College warns of winter crisis impact on training

Dear Cabinet Secretary,

As we enter the winter period, our members are ready and prepared to play their part in ensuring that the NHS meets the annual challenges that this time of year brings.

We fully support all the efforts made by NHS Boards, hospitals and individual units to adapt their work accordingly in order to maintain quality and minimise the risks to patient safety at this time. That’s why we back the representations our colleagues in England have already made to ensure that consultants are fully engaged in developing local arrangements to manage winter pressures effectively and safely.

We remain concerned, however, that while understandably the primary focus for this work has been to address the short term issues of demand for NHS services, there are potential unintended consequences of such an approach, of which we should be cognisant.

Our College believes that plans to alleviate winter pressures should not be prioritised at the expense of the professional requirements of doctors in training. At this time of mounting workforce pressures, we are concerned that short-term decisions may have an adverse effect on training, and therefore on the long-term expansion of consultant numbers.

Our College is aware of situations where the training period for doctors in training, particularly in surgical specialties, has been unilaterally extended as a result of local winter planning arrangements. This is of particular concern, in that such action will have a tangible impact on future consultant numbers at a time when the health service is already facing consultant shortages in a number of specialties.

In response to this situation, the royal medical colleges are agreed on the following set of principles which should underpin the deployment of doctors in training in these circumstances:

a) Clinical supervision in the workplace must be clear and agreed to by all parties and must recognise the lower levels of experience and expertise that trainees may have if working outside their usual specialty.

b) Senior clinical management within the service provider (Medical Director, Clinical Director) must agree to the arrangements

c) Trainees participating in such arrangements must receive due recognition for their work in a form that can be included in their training portfolios

d) There is clear communication from senior hospital management to the trainee and consultants concerned.

e) Arrangements must be agreed with the Local Postgraduate Dean

I would be grateful, therefore, if you would consider using your authority to impress on Health Boards and other NHS services the need to ensure that their winter plans minimise any adverse impact on doctors in training. It is in all of our interests that we work together to address the long-term workforce challenges in the NHS, even in the face of increased short-term demand for its services.

Yours sincerely

Professor Jackie Taylor
President, Royal College of Physicians and Surgeons of Glasgow