Inauguration of New President: Dr John Chambers & 'Any Questions' - A Panel Discussion
Dr Judith Hulf, President of the Royal College of Anaesthetists.
Professor David Graham, Postgraduate Dean, Mersey Deanery
Dr David Whitaker, President of the AAGBI
Prior to the meeting, the official opening of the Anaesthetic Suite and Cecil Gray Seminar room was performed by Dr Will Roberts, President of the Liverpool Society of Anaesthetists, Professor Martin Leuwer, Head of the Mersey Series of Anaesthesia and Professor Peter Calverley, President of the Liverpool Medical Institution who all said a few words in front of an invited audience
The meeting commenced at 19:00 with a welcome from Dr Will Roberts who handed over to the incoming President Dr John Chambers. The new President introduced the panel, Dr Judith Hulf, President of the Royal College of Anaesthetists, Dr David Whittaker, President of the Association of Anaesthetists of Great Britain & Ireland and Professor David Graham the Mersey Dean. Each panel member then gave a 5 minute introductory talk which commenced with Dr Judith Hulf, who briefly talked about the new College building with its Acute Care partners, the newly formed College of Emergency Medicine, the Intensive Care Society and finally the British Pain Society. She then continued to talk about Modernising Medical Careers (MMC) and the role that the College has in supporting the standard and delivery of training to the highest level and her wish to ensure that trainees have realistic opportunities of employment at the end of their training. One of the principles of the College was the safe delivery of patient care across many specialties and she felt this should be delivered by a consultant based workforce.
David Graham then gave a short presentation about MMC which he said was about better supervision of training, the delivery of competent service providers and proper assessment of doctors in training. He also said that the concept of schools within Deaneries had first emerged from Anaesthesia. David Whittaker was the final speaker to briefly present and he talked about the future changes in the consultant workforce, consultant working practices and the introduction of anaesthesia practitioners. He also talked about future consultant vacancies which he anticipated would be 150 every year for the next 10 years without any further expansion in consultant numbers and this contrasts with 400 trainees starting training each year. He also touched on current areas of concern such as on-call, SPA activity, pension and clinical excellence awards. How work in ISTCs will fit in, is still not entirely clear and what the role of anaesthesia practitioners who are currently beginning to come on stream, is also not clear. There is a possibility of an NHS Independence Bill going through Parliament which will take the NHS out of the hands of politicians.
Question time then started and the first question to be tabled was from Simon Bricker, who asked ‘who thought that MMC was a good idea and why is Merseyside pushing it so strongly?’ David Graham started first and commented that with Mersey Deanery being one year ahead of other Deaneries, it had managed to create 100 additional F2 posts by changing service posts into training posts. It was also an opportunity for Mersey to shape concepts in MMC. He did comment that there were difficulties with the numbers but did not think that this would lead to a new ‘lost tribe’. Judith Hulf commented that there was never a ‘lost tribe’ in anaesthesia and one of the consequences of MMC was the potential loss of SHOs using anaesthesia as a stepping stone to other specialties. David Graham said that with greater co-operation between schools, that this would still be possible. Judith Hulf said there had been agreement that there would be aproximately 18,000 run through posts with a further 5,000 fixed term specialist training appointment posts (FTSTA posts). This represents about 25% and the aim was to get this down to 10%. She then went on to point out that up to 50% of SHOs leave Anaesthesia after 1-2 years and to counter this, there would be an Acute Care Common Stem Pathway training which would last for 2 years. This would be run jointly for Anaesthesia and Accident and Emergency Medicine. In Anaesthesia, this could then lead to entry into ST2 year of training or ST3 in A&E Medicine. David Graham commented that the system should be far more flexible than had initially been envisaged.
Dr Mustafa commented that he was very disappointed about the lack of competitive selection after the ST1 interviews. David Graham replied that there would still be exams through MMC and a formal rigorous assessment programme. Judith Hulf commented that she felt that trainees had been given a dis-service since Calmanisation as prior to this, they had episodes of real competition at registrar and senior registrar selection but with run through training, trainees were approaching consultant appointment interviews with little prior experience. Richard Craig asked about the future of exams. Judith Hulf said that exams test knowledge and currently there was no better test of this than formal examination and to remove this formal test would eliminate a form of rigorous assessment of trainees and their progress. She did comment that the Primary exam would be changing but this was in the time scale and not in the standard or content. There were no plans to change the final FRCA. David Graham then asked about how many times it was reasonable for a trainee to take the final exam before being removed from the training programme. Dr Hulf said there was already a mechanism in place for trainees failing exams but currently there was not an absolute number of times a trainee was allowed to sit the exam before no further attempts were allowed.
Richard Craig asked whether the College had a future with the introduction of PMETB. Dr Hulf said that PMETB was currently far too busy with training issues such as approving training curricula to seriously challenge the College in the setting of training standards. Eoin Young then asked about the future destination of trainees and with the implication of a sub-consultant grade. David Whittaker said that it was uncertain at the moment why so few jobs were being advertised but a couple of reasons were clear. Firstly, the economic situation within Trusts and secondly, the opening of ISTCs with the employment of European consultants both had caused changes in the employment market. But he did point out that the BMA, which was supported by the Association and the College, felt the only way forward was a consultant based service only and did not wish a sub-consultant grade to be created.
Dr Oscar Freddy asked whether it was the end of the road for international medical graduates coming to the UK for training? David Graham said that with the ever increasing UK workforce, there would be a lower need for overseas graduates and they would have to pass the residents labour market test which was internationally recognised. This is where a local graduate, meaning that if an appropriately qualified doctor from the European Economic area, could fill a post then they were given priority over an international medical graduate. Later on this subject, Dr Peter Charters commented that the reputation of Britain for being fair was being seriously undermined. This was in the area of the equivalence of training from different countries where he felt there was a different standard being set for overseas and EEA graduates. Dr Hulf commented that it was government policy that had suddenly changed. This had been a rapid reaction to the possibility of UK medical unemployment but David Graham pointed out that EEA doctors had equal opportunities to employment in the UK.
Dr Chris Parker asked whether it would be more sensible to have a free market in training numbers so that they could more accurately shadow employment requirements. Judith Hulf pointed out that finance drives permanent posts and decisions over employing consultants were made in the short term where as training could not be controlled in this way. David Whittaker commented that central control was better than no control as there, inevitably, had to be some planning despite the fact that this always seemed to be inaccurate. This came onto the question of medical unemployment. Both Judith Hulf and David Graham agreed that the prospect of medical unemployment was small however doctors may not be employed in their chosen speciality. David Castillo asked about the person specification and system for entering the MMC system. Rob Gillies, who is an Associate Postgraduate Dean, stated that the entry criteria and person specification should be available in the next couple of months.
Other areas that were briefly covered were the possibility of research which all speakers agreed would still be possible with the support of the respective school and deanery and the inadequate exposure that medical students particularly at Liverpool University have to Anaesthesia. Judith Hulf and David Graham said the best way of improving this was to try and advertise our specialty more widely among medical students and also to create more F2 posts in Anaesthesia which would expose junior doctors to the specialty in greater depth.
David Gray closed the meeting at 21:00 but before this, asked a couple of further questions ending up with the possibility of amalgamating the Association and College. It was pointed out that each organisation had complimentary roles and were actually symbiotic and not in any way working against or in competition with each other. David Gray then presented a cheque on behalf of the MSA for £5,000 to David Whittaker for the Overseas Education Fund and another £5,000 cheque to Dr Hulf for the President’s Appeal Fund.
The meeting closed at 21:10pm and members had supper in the library.