CCT in the cross hairs
Posted on 21 February 2013 by Tim Yates
Is there a more flexible group of staff in the NHS than junior doctors? They already work 24-7 and deploy with little notice anywhere in hospitals to provide effective cover.
Most trainees also make a substantial contribution to acute medical and surgical work. What’s more, the Doctors and Dentists Review Body agrees we’re inexpensive in comparison to other professions.
Junior doctors get themselves trained despite service-focused posts, advancing their knowledge and skills in their own time and out of their own pockets. They accept these compromises because they aspire to excellence — both in personal standards and for patients.
The Certificate of Completion of Training (CCT) embodies these standards and is internationally respected. Earned at the end of a lengthy, quality assured programme, holders demonstrate the high standards required to work independently as a consultant or GP. These fully trained doctors deliver better care and outcomes for patients, make the delivery of the care more efficient, and are the best people to train the next generation of doctors.
Despite this, the CCT is in the cross hairs of a new review of postgraduate medical training, known as the Shape of Training. This ‘once in a generation’ piece of work has solicited contributions from all major stakeholders in UK medicine, including the BMA, and its report will deal with criticisms of our current training system. Some criticisms were raised in the Tooke Report after the introduction of Modernising Medical Careers (MMC) — another recent generational change. Others include the effects of working time regulations and the service commitment on training.
One issue being examined closely in the review is whether the needs of patients are best met by training all doctors to CCT-level. This is a debate polarised by the current crisis in acute and emergency medicine and, to a lesser extent, in surgery. It centres on whether patients would be better served by the ‘specialists’ we currently train or by ‘generalists’ –— a new group to be deployed flexibly and cheaply to deal with staffing problems in acute care.
One suggestion is that we create these ‘generalists’ by replacing the CCT with something like a Certificate of General Training. This would be awarded much earlier, probably after core or very early higher training. Holders would then be ‘trained generalists’ who are ready to provide the service and forget about training. Only a few of these generalists might then return to specialty training.
This would be a retrograde step; it would waste the talents of a tribe of doctors who would not progress, which was something MMC sought to solve, and it would break the system of run-through training needed to maintain recruitment into some specialties.
To make the most of our junior doctors, who are already flexible, good value and hard-working, we need to defend the CCT. Junior doctors must be able to continue to aspire to excellence and to reaching their potential? Isn’t that the point of training, in whatever shape it comes?
Tim Yates is deputy chair of the BMA junior doctors committee
medical education and training
certificate of completion of training
modernising medical careers