Winter pressure is putting junior doctors’ training at risk, leaders warn

BMJ 2018; 360 doi: (Published 08 January 2018) Cite this as: BMJ 2018;360:k100
  1. Abi Rimmer
  1. The BMJ

Junior doctors are being forced to miss opportunities for training because of winter pressure on the NHS, doctors’ leaders have warned.

On 2 January NHS England advised hospitals to postpone elective procedures until the end of January and to defer outpatient appointments and day case surgery in a bid to ease mounting pressure on services.1

Sarah Hallett, deputy chair of the BMA’s Junior Doctors Committee, said that the deferrals in elective surgery and clinics were having a detrimental effect on trainees in surgery in particular, though all trainees were being affected. She said, “The sheer pressure that we are seeing throughout the system at the moment means that trainees in general practice, core medical training, paediatric training—and in fact everybody—are feeling the impact.”

Hallett said that the extra pressure had exacerbated problems that already existed, with senior doctors struggling to find the time to train juniors and the system being under-resourced. “We find that service provision can be prioritised over training,” she said. “It’s essential that this doesn’t happen, because, as junior doctors, the training we receive is essential to ensure that we are developing as professionals and to safeguard the quality of doctors that we produce.”

Stella Vig, a member of the Royal College of Surgeons’ council and a consultant vascular and general surgeon, said that though deferred operations could have a disastrous effect on patients, they also had a damaging effect on surgical trainees. She said that because of the reduction in elective operations in the two weeks before Christmas and the deferral of elective operations in January, trainees could miss out on as much as a sixth of their six month training placement at a trust. “If you’ve lost a sixth of your training in a particular post, you’re not going to be able to make that time up again,” she said.

Vig warned that some surgical trainees might not be able to complete their training because they would not have done the required number of procedures and met required standards. “If the trainees are not fulfilling the criteria we have set for them which display evidence of competency, then we can’t sign them off, and they can’t go into a consultant post,” she said.

Like Hallett, Vig said that the cancellation of elective operations had been a problem before NHS England’s announcement this month. “In reality this has been going on year long,” she said.

Charlie Massey, chief executive of the UK General Medical Council, said he recognised that winter pressure was forcing junior doctors to miss training opportunities. “In this situation, doctors in England should make use of exception reporting, a system through which they can flag issues including working hour breaches and missed training sessions,” he said. “It’s crucial that doctors make their concerns known so they can be addressed.”


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