The outgoing deputy chief medical officer has called on ministers to make a quick decision on what to do about overseas doctors applying for training posts in 2008.
In an exclusive interview with HSJ, in which he announced his resignation, Professor Martin Marshall warned numbers of overseas applications was the biggest problem facing the NHS.
It comes as preparations get under way for appointing thousands of junior doctors to new training posts next summer.
He said: ‘The biggest problem will be numbers. It is a complex area where we need to make a decision.’
The government must either restrict applications to UK-trained doctors and face allegations of unfairness or face another year with too many doctors applying for too few posts.
Professor Marshall said: ‘This is a cross-government issue for the Home Office, Foreign Office, Treasury, Department of Work and Pensions as well as the Department of Health. It is being talked about at a senior level on a daily basis and recognised to be the most challenging issue for 2008 and indeed the future.’
Asked if that decision was needed quickly, he said: ‘Yes.’
He declined to offer a personal perspective, saying: ‘I think it is a tough decision. There are moral, financial and ethical issues. It is a ministerial decision and not helpful for me to say where I sit on it.’
In 2007 half the 32,500 doctors applying for 22,000 training posts were not trained in the UK, even though most of them were already working in the NHS.
The Modernising Medical Careers programme board for England has warned that even larger numbers will apply for fewer posts in 2008.
Professor Marshall was the professional lead for the DoH on MMC and has been in charge of getting its work back on course for 2008.
He said he was confident about new processes that are currently being finalised by the MMC board for England.
‘The understanding and attention that this process has been given by trusts, deaneries and strategic health authorities is so much greater than it was for 2007.
‘I am confident there will not be an organisational problem,’ he said.
The overseas doctors issue was one of the areas of disagreement among the new 18-member board which was set up by Professor Marshall this summer and which is due to put its recommendations for the 2008 applications in front of ministers on 1 October.
The other major outstanding issue is whether to use the discredited Medical Training Application Service in 2008.
Professor Marshall said: ‘The appetite for rejuvenating MTAS is zero but there is recognition that having an electronic portal to support the application process is a good thing.’
The MMC board has agreed on a locally based process using national criteria and a national timescale (for more background, click here).
Professor Marshall said he had been anxious to make sure that anything recommended for 2008 would not run counter to longer-term recommendations due to be made by the Tooke inquiry into MMC and the MTAS debacle.
‘We have sent [Professor John Tooke] our consultation document and asked: whatever the outcome of this, could you live with it? He said yes.’
The DoH confirmed that Professor Marshall will be replaced.
‘We will appoint a senior medical person to take over as senior officer for MMC,’ a spokesperson said.
Chaos countered - but another scalp claimed?
Professor Martin Marshall is leaving the Department of Health to become clinical director of the Health Foundation, a charitable trust.
He joined the DoH in May 2006 to lead the healthcare quality directorate but was very quickly sucked into the chaos surrounding Modernising Medical Careers and the Medical Training Application Service.
He stressed that his decision to leave marks a return to his real interest in quality and patient safety. He will start at the Health Foundation immediately on leaving the DoH.
However, his departure is likely to prompt speculation that MMC has claimed another scalp.
British Medical Association chairman James Johnson resigned in May 2007 over his defence of chief medical officer Sir Liam Donaldson. Some argue that the fiasco was another nail in former health secretary Patricia Hewitt’s coffin.
The case against this is the outbreak of agreement for 2008.
Following the acrimonious breakdown of trust over MMC and MTAS in the first half of the year, Professor Marshall brought together a new 18-member steering group which includes the BMA, NHS Employers, the royal colleges, a strategic health authority chief executive, dean, workforce development director and HR director.
It is jointly chaired by Professor Marshall and Professor David Haslam, a member of the Academy of Medical Royal Colleges.
It first met in July and by September had made enough agreement to unanimously back MMC’s principles and suggest how the application process might go forward in 2008.
Professor Marshall said the discussion and interaction was ‘much better and more productive’ now. This had been achieved through ‘personal relationships’.
MMC: the timetable
July 2007: First meeting of new Modernising Medical Careers board for England.
12 September: Consultation on the way forward for 2008 launched.
15 September: Consultation closes.
1 October: MMC Board must complete decisions and put recommendations to ministers.
8 October: Tooke inquiry into MMC due to publish draft report.
16 October: Health select committee stops taking written evidence for its MMC inquiry.
November: DoH due to issue guidance to trusts and deaneries for 2008.
January 2008: Applications open to junior doctors.