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OBSERVATIONS: Nigel Hawkes How not to win friends and influence people BMJ 2007; 335: 284 [Full text]

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PMETB and the future of "the lost tribe"

Chris M Laing   (13 August 2007)

PMETB and the future of "the lost tribe" 13 August 2007
Chris M Laing, SpR nephrology and intensive care medicine Thames Region Send response to journal: Re: PMETB and the future of "the lost tribe"	A matter PMETB must urgently address is the anticipated role, prospects for career development and training regulation of the 10,000 junior doctors who will continue to be employed by the NHS, but have not secured places on training schemes this year. It was recently stated by the deputy CMO that these doctors will enter service posts and will not be unemployed. In tandem with this development has been the assertion (articulated recently by Professor Alan Maynard and others) that it is unreasonable for all doctors to expect to become consultants or GPs. Most had interpreted this as a likely move towards non-consultant trained specialists equivalent to current staff associate specialists. But such non- consultant specialists will still have to have undergone formal training to be undertaking "specialist" work and its likely they will be graduates of the full run-through ST schemes. So what of those doctors in service posts not accessing specialist or GP ST schemes? On a global and historic level doctors are either specialists or family doctors. Are the architects of MMC are seriously anticipating an entirely new category of doctor, neither specialist nor GP? This would be as bold an innovation as the online application system. Are these doctors to drift between junior service roles in different specialities, with no prospects of career progression, filling gaps in arduous out-of hours rotas until retirement age? Such doctors would doubtless be on short term contracts, effectively excluded from promotion and would have no employment protection rights or access to redundancy schemes should these contracts be terminated. I thought MMC was designed to prevent abuse of the SHO grade for service ends? I suspect the MMC architects have got their sums wrong and fully anticipate that this very large group of juniors will have no choice but to leave the health service before they become unemployable, but wish to diffuse this issue by claiming that juniors are unreasonable to expect some prospect of career progression. This (now very large) tribe will not be lost but extinct. It is vital that there is clarity about what medical graduates can reasonably expect so that young aspirants may make informed choices and the taxpayer can assess the merit of their investment in medical schools. Are we talking about "non-consultant" specialists and "non-GP" family doctors as a means of reducing salary costs? Alternatively are we to anticipate long-term junior- level medical Mcjobs with no specialism in secondary or primary care whatosever? Finally are we expecting a large number of medical graduates not to become doctors at all? Perhaps the MMC protagonists view all three as desirable. PMETB should take a lead role in this debate. Competing interests: None declared