BJJ News
Editorial o be appointed to the post of a full-time consultant in orthopaedic surgery in the NHS is not only the aim of most indigenous trainees but also the desire of a number of surgeons who have trained abroad or in other systems. This is entirely reasonable, but it is inevitable that those applying for such a post should fulfil certain criteria. These were laid out precisely, if not elegantly, in article 8(2) of the Postgraduate Medical Education and Training Order of Council 2010 which came into force on 1st April 2010. For those of you who have somehow failed to read this statutory instrument, it runs as follows: “a person (“S”) is an eligible specialist for the purposes of article 7 (1) (a) if S does not fall within paragraph (1) but has (a) undertaken specialist training; or (b) been awarded specialist qualifications in a recognised specialty and satisfies the registrar that that specialist training is, or those qualifications are, or both when considered together are, equivalent to a CCT in the specialty in question.” In practice, this means that an indigenous trainee has to have completed an accredited training scheme to a satisfactory standard and to have passed the FRCS (T&O). But what of the graduate from abroad who wishes to be appointed to a full-time consultancy in orthopaedics in the NHS? Precisely this question recently came in front of the Court of Appeal in the case of Nakhla v General Medical Council last year. The GMC’s Registration Appeal Panel (RAP) had turned down Mr Nakhla’s application to be registered as a specialist in Trauma and Orthopaedic surgery which is, in itself, a necessary precondition to being appointed a permanent NHS consultant. When this decision was appealed the judge in the first instance overturned the decision of the RAP on the grounds that Mr Nakhla had fulfilled the criteria of article 8 (2) by having passed his FRCS (T&O). She argued that there were three different ways in which an application could prove equivalence; by qualifications, by training or by a combination of the two. The applicant did not have to demonstrate equivalence by reference to training if relying on qualifications or by reference to qualifications if relying on training. The Court of Appeal disagreed. Lord Justice Lewison argued that the judge in the first instance appeared to conclude that passing the FRCS (T&O) was in itself sufficient to satisfy the requirements laid down in article 8(2) and that this was wrong because by accepting this she had failed to consider the second part of the criteria which was that the applicant should be able to demonstrate a range of generic medical skills equivalent to those that would have been required in order to obtain a CCT. These did not have to be identical, but equivalent, and this, in itself, was a value
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judgement.The judge, however, was correct in saying that the ultimate objective of the enquiry was to determine whether the qualifications or training or both of an applicant were equivalent to a CCT. What is more, the GMC could not lawfully prescribe more onerous requirements than those laid down by article 8 (2). The specific outcome of this particular case is not in itself a matter for the profession. However, it appears to reinforce in law that to be appointed as a permanent consultant orthopaedic surgeon in the NHS, a candidate needs both to have passed the FRCS (T&O) and to have completed an accredited specialist training based on the syllabus of the day as approved by the GMC (now that the Postgraduate Medical Education and Training Board has been abolished or its equivalent). This makes complete sense to those of us who examine for the final intercollegiate FRCS (T&O). We are instructed in the clearest possible terms that the standard for the examination is that of a day one consultant in the NHS without experience of sub-specialist training. The examination is generally taken in year five of the six years of training, which in itself is an indication that training is incomplete. While knowledge, clinical skills and the ability to formulate a reasonable management plan are tested, there is currently no way in which operative skills can be assessed. This aspect of a candidate’s practice, along with a number of other practical details, need to be left to the judgement of the head of training and those for whom the candidate has worked. For those who apply from abroad, however, demonstration of the equivalence of training, in addition to their acquisition of the FRCS (T&O), would appear to be paramount.
References 1. Statutory Instrument 2010 No. 473. Health Care and Associated Professions: Doctors The Postgraduate Medical Education and Training Order of Council 2010 2. Matthew Brotherton, Barrister. Nakhla v General Medical Council. [2014] EWCA Civ 1522; [2014] WLR (D) 510. CA: Longmore, Lewison, Burnett LJJ: 28 November 2014 The Incorporated Council of Law Reporting for England and Wales
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