The facts

Emails marked 'Restricted' and with the subject line 'MMC and adapting the consultant contract', were circulated in Spring 2006 to the Chief Medical Officer, to Lord Warner and to other officials, many of whose identities have been redacted. The emails carried the ominous title ‘Working Differently” and represent a “quick and dirty (sic) stab at the issues”.

It was agreed that the majority of patient care should be delivered by trained doctors, but that these did not necessarily have to be consultants. Various options were then considered, including the development of a new grade. However the preferred option was to adapt existing arrangements, since “we need to keep the consultant title”, but to bring in a two-tier system. They argued it was ‘safer’ to bring in a promotion bar, and that a 'bar beyond which only some consultants would progress ... would be easier to defend and operate.” Junior consultants would have a different pattern of work, and some would have their access to Clinical Excellence Awards affected. There was also the “attraction of limiting competition for private work to those in senior roles.”

"The advantage of creating a new structure for doctors coming through the new training is that it avoids having to renegotiate the contract with existing consultants ... which would be bitterly resisted."

The ministerial advice outlines the options for managing this change, which they were worried would still require "careful handling with the BMA".

Referring to trainees emerging under the new MMC system, it states 'the service [ie NHS Trusts] are looking for this new breed ... asap, so should we be looking to bring current trainees on to the new arrangement when they receive their CCT [Certificate of Completion of Training]'.

About the documents

The DoH strongly resisted disclosing these documents on the grounds that it could:

“impinge on the morale of health professionals thus provoking unnecessary concern and discontent ... and inhibit discussions of future options as the submissions talk specifically about the affordability of the consultant workforce.”

The Information Commissioner rejected this view, stating "There is also a significant public interest in ensuring that the public are well informed about options being considered by the government so that they can fully understand the government’s reasoning behind the need to review the Consultant role. The withheld information would allow the public to engage in a constructive debate as to whether the reasons for the review as well as the options being considered have been properly weighed alongside the potential impact on health care services."

The documents are embarrassing for the government, which has repeatedly claimed that MMC would be 'good for doctors, patients and the NHS', and has consistently denied that MMC was linked to cost savings.

Lord Warner was responsible for parts of MMC and the £15b Connecting for Health initiative. At the end of 2006, just before MTAS went live, he resigned ‘to spend more time with his family’.

RemedyUK’s analysis

The signals were clear as long ago as December 2006: the only thing that appears to have changed is the wording. Talk is now of the ‘specialist’ rather than the (sub)consultant.

“The reform of specialist medical training is the next stage of the Modernising Medical Careers (MMC) initiative, designed to improve the quality and safety of patient care through better education and training for doctors and ensure fully trained specialist doctors deliver more NHS services.” DoH press release, 13/12/2006

When RemedyUK attempted to stop MTAS by judicial review we were opposed by many, who argued that although MTAS was bad MMC itself was basically quite good. It would now appear that MMC was little more than a dumbing-down device designed to create a new breed of unter-Consultants. And the horse has well and truly bolted.

We are now stuck. On reflection we feel that:-

• We as a profession have been hoodwinked;
• We cannot turn back the clock;
• Our patients would probably prefer to be treated by a consultant, rather than a sub-consultant, if they were permitted to know the difference, but money is king and the NHS, like the country, is broke, and;
• It will be argued by some that specialists are just as good as consultants for the majority of patients, and that it is logical to have a mix of specialists and consultants in a department.

So what now?

This, we believe, is the profession’s new reality. We have no choice but to move on from here. The question is, how? And in which direction?

We do not pretend to have the answers. What we can do is act as a co-ordinating point for your ideas and views and an ‘honest broker’ for positive efforts to reclaim our profession.

You can leave your comments and ideas, anonymously if you wish. Those who are content to talk to us person to person can email us. We will take it forward from there.