- Department of Health proposals

Summary of DoH proposals

The CMO’s nineteen proposals to reform the SHO grade in line with the strategic intentions contained in the NHS Plan are based on five principles.

The principles state that training should:

• be programme-based (accountable, curriculum-based, formal entry, planned, assessed, time-
  limited)
• be broadly-based to begin with for all trainees
• provide individually-tailored programmes to meet specific needs
• be time-capped
• support movement of doctors into and out of training and between training programmes

Nineteen proposals to deliver the reform

• The 5 key principles should provide the basis for reform
• There should be sufficient opportunities for flexible (part-time) training
• There should be access to early and regular advice
• After graduating doctors enter a 2 year foundation programme of general training (the first year equating to the current PRHO, the second (post-reg) incorporating other generic training
• After the foundation programme, doctors enter a Basic Specialist Training Programme (for 4 years) providing a breadth of education and training within certain broad clinical disciplines (probably 8 or so programme options)
• Limited number of placements on individual training programmes (remedial, re-entry, career
  change etc)
• After completion of the basic specialist programme, those unable to progress to higher (or GP) should be allowed a period of grace before leaving training
• Progress through programmes should be determined by assessment
• In the longer-term assessment should move toward a competence-based system
• The purpose of Royal College examinations should be reviewed, and externally accredited
• Programmes should be managed by programme directors appointed by, and accountable to, postgraduate medical deans
• Trainers should be supported and trained
• Key information on programmes must be available to all trainees
• Appointments to programmes should be the responsibility of deans, meeting nationally agreed standards and practice
• The SHO element of general practice training should follow a similar model
• The needs of non-UK doctors in training should be properly and fairly taken into account
• Urgent work to explore a seamless training grade, with appropriate progress checks, for the future
• The arrangements for awarding a CCST should be changed. New and shorter higher programmes should lead to an earlier CCST for the ‘generalist’ elements of a speciality, at which point a doctor could apply for a consultant post in ‘general medicine’ or ‘general paediatrics’ for example (or the
  doctor could choose to proceed to a CCST in the ‘specialist’ elements of the speciality
• A review of the provision for non-consultant career grade doctors should begin soon

This article summarises the extensive consultation document which can be seen in full on the DoH website, www.doh.gov.uk/shoconsult

Dr Steve Allen
Chairman, BGS Training Committee

BGS Response to DoH proposals to reform SHO grade

There is broad support for the principles of improving the structure, content and delivery of postgraduate training for our senior house officers (SHOs) including the five underpinning key principles.

However, members of the Training Committee and other members of the Society have expressed a number of concerns.

1. The proposals contained no detailed analysis, or estimates, of the resources (financial, time and manpower) to execute these reforms properly. Various members suggest broad estimates of between 10 and 20% loss of service time for trainees and consultants to provide such structured training programmes.
2. The degrees of flexibility outlined in the document might not be sufficient to allow junior doctors to change their career path before or shortly after entering higher professional training.
Loss of the experiential or apprenticeship aspects of SHO training could be eroded to such an extent that “fitness for purpose” might be undermined rather than enhanced. It will be essential to get the balance right on that aspect of training.
3. The time capping of basic specialist training programmes might not take sufficient account of the fact that some trainees learn and mature more slowly than others, yet eventually reach an entirely satisfactory level of competence. The individual programmes and period of grace outlined in the document might not be sufficient to allow for this.
4. The BGS is very concerned about the concept of an earlier award of a general medical CCST with the option of early appointment to a general medical consultant post. This could lead to Acute Admissions Units being staffed by relatively inexperienced doctors without supervision from more senior or experienced colleagues. The BGS would be particularly concerned about acutely ill elderly people (in whom acute medical conditions are often very complex) possibly not receiving adequate acute care.
5. The BGS strongly recommends that experience in geriatric medicine should be included in the foundation programme for all medical graduates and in the basic specialist programme for trainee adult physicians, to take account of the fact that a very large proportion of inpatients across adult specialities are elderly. We are concerned about a lack of clarity of the status of consultants who might be appointed to general medical posts (holding only a general medical CCST). If they then choose, at a later stage, to proceed with higher specialist training, would they then be consultants or specialist registrars?

Dr Steve Allen
Chairman, BGS Training Committee