[yeliab_cram]

Avid readers will probably notice i have ranted on the subject of MMC a number of times before. But now that the press has finally started to cotton on to the big ****ing balls up that is MMC and on the day that Took published his final recommendations, it feels time to see how things have progressed.

I have had the same debate on a number of boards on NMM recently about this topic. There seem to be some significant misunderstandings amongst the populus. Medical training has always been very very competetive. Always. It has always involved sacrafice and grind, and it is well known that not all will make it to their initially chosen destination. Notwithstanding that however, most will remain within the profession somewhere.

Last year saw the first realisation that MMC was a big ****-up. A knee jerk reaction to the introduction of the EWTD in Britain. Junior doctors had their hours cut from 100 per week to 56 and ultimately 48 per week. This meant that to safely staff the ward, roughly twice the number of house officers would be needed. This has been provided by the 56% increase in medical students over the last 6 years.

Thus the first disaster was avoided. But as with much of new labour, the unforseen consequences of short term solutions are going to be massive. Not only our the medical courses of the 21st century watered down, but the consultant firms are being withered away and the experience of doctors dramatically reduced.

To add insult to serious injury, it has now become apparent that whilst there is enough cash to pay for twice the number of house officers, there is not enough cash or rescources to fund specialist training posts for them all. And rather than get stuck as "lost" SHOs, they are going to be forced out of the profession - what with GP requiring its own ST programme and being highly competetive now, due to the massive wages and no on-call.

Last year roughly 10,000 doctors were set to be laid off. There was controversy amongst the medical profession, 40,000 docs took to the streets of london, everyone was angry, and the press largely ignored it. However, it never really came to pass. There was no mass lay off in august. Why.

The answer is simply (and typically new labour) a quick fix. FTSTA posts are one year appointments outside of the training scheme which essentially mop up those who dont get ST jobs. Problem is, they were only supposed to represent about 10% of the workforce. Instead some specialities report 60% of their doctors are on FTSTA contracts.

This year, this means that all those FTSTA doctors, plus the next round of applicants, who massively outnumber the jobs available are competing for the same jobs. If the figures for last year were bad, this year it beggers belief. Around 26,000 doctors applying for around 8,000 jobs.

FTSTA posts are not a solution, merely a stalling tactic.

The fundamental problem was the knee jerk reaction to the EWTD coupled with the introduction of specialist training. The worst part, is that there is no solution on the horizon. Even if the powers that be take the plunge and lay off 18,000 doctors to purge the excess and get things back onto an even keel, in two years it will happen again.

The only solution is to reduce medical school intake again, and find a way to allow house officers to work more than 48 hour weeks without being subjected to the horrific 150 hour weeks of the past. That is going to be far more cost-effective than spending £4.5 billion to train a small football stadium full of doctors you are simply going to lay off.

I am glad to see Tooke suggests the introduction of an NHS board of directors who would oversee NHS management and prevent the political ping pong match that results in only short term plans being made.

Right now we need one thing more than anything else - long term planning and with it, stability. Only then can we start to undo the massive damage that has been done.