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MMC

The Tooke Report

  • Conducted by Professor John Tooke, inaugural dean of the Peninsula college of medicine, honorary consultant physician, professor of vascular medicine

 

 

Report recommendations (issued January 2008)

  • Creation of NHS:MEE (NHS: Medical Education England) to govern postgraduate Medical Education and Training (PGMET)
  • Overseas students graduating in the UK should be eligible for PGMET as should refugee doctors with the right to remain in the UK
  • There should be a sufficient number of Core Training schemes to accommodate all doctors completing Foundation Training
  • The number of ST posts should be fine-tuned by the Royal Colleges, Deaners and employers to reflect technical advances - workforce planning
  • Better information should be given to applicants on competition ratios and likely employment prospects so they can make better choices for their future careers
  • There should be more interaction between managers and trainees (better representation on management committees) - this would encourage trainees to understand service pressures and priorities better and Trust Management would better appreciate the balance between trainees service roles and training needs
  • PMETB (Postgraduate Medical Education and Training Board - independent regulatory body responsible for postgraduate medical education and training) should be assimilated within the GMC.  The greater resources of the GMC would ensure that improvements that are needed in PMET will be achieved more quickly and efficiently.
  • Structure of postgraduate medical education and training should be split
    1. F1 & F2 should be split; universities have responsibility for F1
    2. F2 should be the first year of Core Training (making a total of 3 years of core training) with a small number of actual core training schemes: Medicine, Surgery, Acute Care Common Stem and Community.  Those who wish to change career path should be able to switch between Core Training schemes
    3. Once Core training is complete, doctors should enter specialist training (or staff grade posts)
    4. Selection into Higher Specialist Training should be informed by the Royal Colleges
    5. Candidates to Higher Specialist Training should apply through the Deaneries (not through a central system).  Applications should take place 3 times per year on agreed dates.  Recruitment should be based on standardised application forms and a CV: shortlisted candidates willbe invited for interview.  By spreading recruitment across the year, service provision would not be affected
    6. Staff grade careers should be de-stigmatised and doctors should be made aware of the advantages of such careers, such as more thorough experience if a specific area of clinical practice, together with a consistent team environment.  Staff grades should also be given a reasonable number of opportunities to enter Higher Specialist training and should retain the right to join the Register later on in life through article 14.
    7. Doctors should be allowed to interrupt their careers to gain additional experience, which may enrich their background and experience without fear of being excluded.  (One of the main criticisms of MMC was its lack of flexibility)
    8. GP Training should be extended to 5 years in line with other European countries (3 years core training, 2 years registrar)
  • Doctors should be given opportunities to train in management skills during the postgraduate training and the NHS Institute for Innovation and Improvement has drawn up a Medical Leadership Competency Framework in conjuction with the academy of Medical Royal Colleges.  It has 5 domains
    1. Self-management
    2. Working with others
    3. Managing the service
    4. Improving the service
    5. Setting the direction
 
 
Government response to Tooke report:
Agreed with many of the more general points made (more involvement and discussion)
 
It also agreed that:
  • PMETB should be assimilated within the GMC (due 2010)
  • Staff grade positions should be destigmatised
  • Doctors should be able to interrup their training to enhance their careers through alternative experiences
  • Selection into HST should be informed by the Royal Colleges
  • Doctors should have training in management during their postgraduate training
  • The body NHS: MEEE should be created
 
The government called for further consideration on some other key issues:
  • Unlinking of F1/F2 years and the integration of F2 into core training
  • The transfer between core training schems at the early stages for those who wished to change career path
  • The extension of GP training to 5years
 
 
Tooke's response to the Government response
  • Reinforced the need to deal with the structure of early years of training
  • There are times when decisions need to be taken in the interest of high-quality outcome even if optimal evidence is not available 
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