BMA response to consultation on Unfinished business
Proposals for reform of the Senior House Officer grade
November 2002
1. The BMA welcomes the publication of this report, which we hope will at last mark the beginning of serious action to improve the problems of the SHO grade that have been well documented over the years. There is much in this document that promises welcome changes to the structure and emphasis of SHO training in the UK. We are pleased to be able to support the majority of the proposals that the document makes.
2. We are particularly pleased about the promise to review funding of training posts. The BMA’s Junior Doctors Committee has long argued that trainees’ salaries should be funded to at least 100% of basic salary by the postgraduate deans so that the deans have greater flexibility to remove training approval where training is not up to standard. Deans would then find it easier to place trainees in trusts where training can be delivered well as the trust would not have to find 50% of salary costs before the post can go ahead.
3. We are also pleased to note plans to facilitate the movement of doctors from the non-training career grades back into training posts. Doctors in the Staff and Associate Specialist grades have long campaigned for improved access to training and career progression, so this initiative is well received. It is vital that the plans to facilitate doctors back into training posts go hand-in-hand with procedures for the assessment of experience gained in SAS grades so that this valuable experience can be taken into account and recognised towards training.
4. We are surprised, however, at the inclusion of discussion and recommendations on a number of important issues not directly associated with SHO grade, for example, proposals to reform higher specialist training and the non-consultant career grades. These issues were not originally included in the remit of the Chief Medical Officer’s working party, they were not discussed in full by members of that group, and have been incorporated over the course of the year since meetings ceased, thereby subjecting the publication of the report to long delay. The BMA wishes to see these issues debated and agreed upon in much wider fora and in specific consultation exercises; they should not have been presented in this report almost as a fait accompli. The BMA cannot support the conclusions made in the document in view of these additions which were outside its original remit.
5. A significant proportion of SHO service provision is undertaken by general practice trainees in the hospital sector. Any reform of the SHO grade will therefore have considerable implications for the future of training for general practice in the UK. We are therefore disappointed that there is very little reference to training for general practice throughout the report and note that no general practitioner trainee representative was a member of the working group.
6. More generally, there are many proposals which are not presented with enough detail for fully informed judgements to be made by the reader.
7. We are also concerned that the proposals emphasise ‘training’ rather than ‘education’ of doctors. Currently SHOs are unable to attend protected teaching time because of clinical commitments. If education is to be delivered SHOs will need protected study time.
8. Our comments on the individual proposals in the report follow.