Loss of control of professional standards has been a significant factor in the declining morale of doctors, according to an Online/Comment from Professor Ian Gilmore, the President of the Royal College of Physicians, published today.
"Doctors are feeling under siege in a rapidly evolving National Health Service (NHS), and it is commonplace to debate the whys and wherefores of rock-bottom morale. A common thread is a real or perceived loss of control by doctors….At national level, the profession has lost control of the training of doctors, watching almost powerlessly as the government initiated Postgraduate Medical Education and Training Board (PMETB) and Modernising Medical Careers run their courses," states Professor Gilmore.
In September 2005, the PMETB took over the responsibility for postgraduate training from the Medical Royal Colleges.
The RCP welcomes Sir Liam Donaldson's suggestion that the Colleges now take on responsibility for recertification of specialists. However, Professor Gilmore believes the recommendation that undergraduate training should then be removed from the General Medical Council and transferred to PMETB fails to address fragmented responsibility between undergraduate training, postgraduate training, continuing professional development and recertification.
The PMETB and College responsibilities for postgraduate and specialist training would be better served by sitting alongside undergraduate training, under an overarching GMC, according to Professor Gilmore. Both bodies could function with considerable independence under the overall direction of the GMC. However, he adds that the GMC needs to accelerate its modernisation process for this model to be tenable.
Professor Gilmore says the Medical Royal Colleges, which have made huge progress over the last decade in curriculum development, standard setting and new methods of assessment, have been hit hard by the loss of responsibility for training doctors. While he welcomes the government's moves to improve doctors' performance, he believes strengthening professionally-led regulation is the way forward. If doctors' organisations have control over training, morale will improve and assessment methods that are relevant to the profession will be developed. Quality of care and public trust would also improve, according to Professor Gilmore.
Also published today is an accompanying Online/Comment on a collaboration between physicians' organisations in the UK and USA, which aims to strengthen the professions processes for measuring the performance and competence.
Dr Richard Horton, Editor of The Lancet, comments: "The Royal College of Physicians is an under-recognised resource for both improving patient care and strengthening government health policy. One of the key reasons why medical morale has fallen so dangerously low in recent years is that government has systematically excluded the health professions in designing and evaluating their reforms. Doctors are, first and foremost, advocates for patients. As the NHS fragments still further, the Royal College of Physicians now has a renewed and vital purpose in setting, maintaining, and improving standards of patient care, its historic mission. The government should not only more publicly recognise the leadership role and successes of the profession in improving patient care, but also do more to involve a willing health workforce in planning and monitoring their ongoing efforts to reorganise the NHS."
Contact: Professor Gilmore via Linda Cuthbertson T) 0207 935 1174 extn 254
The Lancet press office T) +44 (0) 207 424 4949/4249 pressoffice@lancet.com
Journal
The Lancet