On 1st March 2007, in a nondescript Birmingham committee room, a panel of consultant surgeons decided to break their employment contracts. In doing so, they guaranteed the front-page storm that government officials were hoping to avoid. Two weeks later, thousands of junior doctors noisily demonstrated in London demanding jobs and training. Patricia Hewitt, secretary of state for health, apologised to the doctors, was “supported” by her party—and then duly dumped that summer. So began one of the most profound and emblematic crises the NHS has suffered in its 60-year history.
What did the Birmingham surgeons do? They simply refused to continue interviewing applicants who had been shortlisted for junior doctor appointments in their area. The system for shortlisting and appointing was, in their view, fundamentally unfair. The winter of 2006-07 had seen the introduction of a new centralised, website-based approach to the appointment of junior doctors to posts and to their training. All over the country, there was growing panic and anger among doctors at the results—both the nature of the new system and the enormous gulf between the 32,000 doctors applying and the 15,000 or so training places available.
A year later, another round of appointments is in full swing, and all seems quiet. So was last year just another one-off Terminal 5-style fiasco, in which new systems crashed and inexperienced staff made mistakes before things settled down? Sadly not. What happened was the result of a gathering crisis in medical education, born of chaotic policies for recruitment and training and made worse by a naive faith in central planning and the vagaries of immigration policy. Put simply, far too many junior doctors—British and foreign—are entering the system for the training opportunities and senior jobs on offer, and this problem will remain with us for years to come.
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