Tooke brings focus but no solutions to those seeking global health work within MMC
The recent interim report of the independent enquiry into Modernising
Medical Careers (MMC) led by Sir John Tooke highlights the lack of
flexibility that was being offered by the proposed run-through training
programs. It forced junior doctors to rethink their future career options,
none more so than those wanting to gain overseas experience (1). This was
illustrated through the lack of flexibility, along with programme
provision and training, for those wishing to gain experience globally
within or outside the Specialist Training (ST) program.
The positive impact of the skills and knowledge brought back to the
NHS by UK medics returning from overseas work is well documented , and
acknowledged by the recent CMO and Crisp reports (2,3). These reports were
highlighted by Tooke et al, and also outline the potential for fresh
incorporation and recognition of the value of overseas experience at all
levels of medical training, along with the consequent need for
collaboration with the relevant accreditation authorities in order to
recognise this experience. Furthermore, work of this sort, if managed
correctly, can play an important part in fulfilling the UK’s key
obligations in aid and development, with UK workers contributing to
workforce capacity in those areas of the world in greatest need (2,3).
The significant desire of a body of UK medical students and graduates
to work internationally (4,5) should be encouraged and catered for by the
postgraduate system. Initially, MMC promised to deliver this through the
principle of increased flexibility that was one of its cornerstones (6).
However, in its final incarnation, it failed to do so. We welcome the
specific acknowledgement in Sir John’s report of the threat to
international health and the highly representative case study which
illustrated his argument(1). However, specific outlines and guidelines as
to how international work could fit into his recommendations are notably
With increased government funding for development in the recent
comprehensive spending review, combined with the recommendations of the
Crisp and CMO reports, it is time to ensure that policy is put into
practice on this issue. A coherent, clearly defined, and adequately funded
mechanism through which UK medical Post Graduates can contribute to health
in the developing world is needed. This must come with a guarantee of
retention of a place on, and gaining accreditation for, the UK career
ladder, or we are likely to fall into the same fragmented situation as
before and fall short of our development aspirations and obligations. We
hope and trust that these issues will be further explored in the final
document and solid, practical recommendations are made to not only
preserve but strengthen and promote the valuable contribution that UK
doctors, particularly in the formative stage of their careers, make to
health in the wider world.
1. Tooke J. 4.4.8 Special Case: Contributions to Global Health. In:
Aspiring to Excellence: Findings and recommendations of the Independent
Enquiry into Modernising Medical Careers. London, MMC Enquiry 2007.
2. Crisp N. Global Health Partnerships: The UK contribution to health in
developing countries; Chapter 6: The UK contribution – Making it Even More
Effective and Sustainable. London, COI. 2007.
3. Donaldson, L. Health is Global: Proposals for a UK-wide Government
strategy. London, COI, 2007.
4. Nicholson B, Lewis G, Martineau F. International health foundation
programmes. BMJ Careers 2007; 334: 23-25
5. BMA HPERU. Cohort Study of 2006 Medical Graduates: First report. BMA,
6. Delamothe, T. Modernising Medical Careers laid bare. BMJ 2007; 335; 733
Competing interests: No competing interests