An august body of senior medics has issued an unprecedented warning that Scotland is in danger of producing a generation of inadequately trained doctors, potentially putting patients at risk.
The Royal College of Physicians of Edinburgh (RCPE) says that much of the progress made in Scotland’s health service could be undone if the incoming Scottish government does not take urgent action to tackle the issues.
In what is effectively a wish-list published ahead of the 5 May election, the RCPE also calls for action on public health, including increased access to weight-loss surgery and the promotion of smaller food package sizes. In addition, it calls for the newly elected Scottish parliament to revisit the vexed issue of minimum pricing per unit of alcohol.
In its hard-hitting document, the RCPE paints a picture of hospitals where there aren’t enough doctors to fill rotas, where consultants don’t have enough time in their working day to supervise the training of juniors and where trainees have to spend the day filling service gaps rather than learning how to do the job.
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It adds that the effects of the European Working Time Regulations (EWTR) – which enforce a maximum 48-hour working week – may not yet be realised, with repeated surveys highlighting a major disparity between the number of rotas deemed compliant with the regulations on paper, and those which are compliant in reality. Almost 80 per cent of trainees who responded to one survey have said that EWTR has had an adverse impact on their training, while there is anecdotal evidence that some trainees may feel compelled to falsify their rotas in order to make it look like they are not working over the prescribed hours, when in fact they are. The document is significant because it is highly unusual for the RCPE to go public with its concerns – some, but not all of which have already been outlined by the doctors’ trade union, the British Medical Association. That the college is publishing what amounts to a manifesto also shows the strength of feeling among the senior doctors, many of them respected academics, on these issues. Dr Neil Dewhurst, the president of the RCPE, warned that the data from several reports, inquiries and surveys “highlighted major problems” in relation to the training of doctors and their ability to provide high quality patient care. “We have now reached a tipping point," he said, "where this evidence can no longer be ignored or considered in isolation. Instead, it is imperative that policymakers look at the totality of this evidence and recognise the fundamental problems which exist. “It is essential that we safeguard the future ability of the NHS in Scotland to deliver safe, high-quality, patient care. To do this, we need to ensure an adequately planned, trained and resourced medical workforce. Failure to do so could lead to a generation of inadequately trained doctors and in turn, compromise patient safety.” Dr Dewhurst warned that increased pressure on the NHS threatened to reduce patient access to consultants, which would be bad for patients. “Whilst it is clear that the Scottish and UK governments may need to work together to achieve a relaxation of the EWTR this is, realistically, a longer-term objective and more urgent action is required from the Scottish government in the interim.” He said that expansion of the trainee and consultant workforce would have resource implications but would be worth it. “By protecting time for training, the NHS could actually save some resources, as this would better inform decisions made by inexperienced trainee doctors when determining what level of, sometimes expensive, investigations to undertake.” According to Dr Kerri Baker, who chairs the RCPE Trainees and Members’ Committee, trainees feel let down. “Many trainee doctors believe they are gaining insufficient training to enable them to function safely and efficiently as the consultants of the future and are also increasingly used only to plus gaps in hospital rotas, often being forced to sacrifice quality training for service provision where, in reality, a balance must be achieved if we are to protect future patient safety. "It is vital that they receive protected, quality training time which will enable them to become fully trained to provide the standard of specialist care rightly expected by patients once these doctors have completed their training and become consultants.” In its document, Health Priorities for Scotland, the RCPE makes a number of recommendations aimed at improving patient safety, quality of care and public health. They were chosen on the basis of a survey of RCPE members and include development of standardised clinical documentation throughout Scotland (to reduce prescribing and other errors), more consultants to manage seriously ill patients and more comprehensive access to diagnostic services out-of-hours and improving continuity of care by working towards a “modest relaxation” of the EWTR. The document also calls for action to combat obesity, including increased access to weight-loss surgery and promoting smaller food package sizes, and reducing alcohol consumption by reconsidering the introduction of minimum pricing.Donate to us: support independent, intelligent, in-depth Scottish journalism from just 3p a day
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