The way I see it

New for 2012

Authors: Ben Molyneux 

Publication date:  07 十月 2011

Ben Molyneux talks you through changes to the application process for specialty training that mean that junior doctors no longer face the “stick or twist” dilemma

Specialty recruitment

Since last year several changes have been made to the way recruitment into specialty training is organised. The biggest of these is the creation of a single website that coordinates offers and rejections from every specialty. It allows trainees to hold an offer (a new feature introduced last year) and introduces a new system that allows applicants to “upgrade” their offer to a more preferred training post.

At the time of applying the trainee will be asked to rank the training programmes or posts in order of personal preference. When the recruitment process is complete, and applicants have negotiated any interviews and exams that may be required, they will be notified and offered a training post. If, for example, the training programme is only ninth choice on the applicant’s preference list, he or she may choose to opt in to the upgrading process. As other candidates who scored more highly choose to accept or reject their offers, applicants may be able to upgrade their offer to something higher on their preference list if a place becomes available. This new system will mean that even if you have accepted a job offer you will still be able to upgrade to your preferred job should it become available. Candidates will be able to opt out of this process at any time.

This is a positive step, as it means that more trainees will get the job they want, and there will be fewer problems for employers as fewer trainees reject a post at the last minute in search of a better offer.

These relatively modest changes come after a huge amount of work behind the scenes by the Department of Health, the deaneries, the BMA, and the medical royal colleges. The ultimate aim is to create a national recruitment office that will deal with all recruitment from the foundation programme, through core training, higher training, and up to completion of certificate of training (CCT) level.

Such a system is still some years off but has potential benefits for junior doctors and for workforce planners. A unified secure system that stores an applicant’s basic information will considerably reduce time spent filling in forms, particularly by people applying for several specialties. It will also help match training posts to trainees, will stop the NHS wasting money on multiple IT systems, and will help us to properly plan the medical workforce of the future for the first time ever.

Workforce planning

We currently have huge holes in our understanding of the medical workforce. We know that around a quarter of junior doctors don’t go from foundation year 2 straight into specialty training. But what we don’t know is where they go, if or when they come back, and the effect of this movement on the number of doctors we train in this country. We also know that a considerable number of trainees begin core training and then do not progress. Again, with a clever IT system we could get proper intelligence to monitor this.

The NHS has a terrible record for workforce planning. Over the years we have had huge peaks and troughs in the number of doctors we produce. In a time of economic belt tightening we need to ensure that we don’t saturate the market with doctors, leading to potential unemployment, or cause an undersupply that compromises the safety of patients.

Implications of Health and Social Care Bill

The small incremental changes to recruitment to specialty training have delivered steady improvements since the dark days of the medical training application service (MTAS). The huge structural changes in the Health and Social Care Bill, however, threaten to derail the process of specialty training and undo the improvements that have been made.

The reforms propose to create a new body, Health Education England, which will hold the NHS training budget of nearly £5bn. It will commission our education and training from new local education and training boards, which will in turn ask local hospitals and general practices to provide that education.

These new bodies will replace the current system of strategic health authorities and deaneries, which works very effectively. The concern is how the transition is handled, who handles the money at what stage, and where accountability lies. The details are yet to be worked through, but one of the most immediate concerns is recruitment.

If deaneries and strategic health authorities are unable to retain staff because of uncertainty about their future, there is a real risk that recruitment into specialty training could fail. Noting this concern, the Medical Programme Board has set up an assurance group to monitor this situation; and although things nationally remain on amber alert, a collapse of the system doesn’t seem to be imminent.

Although it would be easy to point out that without the reforms of medical education and training we could maintain a lot of the status quo and provide much needed stability to the recruitment system, we will have to work effectively to ensure that these reforms work well—for us as trainees, for employers, and ultimately and most importantly, for patients.

Ben Molyneux deputy chairman, BMA Junior Doctors Committee

Cite this as BMJ Careers ; doi: