Doctors trained in communication

Junior doctor training will undergo a radical overhaul this week despite concerns from the British Medical Association (BMA) regarding funding, implementation and future job prospects for doctors.

Communication and safety will become key areas in a new two-year foundation course, which will begin straight after medical school. The new scheme, called Modernising Medical Careers, has been designed to replace the existing house officer system, which many feel has run its course.

The first year of the new training scheme concentrates on communication and consultation skills, patient safety, teamwork, and clinical skills. The second year will offer experience in primary care, and an opportunity to step in where there may be a shortage of doctors. When the training scheme is finished, doctors are expected to take up specialist training posts, where they can choose which area to specialise in (eg, surgery, paediatrics). The existing system of pre-registration house officers and senior house officers, which can take over three years, will no longer exist.

Yet, the BMA has given the new scheme a lukewarm reception in public. Despite a vote of no confidence for the scheme at last year's BMA junior doctors conference, Simon Eccles, chairman of Junior Doctors Committee, admitted this week that “we support the principles underlying the new system.” He added: “[However], the way the transition has been planned has risked worsening workforce problems... Modernising Medical Careers could bring major benefits to both doctors and patients, but its implementation needs to be properly planned and funded. It is vital that carefully thought-out solutions are put in place over the coming years or workforce problems will worsen.”

One of the main issues for the BMA is that doctors who complete the current system cannot find jobs at the end of it - and the new shorter system will simply exacerbate the problem.

The Department of Health has downplayed the unemployment issue and 5,000 trainee doctors will be given the go-ahead to start the Foundation Programme - the first stage of the process - this week. Health Minister, Lord Warner, noted: “This is just the beginning of a much wider ranging change of medical training, driven by the needs of patients and the NHS.”

Despite government optimism, the BMA points out that cutting training down to two years, from three or more, will inevitably diminish the number of positions vacant for newly trained doctors. It feels that the problem is very closely linked to another major issue that it has highlighted over the past few months - a lack of job opportunities at every level for newly trained doctors, caused by rising numbers of trainees and foreign doctors moving into the NHS.

Without a proper look at these problems the new scheme may be a potential solution to training problems, but the wrong prescription in the context of job shortages for new doctors.