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Unfinished Business: Proposals for Reform of the Senior House Officer Grade
Introduction
1.1 Most young doctors seek an appointment as a senior house officer (SHO) on completing their year as a pre-registration house officer. During their time in the SHO grade they undertake increasing supervised responsibility for patient care and develop a wide range of general and basic specialist skills needed for their chosen specialty.
1.2 After working in a number of SHO posts, they then complete training in general practice or enter a higher specialist training programme in hospital or public health medicine. This is the route by which doctors obtain the qualifications and experience to become either consultants or principals in general practice. Some, however, will seek work in hospital practice in non-training or non-consultant career grade posts.
1.3 Over the last decade, there have been major reforms to higher specialist training including a new specialist registrar grade to replace the previous registrar and senior registrar grades. There have also been important improvements to the education, training and working conditions of pre-registration house officers and of general practice registrars.
1.4 SHOs have been left behind. They have not benefited from the reforms enjoyed by trainees in other training grades. As a group they have been described as 'the workhorses of the NHS' (implying a disproportionate amount of service work compared to training) and a 'lost tribe' (suggesting a lack of coherence in the organisation of training).
1.5 The Government accepted the recommendations in '
A Health Service of all the talents: Developing the NHS workforce'
1 to "sort out the senior house officer grade" and made a commitment in
The NHS Plan2 to reform SHO training. This commitment is mirrored by the administrations in Scotland, Wales and Northern Ireland.
1.6 This Report takes into account the thinking of a Working Group convened to consider the options for modernising SHO training and the many organisations that gave evidence to its Sub-Group. It also reflects work in the Department of Health to analyse the workforce implications of reform and the effect of the Working Time Directive.
1.7 Members of the Working Group (
Annex A) were invited in a personal capacity to provide expertise on postgraduate medical and dental education as well as a service, management, educational and lay perspective.
1.8 The Working Group established a Technical Sub-Group (
Annex B) to gather evidence and views on reform. It invited comments from 48 stakeholder organisations. Replies from 34 organisations informed a series of focus-group sessions convened by the Sub-Group (lists of contributors at
Annex C).
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