Medical Educator authors marched in 2007 to support the rights of junior doctors and to protest about what became known as the MTAS fiasco. “A bungled reform a day keeps the Junior doctors away” was the verdict form the Telegraph newspaper. But what was behind the story of MMC (the Modernisation of Medical Careers), who were the individuals involved in supporting the rights of those doctors, and what is the state of play now, nearly 2 years on from doctors marching through the streets of London.
A representative of RemedyUK, the key organisation behind the junior doctor movement speaks to Medical Educator. Dr Marks is a Consultant Anaesthetist, former training programme director, and spokesperson fro Remedy UK. Here he speaks to James Bateman, from Medical Educator.
Thanks for speaking to us Richard. You got involved with RemedyUK after you were disappointed with how the Government had handled the MTAS situation?
Yes, RemedyUK started in November 2006 and I joined it in January 2007. Of the key 6 people who started it, I was the last one in…..
When I came in I had spent the whole of 2006 trying to get our local training rotations to work under MMC [modernising medical careers], but I simply couldn’t make it work. The recruitment system looked like it was just going to be a big mess. I was feeling despondent, but then I went to a meeting of RemedyUK. They were planning a protest march, and I thought, if anyone’s going to sort it, then these guys will.
I think the march had a very large impact on doctors at the time. The vast majority of junior doctors in the UK were either aware of the march in 2007 about MTAS (Medical Training Application Service), or on it. Do you think the campaign has reached medical students?
Not really. We have medical students in the hospital that I work at. I don’t think that most of them are aware of what the problems are.
We tended to agree from our own experiences of contacts with students. We then asked Dr Marks to tell us a little about the current legal campaign. He highlighted the background to the MTAS enquiry following the march in 2007. He went on to describe the potential problems with dealing with a regulatory body (the GMC) and the existing organisation the BMA (British Medical Association) who had been perceived by many junior doctors to be less vocal in the defence of its members. He went on to say:
MTAS was technically just a computer system but it was the whole application process around the recruitment which was the disaster. The BMA had called for it to be stopped, but didn’t really do much more than that.
There was then some legal proceedings between thee two organisations which we will not cover in any more detail here. Dr Marks also commented:
The bad thing was that for the first time run-through training was being offered, which meant that the stakes for getting or not getting a job were higher than ever before.
Dr Marks makes a point here that resonates with colleagues who are junior doctors: the failure to get onto a training programme was almost seen as a “one shot” approach: failure meant that you were then destined to pursue a different speciality.
The process by which you would get or not get a job seemed to be less fair, and there were a lot of issues around the recruitment process. We thought it should never have been allowed to happen.
This is echoed by the grass roots support of RemedyUK by junior doctors. Want to see for yourself? Ask a doctor that you work or train with! Dr Marks then highlighted a series of reviews that cast a damning verdict on the MTAS process. Read more about them here, or listen to the podcast. The summary of the verdicts was as follows…
All the independent reviews said in various ways that was a complete disaster.
The role of the regulatory body for doctors in the UK, the GMC, was then discussed.
What we (RemedyUK) then thought was, why hasn’t the GMC taken a view on this? On two grounds…
Dr Marks went on to explain the rather poorly-defined concepts of professional misconduct and deficient professional performance.
At the end of last year we wrote to the GMC to say we thought they should hold an enquiry into this. There were 1600 signatures to a letter; but the GMC wrote back and declined to hold an enquiry.
As a result of this, and following legal advice taken by Remedy, the issue of the GMC’s role in the regulation of the management issues and application process is going to be scrutinised. The process is complicated but summarised on the Remedy Website as the following:
The pain, insensitivity and incompetence that MTAS created has not gone away. Neither have the people responsible for it, who continue to cling to their positions of power and responsibility. Last year we wrote on behalf of 1600 signators to the Fitness to Practice Directorate of the GMC, calling for an enquiry into whether those responsible were guilty of misconduct and/or deficient professional performance. The GMC refused our request, since it was apparently the wrong kind of misconduct.
We intend to challenge this decision. We intend to take the GMC to court, and seek judicial review to determine whether or not they have acted unlawfully in making this decision. Our lawyers believe there is strong case law and precedent which supports our view; we have already issued a Letter Before Action and are awaiting a reply.
Good lawyers are not cheap, and we aim to raise £20,000 to cover our legal costs. We are hoping to raise this from ordinary doctors – not only those directly affected by MTAS but from others who were appalled at the level of managerial incompetence, the lack of accountability of those in ivory towers and the failure of the GMC to grasp this nettle and show leadership. Should those entrusted with the highest responsibilities in medicine be immune from charges of deficient professional performance? Or are they as accountable as the rest of us in our own individual fields of practice? Do the concepts of accountability and revalidation apply to some but not to others?
We have mobilised our legal team and our fund-raisers. Many of our regular supporters have already contributed to our fighting fund, for which we are immensely grateful. But we have not yet raised enough. We are asking for a one-off donation of between £10 and £50 by you to make this happen. We also need help in bringing this campaign to the attention of consultants, GPs, retired practitioners and others who are not yet aware of what we are doing and who would be interested in helping.
We have just a few weeks to raise the money – time is of the essence.
But what about the medical Students: we asked Dr Marks about his perspectives on how students can get involved. His answers were as follows: awareness of the current situation can only empower medical students applying for jobs in the current market. Perhaps more worryingly, junior doctors may not be willing to come forward for fear of damaging their own career prospects. Dr Marks commented
We even get fairly regular emails saying, dear Remedy, can you do something about me because this something has happened……then they write back and say, actually, don’t because I don’t want to get into trouble, and I don’t want to make things any worse for myself.
Overall there are grey clouds and blue skies over the application processes for jobs. Advice for students? Dr Marks had the following advice for the current crop of specialist trainees: his words may seem frank, but reflect reality.
I say to them all- in 5 years time you are going to be competing against each other for consultant jobs – make sure that you’re better than the next person… We are moving into a competitive market.
Overall Medical Educator supports the goals of RemedyUK and we encourage all our readers to become informed about the organisation from their website accessible here. You can also follow them on Facebook and Twitter. Donate to their legal challenge here.