Making the new deal for junior doctors happen

Abstract

How can the new deal for juniors be implemented in today's overstretched health service? How do you get clinicians and management to work together? On the Wirral falling house officer morale and recruitment stimulated a new approach, action learning, which proved to be highly successful. Action learning is not a new approach in management terms, but it is rarely used in the health service. Guided by an experienced facilitator, a group of people learn management skills by exploring and resolving practical problems relevant to them. A group of general practitioners and consultants used action learning to teach themselves more about management and at the same time to make changes which addressed many of the junior doctors' difficulties and solved the hospital recruiting problem. The plight of junior doctors with regard to hours of work, educational opportunities, and morale has been recognised.*RF 1-5* Despite the efforts of the General Medical Council,6 postgraduate deans,7 the Department of Health,8 and individual consultants a recent survey showed that the training and working conditions provided for house officers were still unsatisfactory and inconsistent with the GMC's recommendations.9 Despite all these recommendations there are no established methods for stimulating change locally. It is difficult to produce lasting change by edict from above,10and threats may enforce only reluctant compliance with the minimum requirements.11 The Wirral Hospital NHS Trust is a large district general hospital,15 miles from the University of Liverpool Medical School. It provides a comprehensive range of specialties and employs 30 spreregistration house officers. Despite having met the recommendations of the junior doctors' new deal on hours,8 recruitment had become increasingly difficult over the previous two years and there were only 10 applicants for posts starting in August 1993. For August 1994, however, the trust is oversubscribed. We …