Intended for healthcare professionals

Rapid response to:

Analysis And Comment NHS reorganisation

Who's kicking who?

BMJ 2006; 333 doi: (Published 21 September 2006) Cite this as: BMJ 2006;333:645

Rapid Response:

More patient choice with less doctor choice: bad for everybody

Hawkes[1] provides one of the clearest accounts of the barrage of
politically motivated changes the NHS in England has ever had to endure.
This outstanding article cuts through political correctness, pointing out
the true motivations for recent government policy – money, power and

The rushed implementation of proposed changes to postgraduate medical
education are a particular concern[2] and serves as a pertinent example.
One of the five key principles for reforming senior house officer
training, originally set out by the Chief Medical Officer in August 2002,
was that ‘training should allow for individually tailored or personal
programmes’.[3] In other words, doctor choice.

However, Modernising Medical Careers material published 18 September
2006, regarding online application into specialist/GP training states that
‘specialty trainees will be able to apply for two specialty groups and two
units of application (UoA) for each specialty’.[4] This reverses the
current position of doctor choice and flexibility of speciality and
location, to one of inflexible and limited choices – allocation. The
prospect of being forced to move at relatively short notice, particularly
difficult for those with families, to any location within the four UK
countries, in order to work or train in possibly an undesired specialty,
reminds doctors who is doing the kicking. Ultimately, poor morale and lack
of interest in one’s specialty will result in a deterioration of patient

[1] Hawkes N. NHS reorganisation: Who's kicking who? BMJ 2006;333:645

[2] Allan R. Modernising Medical Careers. Clinical Medicine

[3] Department of Health. Donaldson L. Unfinished business. Proposals
for reform of the Senior House Officer grade. London: DoH, 21 August 2002.

[4] Modernising Medical Careers. Training Tomorrow’s Doctors. An
Update for Applicants to Specialist/GP Training 2007. Published 18
September 2006.
(accessed 25 September 2006)

[5] Grunfeld E, Zitzelsberger L, Coristine M, Whelan TJ, Aspelund F,
Evans WK. Job stress and job satisfaction of cancer care workers.
Psychooncology. 2005;14:61-9.

Competing interests:
None declared

Competing interests: No competing interests

27 September 2006
Amit Patel
Senior House Officer in Cardiology
The Heart Hospital, UCLH NHS Foundation Trust, 16–18 Westmoreland. Street, London W1G 8PH, UK