Ms Candace Gillies-Wright

Our ref:FLM/mc

Your ref:

28 January 2010

Ms Candace Gillies-Wright

Committee Manager

The RoyalCollege of Psychiatrists

17 Belgrave Square

LONDON

SW1X 8PG

Dear Ms Gillies-Wright

I refer to the recent request from the President for comments from WIPSIG on the report Women Doctors: Making a Difference and am pleased to be able to respond as follows.

Overall the report was commended for being very practical and giving steps forimplementation rather than grandiloquent statements of aspiration. It was found to be interesting and informative, as well as very thorough.

Concern was raised as to how long it would take to implement the recommendations and it was suspected that in the current climate there may not be the money to pay for these. Many of the issues highlighted were agreed with, such as difficulties in arranging LTFT training, childcare problems with rotas and with changing posts and difficulties in entering certain specialties.

It was felt with the ever-changing healthcare scenario, the era of increased regulation and the EWTD etc,that education is paramount, both in schools, where students might be deterred from applying to do medicine, and at undergraduate level. Employment prospects are very important as is a realistic view of how medicine is becoming increasingly specialised.

One criticism was that slot-shares are, in practice, very difficult to operate due to trainees’ differing needs in terms oftraining, geography, childcare etc. They are also expensive, for example with banding for on-call (unless one trainee doesn't want on-call); if it is split, it costs more and it is the Trusts who pay for on-call for trainees, as Deaneries only pay the day time work.

The recommendations led to more debate; for example, the suggestion that every doctor has her own webpage on the trust site. No-one could see the value in this. The recommendation to have childcare costs paid through gross earnings was liked, but thought to be unlikely to happen. The recommendations around allowing mentoring and coaching to be part of a job plan (and properly remunerated) were good, as well as increasing access to use ofthese through local registers. Trusts arebecoming very keen to squeeze as much clinical work as possible from consultants, endeavouring to get them either to give up 'extras' or do them in their own time.

Encouraging more access to flexible training and less-than-full-time working is to be commended, however, it was thought that postgraduate scheme managers and TPD's should have the necessary information/ training/ skills on providing this as agenuineoption to alltrainees (not just women or parent doctors),demonstrating visible support for thisand actually being able to accommodate these optionsinto the wider training programme without unnecessary upheaval and inducing guilt into those requesting these options.

Other comments included:

- Leadership developmentmust be a focus, particularly given the unprecedented challenges facing the NHS over the next few years. Whilst agreeing that starting early with free leadership development courses would be desirable, it was also thought that supporting women into senior positions as MD's, CEO's, senior academicsand providing ongoing training in those positions was also important.

- A major problem for young women with taking academic posts is that universities count as differing employing bodies to theNHS, so continuity of service for maternityrights is lost, which can be disastrous financially and put people off moving to academic posts.

- Academic posts are becoming less popular generally and members knew of many people who have switched back toNHS posts, as both theNHS and the Universities want their 'pound of flesh' and RAE of Universities is getting tighter and tighter so they demand that all academics arereally active.

- Money is the fundamental problem since banding came in and this is almost certainly why flexi posts are decreasing. It is also probably whyjob shares are becoming less common. In the past Trusts would fund handover sessions but increasingly you see 'stand alone' five session posts being advertised because they are cheaper. Another problem is that increasingly with revalidation and lots of mandatory training, two part-timers cost more as each one needs the same training annually as a full-timer.

- The idea of mentoring was liked and it was thought should receive emphasis, but the choice of mentors would be important. Information about this at the time of regional/local induction needs to be well organized.

- The examples given were all of very high achievers. It was felt that there needed to be room for and emphasis on the ordinary doctor who may not be able to, or want to, pursue consultant posts and that there should be a sense of pride, purpose and value at whatever level we work, as achieving a degree in medicine is an achievement in itself.

- Doctors train to work with patients yet many move, through promotion, away from that and that staff and associates need to be protected. When asked what a consultant led service could look like, it was suggested that perhaps the continental model of specialists working under a Super Specialist could be the answer.

- Much is said about achieving a healthy work life balance and working more flexibly, but ultimately within the NHS there seemed to be little sympathy for this and hospital medicine therefore needs to be more flexible.

-With an increasing number of women in the work place, it was felt that changes needed to evolve.

- It was noted that Hospital-based childcare is minimal and almost non-existent at the moment across many trusts in various parts of the country. For female trainee doctors, especially SpRs /ST4-6's this is terribly difficult as they have to rotate and move between various jobs/sites andTrusts during training. It is full of practical difficulties including long waiting lists and the need to look for child care arrangements nearer to home than place of work, given frequent changes in location.

- The fact that training is largely competency rather than time-based now needs to be formatted better as in reality it is still the time in training that counts! This has repercussions on female doctors taking maternity leave etc. This also ties in with revalidation and clarity is needed as to how these gaps will be filled to accommodate those not having the usual working patterns.

Yours sincerely

Dr Fiona L Mason MB BS FRCPsych DFP

Chair of WIPSIG