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Written 'Suggestions' from CMF to the MMC Inquiry Team's e-consultation on Modernising Medical Careers

Published: 26th July 2007

1. Christian Medical Fellowship's status

The Christian Medical Fellowship (CMF) is an interdenominational organisation, founded in 1949, with more than 4,500 British doctors and more than 1,000 UK medical students as members. All are Christians who desire their professional and personal lives to be governed by the Christian faith as revealed in the Bible. Qualified members practise in all branches of the profession, and through the International Christian Medical and Dental Association are linked with like-minded colleagues in over 100 other countries.

2. These 'suggestions'

We regularly make submissions to governmental and other bodies, usually on matters of medical ethics. Here, CMF feels corporately that the important principles for future medical training being considered will have a profound effect on the culture and nature of health care in the UK, and a massive impact on care in the developing world, and therefore wish to make brief comment corporately.

We had originally intended to do this via the e-consultation process (and an individual had registered as responding on behalf of our organisation) but we realised that pathway was logistically inappropriate in that we could not meaningfully represent the many different perspectives of our individual members. We have already publicised the Inquiry to all our members via our regular e-Newsletter and therefore trust that many individual members will have taken part in the e-consultation.

Corporately, we wish to draw attention to concerns of principle in three broad areas:

3. Key principles to be recognised in 'Modernising Medical Careers'

• Encouraging and recognising experience overseas
• Supporting marriage and family life
• Ending unjust discrimination

4. Encouraging and recognising experience overseas

4.1 One of CMF's formal aims is 'To mobilise and support all Christian doctors, medical students, and other healthcare professionals, especially members, in serving Christ throughout the world'. Historically, Christians have been active since the 19th century in taking healthcare to needy parts of the world, and that continues today.

4.2 Through our dedicated 'HealthServe' staff (www.healthserve.org/) we are involved in:

• Supporting 162 members or associates working long term in the developing world
• Advising and maintaining links with 60 members who have returned from such long term service in the last 5 years
• Supporting 582 members who are either currently involved in short term trips overseas or who have expressed such a definite desire, with 250-300 of these being 'active' at any one time

As a rough estimate therefore, between 420 and 750 members are likely to be involved in an overseas work, either short or long term.

4.3 We therefore have a very strong interest in maintaining such a commitment, and are encouraged that throughout the profession there is greater recognition of the two-way value of such service:

• Benefit through service provision and training to the developing world
• Benefit to the NHS through new attitudes and skills brought back

These benefits have been noted by the Chief Medical Officer in a Department of Health document [1], by the British Medical Association [2], and by the former Chief Executive of the NHS in England, Lord Crisp, in a Report [3] for the Department for International Development.

As encouraging examples, we particularly commend the joint schemes with VSO of the Royal College of Paediatrics and Child Health and the Royal College of Obstetricians and Gynaecologists, and would wish that other specialties could take up similar projects.

4.4 We know the Inquiry appreciates that doctors serving overseas should have sufficient relevant UK experience in their specialty before going, and this is likely to be at ST 2 level and upwards. We also know that the Inquiry is aware of doctors who have served overseas who have had great difficulty on return. For example, a member writes:

I was a missionary surgeon for 11 years and then had a dreadful time getting back into the system including causing a meeting of all four surgical College Presidents to discuss my case to allow me to sit the exit FRCS Exam in my specialty. I was allowed, and had three consultant job offers immediately after passing it ten days later!

Recommendations: The future medical careers pathway should recognise these factors and therefore:

• ST training should be sufficiently flexible to recognise overseas experience
• An overseas option should thus be built into the training process
• There should be no penalty for lengthier periods spent overseas
• There should be a process for validating work in more remote rural areas as well as in the major centres of the developing world

5. Supporting marriage and family life

CMF supports God's ideal of the family headed by two married parents as the fundamental unit of stable society and one which is good for health. Married members seek to model this.

The Inquiry will be aware that medical marriages and medical families face more pressures and threats than most, particularly when both spouses are working doctors. Recognising that this Inquiry is not about MTAS, we are nevertheless concerned that one outcome of that application process so far has been to complicate the question of the geographical area (or even the UK country) within which to work. This risks separating engaged or married couples, and adding to the stress they face. This cannot be good for those doctors, their families, their colleagues, or their patients.

Recommendation: The future medical careers pathway should recognise these factors and every facility should be given so that engaged or married couples can train in the same geographical area if they wish.

6. Ending unjust discrimination

Our Affirmation on Christian Ethics in Medical Practice (www.cmf.org.uk/fellowship/doctors/cmf_ethics_affirmation.htm) states 'in relation to colleagues' that we commit ourselves 'to work constructively with colleagues and … in training doctors, nurses and paramedical workers, for the benefit of individual patients and the advance of health care throughout the world'. This statement implicitly includes the concept of justice.

CMF has 280 members who qualified outside the UK and Ireland, and has informal links with other UK groups of 'international' doctors. We are acutely aware of the injustices suffered by some who in good faith came from overseas to the UK for further training, and faced discrimination in seeking employment.

The effective abolition of permit-free training following changes in 2006 to UK immigration law has already dealt many an injustice (an issue clearly outside the scope of this Inquiry). We note that the Inquiry recognises we are 'in a global market' and the consequences of this affect doctors from overseas as well as UK-trained doctors. We note the relative shortage of genuine UK training posts.

We do not presume to have specific answers for future training and workforce planning that can successfully hold all these issues in tension, but believe the principle is so important that we make the following recommendation.

Recommendation: The future medical careers pathway should recognise the principle of justice and make all its implementations accordingly. Doctors from abroad who are permitted to work in the UK should be treated on the basis of merit and not discriminated against in the job application process.

7. Conclusion

We wish the Inquiry well in its continued deliberations, are grateful that these 'suggestions' will be considered, and are willing to contribute further if requested.

For further information:

Steven Fouch (CMF Head of Communications) 020 7234 9668

Media Enquiries:

Alistair Thompson on 07970 162 225

About CMF:

Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 5,000 doctors, 900medical and nursing students and 300 nurses and midwives as members in all branches of medicine, nursing and midwifery. A registered charity, it is linked to over 100 similar bodies in other countries throughout the world.

CMF exists to unite Christian healthcare professionals to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.