Fareha Lasker and Debora Miranda interviewed medical students to get their perspective
Medical students seem most worried about the logistics of their future career. They do not want to become “paperwork dogsbodies” but remain caregivers.
The proposed reforms mean a lot of GP time will be spent managing or budgeting – skills that are not taught formally during medical student training until they have already made the choice to specialise in General Practice.
Currently, students learn about the running of a practice informally through talking to GP’s. Third year placements do include ones where patient management in the community is maximised but little time is spent on ensuring students learn essential management skills.
The students feel a longer placement in general practice could help, but the most successful way would be through formal business management.
Harriet Dewhurst is an intercalating student, meaning she is taking a year out of the traditional medical training to learn about other related fields such as immunology and disaster medicine. She believes offering intercalating students the choice of business management as a module could make all the difference.
Adapting the teaching system to the proposed reforms may not have been a priority at the British Medical Association (BMA) meeting on 15 March although students were present. However, it is unclear whether this was in a listening capacity or the student voice was actually engaged in making the decision.
The BMA has actively invited and encouraged students to their meeting, reflecting the importance the reforms may have on their future. No messages are relayed to the students from the university regarding updates on the proposals, instead an informal system with doctors “higher up” answering any queries. Otherwise, students rely on the mass media, especially trusting the BBC, to keep them informed.
Essentially, the formation of GP consortia would lead to dismantling of the Primary Care Trusts (PCTs), an idea which “doesn’t make sense” to the students.
“Why fix something that isn’t broken?” asks third year student, Daniel Trotman. He thinks as PCT staff are better able to manage budgets, we may see them being re-hired by GPs who cannot or will not take the responsibility. This may render the dismantling an expensive and, in the long-term, pointless exercise.
Although it makes sense to give GPs money as they are better placed to know their patients, the students feel this is a step back by the Government from the responsibility of health care provision.
Harriet definitely wants to work for the NHS. But “if there was a chance of being a GP who has to be budgeting all the time, I wouldn’t. That is not what our five year course is training us for.”
Pictures courtesy of Roger Cornfoot and Wikicommons.
Video Transcript:
Fareha Lasker: We’re here at a London medical school to find out what the future generation of health professionals thinks of the proposed reforms. This school has been training medical students since 1733 and today teaches biomedical science, radiology and clinical practice amongst its other specialisms.
FL: With the BMA meeting that happened on the 15th of March, that actually made the decision regarding the proposed reforms, do you know if any medical students were engaged?
Daniel Trotman: I know there were students there. I don’t know how much involvement they actually had, whether they were just there to listen or whether they actually got to talk but essentially they are trying to get as many students involved in the reform just to understand what’s going on, because it is going to affect our future and how we will work within the NHS. So it is important for us to know as early as we can really.
FL: how have you kept up-to-date with the NHS reforms, has it been through the school, has it been off your own back?
Harriet Dewhurst: It’s been a bit of both, really. There’s always someone to talk to in our university if you need to find out what’s happening in the higher-up stages. But I think most of the time has been Internet and BBC news.
DT: Yes, it’s been a lot of media stuff. It’s been talked about a lot for quite a while, especially with the new Government and everything, so it’s a lot more media based. We don’t get any formal information from the Uni, but there are always staff members that you can talk to.
FL: A lot of your placements are hospital-based. Do you think maybe it would be an idea to get you guys involved in General Practice in placements even if you’re not thinking of the specialism earlier on as well, just to give you a better, broader overview of what’s going on?
DT: From our third year you do get a placement within GP, which has a lot more patient contact than the actual management side. But it does give you an idea of how a GP is run. It could be arguably with the new changes that it might be necessary to do a longer placement in GP or actually have formal teaching with the GP on those changes. That could be quite useful in the future.
FL: So what in general are your opinions of the proposed changes?
HD: As a medical student I’m a little bit worried because I understand that some of the GPs could say “OK, everyone who’s got a hip fracture that will all be done privately”, which means that as a medical student those are procedures we wouldn’t be able to see in our training. It’s also slightly worrying that if things do get more privatised through the reforms we won’t get as much funding for our training, so these are my worries about the reform. I don‘t really see the need for it. It might just be me being naive but at the moment I can’t understand why it’s happening.
DT: I think the other issue is that with the government giving all the money to the GPs they are essentially, to an extent, removing themselves from the responsibility of the health care. And it could mean, although we think that we are saving money and patients are getting better care, but if something were to go wrong in the GP consortia then there is no back up from the government to sort it out and therefore that whole area could then have problems with their healthcare further on. We could end up with certain areas in the country having great health care services with others not having a good system overall. So it could be damaging in the long term.
HD: I think it’s also important to think about the incorporation of the hospital doctors and public health professionals. That’s a really key element- It seems the power has been taken away from them. GPs do have a very vital role and they do need more power but if it’s exclusively to them, it’s a bit worrying.
FL: Obviously, this is the future of the NHS and the future of your career- does this affect your choice of specialism or maybe even the idea of working for the NHS in the future?
HD: I will definitely work for the NHS in the future- there is no question of that. But I want to be a doctor, I don’t want to be a manager. So if there was any chance of me going into being a GP and having to manage all the budget and everything the whole time, I wouldn’t do it because that’s not what our five year course is training us for.
DT: I totally agree with that. You do want to be an actual doctor, rather than a secretary or paperwork dogsbody. I guess it could affect where you decide to work in the future. Because with certain trusts there’ll be bigger areas- you may only get to do certain procedures in certain areas. You may decide I want to go live there just so I can do whatever speciality I want to do. It could mean that we’re not all in the right place, just where is right for the trust.
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