Modernising Medical Careers

Modernising Medical Careers (MMC) is a new programme for postgraduate medical training being introduced in the UK from 2005 onwards. The programme will replace the traditional grades of medical career before the level of Consultant. The different stages of the programme will contribute towards a "Certificate of Completion of Training" (CCT).

=The new programme= A two-year Foundation Programme has now replaced the former one-year Pre-registration house officer term and the first year of the former Senior house officer term. The title "Pre-registration house officer" has been replaced by "Foundation House Officer 1", but they are still only provisionally registered with the General Medical Council (GMC) during that year. Full registration takes place at the end of the first year of the Foundation Programme similar to before. From 2007, this will change as the GMC will award full registration based on the achievement of the outcomes required in the foundation curriculum.

The Foundation Programme consists of two years training divided by rotations of four months in different specialties. The two year programme is marked by continuing assessments and intends to provide a more comprehensive exposure of different clinical/ academic fields in healthcare. The biggest difference in training is the introduction of a national curriculum and explicit assessment processes. In addition, every participant will need to maintain a national learning portfolio and will have formal access to careers advice and support.

On successful completion of the F1 year, doctors will move straight into the F2 year without having to compete again as they have been accepted on a two-year programme. Under the previous system, doctors applied for SHO jobs within six to eight months of beginning work as a PRHO.

Graduates from the Foundation Programme are eligible to apply for either specialist or general practice CCT training. This will be divided into Basic Specialist Training programmes and Higher Specialist Training programmes. These applications will be under the newly created Medical Training Application Service. On completion of these training positions, trainees will be awarded a CCT and will be entitled to enter the Specialist Register or the General Practitioner (GP) Register as appropriate.

Change in an organisation on the scale of the NHS is always difficult. Concerns have been expressed by the British Medical Association, among others, that the reforms have not been fully thought through, and may worsen the training situation for many junior doctors.

Criticisms
A number of criticisms have been made about the new MMC system. Many of these have centred on the transition to the new system and the Medical Training Application Service (MTAS). In order to implement MMC, all trainees not appointed to specialist registrar posts for 1 August 2007 have been required to apply for posts on the new MMC curriculum. This also means that all posts below specialist registrar level have to be converted to the new system. However, the application process has had technical problems, and there have also been criticisms over the weighting and marking of the applications. There have also been concerns expressed over the number of training posts available, cited by the Government as 23,000 posts for 32,000 applicants, and the subsequent risk of unemployment. A subsequent count of posts has been revised down to 18,500. On 17th March doctors marched in mass protest orchestrated by Remedy UK against the system in London and Glasgow.



The Department of Health launched a full review of the recruitment process for specialty training on 9 March 2007. On 22 March 2007 the Review Group issued a statement building on the recommendations they had made and guaranteeing interviews to all long-listable applicants. These recommendations were not found acceptable by the British Medical Association's junior doctors committee and they pulled out from the negotiations with the government on 23 March.

Professor Crockard's resignation
Professor Alan Crockard resigned as national director of Modernising Medical Careers on 30 March 2007. In his letter of resignation to Prof Sir Liam Donaldson the chief medical officer for England, Professor Crockard stated that he was increasingly aware that he had "responsibility, but less and less authority" and that "the overriding message coming back from the profession is that it has lost confidence in the current recruitment system". Professor Crockard asked that this be urgently addressed "in the interest of the most important people in the whole process, the junior doctors".

Alex Liakos resignation
On 31 March 2007, Alex Liakos, one of the student advisers to MMC, also resigned, citing widespread misgivings about MMC as a whole and "tokenistic" involvement of doctors in the process.

Ms Hewitt's apologies
On 3 April 2007, during an interview on BBC Radio 4's Today programme, the Health Secretary Patricia Hewitt apologised to junior doctors over the crisis, saying that the application scheme had caused "needless anxiety and distress". The BMA welcomed the government's acknowledgement of the problem but stated that "an apology isn't enough". Patricia Hewitt's apology was repeated to parliament on 16 April 2007, in which she stated that "the problems that have arisen relate in the main to the implementation process and not to the underlying principles of Modernising Medical Careers."

Later that month Shadow Health Secretary Andrew Lansley accused Ms Hewitt of failing to express genuine regret over the situation. .

Ms Hewitt made another apology on 1 May 2007 in the House of Commons after the suspension of the MTAS website due to security breaches that she described as "utterly deplorable". .

Professor Heard resignation
On 5th April 2007 Professor Shelley Heard resigned as MMC National Clinical Advisor, expressing her support for MMC in principle but citing the major problems with the recruitment process and concerns over the conclusions of the Department of Health's Review Group.

MTAS website taken offline
The MTAS website was suspended on April 26 2007 after a Channel 4 News report stated that applicants had been able to see each other's files by changing two digits in the personalised web address given to each individual. At that point the Department of Health announced that this was a temporary suspension.

On May 15 2007 MTAS was shelved by ministers due to security breaches. Patricia Hewitt said that after the first round of recruitment, the system would only fulfil a monitoring role this year.

Judicial review
A judicial review of MTAS was requested by pressure group Remedy UK, who demanded that the appointments process should be scrapped altogether. The case was heard in the High Court from May 16-17 2007. On Wednesday May 23 2007 Mr Justice Goldring ruled against Remedy UK, stating that "although far from ideal", the Review Group's decision on amending the appointments process after the first round of interviews was "within the range of reasonable responses", and that the Review Group was "entitled to reach the decision it did given the circumstances facing it at the time". Although he ruled against invalidating the interviews that had already taken place, Mr Justice Goldring added that this judgement did not imply that junior doctors were not entitled to feel aggrieved, as "the premature introduction of MTAS has had disastrous consequences". Remedy UK have said they will not appeal the verdict, in order to avoid further uncertainty for junior doctors.