College News - February 2013

13 February 2013

Appointment of the Chair of the MRCP(UK) Part 2 Clinical Examining Board (PACES)

The Federation of Royal Colleges of Physicians of the UK is seeking to appoint a Chair of the MRCP(UK) Part 2 Clinical Examining Board.

The successful applicant will have overall responsibility for the clinical and academic leadership of the Clinical Examining Board and for the on-going development worldwide of the MRCP(UK) Part 2 Clinical Examination in the context of the overall development of the MRCP(UK).

12 February 2013

RCPE Response to Shape of Training Review

The Shape of Training review is expected to fundamentally change the structure of medical training in the UK. Our response to this consultation highlights our belief that –

there is a rising need for all-age generalist expertise in hospital medicine to ensure patients have equitable access to services that are delivered efficiently and effectively in hospitals.

the status and working patterns for general physicians and their trainees must be addressed urgently to combat an imminent crisis in the staffing of acute medical rotas.
patients welcome continuity of care and this could be delivered in some hospitals by the development of a cadre of consultant general physicians carrying lead responsibility for patients throughout their hospital stay and accessing other specialist input as required.
the political imperative to treat patients close to home whenever possible is laudable providing there is investment to train doctors in primary care accordingly and ensure they have access to the necessary equipment and support to prevent hospital admission. Further research is needed to demonstrate that community-based care for much of the current acute medical workload is both safe for patients and cost effective.
much is made of older patients causing the pressure of inappropriate medical admissions and that a change to community delivered services will resolve the issue. The College believes this is something of “myth and legend” and calls for more research and pilot projects to assess the safety and financial implications of transferring care. As the population ages but patient expectations are sustained, the demand for secondary care diagnosis and intervention will increase and patients will be admitted more frequently unless the shape of primary care is radically changed.
General Medicine and Geriatric Medicine are specialties requiring the same if not longer training than single organ specialties; fast tracking general medicine training will not deliver doctors capable of independent practice (CCT level), will be a highly unpopular option with trainees and will not address patient expectations for consultant delivered care.
the NHS requires fully trained clinical practitioners in general medicine to expand the availability of consultants 7 days a week and for an extended working day (patient safety and effective and efficient working).
Acute medical specialties should require the great majority of trainees to dual accredit in general medicine, reflecting the continuing need for doctors in other medical specialties to contribute to acute unselected medical receiving. Their level of contribution to general medicine may change over individual careers with perhaps a greater emphasis early after CCT and decreasing as specialty sessions increase. To ensure this remains an attractive training option and to secure a steady flow of fully trained consultants, general and specialty training must occur simultaneously although the balance of general and single organ specialty may vary over the course of training.
it must be remembered that, given their current level of contribution to acute unselected medical receiving consultants in other medical specialties are also under great pressure and have no capacity to increase their general medical work. Recent RCPE surveys indicate that nearly half of consultant physicians in the acute medical specialties in Scotland spend at least 30% of their time contributing to acute and general medicine.
in promoting generalism, it is vital that the specialty of Acute Internal Medicine continues to develop to provide leadership within acute medical units.
early broad-based training programmes (that include general practice) are recommended to re-introduce some lost flexibility into the career pathways, reduce wastage when trainees change direction and foster greater cooperation between primary and secondary care.
trainees and trainers must have adequate time for training to deliver GMC standards. This is currently under severe pressure through gaps in rotas and limited SPA time, particularly for newly appointed consultants.

Read the full RCPE response

Our Trainees & Members’ Committee has also submitted a response to the review in which they highlight –

the Review presents a significant opportunity to start to address some of the inter-related problems which exist in medicine in the UK and which previous, narrower, Inquiry Reports have unfortunately failed to resolve. In earlier recognition of these issues the RCPE T&MC published the Charter for Medical Training in 2011 which provides a practical foundation for ensuring that both doctors' training and patient safety can be improved. We believe the Charter for Medical Training provides a firm and ready-made basis for cross-specialty adoption and its key recommendations should be integrated within the output of the Review.
patient safety and the continued provision of high quality care must be central to the review; continuity of patient care and of training are of paramount importance;
CCT/CESR is fit for purpose and is an international benchmark of competence and ability for independent practice as a consultant; postgraduate training however is life-long;
the introduction of a sub-consultant grade would be detrimental and is opposed; the consultant model ensures the highest standards of safe and effective patient care, is what patients choose and ensures that medicine remains an attractive career; similarly the terms “trained doctor” and “stand-alone practitioner” cannot be supported;
flexibility in training encompassing LTFT training and movement between specialties with recognition of previous experience is crucial;
the aging population and increasing co-morbidity require an expansion in the number of generalists; it does not follow that the number of specialists should be reduced as most specialties already operate beyond capacity; robust data must remain central to workforce planning;
generalism must not be seen as a "stepping off" point in medical training and cannot be completed in a shorter time frame than already exists in postgraduate medical training;
consideration should be given to training for all doctors in medicine for the elderly and general practice within their early postgraduate careers; and
consideration should also be given to the extension of Core training with further consideration of a return to six-month core general medical and surgical placements in F1;
it is difficult to separate training from the medical workforce as a whole; in particular senior doctors must be able to lead on training and service organisation requiring sufficient time and resource within job plans; and
any changes to the current system of medical training must be phased to avoid destabilisation of the medical workforce and compromise of patient care

Read the full RCPE Trainees & Members’ Committee response

06 February 2013

Statement on Francis Inquiry

The RCPE is a co-signatory to the Academy of Medical Royal Colleges and Faculties' (AoMRC) statement on the Francis Inquiry into the failings at Mid Staffordshire NHS Foundation Trust.

Access AoMRC statement on Francis Inquiry