Working Time Directive and Modernising Medical Careers

Working together to 2009 and beyond

Working Time Directive (WTD) 2009 and Modernising Medical Careers (MMC) are inextricably linked. The reorganisation of roles and programmes for doctors in training will be a key enabler to meeting Working Time Directive targets as we move towards 2009. The way that the transition will workbetween the old and new training programmes has now been announced.

It would be difficult to implement WTD 2009 without a reform of medical training. By addressing both these changes at the same time there is an opportunity to set out new ways of working that will besustainable for the longer term.

MMC aims to improve patient care by delivering a modernised and focused careerstructure for doctors through a major reform of postgraduate medical education. It aims to develop demonstrably competentdoctors who are skilled at communicating and working as effective members of a team. MMC will also bring about significant changes to career structures, providing qualified staff who are able to meet the changing needs of patients and the NHS.

To do this, MMC has created the two-year Foundation Programme that will, for thefirst time, require doctors to demonstrate their abilities and competence against set standards. There will be an opportunity to develop experience in a wider range of specialties thanks to the introduction ofnew four-month placements. This willoffer doctors the chance to think aboutpossible career options or to build a wider appreciation of different settings in which medicine is practiced before embarking onspecialist training.

The new training arrangements set outunder MMC are designed to lead to more relevant and focused training which canhelp ease the pressures on trainees' time. The new training programmes will focus on developing both a doctor’sprofessional and clinical skills to explicit standards set out in curricula written bythe Academy of Medical Royal Colleges.As now, doctors in the new trainingarrangements will be key providers of rotacover which should in turn be a benefit in developing WTD - compliant rotas.

Case study – MMC workingto support 2009 compliance

At the Homerton Hospital a workforcechange implementation group was established to involve and engage therelevant stakeholders. This includedthe chief executive, the clinical tutor, the Foundation Programme directorand directors of finance, HR andservice development. From January2006 the group started to meet on a monthly basis and since has grown to include all clinical directors, college tutors and interested consultants.The group has given specificconsideration to issues ranging from the effects on the service of MMC to the new WTD. As a result, managershave found the organisation canactually be fairly radical in howservice is delivered. For instance, the WTD 48 hour limit, which could have been an issue, became quickly taken for granted and is now implicit in allrota planning assumptions.

A key principle of the MMC reforms is that career progression should bebased on the acquisition of definedcompetences, rather than the length oftime spent in a grade. Maintenance of standards remains paramount - it is only by demonstrating competence that a doctor will be able to progress throughtraining and achieve the standardsrequired to obtain the Certificate of Completion of Training (CCT).

New arrangements for specialist and GP training

The new arrangements for specialist and GP training programmes have just been announced and are to be introduced in August 2007. These are the result of more than three years of discussion with numerous stakeholders including the medical royal colleges, the NHS and the British Medical Association. They form the second stage of the MMC initiative and will undoubtedly support trusts intheir planning work towards WTD 2009.

Starting early in 2007, doctors currently in foundation programmes, senior house officers and non-consultant career grade doctors will be able to compete for places in the new specialist and GP programmes which will replace the current training grades in August thatyear. The reconfiguration of the SHO posts will provide a vital opportunity to reconfigure the workforce, in anticipation of the reduced number of hours per doctor worked that result from WTD 2009 objectives.

During the first year of the transition to the new programmes, there will be several different entry levels in most specialties so that doctors will becompeting against those of broadly equivalent experience and training. The application process will be much improved and, in England, recruitmentwill be done via an electronic portal called the Medical Training Application Service (MTAS). This new process will enable a single application form to be submitted for several vacancies, rather than the present complex multi-application system.

Training that is based on service need. The end product of training inevitably must be shaped by service needs to provide a workforce of specialists and GPs that is required by patients and the NHS.A key part of this involves meeting WTD compliance over the next three years to improve the health and safety of staff. Another area the new training specifically addresses is the Hospital at Night programme. These teams work towards safer safe and effective clinical care at night and the operational framework forthe Foundation Programme notes that foundation trainees will be an importantcontribution to this. In all, the flexible workforce provided by Modernising Medical Careers will reflect changing demands and a changing NHS – particularly as the interface between primary, secondary and community careservices becomes far less distinct withmore activity taking place outside hospitals. In short, MMC is aboutdeveloping the doctors of the future that patients need, whilst offeringdoctors a clear career pathway andstructured training environment.

The aim is that tomorrow’s doctors will bea ble to progress more quickly and in a more structured way, reducing the time spent on unnecessary or inappropriate training. Flexibility through competency-based training will result in doctors better able to respond to changing patient needs within the NHS. Ultimately, the new postgraduate training structure will be a big step towards sustained health service compliance with the Working Time Directive for 2009 and beyond.

For further information on the latestModernising Medical Careers developments check www.mmc.nhs.uk