MTAS and protests

Following the MTAS Chaos this year, some Academics are trying to make the Review Group set up by the Department of Health see sense, but their latest email update indicates they are having problems.

Following our letter to the Times, 4th April, the deputy CMO in charge now of MMC/MTAS requested a meeting, brokered by the PRCP, which seven of us attended together with the Director of NHS Workforce. We reiterated our absolute opposition to the principle of appointments by one-strike-and-your-out interviews. We expressed amazement at the perpetuation of an appointments system after its short-listing stage had been accepted as flawed. We questioned the rigour of medical representation on the Review Body when two College presidents obtained separate arrangements for their UoAs or Specialties, and the other two declared themselves happy with the MTAS appointments within their specialty.

We were told that the apparent intransigence of the Review Body reflected both their desire not to waste interview time already conducted, and feedback from Focus Groups, Deans and SHA Chiefs that the widespread discontent with MTAS evident in the media, marches and polls was incorrect. Surprisingly, it was conceded that neither a staggering of the 1^st August start date, nor a selective return to Deanery-specific appointments in a first or second round had been absolutely excluded from consideration by the Review Body.

We explained to the deputy CMO our view that most grief from the one-strike proposal would be felt at ST3/4 level, because of the considerable investment to date in a branch of Medicine, and lack of realistic future in hospital practice if unsuccessful. Whereas a lottery in ST1/2 appointments might only be replacing the previous lottery of SHO appointments, this argument was untenable at ST3/4. The risk of failure is particularly severe in high-competition ratio specialties. We therefore proposed an immediate reversion to Deanery-specific appointment for ST3/4 appointments in those specialties not content with MTAS, with a proportion of posts held back for the top 20% or so already interviewed (to avoid unnecessary repeat interviewing). Subsequently, we have also requested that applicants to high-competition-ratio specialties in England are given partial equivalence to applicants in the devolved nations, being permitted a backup choice. Before and after our meeting at the RCP we have asked several bodies – Royal Colleges, their Academy, the Review Body – to ballot on this (or other) proposal. The responses, uniformly negative, have been that the questions are too complex to ballot, that the Review Body already has feedback, and that complainers on blogs and marches are unrepresentative.

A complete suspension of MTAS is no longer likely or feasible – not least because Deans report plenty of Consultants willing to continue as MTAS executioners in the one-strike process. Since our meeting at the RCP, we have allowed breathing space for the interest professed in our proposal to be taken further. So far, all that has been offered is of more FTSTAs at a second round. This is not acceptable. All the time, August 1^st approaches. It is still possible – some might think probable – that MTAS will implode, perhaps because PMETB discovers its responsibilities, or the meaning under English law of the balance of probabilities. Even if everything in the garden had been rosy so far, it is inconceivable that there will be a level playing field for applicants interviewed in rounds 1a vs. 1b.

I keep thinking of the experience of the European constitution as an example of a huge monolith devised by bureaucrats, promoted as unstoppable because of the amount of time spent erecting the monolith, but finally demolished by the late arousal of democratic opposition. Two years later even the bureaucrats can probably not remember why the constitution was so important. MMC seems the same. The new ballot provides the slumbering mass of doctors one last chance. Please visit http://www.cai.cam.ac.uk/people/mjb14/ to answer the yes/no questions regarding alternatives to the Review Body proposal, and register your approval score for the various bodies/persons involved with the MTAS fiasco. Please forward this message (minus the first paragraph) or website address to as many other doctors as possible, of all grades, in your region and specialty.

I have heard the marchers in March dismissed by an influential medic as unrepresentative complainers about anything and everything. This is preposterous. The ballot will irrefutably document views of MTAS and preferred alternatives according to doctors’ location, grade and specialty. In March a single letter to the BMJ led 2250 to our poll. A similar number this time may be enough to shame the Review Body. A poll of 10,000, with results published widely in the lay and medical press, would be impossible for our inglorious masters to ignore.

Morris Brown

Cambridge

The campaign group Remedy-UK, set up to fight MTAS, is also now appealing for donations to its' "War Chest" to fight the government in court. See here or donate here.