theMEDICALSTUDENT
January 2014
The voice of London's Medical Students/www.themedicalstudent.co.uk
Unemployed Doctors?
The Hippocratic Oath
Private medical schools >> page 4
We look at its history >> page 18
Medical School Life
Legal Highs
Are we losing ourselves? >> page 11 We take a look >> page 7
NHS Entry Exam Proposed Krishna Dayalji What would you say if you were told that you would receive full General Medical Council (GMC) registration at the time of graduation from Medical School? Would your opinion change if you had to pass an additional exam to work within the NHS? This part of the proposal that has been put forward by Health Education England (HEE) this December. In a recent report, HEE have proposed that the ‘point of registration should be brought forward to align with graduation, coupled with enhanced selection processes to the Foundation Programme to ensure the best applicant’s progress.’ Under these new plans, all medical students in the UK would be granted full registration to practise medicine upon graduation from university. However, to secure a place on the Foundation Programme, students must successfully pass a new national entry exam, ensuring only suitable candidates work in the National Health Service (NHS). The exam is seen as one way of improving the quality of foundation trainees entering employment within the NHS. HEE argue that the proposal will “shift the moral imperative from the promise to medical students into a promise to patients for the highest quality care from the best candidates entering UK training.” However, those who fail to pass this additional exam would be registered doctors able to work either privately or abroad. Therefore, medical graduates would no longer
need to begin their medical careers within the NHS in order to gain full GMC registration to practice. They would not be left as they are now without a registered professional qualification. In concordance with the recent Shape of Training review, the report aims to provide a permanent solution to the oversubscription of the Foundation Programme. Currently, only upon successful completion of the Foundation Programme can junior doctors achieve a full licence to practise in the UK. 2014 will be the fourth consecutive year that the programme has been oversubscribed, and the demand for places on the programme is likely to continue with medical students applying from UK and European medical schools as well as the development of private medical schools. The mantra of the report is that HEE ‘must ensure that medical trainees who are competent and able to complete training programmes successfully are supported to secure full registration.’ This is in sync with the Shape of Training review, which advocates for early GMC registration for medical schools after graduation from medical school. Previously, the National Health Service (NHS) has created extra places, increasing costs further. Last year, 160 more places were added to the programme, however the report highlights how this is an unsustainable solution, and the introduction of the entry exam is the preferred option for HEE. If the proposal is approved, fundamental changes will be required to the Medical Act, resulting in a major change
to recruitment and training of junior doctors within the NHS. The report states that a decision to proceed should be taken as swiftly as possible, ensuring that the changes to the Medical Act can be enacted as part of the Law Commission review of regulators in 2014. There will also be a three-month consultation on the final proposals, and it is believed that it could take five years to implement. The intention is to make a transition away from the ‘moral obligation’ school of thought and towards improving the standard of medics joining the NHS. But will the proposal simply act to reduce spending and save costs, or will it act towards improving patient care? The BMA Medical Schools Committee (MSC) have expressed concerns over this very point.
Co-chair, Harrison Carter, highlighted the fact that despite HEE claiming improvements in patient safety, the worry remains that ‘reducing basic medical education by a year will result in the opposite.’ He added, rather worryingly, that ‘The proposal could also mean that medical graduate unemployment is more likely, with more applicants to the foundation programme being possible from those outside the UK and Europe. This would be an enormous waste of both public and student investment in medical education.’ Of further concern is the potential ending of the fouryear graduate-entry medicine programme, as losing the extra year could disqualify the courses from meeting the European minimum length of basic medical training (by in-
cluding the foundation year one). MSC co-chair Andrew Wilson asserted: ‘A number of safeguards need to be in place if this proposal is to work for patients, for medical graduates and for medical education.’ A fear amongst medical student committees is the lack of evidence to suggest that an additional national exam would be of any benefit for graduating medical students, patients and the NHS as an entity, and there are queries as to whether this proposal is likely to solve the oversubscription of the foundation programme. I suppose the real question is, will it work? TMS would love to hear your views regarding this proposal. Send forward your thoughts to news@medicalstudent.com and we’ll publish them next month!