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Medical professionalism matters

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Does specialty training have a future in the NHS?

I am currently working as an ST5 psychiatry trainee in an NHS community drug and alcohol service.

Over the past 2-3 years the addictions services run by this trust have significantly reduced so that now only my service remains. There are no longer in patient detox beds and the services in other boroughs that the trust serves have been handed over to the third sector.

This has had a direct impact on my training. This year I have not had any experience of managing an inpatient detoxification, the addictions service is depleted in money and this has put my post under threat for the April rotation, this would mean no further addictions training being provided by this trust.

The post has been saved at the last hour, but only for one more year. There were conversations about creating a post in the third sector, but clinical supervision would be insufficient and quality of training therefore not guaranteed.

I am aware that this is happening nationwide; there were previously 56 addictions posts across the UK now there are just 18. I am sure addictions is not the only sub-specialty that this is happening in.

Across all medicine and surgery portions of services are being siphoned off to the third sector that wins tenders by cutting costs – they don’t want to pay for training. And that’s not just training of doctors, it’s nurses, occupational therapists, physiotherapists etc.

We can only imagine the crisis of patient care that we are storing up for the future. What happens in 10 or 20 years’ time when we have no clinicians with the knowledge and skills that we have now? Today’s illnesses are not going to magically disappear. In addictions the types and numbers of illicit substances are going up not down; we need more skill not less.

The short-term financial decisions being made by our trusts and Clinical Commissioning Groups are being made due to the nature of the system being converted to run like a business rather than a self-sustaining resource. Financial targets are killing the NHS. Whatever replaces it will have to provide training, but what will that look like?

I am beginning to realise how lucky I am to have the bulk of my training days behind me now and to have had the opportunity and experiences I had before services disappeared.

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Discussion

  1. Andy says:

    Agree on the shrinkage of services affecting the quality of training, though your example could possibly be sidestepped with a secondment or two: I detox’ed many as inpatients working in gastroenterology, as a necessary side-effect of having to admit for other reasons.

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