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The NHS' commitment to junior doctors must not go the way of the January gym membership

08 Jan 2016

Miss Clare Marx, President of the Royal College of Surgeons

The New Year cheer came to an abrupt halt on Monday as talks broke down and industrial action once again became a reality. All of the surgical colleges have been clear that the Government should not impose a new contract and negotiations must continue. Whatever the eventual outcome of this contractual dispute, our fundamental concerns will not be addressed in the negotiations – that is how do we truly value, nurture and support our workforce?

The New Year is an opportunity to set out resolutions for improvement and challenges the NHS, and indeed our College, to learn from the concerns expressed by junior doctors to better support the entire medical workforce. This approach must not fall the way of the clichéd gym membership: a commitment made in January, dropped by February.

The dispute has put workforce morale firmly under the spotlight, including the shape of medical careers and the future of the NHS. We recognise how vital trainees are to the NHS and that the College has sometimes been distant from surgeons in training and we have committed to do more to support and communicate better with trainees.

There are three particular areas on which the whole NHS need to focus. I also encourage you to leave your own ideas and thoughts in the comments section below.

1. Improve Training

While patient care must always come first, the College has long pressed for a better balance between service commitments and surgeons’ training needs. This has come through loud and clear as a major concern at our recent ‘trainee voice’ regional events, which we plan to continue into 2016.

In a previous blog from Ian Eardley (Vice President) and Karen Smith (Director, Professional and Clinical Standards), we set out our thinking on how training in surgery needs to change. We also remain concerned about the wide variation in mortality rates and standards across surgical departments for emergency patients across the UK. A particular focus therefore is how we train surgeons to undertake emergency general surgery and we are considering a potential pilot with Health Education England in the future. Changing curricula and the way we train always provokes passionate views and we want to continue to hear how you feel training can improve.

2. Make the most of junior doctors’ insights

Both Sir Robert Francis and NHS England medical director Professor Sir Bruce Keogh have warned that too many trainee doctors are not valued or listened to in their workplace. At Mid-Staffordshire hospital, Sir Robert reported that “the system for reporting… did not give sufficient weight to concerns raised by trainees”.1

Last year I chaired a roundtable event at the College to discuss this and what NHS organisations can do to listen, hear,  and involve junior doctors on quality improvement, education and training, and clinical research. Junior doctors (including the Association of Surgeons in Training) were present at the roundtable to put forward their views directly, as well as representatives from Health Education England, the CQC, medical schools and other royal colleges – all of whom agreed we can do so much more.

Today we are publishing a document which sets out some of the best practices in these areas and shares case studies which we strongly encourage employers and senior surgeons to learn from.  The Student Audit and Research in Surgery (STARSurg) network is one great example, and Ed Fitzgerald has previously blogged about this for us.

Short rotations and frantically busy hospitals mean it is all too easy for trainees to be inaudible in the noise of these institutions. They then feel it is not worth their while contributing their expertise to the general improvement of the health service. Our roundtable did not have all the answers, but we hope today’s document points towards some examples we can learn from, and to get the profession talking about how best to learn from trainee doctors.

3. Reconnect with employers and remember what’s great about medicine

We see how all too often young doctors feel disconnected from their employer as the culture in the NHS changes and there is less individual and corporate ownership of those passing though as trainees. Many comment they feel the apprenticeship model of training has been lost and with it some of the important mentoring functions of trainers.

Yes patients must come first and foremost in work and training structures. Yet it’s also clear that more needs to be done to help doctors in training reconnect with their seniors. Consultants and senior trainees must see the need to support and mentor their newer colleagues as a vital part of their professional duties. We see this happening in many good units across the country, but it is sadly not a consistent occurrence.

Celebrating what is so amazing, so rewarding, and so life-enhancing about working in medicine and surgery must take a higher priority. Being a doctor is tough, physically, intellectually and emotionally. Amid concerns about the sustainability of the NHS, endless new initiatives, and the increased scrutiny of doctors, it is easy for us to feel disempowered. The future, however, is ours. Being positive and yet realistic is with in all of our reach. Every week doctors around the country do fantastic things; go the extra mile, both at work and outside, like Dr Matt Smith who risked his life to come to the help of a victim of the recent Leytonstone stabbing. As doctors we have the ability and pleasure of doing great things for our patients.

Political arguments will push the NHS around and there will continue to be tough moments in our careers. We must not let these overshadow how amazing the institution of the NHS is and what a terrific career surgery and medicine offer.

As negotiators return to ACAS we do not know what will be the eventual outcome. Regardless, following the negotiations, the British Medical Association and NHS Employers must put aside their differences and set out a positive vision of valuing and nurturing the workforce, as contracts will not address many of our broader concerns with medical careers.

So let’s use 2016 to tackle these. Come what may, we, as a College, will be committed to improving training, fostering the growth of our doctors in their careers, and recognising their valuable insights into the future of the NHS.

1. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013 February 6. Available from:

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