Medical schools have called for the lifting of 60-year-old restrictions on the activities of newly qualified doctors, raising concerns of an impact on patient safety, HSJ has discovered.
The Medical Schools Council has suggested the 7,200 doctors who graduate from medical school each year should be given full registration with the General Medical Council straight away, rather than wait 12 months as they do at present.
The council believes this will tackle difficulties graduates experience gaining registration due to a shortage of places on the foundation programme that all pre-registration doctors are legally required to complete the first year of before gaining full GMC registration.
The programme sees new doctors placed at trusts with their work being supervised by education providers. Doctors are not allowed to write private prescriptions or to work locum shifts without prior permission during their first year on the programme.
Under the medical schools’ plans, graduates could avoid joining the programme, and be fully registered with the GMC to practise medicine, without being subject to such restrictions.
The number of applicants to the programme has exceeded the number of places for three successive years. Approximately 300 doctors missed out on a place this year.
The GMC has warned that scrapping pre-registration, which was first introduced in 1950, could pose patient safety risks from doctors who are potentially unfit to practise.
In its annual review document the MSC said there had been significant changes to medical education and supervision since the middle of the last century. It argued: “The value of provisional registration as originally conceived is therefore questionable in terms of protecting patients, and 60 years after its introduction MSC believes that the time has come to re-examine its purpose.”
It added: “There is no suggestion that fully registered doctors would receive less supervision than those who are provisionally registered. There is no reason to expect that they would view differently the limits of their competence. The reality is that medical education and training are now much better for being regarded as a continuum, and the graduation/registration divide is a necessary but ultimately minor point on a long journey.”
But in a letter to Health Education England, GMC chair Sir Peter Rubin argued patient safety and the quality of education must be the starting point for any discussion on removing pre-registration requirements.
The letter, seen by HSJ, said each year approximately 200 graduates got into “serious difficulties” in their foundation year.
“We would need to be clear about how the public will be assured how the risks they present would be managed in the absence of a system of provisional registration,” Sir Peter wrote.
“We could not accept a position in which large numbers of new graduates were potentially unfit to practise in circumstances where this fell to the GMC to prove.”
The letter also warned that the public needed assurance that doctors who were not selected to enter the training programme were appropriately monitored. Sir Peter wrote: “The public would not readily accept a position in which the weakest and most junior doctors had the least supervision and support.”
Under pre-registration the onus is on doctors in the first year of the programme to show they are fit to practise and to be fully registered.
A spokesman for the British Medical Association said: “‘Altering what is currently one of the most robust and respected medical education systems in the world could have a serious knock-on effect, including significant consequences for junior doctor recruitment, given that in the last few years there have been more students than there were placements available.
“Junior doctors will also face the loss of a provisional year which provides them with crucial training. This proposal must be thought through properly before it is implemented and discussed with the BMA and wider medical profession.”
In its mandate to Health Education England, released in May, the government made clear it wanted a “clear and sustainable path which enables all suitable graduates to secure full GMC registration”.
The Medical Schools Council executive committee is due to meet next week under new chair Iain Cameron and debate the policy further.