Prof. Terence Stephenson, Chair of the General Medical Council, reflects on his appearance last week at the House of Lords select committee to discuss the Long-Term Sustainability of the NHS.
I was recently invited to give evidence to the House of Lords committee looking at the sustainability of the NHS, where I was asked about the challenges for the NHS in 2030 and how we can prepare for them now.
It’s clear that an older population with more co-morbidities means we’ll need more generalists and more people in primary care. Already 90 per cent of people who attend an NHS appointment are seen by a GP. So I think it would be rash to train people today for a fixed role in 2030; we need to train doctors in a more flexible way, and for doctors to take a more flexible approach. The GMC is looking at that with our review of flexible training and our framework of generic professional capabilities which will launch next Spring. We also need the capacity to retrain those already working in the NHS, to enable them to adapt to the changing health landscape.
Our approach to training in the UK is not helped by the reliance of the NHS on trainee doctors
Our approach to training in the UK is not helped by the reliance of the NHS on trainee doctors. Over the last four or five years I have been to 23 different countries and seen how they train doctors. There is no country in the world that takes as long to train as us because there is no country in the world that is so dependent on its trainees for delivering the service. In most countries, training is much more formalised and structured. We have to recognise that we have 55,000 trainees out of a workforce of 150,000 and that, for much of their time, their training is long because they are not being formally trained, they are providing a service.
Do we have the capacity to change our approach to training? Yes, we will be working closely with the medical royal colleges to adapt their curricula for post-graduate training and with postgraduate deans to ensure there is flexibility in the journeys that doctors will take through training. We also need to free up time for trainee doctors, many of whom are spending a lot of time doing things that don’t require a medical degree. There needs to be a focused conversation about other entrants to the healthcare workforce who would allow us to free up doctors to do what we all want them to do – make diagnoses and get patients on the right treatment pathway.
The medical workforce isn’t the only body confined by rigid structures. The GMC’s legislation is the 1983 Medical Act, which is now over 30 years old. We would like new enabling legislation which allows us to reform our practices, protect the public, improve professional standards, change training and change the way that we deal with fitness to practise issues. We cannot change the current over-prescriptive processes we have without primary legislation.
That’s stopping us getting upstream to where problems originate. We get 10,000 complaints a year about doctors, of which about 7,000 we close very quickly. With the other 3,000, we put people through the mill and eventually 80 to 90 people are struck off. We are dealing with legislation that was not designed for 10,000 complaints a year. Many of those complaints could be dealt with locally and those doctors do not always need to be taken out of practice; it is a hammer to crack a nut.
Modern regulation should be targeted, proportionate, data-driven and intelligent. It should not be a blunderbuss. Whether it is the way we inspect medical schools or the way we deal with complaints, we should be focusing our attention on where we need to and not labouring under very old legislation where one amendment can take two years. We need Parliament to give us legislation fit for 2030, not fit for 1983.
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Tom Bandenburg, Project Manager of the National Training Survey, discusses why we survey doctors about training across the UK.