Maladministrating Medical Careers

Since Monday, when the Medical Training Application Service (MTAS) announced which doctors would be shortlisted for an interview in their new system, a tsunami of discontent has been rumbling on the horizon. It has taken until Friday for the full scale of the problem to reach the media: Under the guise of ‘modernisation’, the government has effectively culled 8,000 jobs at once. Predictably, this has inspired anger among doctors, especially since many of the applicants have found themselves off the shortlist for the post that they currently hold!
Many are considering leaving the country.
As one would expect, Dr Crippen has more information on how poorly the process has been managed. But a quote from a person named ‘fishgoth’, posting on the website, sums up the problem:

MMC is an ill thought-out wankfest, destined to destroy the careers of thousands of junior doctors. This shameful cuntathon of an online exercise in humiliation will leave large numbers of doctors, some with several years experience in a speciality, fighting over the crumbs of a few jobs that will ultimately produce ‘specialists’ with fuck-all experience

‘Fishgoth’ is a surgeon, writing late at night after an exhausting shift. In addition to the problems raised, it is clear that the Modernising Medical Careers process has actually served to raise the blood pressure of doctors who we hope remain calm during a crisis, our crisis. He (I suspect it is a ‘he) rages on:

My future, my earnings and my ability to pay off a mortgage have suddenly been channeled into a two week wank-fest of an online application which kept crashing

It may be that, despite the MMC policy being so flawed, the fact that it is a government policy means that there is very little redress for juniour doctors who complain, or protest about it. All policies, after all, have winners and losers. However, I think that the problems with the MTAS website may be an achillies heel.
When many doctors found that, for one reason or another, they could not submit their application properly, they naturally asked for assistance from the MTAS team. MTAS recommendations were embarrasingly amateur. They suggested that all doctors log-in using Internet Explorer, and try submitting their application in the early hours of the morning. This is totally unacceptable, akin to shutting a government agency when it is supposed to be open.
What is more, it looks very much to me like maladministration (i.e. when a government agency has not applied policy correctly). All government websites must comply with accessibility standards, allowing a fair measure of the population to access any particular site. The MTAS site would fail even the least demanding of these standards. It is therefore in breach of the governments own legislation in this regard. Disappointed doctors may find that the most effective means of redress may be via the Parliamentary and Heath Service Ombudsman.
In the coming days, I hope to compile a more detailed post here, on what is meant by ‘accessibility’ in the web design sense of the word, and how the online application forms employed by MTAS fail accessibility standards.

14 Replies to “Maladministrating Medical Careers”

  1. Rob, I know where you are coming from. I can’t quite believe that this has happened. I feel so frustrated that this MTAS wankfest has been allowed to happen. This unfortunately highlights the all too common place incompetence of government when it trys to deliver e-commerce solutions. If you get e-commerce wrong it can leave people feeling cut off and helpless to the system. It’s a sad situation as it’s effected the very people who are trying to keep the humanity and caring nature in our increasingly isolated and fractured society.

  2. I’ve got no sympathy. The NHS has been run for the benefit of doctors for far too long, they leach money out of the system and operate what in any other industry would be called Spanish practices. And with GPs now on 6 figure salaries for sitting behind a desk saying “there’s a lot of it about/take these twice a day and come back in three weeks” the whole profession only has itself to blame for a long overdue shakedown. Lawyers should be next.

  3. Well said Rob. This latest fiasco has served to make me, as one of those doctors for whom the NHS has been run according to Matt Munroe, feel even more helpless than I usually do. Every doctor who I have spoken to opposes modernising medical careers so why have we let it happen? The government has obviously got a few influential doctors in its pocket and damn the rest of us. They consult and take no notice of the result.
    I hope Matt Munroe is aware that in years to come if this government has its way we will have fewer doctors, with less training than current consultants, and most health care will be provided by non doctors. If I were 20 years younger I would be fearing for my health care in the future. We are sleep walking towards the dumming down and break up of the NHS. Yesterday was supposed to be a day of action to protest against all of this but have you seen anything on the news about this?
    Matt Munro, your breath taking generalisation about doctors raised my blood pressure and I wonder what your evidence is for this statement?

  4. Matt Munroe – you should be ashamed of yourself – I too would be grateful to know your sources – have you had to make life or death decisions?- have you had to get up at 2am to visit a sick child and agonise over your decision to admit or not to hospital – have you then gone back and spent hours with that child and then gone to work at 8 am. How dare you degrade doctors with such piffle and generalisation.
    Although I am very angry with you – I still have enough humanity to hope you never have to rely on the NHS to save your life.
    I have witnessed the effect of this ridiculous system and it is just a faceless way of making a cull. Rob is correct – they will all be forced to leave and then Matt Munroe can sit at his computer and see if a website will answer his health queries – that is before it crashes or will not download in the correct format.

  5. Well Grannie and Kathy – this discussion has come at a propinquitous moment for me -I tried to get an appointment this morning to see a doctor and guess what -it involved phoning continuously from 8:30 till 9 only to be told that all todays appointments had all gone, they only offer appointments on the day and I could “phone back after 10:30 to see if there are any cancellations” I have a fairly flexible employer and some degree of workplace autonomy (many don’t) but I cannot just drop everything and leave work should there be a cancellation so I will have to try again tomorrow. And what time do they close in the evening (after a 2 hour lunch break, natch) – 6:00 ! When most people are still at, or on their way home from work. My options are to visit the nighmarish, chav filled “walk in centre” on the nearest council estate, queuing up with the fighting drunks in casualty, or going through the whole charade again tomorrow – meanwhile the lump on my face continues to grow ! That is not an adequate let alone a professional service. And I won’t relate the conversation I had with my local GP surgery when trying to arrange a home visit for a 6 month old baby – it basically boiled down to if he’s breathing you can bring him in (by car, in the rain ! Try looking at the service you give from the perspective of your patients rather than yourselves for a change.

  6. The disaster that is MTAS continues. Round one of interviews in Birmingham was cancelled today after after about one hour of starting the interviews by the dean, who, incidentally, is a member of the modernising medical careers team. It now also tranpsires that many application forms have not been shortlisted due to lack of time, therefore, many doctors were not actually considered for shortlisting in the first round.
    In response to Matt, I am sorry that the lump on your face is bothering you so much. You have mentioned three different options available on the NHS to have this lump seen within the next few days. The walk in centres are staffed by fully competent, medically trained staff as is A&E. In any other country, you are lucky if you have one free option.
    Your GP was right to ask you to bring the 6 month old baby into the surgery. Either, the baby is so unwell that you are required to put out a 999 call, or, the baby can come to the surgery. House calls and paperwork is what keeps GP’s busy in the “2 hour lunch break” that you talk about. Patients can be better assessed in a surgery than at home and appropriate treatment and referral initiated. At least six patients can be seen in a surgery in the time that it takes to assess one at home. You are very lucky to live in a country where a lump on the face is seen within the week, no charge included. It is about time people started to appreciate the services available in this country, and rather than complaining all the time work together with the health services, understand their limitations and help them.

  7. Matt – You are testing my patience – I am very worried about your lump growing at a rate that you can see it visibly changing by the minute nay benefit of the doubt – hours – I cannot believe that if you gave a brief outline of your concerns you would see a doctor within a day or two – ringingat 8.30am for an appt that day is surely for people who have become ill overnight – some slots must be kept free and the others have been taken up by those booking a few days in advance.
    Also – I don’t have patients (of either variety (c) as you can probably guess) but doctors are patients too, so stop doing a them and us scenario.
    I also agree with Tyra re the 6 mth old baby problem.
    Our Doctors’ surgery does not close over lunchtime and one of the Doctors works ’till 8.30pm eack weekday eve for the 9-5 workforce.
    BTW the rain will not do the baby harm if he /she is wrapped up so “get over it” and I bet it wasn’t raining – you are just being emotive – are you sure it wasn’t rain AND snow!

  8. Matt, your lack of empathy continues to astound. Regarding your problems with the NHS, I do suggest you read more of Dr Crippen’s blog, linked above. He is often very lucid about the problems with the NHS, and gives civil servants pretty much the same benefit of the doubt that you give to doctors.

  9. Rob – Thanks for that bit of analysis, I am aware that empathy is not my strong point, sometimes that is a disadvantage, sometimes not. In terms of acessing medicine, where my health, and especially my sons is concerned I am really only intersted in having it resolved, if that ruffles someones feathers then sorry but I’m sure thats exactly what most peoples (including doctors) priorities would be.
    Kathy – I’m amazed at your disbelief. Ever since the government introduced a target that all patients should get an appointment within 48 hours, many GPS have managed to hit that target by the expedient of not giving anything other than same day appointments. If you can’t get an appointment you have to ring for another one the next day, hence the target will always be met. Even by new labour standards the alice in wonderland logic is staggering I’m sure you’ll agree. Thanks for your concern by the way, I went to a walk in centre in the end, only waited 10 minutes to be seen and it turned out to be only a boil, unsightly and irritating but not dangerous unless it persists, to reduce the proabability that it will, I spent a fun evening last night with some very hot water and a jar of Magnesium Sulphate.
    I also heard more (on Radio 4 I think) where the real issue with MTAS was presented not as IT (although that is always a problem with anything in the public sector) but that posts would be allocated not on the basis of anything as usefull as clinical experience but on touchy feely bollocks like “communication skills” and “teamwork”. As a long suffering victim of this type of public sector PC claptrap you all have my sympathy.

  10. Well, what a nice contrast between your first post on this subject Matt Munroe and your latest post. Lovely to see the development of sympathy, even perhaps empathy, when in possession of more information. Glad that the lump on your face wasn’t anything too serious although I am sure quite painful. Hope its now healing nicely. What about coming on the march for the junior doctors next Saturday?!!

  11. This is a copy of the latest email sent to all applicants acknowledging there have been problems and the outcome of the review into the first round so far.
    Dear Applicant
    The Department of Health has asked us to lead a review into the first round of
    the Modernising Medical Careers (MMC) recruitment and selection into specialist
    training made through the Medical Training and Application Service (MTAS). A key
    aim of the review is to ensure that this will result in the best candidates
    being appointed.
    The terms of reference are to:
    • Understand what has worked and not worked to date
    • Identify and promote good practice
    • Recommend action to remedy any weaknesses, taking account of legal and
    operational constraints
    • Identify specifically what further action or guidance is required:
    o Immediately (or before completion the first round)
    o Before commencement of the second round
    o Before any subsequent rounds
    • Develop improved arrangements for the support and care of applicants
    The review group has met twice. We have identified shortcomings in the process.
    We have decided that the first round should continue but we have recommended
    immediate steps to strengthen the interview process. These have been
    communicated to Deans and will be communicated to all applicants and selectors
    as soon as possible via the MTAS and MMC web-sites. An understanding of
    existing PMETB principles (para 5 (see below)) clarifies guidelines for
    interviews at ST2 and ST3. []
    The review has identified concerns that some excellent doctors may have been
    overlooked. The group has recommended all applicants who have not been invited
    to an interview should be given the opportunity to have their application form
    reviewed by a trained advisor. This may result in the offer of a first round
    Significant changes will be made to improve selection in the second round. This
    will include changes to the application form and the scoring system. The
    Department has accepted the need for change and the revised approach will now be
    • tested with junior doctors, selectors, deanery recruitment teams and
    employers, and
    • agreed with the Medical Royal Colleges, Deans, trainee and consultant
    representatives and employers before they are introduced.
    It is our intention that there is real opportunity for applicants going into the
    second round.
    The review group has also recommended that further advice and information should
    be made available as quickly as possible for applicants. The Department has
    accepted that this will include:
    1. information about competition ratios by specialty, entry level and geography
    2. the process and timetable for making applications in the second round plus
    generic guidance about what panels will be looking for
    3. generic feedback on how applicants can improve their applications for the
    second round
    4. information about sources of support for applicants
    5. enhanced Frequently Asked Questions on the MTAS website, building on feedback
    from the first round
    The necessary time to deliver this process is being assessed and tested and will
    be announced as soon as possible.
    The next stage of the review will be to consider what further arrangements might
    be needed for the support and care of applicants. The final report of the review
    will be available by the end of March.

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