of Morris Brown.	I would offer my support to the views expressed by Prof Morris Brown. I also find myself in full accord with Prof Bates; MTAS appears to promote the mediocre over the talented. It is very demoralising to watch the some of the most talented jumiors on the Soth East Scotland rotation have to leave owing to lack of a training number. Competing interests: None declared
Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 25 June 2007
Paul J Andrews, medical SHO dorset county hospital, williams avenue, dorchester, dt1 2jy Send response to journal: Re: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	Sir. It is incredible that as a profession we have allowed this MTAS and MMC fiasco to proceed and gather such momentum. The principle problem with our responses to government pressure has been that they have been weak, complicit to a greater or lesser extent, and we have signally failed to force the issue in our favour by refusing to have anything to do with the process. Colleagues tell me they have had interviews in which building things out of lego has taken precedence over any assessment of true clinical competence. And yet still there are supporters of the system. If it is as good as we have been promised, it is curious that it is not used in industry. Now that we have got this far, the royal colleges and the BMA have a duty to try and achieve the best solution - not necessarily the easiest, nor (sorry, BMA) that which best appeases the government. The ongoing dilution of quality in UK medicine will affect all of us. To pretend that we can afford to let it hapen and somehow sort it all out later is ludicrous and dangerous. A robust and uncompromising stand is needed now. Pandering to the vagaries of government ministers in the hope they will be nice to us simply won't do. Competing interests: None declared
In support of Prof. Brown 25 June 2007
Ally Rooney, Neuro-oncology Research Fellow Western General Hospital, Edinburgh EH4 2XU Send response to journal: Re: In support of Prof. Brown	I agree with Prof. Brown and colleagues. Hopefully it will not be considered trite to recall the words of JK Rowling and wonder if "the time is coming when we will have to choose between what is right and what is easy". Talk is sometimes cheap and mere reassurances from politicians (medical or otherwise) carry little weight these days. For me the central charge against the Colleges is that they have, through inaction, lent legitimacy-by-proxy to the review process behind which certain politicians have been able to hide. I do understand that the higher circles of the profession have closer links with politics, and the attendant pressures, but complicity is either in the best interests of your juniors or it is not. Prof. Brown, supported by polls of real junior doctors, emphatically endorses the latter. The debate must be engaged. Of course, the Colleges have a responsibility all to their members, not just their juniors. They now must decide urgently if that higher duty is best discharged by preserving the political equilibrium for all at the cost of the trust, career and morale of many of their juniors. Their reasoning and conclusions ought to be made public. By such means may we yet reach, to quote the great author once more, "a parting of the ways"? www.remedy-scotland.org.uk Competing interests: Active member of Remedy Scotland; Pre-membership Psychiatric Trainee, have 1st choice job.
Doctors should take back control 25 June 2007
Clio Bellenis, Consultant Chld Psychiatrist Eastleigh Health Centre Send response to journal: Re: Doctors should take back control	I cannot imagine any other occupation - professional or otherwise - submitting meekly to being treated the way our juniors are being shoved around. How did anyone ever think it was reasonable to expect any adult, perhaps with a young family settled in school, to apply for a job described in the vague terms of MTAS - ie within a whole deanery, trading speciality for location. Doctors training has always been difficult, and many of us strung it out as long as possible, but turning into a sausage factory can help neither the public nor the individual doctors. No other occupation would have let the bureaucrats take over their training programmes. What are we that we have been seen to roll over and die so meekly? how can we seriously protect our patients interests if we cannot even protect the interests of our own successors? Competing interests: None declared
We must act now. 25 June 2007
Felicity J Meyer, Consultant Vascular Surgeon Norfolk and Norwich University Hospital, NR4 7UY Send response to journal: Re: We must act now.	When 'The Lost Tribe' reviews were initiated, reforms that gave SHOs a defined role and training goals seemed long overdue. I did not believe that things could be much worse. SHOs worked unbelievably long and unremitting hours and the training was often non-existent. The one saving grace was that if you were good enough, you would get a numbered training place at the end. Well, things have got worse, much worse. You have to decide your career path pretty much at Medical School and your chances of getting a job, any job, depends on luck. I have watched excellent SHOs fail to get places under MTAS and it feels as if the world has gone mad. We cannot let our juniors continue to suffer like this. We all know the Tooke Inquiry will report too late to help the current group of SHOs, that is, if it says anything useful at all. The Fidelio group is right. Scrap it and start again. The BMA and the Royal Colleges must support this view point. After all, their jobs depend on it too. Competing interests: None declared
Re: An Open Appeal 25 June 2007
Louella Vaughan, Consultant Physician St Thomas' Hospital, London, SE1 7EH Send response to journal: Re: Re: An Open Appeal	Sir, I find the accusation that the response of Prof Brown and co. to the MTAS/MMC crisis has been 'hysterical' and 'disproportionate' utterly ludicrous. What currently hangs in the balance is not just the fates of our junior colleagues, but the survival of medicine as a proper, self- regulating profession. About ten years ago, the Australian Government sought to interfere with post-graduate training (with the same goal of reducing costs) by having the Royal College of General Practitioners limit entry to its training programme. The end result would have been about 400 unemployed doctors per year. The Australian Medical Association was up in arms. Despite the protests of the GP branch, it arranged an emergency conference and then co-ordinated a national strike (which consisted of non-urgent elective procedures and outpatients being cancelled). The government backed down almost immediately. The response of the BMA, when faced with over 10 times the number of unemployed, by contrast, has been limp and pathetic. However, the real responsibility lies with the Royal Colleges for colluding with the government in introducing a system which will universally lower standards of health care, while creating mass unemployment. The Labour Government has actively sought to appropriate all the power of the medical profession to govern its standards and activities. Our leaders have failed to protect us and they need to be held to account. I further support the proposal that all juniors should remain in post for another six months until an appropriate (not quick!) solution has be found. Thank God that Prof Brown and 'Fidelity' are brave enough to do what our 'leaders' should have done. Competing interests: None declared
Re: Support for statement 25 June 2007
Ian F Russell, Consultant Anaesthetist Hull Royal Infirmary, HU3 2JZ Send response to journal: Re: Re: Support for statement	I fully endorse the sentiments expressed by Professor Morris and colleagues. We are now in an unmitigated mess and the Colleges seem to lack the will to do anything about it. The allocation of training posts is anything but clear as I see trainees of two to three years experience, with several peer reviewed publications and all their college exams behind, them heading for the scrap heap – or abroad. Competing interests: I will need someone to look after me in a few years !
The current state of play 25 June 2007
Christopher Twine, Clinical Fellow Newport, NP20 2UB Send response to journal: Re: The current state of play	As always I agree with Prof Browns sentiment. Many of my colleagues do not have job offers, and many friends in other hospitals report the same thing. The scale of the problem is not being overplayed, and the DoH, Royal Colleges etc. should provide evidence before asserting such claims. I am still concerned about the whitewash forthcoming from our 'elected' officials. At least the printed BMJ is now trying to be seen to cover the issue in more detail.1 References 1. Twine C. Editorial independance and the BMJ. http://www.bmj.com/cgi/eletters/334/7603/1067 Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 25 June 2007
Michael Douek, Senior Lecturer in Surgery Department of Surgery UCL, RFUCMS Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	The priority for the medical profession should be to continue to strive towards excellence in training and to protect the talented juniors who have been affected by the MTAS/MMC experiment . An independant body (ie: independant of the NHS and DOH) should deside on the most appropriate course of action and in the mean time, candidates should be appointed to FTSTA posts when adequate selection has not taken place for ST posts. Competing interests: None declared
total complacency amongst the royal colleges 25 June 2007
Katrina L John, A&E Middle Grade Whittington Hospital, London Send response to journal: Re: total complacency amongst the royal colleges	Thank you Professor Brown and colleagues for what you are doing. Without you and RemedyUK the last several months would have been even darker. Your approach is pragmatic, sensible, professional and tough. I absolutely agree with your suggestions regarding a fair solution to the recruitment fiasco. I am disgusted with the ivory tower approach of the royal colleges (with the exception of the college of surgeons) who have done everything to reinforce the stereotype that they are simply glorified bureaucrats playing with the hard earned money of doctors behind a smokescreen of maintaining excellence in the profession. It is ironic that, at a time when this very excellence is being severely threatened, they have at best acquiesced to the destruction of careers and life plans of thousands of junior doctors and at worst cooperated with the DoH in actualising this. The royal colleges, along with the PMETB and the CMO seem to be beyond accountability to the very people who justify and pay for their existence.Their behaviour throughout this whole process, and thier silence before, when they must have forseen what was going to happen, is dispicable. The royal colleges either need to stand up properly to the DoH (i.e no more soft peddling) and take back the reigns of training doctors or stand down and admit they are not fit for purpose. I have read the comment is free debate on the Guardian website, many of the blogs on the Remedy site, letters to various newspapers and the entries on this debate. Apart from the odd defensive official letters from bodies such as PMETB and the royal colleges, I have read very very few that can offer a good word about this process. It seems to me that there is in fact no debate. Everybody seems to agree that the process of MTAS and MMC has been an unprecedented disaster that has had a profoundly negative impact on the lives and well being, let alone the careers, of junior doctors. The drastic impact this will have on the working of the NHS and patient care will soon become apparent. There are many excellent and fair suggestions as to how the debacle could be resolved, the most sensible of which have been put forward by Professor Brown and co. Yet they fall on the deaf ears of an elite minority who either inhabit a different earth to everyone else or who arrogantly disregard the evident truth for the sake of their own agendas. A generation of junior doctors have been sacrificed for these agendas and it is an absolute scandal. I have a job from a round 1A interview. I had 4 interviews that were all hugely inconsistent in standard and process. I did not get my first choice but have accepted my second which will mean me leaving my partner of 5 years to live in another area of the country at an as yet unknown hospital. I have fared well compared to many but in no way do I recognise it as an achievement. I have simply escaped, at least for the forseeable future, the necessity to fill in banal application forms and worry about getting a job. My partner has spent nearly £100,000 as a foreign student to study medicine here in the UK. He is not legally allowed to stay and work after his FY2 year. We were prepared to look into all ways of working the system so that he could stay and we now realise there is no point. We can't get trained properly here anyway. We're sitting our USMLEs and planning our move to the US. Many friends with no previous intention of moving abroad have written to me enquiring about the USMLEs. They are hard exams that cost approximately £4000 to complete in full, not including the cost of study materials. These are the lengths people are prepared to go to train in the profession that they have committed their lives to. Absolute shame on all those involved in providing and planning the training of doctors in the UK. I have no confidence in their willingness or ability to do this or to stand up firmly to the DoH who have disengaged and ridiculed the whole profession. Competing interests: MTAS participant
MTAS- the other debacle 25 June 2007
Graham P WINYARD, Retired - Send response to journal: Re: MTAS- the other debacle	Tony Delamothe's editorial is particularly welcome as it starts to expose the central role that the government's botched approach to medical immigration has played in the present disastrous situation. Even if MTAS had worked perfectly, we would still be facing a major crisis this summer with large numbers of UK graduates failing to secure training posts because of the huge excess of applicants over available places. The Department's original broad policy intent was to control the inflow of non-European doctors to match vacancies left after competition among UK and EU doctors, through the introduction of the "resident labour market test". It successfully took the first necessary steps by closing permit-free training, incidentally attracting much criticism for this from the Colleges and the BMA, but then failed to take effective action to close the loophole created by the Home Office's Highly Skilled Migrants programme, in spite of clear warnings from Postgraduate Deans on the potential implications. As a result, thousands of international medical graduates (IMGs), often with substantial clinical experience, are now in competition with graduates from foundation programmes for limited numbers of training programmes. While there are many reasons to support the training of IMGs in the UK, it makes no sense whatsoever to invest in substantial expansion of our medical schools without ensuring adequate access to specialty training to enable their graduates to pursue useful careers in the NHS. Resolving this policy question is an essential and urgent part of both resolving the current crisis and establishing sensible long term arrangements. This needs to be recognised by all those currently lobbying for change. Competing interests: Postgraduate dean, now retired; past Chair COPMeD; DCMO 1993-9
Stay united and lobby for more consultant posts 25 June 2007
Damian J Kelly, SpR Cardiology Glenfield Hospital, Leicester Send response to journal: Re: Stay united and lobby for more consultant posts	Prof. Brown and the fidelio group are to be applauded, and rightly hightlight the central issue of medical quality. Excellence will only be achieved through autonomy: financially-motivated government attempts to control the job market will only drive down standards of care. Manpower planning must in future be arranged independently of the DoH. Resignation of responsible medical politicians might satisfy many, but will only increase government antipathy. To re-designate 50% of hard- won ST jobs at this late stage would damage juniors' morale even further. Action should be co-ordinated through the Royal Colleges to press for urgent funding for more 'proper' consultant posts in 6 years time, and with them more training posts for 2008. These should be appointed twice- yearly at deanery level, with provision for flexible-training, fellowships and inter-deanery transfer. Merely delaying a massive bottleneck by a year or more can't be the answer. Competing interests: None declared
Time for the College Presidents to Act 25 June 2007
Richard J Motley, Consultant Dermatologist University Hospital of Wales, Cardiff, CF14 4XW Send response to journal: Re: Time for the College Presidents to Act	Professor Brown and colleagues deserve congratulations for standing up for our juniors and the quality of medical training in the UK at a time when the leaders of our profession and the presidents of the colleges (excepting the Royal College of Surgeons) appear at best passive and at worse complicit in this fiasco. I believe those Presidents who have failed to represent the strong views held by a significant proportion of their constituents should now hold a referendum to ensure that they still enjoy members' confidence. Competing interests: None declared
Another victim's perspective 25 June 2007
Ben S Clark, SHO Psychiatry Bethlem Hospital, BR3 3BX Send response to journal: Re: Another victim's perspective	I can only agree and echo what many of my peers, seniors and betters have said about this. In my own instance I graduated with ambitions to enter academic psychiatry, via a route of clinical medicine to give me better grounding in neurology and organic medicine. Even 2 years ago this was eminently possible, then almost overnight (because of the clandestine "consultation" which preceded MTAS) this option became next to impossible. Furthermore, having worked, strived and earned a place (and this did include competition back then, yes) in a decent rotation which could further this, I now find myself out on my ear in a dead-end placement with no idea of what the future holds beyond next August. Far from being able to contribute to medical science in the future, I now feel it's going to be difficult to contribute to my mortgage before too long. This was not what I signed on for 10 years ago. This was not even a situation I applied to 2 years ago. To make matters worse, I am not convinced that every applicant who has been appointed in my stead is necessarily my superior or better (although many undoubetedly will be), but merely more adept at answering woolly, irrelevant questions in formulaic ways. Furthermore, I have worked with many FY1 and FY2s who have graduated through this system and I am now extremely worried that the whole notion of Competencies has significantly undermined the empowerment and resources junior doctors once had. As this system progresses, I can see this trend only getting worse. This has been an abuse of power. It has been grossly unfair. And it has been tremendously short-sighted... and no matter how many people purport the "benefits" of this brave new world, I fear that in the future only the sick and the old will realise how fatally flawed this whole messy exercise has been. Competing interests: None declared
Department of Health and the Royal Colleges - Special Relationship? 25 June 2007
Boyd Ghosh, MPhil Student CB2 2QQ Send response to journal: Re: Department of Health and the Royal Colleges - Special Relationship?	I would like to support Fidelio and Professor Brown in calling on our Royal Colleges to stand up for us. The commencement of MMC will result in a lottery among doctors, with many losing the prospect of entering into the specialism of their choice, often having committed themselves for a number of years. While the process was not envisaged in this way, the lack of flexibility in the process will result in a wastage of talent in competitive specialities. In addition, this years results will lead to a large number of doctors failing to secure a post and therefore leaving the profession or moving abroad. There comes a time in any "special relationship", such as between the Colleges and the Department of Health (or between Bush and Blair) where you have to say to your "partners" that you are no longer able to support them as their plan will result in the long drawn out demise of the medical profession due to disaffection in juniors, wastage of talent and poor processes in recruitment. Please don't sentence us to uncertainty and random allocation to specialities. Please act now for this years cohorts and the years to come by acting on our behalf. Competing interests: None declared
Insult after insult 25 June 2007
shelley dale Riphagen, PICU consultant Evelina Children's Hospital, @Guys and St Thomas', London Send response to journal: Re: Insult after insult	Interfacing with junior doctors of exceptional quality, many of whom have not been successful (lucky) in the MTAS fiasco, you only have to put yourself in their shoes to know how long you would tolerate this type of upheaval in your life and carreer before you were fed up and left the country. A Number of the junior doctors with whom we have contact , have had overseas experience, and have now returned home to the UK to settle down and specialise. They now have a clearer picture, than after they left medical school and house jobs, of how they want to spend the rest of their medical lives. Unfortunately with the system as it is, with little choice of where you want to work, what hours you are prepared to work and no guarantee of a job at the end of the time , they are now planning to leave the country completely to study elsewhere (US and Austr). What a disgraceful loss of potential medical excellence and waste of money, by a country whose medicine and medical training has always been the world example for all other countries to follow. Competing interests: None
Keep the new name, just bring back the old system 25 June 2007
Adrian J McKenna, SHO Surgery N Ireland Send response to journal: Re: Keep the new name, just bring back the old system	MTAS did not work, but I feel that it should be recognised that MMC is the disaster and not MTAS. Everyone knows MMC will not work because - It is too inflexible. It has been rushed in, and has not been thought out. Nobody seems really sure what is going to happen. A vast number of jobs have not been filled, and large numbers of candidates have no jobs. The NHS faces melt-down in August. I cannot believe the Royal College of Surgeons have agreed to a system which selects candidates at ST1 level for run-through surgical training, who have a maximum experience of 4 months in that specialty. (not including PRHO experience) How candidates are expected to know what speciality they would like to train in, never mind how trainers are supposed to select the best candidates at that stage in their careers is beyond me. Once selected, is that it?? Can you put your feet up safe in the knowledge that the next interview that you do is for a consultant post? Those not selected. What do they do? Personally, I like a lot of other people, am not 100% sure what specialty I would like to end up doing. I just know that MMC has been a demoralising and de-motivating experience. Medicine is all about accountability, and the people responsible for MMC, and the implementation of it, should be made accountable for their actions. I feel the only option is to continue with MMC in name only, ST1 and ST2 should be made similar to old SHO rotation posts, and doctors should be selected at ST3 level for run-through training, like old SPR numbers. MMC cannot be so inflexible. Especially the entry criteria with regard to location, experience and the specialties you can apply for. Why can't I be allowed to apply for more than one surgical specialty? What is the rationale behind that?? Furthermore, doctors should be allowed to apply for the level thay feel most comfortable at. MTAS had some doctors in the ridiculous situation that they were too experienced to apply to ST2 and ineligible to apply to ST3. And the rules regarding deaneries and locations, have put far too many families and relationships under strain. MMC seemed a good idea, but was it conceived over the space of an afternoon? I feel it is time for the Royal Colleges to take a stand. They must recognise that the Government is taking on the Medical Profession and winning. Let doctors train doctors. It’s time for the Medical Profession to fight back. Come on Royal Colleges... We wait more in hope than expectation. Competing interests: None declared
Royal Colleges must stop being so spineless 25 June 2007
Jan K Melichar, Consultant Psychiatrist & Honorary Senior Lecturer AWP NHS Trust, Bristol Send response to journal: Re: Royal Colleges must stop being so spineless	I wish to add to the call to make the Royal Colleges (and the BMA) talk in the public arena, with a united voice, about moving on as outlined in Fidelio's open letter. It shames me that the BMA and the Royal Colleges continue to harp on about the need to remain behind the scenes and be discreet. Since when has any Government listened to behind-the-scenes softly-softly approaches from doctors? Look at the lack of any coherence in today's NHS to see how little clinical input there has been. I had thought that those at the top of our profession had more backbone and I can only think that this spineless approach has continued because of some perverse incentive to not 'rock the boat' - perhaps the potential future promises of Knighthoods or Damehoods? Only when there is open and frank public debate will change occur - there was little in the way of progress with this debacle until RemedyUK and Fidelio started making noises, in spite of much behind-the-scenes murmuring by the other august bodies. Good luck. Competing interests: I train junior medical staff and see how badly they have been treated.
Please help us 26 June 2007
Onkar S Dhillon, research fellow cardiology dept. of cardiovascular sciences, Level 4 RKCB, LRI, Leicester LE2 7LX Send response to journal: Re: Please help us	The apathy that I have encountered from senior doctors who are all snug in their consultant posts and private practice is disgraceful. I thought most of us became doctors to have a positive effect on this world. By that dictum surely they can't they stand by and watch their juniors suffer this travesty? This has truly been one of the most challenging periods of my life yet I feel I have learnt nothing from it except that our seniors have let us down. There is still time to make amends. Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 26 June 2007
Christopher H Blake, SpR Urology Royal Devon and Exeter Hospital Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	When will our so called representative bodies: the colleges and BMA actually start to represent and uphold the medical profession in the face of this politically driven debacle? I applaud Professor Brown et al, finally a voice of reason in the darkness. Competing interests: None declared
Re: An open appeal to our Royal College presidents: Please stand together for our Juniors 26 June 2007
Helena Tabry, SpR General Surgery QE Hospital Woolwich SE18 Send response to journal: Re: Re: An open appeal to our Royal College presidents: Please stand together for our Juniors	It is great to see many other senior doctors following the wonderful example set by the presidents of RCSEng and ASGBI. I think the 'compromise' approach suggested in this article is the most workable; together with a realisation that we must not let this disaster happen again. No government can govern without a mandate, so let's give a clear message to our new prime minister by joining with our distinguished colleagues in voicing our objections to bullying, intimidation and mindless bureaucracy. Competing interests: Suffering from sleep deprivation from so much counselling of my distressed junior doctor friends.
Support for Prof Brown and colleagues 26 June 2007
Paul A Clarke, SHO Anaesthetics and Intensive Care Royal Devon and Exeter Hospital Send response to journal: Re: Support for Prof Brown and colleagues	Prof Brown and Remedy UK have been the only voice of common sense throughout this disaster. How the Colleges allowed PMETB to take over quality of training just doesn't make any sense at all if they want to retain any jurisdiction in maintaining the quality of the workforce. It is essential now that they stand together, and follow the example of RCSE in opposing these ridiculous reforms. Medical training is a highly complicated issue which needs to be designed by professionals with an intricate knowledge of the details and standards necessary - not by a politically mediated group. As well as the issue of what happens in the future, the Colleges need to realise they are about to lose many valuable and talented trainees, although swift and decisive action may still prevent this. But this would have to come from the Colleges, as trust in the Government and BMA has disappeared. I agree with Prof Brown's sentiments, and can only hope that soon the inflexibility and other principles of MMC and MTAS are reconsidered. Competing interests: None declared
More support for Prof Brown 26 June 2007
Ben Underwood, SpR in Psychiatry St Clement's Hospital Ipswich Send response to journal: Re: More support for Prof Brown	Who amongst us now would wish to pay our way through medical school, leave with a debt of perhaps 50,000 pounds and then find ourselves unemployed after 2 years however good a doctor one may be ? The BMA and the Colleges (with one notable exception) have been at best weak and at worst complicit in the whole fiasco. It is telling that junior and senior doctors feel that their appointed bodies have been so ineffective that they have created their own groups in Remedy and Fidelio respectively. The role of the BMA and the Royal Colleges are to advocate the views of their members. They have failed to do so adequately thus far, a point exemplified by these rapid responses. Rather than view Remedy and Fidelio as threatening they should welcome them, support them and form an effective alliance. Competing interests: None declared
I am a moron 26 June 2007
Rahul V Bhintade, SHO Ladywell Unit, Lewisham Hospital Send response to journal: Re: I am a moron	Dear all, After great soul-searching and introspection, I have come to the conclusion that I am one of the morons of society. After toiling almost 10 years in intensive medical training, right from when I was 16 till now, deciding that I have to burn the midnight oil and sacrifice social life, I have come to this place today, when the government has decided that I am not fit to be a doctor (no reason... And it's nothing personal, so I shouldn't mind)... The government has decided that it cannot have me working in the hospitals to keep the patients treated.... The reason I think I am a moron is that If I had otherwise wasted my life as a drink-problem guy or a cocaine-sniffing addict, or worse still, plotting for various terrorising activities, I would have been given not only a sympathetic ear, but also a place to stay, benefits and tax-free money with absolutely no work required.... But NO, I decided to deny myself and do exactly the opposite. I think the government is right in not giving us our jobs (which incidentally, we were doing before the govt stepped in) and making us think about these alternatives (which I had missed 10 years back)... And think about that as we are considered intelligent for being doctors and all ( I disagree, as I have already said, or else we should have seen THIS coming), the boost that it would give to ingenious ideas to get benefits!!! Cannot say anything more as my mind is getting numb.... I wonder how all the hospitals are still working... all those disenchanted doctors, soon to be ex-doctors or jobless ones, at least, are STILL trying to prop up the NHS (and I am one of those morons, too)... Thanks, all of you, the government, the BMA, the Royal college honchos, and anybody I have missed, Thanks for rubbing the message in.... NOW, since I have accepted that I am a moron, could I be considered as a special needs candidate and given a job? Competing interests: None declared
MMC/MTAS, The BMA and the Royal Colleges 26 June 2007
Peter McNamee, Consultant Nephrologist BT4 2RE Send response to journal: Re: MMC/MTAS, The BMA and the Royal Colleges	The BMA and the Royal Colleges have colluded with government, permitting the devaluation of the medical profession and derailing the careers of thousands of talented juniors. The leaders seem oblivious to the pain and anger of both senior and junior doctors. I think that the full extent of the incompetence of those involved in this debacle will not become apparent until August but do not believe it is now possible to rescue the situation before then and fear for patient care and safety this autumn. I believed that the role of the colleges and BMA was to promote excellence in medical care. If minimum competency is to be the standard of the future I see no role for these organisations. I also foresee UK medical standards falling compared with other developed nations. I would support the efforts of Professor Brown and colleagues to bring some sense to this terrible situation. Competing interests: My son is an FY2 doctor
MMC 26 June 2007
Allan P Corder, Consultant Surgeon The County Hospital, Hereford, HR11SG Send response to journal: Re: MMC	The colleges must regain control of medical training and selection. They must also look at themselves carefully to see how they allowed the current shambles to develop. Competing interests: None declared
Well done Morris Brown et al 26 June 2007
Charles P Warlow, Prof Medcical Neurology Western General Hospital, Edinburgh, EH91TE Send response to journal: Re: Well done Morris Brown et al	Well done Morris Brown and others for keeping up the pressure on the Department of Health. If only the Royal Colleges had been more robust on our behalf. We must return to a flexible training system that encourages research and experience in other countries, and that allows junior doctors to find a speciality programme and place to live within the necessary limits of the training posts that are available to fill expected consultant vacancies in various parts of the UK. Whoever was responsible for the MTAS application system should own up and defend themselves. Competing interests: Daughter 2 years away from this mess
Experience of a national recruitment process for general practice 26 June 2007
Mayur Lakhani, Chairman Royal College of General Practitioners, Simon Plint, GP Dean, COGPED Send response to journal: Re: Experience of a national recruitment process for general practice	Tony Delamothe’s editorial (1) concludes “Jefferis’s article (2) shows that a scheme that combines central computerised application with local selection is not necessarily an impossible dream”. We would like to report on the successful development of just such a national recruitment process for general practice training in Britain. The key to success has been the years of work by deaneries bringing about the convergence of the selection processes, not just a validated competency based method (3), but a system (4), managed by a national recruitment office, which deaneries have positively opted into. Difficult to believe, but we also developed our own central computerised application system which we used before MTAS, which gave candidates and administrators alike a sense of control over the application process. The GP recruitment system has withstood the challenges of MTAS, and preliminary evaluation of the process shows that candidates found the system fair and delivered professionally. This is a positive story which we look forward to reporting to the Tooke inquiry, and which we are confident will lead to the development of a stronger GP workforce. Professor Mayur Lakhani, Chairman, RCGP Simon Plint, GP Dean, COGPED 1. Delamothe T. Centralised application services for specialist training BMJ 2007;334:1285-1286. 2. Jefferis T. Selection for specialist training: what can we learn from other countries? BMJ 2007;334:1302-1304. 3. Patterson F, Ferguson E, Lane P, Farrell K, Martlew J, Wells A. A competency model for general practice: implications for selection, training, and development. Br J Gen Pract 2000;50(452):188-93. 4. Patterson F, Ferguson E, Norfolk T, Lane P. A new selection system to recruit general practice registrars: preliminary findings from a validation study. BMJ 2005;330(7493):711-4. Competing interests: The RCGP and COGPED recommend policy and operate selection procedures
Disgusting and Demoralising 26 June 2007
Chris D Briggs, Specialist Registrar General Surgery Sheffield Send response to journal: Re: Disgusting and Demoralising	Sir, All praise to Prof Brown and his fellow authors for their forthright approach and honest representation of the professions views. They continue to show that we do have a backbone, just not in the Royal colleges or in our so-called "union" the BMA. Their attempts at negotiation in this disaster have been utterly disgusting and demoralising and in my opinion have weakened our position. The change to training brought about by the white paper "Unfinished Business" has been a disaster from the beginnning, and unfortunately there is no end in sight. Where were the colleges when this all started?? Training has been wrenched away from their control into the hands of the supposedly "Independent" postgraduate medical education and training board and they continue to allow the fiasco of MMC to proceed unabated. Our Junior colleagues are being treated like school children rounded up in the playground. When will we realise that they are Professionals, as are we all, and they should be treated with respect and recognition of their commitment to becoming our peers and leaders of the future. Now is the time to take a stand for all our sakes and take back responsibility for our own training and education, because if we don't who knows where this will end. I would happily unite in supporting this stand against the bureaucrats and I know everyone I have spoken with locally feels the same. Bravo Prof Brown et al. Competing interests: None declared
MTAS Disaster 26 June 2007
Lynne Carmen Fryer, Consultant OMFS Ipswich hospital NHS Trust IP4 5PD Send response to journal: Re: MTAS Disaster	I completely support the call for the resignation of the CMO and all associated with this disgrace. The Profession must have courage and stand up to the Government. The Royal Colleges should be instrumental in this action and wrestle power back from PMETB. Competing interests: None declared
The dilemma of through-run MMC training 26 June 2007
Michael J. Kelly, consultant colorectal surgeon University Hospitals of Leicester, LE5 4PW Send response to journal: Re: The dilemma of through-run MMC training	I just do not accept, and have never accepted, that it is sensible to appoint trainees at ST1 whith a straight run-through to consultant appointment unless they are actively thrown out. We are hopeless at "throwing out" underperforming trainees with whom we work (as the RITA system shows, time and time again). And I am just as hopeless at this as everybody else! In surgery, it is like selecting applicants to become airline pilots who have not even flown a Tiger Moth. The result is that we are selecting academically gifted young people who are in love with the idea of becoming surgeons, but have no data on whether they themselves have the aptitude for it, or will wish to take on its reality. Their selectors are equally adrift. For those trainees who then reach the conclusion during the next four years that surgery is not for them, there is no effective and honorable mechanism to step sideways and try something else. Surely the system that MMC has replaced was, with all its imperfections, 1000 times better than what we now have (more or less) in place. Competing interests: None declared
Damage limitation 27 June 2007
s judd, research fellow queens medical centre Send response to journal: Re: Damage limitation	As a result of inertia within the profession and being strung along by a series of impotent and self serving review groups we now find ourselves in a fairly disastrous situation. Not only are large numbers of juniors looking at unemployment or the prospect of sub standard non- training posts, we as a profession have relinquished a large slice of our independence, autonomy and integrity to a government intent on demoralising and debasing us. The only way out of this mess is to give contracts for 1 year only to all successfull candidates and use a meritocratic and well thought out selection process next year. Perhaps even reverting to the system that was working perfectly well until tony, patsy et al stuck the boot in. Competing interests: None declared
Accountability and Integrity 27 June 2007
Alastair R Deery, Consultant Pathologist St Georges Healthcare NHS TrustLondon Send response to journal: Re: Accountability and Integrity	The lack of any resignations from the accountable senior officers of the Royal Colleges (as opposed to the BMA) is shameful (and unacceptable to me) and hopefully surprises most. These are some of they, that have long anticipated and received and taken rewards and honours for merely appearing to struggle, before acceding to the latest and meanest political imposition (for impositions they are) for "change". Withdrawal by a surgeon is hardly adequate. If any wisdom or integrity was ever present and therefore remained, among those lofty college folk "representing" the profession and discussing these deep and meaningless and educationally unevidenced changes to how medics train, then they would demonstrate it, in the only ethical way and please leave now............I know silence! Competing interests: No competing interest.
Is anyone out there in favour of the current MTAs/MMC system? 27 June 2007
mary g harrington, consultant geriatrician Airedale General Hospital bd 20 2TD Send response to journal: Re: Is anyone out there in favour of the current MTAs/MMC system?	The accusation levelled that the disgruntled are over-represented in the published response does not seem true when viewed from this DGH staffed by a mix of FY1, FY2, SHO, and their equivalent trust doctors. Could we hear from those who are in favour of the Colleges/ Deaneries/ Department stance but have not been actively involved? What are your reasons for supporting the continuation of this process? This correspondence is as open to you as it is to me. Or is the silence because there is no one out there from whom I might 'audem alterem parte' ? Competing interests: None declared
MTAS: A Disaster 27 June 2007
Charles N McCollum, Professor of Surgery 2nd Floor, ERC, The University Hospital of South Manchester, Southmoor Rd, Wythenshawe, M23 9LT Send response to journal: Re: MTAS: A Disaster	The MTAS programme was a disaster. MMC and PMETB should resign immediately. We need to return to a Deanery based process until a proper career structure is designed that is sympathetic to the different needs of surgery and other specialities. The BMA has failed to represent its members, and the Royal Colleges must take a firmer stand than they have done to date. Competing interests: None declared
What now for the dispossessed? 27 June 2007
Glenis K Scadding, Consultant Allergist RNTNE Hospital , London WC1X8DA Send response to journal: Re: What now for the dispossessed?	Morris Brown et al are absolutely right- a rapid and unified response from the Royal Colleges is needed, not only for better future planning but also to find some way of employing those 8000 plus expensively trained , dedicated and hard working young people who have put effort, time, energy and money into becoming qualified doctors. Suggestions of voluntary ( presumably unpaid and unrecognised for training purposes) work are laughably inadequate.It is not as though there is no work for them to do- merely no government money to pay for them to do it.Explaining the waste of £2 billion spent in training doctors who are then paid unemployment benefit may be beyond even this bunch of spinmeisters at the DoH. This situation could be rectified if the Colleges put their collective muscle together and stood up for their members. Competing interests: None declared
MTAS shambles 27 June 2007
Allistair Stark, Consultant haematologist Dumfries DG1 4AP Send response to journal: Re: MTAS shambles	Brown et al have it completely right. Now is NOT the time to keep quiet about the farce that MTAS has become. We must revert to a scheme that encourages submission of CV's, appointment on merit, and local job appointments. We should be given the answers to the the following: Who dreamt this fiasco up in the first place? Who arranged for the software to written? Who wrote the 'questions' that supposedly discriminated between those who should get and those who shouldn't? I can't find these answers. We should know - surely there weren't doctors involved at the start?! And surely someone should be accountable, and not just the politician at the top. Not that there is any chance of the Secretary of State resigning - I should imagine she cares too much for her job and pension rights (outrageously generous as they are) And finally what of our CMO? No wonder there was a motion critising the CMO at the recent ARM of the BMA; both in MTAS and the review of performance of doctors, Donaldson has been associated with processes where good advice has been completely ignored. Surely he should go. Competing interests: My daughter is a medical student at present.
Let's stop being so nicey nice 27 June 2007
Louise M Pealing, SHO HIV/Infectious disease UCLH, London UCLH London, WC1 Send response to journal: Re: Let's stop being so nicey nice	I am so grateful that we still have our senior colleagues delivering their clout to this debacle. We must have an open debate over this disgraceful process, and it must be empassioned, noisey and result in change for the best. Please can we stop being so nicey nice about all this, it is feeble and debilitating. Competing interests: None declared
fomenting poor morale within the profession and hampering change 28 June 2007
Dan Harding, Consultant Anaesthetist Queen Mary's Sidcup NHS Trust, DA14 6LT Send response to journal: Re: fomenting poor morale within the profession and hampering change	In addition to placing a substantial proportion of junior doctors in the miserable position of career uncertainty and domestic disturbance, the MMC and MTAS process is hindering the very process that it was meant to bring about, that is change. I feel desperately sorry for my junior colleagues, a proportion of whom are so fed up with their careers that they are considering leaving medicine altogether. The process is also causing considerable fallout on the internal workings of the institutions in which these Doctors work. Trusts do not know the experience of the new appointees due in less than five weeks time, let alone their names and addresses. They may not even know whether they will be getting their quota of new doctors on August the first. There is a real danger that service will be disrupted as a result, therebye placing even more strain on the situation. The announcement by the (recently departed) secretary of state promising a three month job extension to all those who have applied in the first round of the MTAS selection process has placed the Trusts in an even more uncertain position. Competing interests: These views are my own and may not represent the views of the institution in which I work
Morris Brown speaks for the profession 28 June 2007
Ruth M MacInerney, Consultant Physician Chesterfield S44 5BL Send response to journal: Re: Morris Brown speaks for the profession	Unlike the BMA, which has consistently refused to find out what its members think on this issue, Morris Brown has articulated the views of the profession. No one I know has a good word to say about MMC, let alone MTAS. Patricia Hewitt has resigned. Surely it is time for Liam Donaldson to follow. Competing interests: None declared
In support of Prof Brown 28 June 2007
D Owen, Research Registrar Hammersmith Campus, Imperial W12 OHS Send response to journal: Re: In support of Prof Brown	Although the political apathy of our profession is not DIRECTLY to blame for the disastrous state we find ourselves in, it is probably true to say we could have prevented this had we not been so apathetic. In the aftermath, Prof Brown seems to be the only driving force willing to attack this problem head on and I support his group whole-heartedly. If Gordon Brown is serious with his constant references to "change", then the entire approach of MMC is a good place to start Competing interests: None declared
Plan B 29 June 2007
Simon T Adams, Clinical Fellow Royal Bolton Hospital Send response to journal: Re: Plan B	Firstly I would like to say a huge thank you to those senior doctors who have tried to support my colleagues and I in the "lost tribe". Secondly, a similar thank you to those senior doctors who advised me that my plan B should in fact be my plan A. Plan A produced nothing more than a charity, meaningless, half-hearted interview. Plan B costs more and involves a few long-haul flights but I have always respected the advice of my trusted seniors. MTAS -Move & Train Abroad, Sunshine. Competing interests: None declared
We have let our Juniors Down 29 June 2007
Daniel M Sado, SPR in Cardiology St Marys Hospital, IOW Send response to journal: Re: We have let our Juniors Down	I was lucky enough to get an NTN at the end of last year and so just missed out on MTAS. This year, on both a formal and informal basis, I have spoken to many trainees who have been affected by the process. What is clear to me from these conversations is that we have lost the good will of a large number of our profession. As we all know only too well, the NHS will only function on the good will of it's staff and so the long term impact of this is going to be huge. What I find most upsetting is that MTAS was effectively a betrayl of trust... Prior to MTAS it was pretty clear to all doctors what looked good on application forms - prizes, publication, MD, PhD, experience etc. One can debate whether these things show quality, however we all knew what we needed to do if we wanted to get into a competitive field. The MTAS application form effectively nullified these skills in favour of those who could tell a story effectively in 150 words. Having universally agreed that the form was not "fit for purpose" we still continued and allowed those who did well on it to get more interviews and hence a better chance of getting a job (see the Prof Brown survey results). My heart goes out to the junior doctors that have suffered as a result of this debacle. I fully support Professor Brown and his colleagues for what they are doing for junior doctors. Competing interests: None declared
Re: Let's stop being so nicey nice 29 June 2007
Tom A Milligan, SHO ENT York York Hospital Send response to journal: Re: Re: Let's stop being so nicey nice	Thank goodness senior doctors are taking a public stand against the horrendous conditions junior doctors have been put under by MTAS. I realised there were going to be huge problems with the system in Nov 2005 when I attended a teaching week with my surgical rotation. An ad hoc question and answers session with the Royal College of Surgeons national careers advisor revealed two worrying facts: First, that the Royal colleges were going to have to work within the confines of MTAS for fear of losing the job of assessing doctors and exam setting if they confronted the government. Second, when I asked what I could do to maximaise my chances of being selected for plastic surgery given that I was a 2003 graduate, I was advised to think seriously about changing my future specialty as there were unlikely to be enough jobs to go round. Both these facts have proven to be true. I did not apply to MTAS, despite having passed all of MRCS at the first sitting and never having failed a medical school exam. My future feels bright but mainly because, like thousands of others, I do not want the NHS to be my employer in the future. The mental stress and anguish caused by this process started well before any headlines were written. Senior doctors who do stand up for the profession should be lauded as without them, the the govenments meddling will continue to disenchant and will lead to a generation of dissatisfied doctors, in the wrong speaciality and with no emotional reserve to feel empathy. Competing interests: None declared
Re: Support for Prof Brown and colleagues 30 June 2007
Catriona Sykes, Clinical Fellow, Medicine, Dumfries Dumfries and Galloway Royal Infirmary, DG1 4AT Send response to journal: Re: Re: Support for Prof Brown and colleagues	Prof Brown has done what the Royal colleges and review bodies have utterly failed to do. He has canvassed the opinions of juniors; the people who have endured a terrible year of uncertainty and frustration and had the most to lose through MMC. The Royal Colleges need to listen to the opinions of their members and take a stand against a system which we all know is going to destroy the practice of medicine in this country. As doctors we should take responsibility for our training and the care of our patients and the colleges should be leading the way. They aren't and so ordinary doctors are not being adequately represented. Competing interests: MTAS applicant!
Further support for Prof Brown. 30 June 2007
Jamie Peyton, SpR Anaesthesia Bristol BS2 8HW Send response to journal: Re: Further support for Prof Brown.	I would like to add my support to Prof Brown's letter. The startling level of incompetence demonstrated by the DoH has been matched only by the lack of fight shown by our representative bodies. The political agenda behind MMC and MTAS is clear and will result in a weaker profession and harm our patients. The next step for our 'leaders' must be to demand the resignation of Liam Donaldson and Carol Black - they cannot be allowed to continue in their current roles and have lost the support, and more importantly, the trust of the medical profession. Competing interests: None declared
Medical reforms put patients at risk 30 June 2007
Jane E Graham, SHO Acute Medicine Addenbrooke's Hospital, Cambridge, CB2 2QQ Send response to journal: Re: Medical reforms put patients at risk	The Government and Royal Colleges continue to hide behind the Tooke review, failing to accept the impending crisis in August when patients’ lives will be put unnecessarily at risk following the farcical introduction of MMC using MTAS. Labelling Prof Brown and his group, all highly respected clinicians, as ‘going too far’ only provides further evidence that the Government has no concept of the gravity of the situation the NHS is now in. Key responses to the initial ‘Unfinished Business: Proposals for reform of the Senior House Officer grade’ in 2002, clearly predicted some of the potential problems the rapid introduction of MMC would create. In reality, the situation has been much worse. The phrase “there has been consultation but no real listening” appears to repeat itself over and over. Despite the judicial review highlighting the MTAS process as unfair, I feel let down by the deaneries who in knowing this information, still offered run-through training posts rather than posts subject to review at 1 year. I agree with Morris Brown wholeheartedly. For the sake of the profession and the health of the Nation I call on the Royal Colleges to stand united against the implementation of these reforms before it is too late. To stand united against these detrimental reforms demonstrates the power and conviction we as doctors have, to stand up for our own rights and those of our patients’. Competing interests: None declared
A robust stance is required 30 June 2007
Duncan J M Macdonald, SpR in trauma and Orthopaedics Glasgow Royal Infirmary, Glasgow Send response to journal: Re: A robust stance is required	Professor Brown and his colleagues are to be commended for their actions. At a time when junior doctors need firm support from senior members of the medical profession, there has been no other medical leaders brave enough to take a stance. The royal colleges have acted as though they are in the back pocket of the government and we should question why we have to pay for the privilege of membership when this is the support they give us. I strongly feel that nothing less then a robust approach is required from our leaders in working with the Department of Health otherwise we shall forever more be trampled on by politicians and bureaucrats. Competing interests: None declared
cogs in a machine 3 July 2007
Iona Heath, GP Caversham Group Practice NW5 2UP Send response to journal: Re: cogs in a machine	Any system that treats human beings as interchangeable cogs in a bureaucratic machine is despicable. MTAS is such a system. Competing interests: None declared
Rage Against the Machine 3 July 2007
Jasjit K Dhillon, GP registrar maternity leave Send response to journal: Re: Rage Against the Machine	Thank you Professor Brown and colleagues. The profession is under attack and working lives for Doctors are under great strain. Our employment prospects and thus practical considerations such as how to pay the mortgage, pay our debts and look after our dependents cause us to lose sleep at night. On top of this we need to study, pass exams and remain up to date as a matter of course, with the attendant financial commitment this involves. Doctors married to or partners of anbody else in a highly demanding field face difficult choices that put relationships to the test...more difficult when children are involved. Modernising Medical Careers has been hi-jacked and is a reactionnary imposition on our training because of Shipman. The Government has cunningly used an opportunity presented by the mass-murderer to gain a stranglehold on the profession supposedly in the best interests of patients, yet refused to counter a long overhaul in the death certification system, which may actually prevent another Shipman. I dread to think what further reactionnary measures we will have to endure as it emerges that junior doctors are now counted amongst car- bombers. I simply want to be a good doctor. Actually, I want to be an excellent GP who has time for my patients and time to read. I welcome any robust and valid process that will improve my education and training. However, I strongly resist the battery farm method of mass producing dumbed down versions of Drs on the cheap. The Government has failed to uphold promises made (eg GP pensions) has continued to stall on major issues(awarding the SAS contract) and has betrayed international medical graduates (and is still betraying international medical students) in a scandalous manner. So far Brown has exhibited signs of continuing to be reactionnary and inflict ill-considered policies on us all (GP out-of hours access). The Government should be held to account by our most senior bodies who should not be distracted by a change in PM and re-shuffling of the cabinet (hardly democratic) And if those senior bodies turn a blind eye or are in collusion, then they too should be held to account by the STRONGEST means possible by us and the public. We also need to remember that the MMC/ MTAS debacle is not the only reason Drs are miserable. Access to flexible training is deplorable. Drs on sick leave/ maternity leave/ seeking time out/ seeking to return to work, particularly on a less than full time basis are treated appallingly by the Trusts. The EU 7 year rule should be counted as a family planning method, especially as you were not aware of it when you started training and inconsideratley chose to start a family in the middle of your training. The BMA news ran an article on work experience in the NHS for school leavers recently. An excellent idea if you actually tell girls the truth about trying to have babies, look after them properly and trying to progess in your chosen (or these days, not so chosen) field. Competing interests: None declared
Numerical indicator nonsense 4 July 2007
JOHN HUTCHINSON, CONSULTANT INTENSIVE CARE HR1 2ER Send response to journal: Re: Numerical indicator nonsense	As the father of an F2 doctor who has been unsuccessful in obtaining an offer of a training post in General practice by a numerical indicator of the value of 0.67 out of 96, I have only total contempt for the collection of dimwits that put this system together. How can subjective views of an individuels performance be quantitated to that degree of precision. The CMO and Lords Hunt and Warner have gone very quiet all of a sudden. They appear to have disregarded the obvious point that all doctors have to be trained in something in order to work - in sharp contrast to politicians. These and and the various Secetaries of State themselves rely on political patronage to obtain their own positions, and felt that they had to make changes to justify their positions. Did they submit themselves to the daft role plays and reflective nonsense they have inflicted on others? I doubt it. In my own experience over 25 years, the previous system of selection was fair and provided a clear balance between service provision and training oportunities for young doctors from all parts of the world, irrespective of background. Liam Donaldson should now return to his surgical career. Competing interests: None declared
loss of confidence 22 July 2007
Philip J Dawson, GP rh16 4bn Send response to journal: Re: loss of confidence	Dear Sir, I am concerned that doctors who have been through this process will no longer be able to respect and have confidence in the management they work for. At what point will the royal colleges or the Department of Health make any attempt to repair this damage and loss of confidence. There are implications in which ever decision they make. No apologies nor recompense would confirm they want a stand off. Apologies would suggest they wish to grow and develop the doctors that will care for the nation they seek to serve. no decision would suggest they hope the mistakes will go away. I am concerned that £250,000 of tax payers money is spent and then wasted by not further developing the doctors we have trained. I feel it will start to weaken the relationship with management and team working that gives the best care for all out patients and of course ourselves! Philip Dawson Competing interests: None declared