Oxford Medical

The Tooke Report is the published findings of an inquiry led by Professor Sir John Tooke into Modernising Medical Careers (MMC) training for UK doctors. The report was published on 8 January 2008 after former Secretary of State for Health, Patricia Hewitt, invited Sir John Tooke to carry out the inquiry into MMC, in the wake of the 2007 recruitment debacle of trainee doctors for specialist training.

The full title of the report is Aspiring to Excellence: Final Report of the Independent Inquiry into Modernising Medical Careers.  MMC was an unpopular training structure for UK doctors and the Tooke Report strongly criticised the UK Government’s handling of the scheme’s implementation. Under MMC junior doctors could reach consultant level in an average of 11 years, rather than the current 14, by selecting a specialty early in their career. The Tooke report found this incentive was unlikely to encourage excellence or to allow for sufficient flexibility to the NHS’s changing workforce needs.

The report proposed MMC should be replaced by a new training system, one that was based on wide-ranging consultation with medical professionals and organisations. The report and its findings were largely welcomed by the medical world and the majority of health employees were keen to scrap MMC. Out of 39,850 responses to the report’s recommendations, 87% agreed or strongly agreed and only 4% disagreed or strongly disagreed. However, the Department of Health (DH) only accepts about 25% of the report’s recommendations and does not want to see it fully implemented.

 The Tooke Report listed 45 recommendations, including:

• The underlying principles of postgraduate medical training and education should be redefined with an emphasis on flexibility and aspiration to excellence
• All policy development should be based on available evidence
• The DH should consult with the NHS and the medical profession on any proposed policy changes which may affect the postgraduate doctor training and education
• There needs to be clarity of all doctors’ roles, taking into account patient and public expectations
• There should be better opportunities for medical management training
• At the end of first year (FY1), doctors should be chosen into a small number of specialities, for example surgical disciplines or family medicine
• Doctors should have the option to interrupt their training for one year or longer by arrangement, to seek different experiences that will enhance their career and contribution to the NHS.
• The length of training in General Practice should be increased to 5 years, with 3 spent in Core and 2 years as a GP Specialist Registrar

 The Tooke Report highlighted 8 key areas for attention:

1. The Postgraduate Medical Education and Training (PGMET) needs clear policy objectives and guiding principles, including aspiration to excellence
2. Medical education at every stage of doctors’ careers should be focused on outcome
3. The DH policy development and guidance needs to be enhanced, including better relations between departments as well as between health and education sectors
4. Workforce objectives should be integrated with training objectives
5. The profession must develop means to provide articulate advice on issues of major importance to medicine and people’s health
6. The postgraduate training structure and funding means need to be reviewed
7. The Postgraduate Medical Education and Training Board (PMETB) should merge with the General Medical Council (GMC) for the “continuum of medical education”
8. The structure of postgraduate training should become broad-based for further specialist education