RemedyUK was formed in November 2006. Its founders realised that rational concerns about implementation of the training reforms (MMC) were being ignored by those entrusted with implementing it.
Who we are
A movement of doctors which challenges implementation of training reform and in employment strategy in the NHS. We have reclaimed strength in voice and in action which has been lacking the profession in recent years.
MTAS and MMC
Remedy objected to many of the concepts underlying MMC, as well as to the inept disaster of MTAS (the 2007 Recruitment Process for junior doctors).
We organised the largest medical march of the century – 12,000 people marched through London and Glasgow to protest against both MTAS and MMC.
We were notified of details of the security breach in MTAS which gained significant publicity. Later we obtained full information via a Freedom of Information request, and we joined with Fidelio in their call for consultants to boycott this unfair system. We also attempted to stop MTAS through both political means and through the courts.
Intense lobbying of MPs culminated in a Mass Lobby at Westminster linked to an opposition debate in Parliament that was defeated by a government three-line whip. A second Mass Lobby was held later in the year.
A judicial review of MTAS was organised by Remedy, and we teamed up with Leigh Day Solicitors and Blackstones Barristers. We successfully arranged funding, permission and expedition, and our legal team collated a large number of witness statements from junior doctors and senior doctors, together with a statistical analysis of the process. The case was heard but was actively opposed by the BMA who put their own interests first. The case was lost on a point of law. Justice Goldring was highly critical of the unfairnesses of MTAS, but was won over by the legal arguments. His full judgement summarises the problem.
During the court case we uncovered fatal flaws in the matching algorithm of MTAS – this discovery led to the site being mothballed.
We have briefed MPs (including member of the Public Accounts Committee) on MTAS.
GMC Accountability for MTAS
Remedy believes that those responsible for the fiasco of MTAS should be accountable to the GMC in the same way as other doctors who underperform in the course of their professional duties. We first called for this in a letter to the Times on 1st August 2007.
A series of enquiries failed to establish accountability, and we renewed our call in a letter to the Lancet in June 2008.
We wrote to the GMC on behalf of over 1600 supporters asking them to hold a Fitness to Practice enquiry into the architects of MTAS, but despite the clear precedents and case law the GMC declined this invitation. We have challenged their decision in a judicial review, and we have obtained permission and funding for the case to proceed.
The MMC Enquiries
Remedy lobbied extensively for both the Tooke and MMC enquiries and we believe we were instrumental in getting them off the ground.
We gave written and verbal evidence to both of these. Our Written Evidence to the Health Select Committee was widely referenced in their Final Report
We held a mass vigil outside Parliament on the first meeting of the Health Select Committee hearing to raise awareness of the importance of the hearings.
We have called for a full implementation of Tooke, and were critical of the DH response which we felt was tardy and spiritless.
We made (uncredited) contributions which were incorporated into the Role of the Doctor consensus statement, and we have briefed a number of civil servants about the problems with RTT. Unfortunately many of them have moved on after a few months in post without effecting any real change.
Remedy have always been concerned that manpower planning has been poorly thought through. A Freedom of Information request revealed documents affirming that Modernising Medical Careers had been conceived by the Department of Health as a Trojan which would facilitate the development of the Subconsultant grade. They had successfully pulled the wool over the eyes of the Juniors committee of the BMA.
We do not relish the idea of a new subconsultant grade, but recognise that most doctors completing their CCT do not immediately become substantive consultants and that time spent in post-CCT pre-Consultant stage is becoming de rigueur. Outcome statistics from training programmes obtained from one Deanery have confirmed this. We believe that this needs to be formally recognised, and we have lobbied the BMA (our Trades Union) and other bodies for an open discussion around this.
We raised this initially as part of our evidence to the Health Select Committee, where it was met by incredulity. It was picked up by the press, including a headline in ‘The People’ reading What a doc up! EXCLUSIVE NHS chaos AGAIN’.
The mechanisms underlying gaps in hospitals were the combination of MMC’s ‘streamlining’ of training and the loss of the ‘Lost Tribe’ of free labour, coupled with the expulsion and alienation of international medical graduates.
Remedy has held a series of press campaigns to raise awareness, including a ‘Mind the Gaps’ campaign, a ‘Make Some Noise’ campaign and we obtained some leaked memos revealing the extent of the problem.
We sought and obtained GMC guidance for junior doctors caught between the Scylla and Charybdis of working non-EWTD-compliant hours whilst maintaining a service.
Working Time Directive
Remedy believes that the recent reduction in juniors hours down to 48 per week is bad for training and patient care. We have proposed a solution – the Barbados plan – which encourages doctors to take up the purely voluntary opt-out.
Our survey carried out in August 2009, the first month of the 48-hour regulations, showed that nearly half of hospital doctors� rotas failed to comply, often because rotas which met the target on paper failed to do so in practice.
We have lobbied extensively on this, holding briefing sessions with MPs of all parties, speaking to the press, television and elsewhere, and have attempted to change BMA Policy on this. We have enjoyed considerable support from some of the Royal Colleges who share our views. We have highlighted issues around doctors who deliberately under-report their hours – as highlighted by PMETB – and the double-whammy of doctor shortages with shorter hours.
We have supported IMGs who were unfairly (and illegally) dealt with by the MTAS system, and carried out a consultation amongst our members about this.
PMETB distanced themselves from involvement with MTAS when the it hit the fan. We were unhappy about this – in view of PMETB’s generic requirement that recruitment processes should be open fair and effective – but our attempts to mount a legal case on this were unsuccessful. We also found that the Department of Health were claiming MTAS was an examination (in order to circumvent FoI and we countered this by charging that PMETB’s Examinations committee should therefore have been required to approve it.
We have lobbied PMETB over no-fault ARCP failures, and we have supported the PMETB Trainees survey as a way of getting information about the standards of training across the country. We attended the PMETB National Stakeholders Conference
Remedy supports the idea of central preferencing as a way to avoid the unfairnesses of the once-a-year all-or-nothing recruitment process. We presented a paper on this to the DH and a number of Royal Colleges.
We took part in the consultation process for 2008 recruitment, and were panellists at the DH Stakeholder Events in London, Birmingham, Leeds and Bristol in Spring 2008.
Remedy has liaised with the Birmingham University team that is carrying out a national evaluation of specialty selection.
ARCPs with teeth
The unfairness of the 2007 and Runthrough guillotine has locked unsuccessful applicants out of training. Remedy has campaigned for ARCPs to be made more stringent, as a way of creating vacancies within runthrough programmes for those who only received FTSTAs. We have lobbied relevant stakeholders on this.
We have also called for a ‘no-fault failure’ ARCP outcome to cover the situation where doctors do not gain the relevant experiences through reasons beyond their control. We have had some support for this. However we have been told by a number of Deans that this outcome could not possibly arise because there are no jobs that do not provide the necessary clinical material.
Employment Agency Legislation
Remedy suspected that Deaneries should be subject to Employment Agency legislation, and have been lobbying for this to be enforced. We presented a briefing document on this to the government, which was widely distributed, and we have used this legislation as the basis for a number of successful appeals against some unfairnesses.
The government has responded through BERR by attempting to revise the legislation so as to specifically exclude Deaneries from these regulations. We have taken part in the consultation process.
We have also called for a series of changes to the new junior doctors contract, and have lobbied for fairer and more open criteria for approving interdeanery transfers.
Reclaiming our Profession
Remedy believes that doctors have become downtrodden and marginalised as a result of government micromanagement, the drop of status of doctors resulting from changes such as Hospital at Night, cynical workforce planning and a general lowering of professional standards. We have campaigned for the profession to reclaim is professionalism.
We carried out a survey in conjunction with 72dots to obtain a statistically representative survey of doctors’ values, beliefs and motivations. This has shown the psychological and ethical profile of doctors.
Consultation on the Darzi Reforms
We carried out a survey of views to the changes Lord Darzi proposed to medical education
We sent this to Lord Darzi himself – his PA thanked us for sending it to him – he did not have any comments on the report although he found it interesting.
We launched a magazine which carried reflective and in-depth articles on items concerning medical education and medicine. It was critically acclaimed but a financial disaster; the lack of advertising revenue has forced us to suspend it. Back issues can be seen online or on the ISSUU website.
Lobbying the BMA
We have held meetings with the BMA where we have sought to change their views. We have encouraged members of Remedy to attend BMA Divisional meetings in order to shape BMA policy.
The Costs of Training
We successfully lobbied the JRCPTB to review their fee structure, and have carried out a survey of the costs of training.
Lectures and Presentations
We have attended a number of public meetings including:-
BAPIO Doctors in Difficulties conference
Medical Success Exhibition
Wessex Anaesthetists in Training meeting
London Jewish Medical Society
Royal Society of Medicine ‘Living with MTAS’ conference
North Thames Anaesthetic Meeting
Fidelio Press Conference at Royal Institute, London
Association of Surgeons MMC Consensus meeting
Press and Television
We have made many contributions to mainstream radio, television, newspaper and other media, including Channel 4 News, BBC News and the mainstream press. Highlights have included a tete-a-tete with Jeremy Paxman on Newsnight and interviews on Radio 4 Where’s the Femur, Today, PM and The World Tonight.
We have also helped with contributions to diverse media including the Health Service Journal, DNUK Podcasts, Medical Educator, BMJ, British Journal of Hospital Medicine and Hospital Doctor (we contribute a blog to the online Hospital Doctor site) and to Parliamentary Monitor, Prospect Magazine and People Management.
We have a Facebook group and a Twitter feed.
We greeted Alan Johnston, on his first day as Health Minister, with a bouquet of flowers (one for every doctor that had been lost as a result of MTAS).
We launched the “Toad of the year contest” to find the contributor of a letter sent to the Douglas review which read:-
Hello there – just thought I’d mention that I was placed between Patricia Hewitt and Philip Hunt at a dinner last night and I gently told them how immensely important and forward looking MMC is and how crucial for patient safety. They agreed – but were a bit burned by a royal colleges meeting. …… Still, there’s no question but that they recognised the importance and great stride forward represented in MMC.
Early Day Motions
We have helped sponsor a series of Early Day Motions to Parliament.
That this House regrets the rushed introduction of Modernising Medical Careers (MMC) in 2007 without adequate piloting; is concerned at the events surrounding last year’s recruitment to medical training; urges the Government to recognise the pressing need for significant additional training opportunities for experienced junior doctors to ensure they are not artificially disbarred from career progression by the introduction of MMC and that patients can continue to benefit from a motivated medical workforce whose members have been treated fairly; notes that each junior doctor has cost the tax payer �250,000 to train; and commends the ongoing work of Remedy UK in providing a voice for the concerns and aspirations of grassroots doctors.
The Remedy Job Site
In 2008 we set up a central website which scanned the Deanery and other websites. The intention was to provide a single source of where training jobs were being recruited. The service ran for almost two years. Unfortunately financial pressures have made the site unsustainable.
Personal Help with cases
We regularly receive requests from individual doctors for help with their careers, their employment contracts and their rotas. We can sometimes offer direct guidance or support, and have established an informal network of legal assistance to back this up. We have helped individual cases including:-
Helping a doctor swap from one stem of ACCS to another
Facilitating swapping medical specialties
Lobbying for doctors who had been made offers which were subsequently withdrawn
Helped a surgeon move from the North of England to London after an administrative error had placed him (an MP was involved with this too.)
Helped with a number of cases of suspected bullying by seniors.
We held a successful Contract Clinic with the HCSA.
Remedy started life after a conversation between two junior doctors in a coffee room. We have now established a vibrant and dynamic organisation with all the necessary infrastructure, including an office in London, a mailing list for our newsletter, a constitution, a website and the supporting software. We have held a successful AGM that was addressed by Clive Peedell.
We have established Remedy Reps in many hospitals.
We obtained a one-off grant from the Rowntree Trust which enabled us to carry out some of this work. But the majority of our income comes from ordinary members who pay us to carry out lobbying and political work on their behalf.
If you do not currently contribute financially then please consider doing so.