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Doctors

Volume 467: debated on Tuesday 13 November 2007

1. What estimate he has made of the number of British-trained doctors looking for permanent placements; and if he will make a statement. (162930)

The estimated number of junior doctors who will complete their specialist training in England in 2007, and who are therefore likely to be looking for permanent posts, is 5,400. That number also includes those doctors who may choose to take a voluntary break before applying for posts.

The Department of Health made a complete hash of negotiating the GP contract, giving doctors a great deal of extra money for doing what they were in many cases doing already. Does the Secretary of State agree that the contract has now attracted a great many doctors from overseas with the result that home-trained doctors are now unemployed in their thousands? When is the Department going to acquire some commercial sense and look after taxpayers’ money properly and have better regard for doctors trained at taxpayers’ expense who now have no prospect of a permanent placement?

The right hon. Gentleman is confusing several different issues.

On the GP contract, I do not accept that it was a bad deal. The contract reversed the trend whereby we were losing GPs because, by and large, medical graduates did not want to be GPs. The latest statistics show that 100 per cent. of GP training posts have been filled. The contract also incentivised GPs to look at preventive health issues for the first time—taking patients’ blood pressure, for example—so prevention as well as cure is now their concern.

That contract has in no way led to the situation that I think that the right hon. Gentleman is getting it confused with. I accept that there is an issue about the fact that there are 10,000 international medical graduates trained as undergraduates abroad who are seeking positions in postgraduate training in this country, but we are seeking to resolve it.

We are in the position of having several thousand UK graduates who after seven years of training—and, in many cases, with substantial debts—are without work. They now face all the associated costs—both economic and human—that go with it. One of the worst indictments in the MTAS report related to the lack of centralised work force planning. Will the Secretary of State therefore reassure the House that he will ensure that such planning is introduced so that we never again face the scale of loss and injustice that we have seen in recent months?

Also apropos the previous question, no one will be unemployed when our employment guarantee ends on 31 December. The question from the right hon. Member for Wells (Mr. Heathcoat-Amory) was about British-trained doctors. There are 3,600 UK undergraduates who have not accepted a training post for 2007 and about 1,650 posts are still to be filled, though our undergraduates will be competing with international medical graduates. However, the sum total of all that is that, at most, we expect 100 people to be unemployed, because the vast majority of those applicants are already working in a job in the NHS. That is not to undermine the important points that my hon. Friend raised about MTAS and the distress caused to junior doctors this year.

The interim report on MTAS by Sir John Tooke—an excellent piece of work—set out a number of recommendations, which we are examining. They relate to the system in 2009 rather than in 2008, so we need to ensure that the lessons are learned for next year as well. It is a valuable piece of work and when we receive Sir John’s final report, I know that it will ensure that the problems that we faced this year are not repeated in future years.

There will be opportunities—perhaps for the Select Committee—to discover who was responsible for how the modernising medical careers initiative and the medical training application system developed. However, looking forward from now, will the Secretary of State make it plain who should be gathering evidence of where there are too few applicants in some specialties—as with applications for anaesthetics in London, for example?

Strategic health authorities should be doing that. The hon. Gentleman is absolutely right. In trauma and orthopaedics, there is only a 95 per cent. fill rate; in paediatrics, 95 per cent.; and in psychiatry, 94 per cent. Jobs are there if some trainees are prepared to pursue a career other than their originally intended one, but the information should be gathered by the SHA. As my hon. Friend the Member for North-West Leicestershire (David Taylor) said, we need to be much better at work force planning. If we follow Sir John Tooke’s advice, we will get to a satisfactory end. One final point to note is that John Tooke himself said:

“Modernising Medical Careers (MMC) was an honest attempt to accelerate training and assure the fundamental abilities of the next generation of doctors”.

It was not the concept of MMC that was at fault—we are now in a far better place than under the old opaque and unfair system—it is just that we need to ensure that the problems of this year are not repeated in the future.

Until the mess that Ministers made of modernising medical careers, junior doctors were rightly accommodated free of charge in hospitals. Now we discover, after Ministers slipped it through on the sly—unannounced to MPs or to the doctors themselves—that doctors in their first year, who do not have the option of renting privately as they are required to move every few months from hospital to hospital around the country, are to be forced to pay rent to each hospital. Is there no depth to which Ministers will not sink in hammering our junior doctors?

There are many depths to which we will not sink—[Interruption.] I guarantee that they are diminishing all the time. I was unaware of the particular issue that the hon. Gentleman raises, and I will look into it. Sir John Tooke points out that the profession was also in favour of the basic principle of modernising medical careers. There was a real consensus on the need to move to a much more open system. Before that system was introduced, we had no national data telling us about shortages in differential specialties. It is the right road to pursue, but I shall look into the question of doctors being charged rent.

I was shocked to hear that the Secretary of State did not think that the new doctors’ contract was a bad deal. We have now learned that salaries have increased by 25 per cent. and productivity has decreased by 15 per cent. If that is not a bad deal, could the Minister tell us what is? I cannot imagine a worse situation for my constituents in Northampton.

I think that the hon. Gentleman is talking about the GPs’ contract, not MMC. Before 2004, GPs were retiring and not being replaced; medical graduates did not, by and large, want to be GPs; GPs were not incentivised in any way to look after their patients’ well-being, and the profession was not paid decent money and deserved a new contract. I completely disagree with the hon. Gentleman and his Front-Bench colleagues who believe that we should return to a situation in which GPs are called out at 5 o’clock in the morning out of hours, and are then expected to treat people properly at 9 o’clock in the morning. I disagree that the GP contract was a mistake, and we intend to build on it to ensure that GPs are much better incentivised to increase access to health care, which is another public priority.