ONE of Scotland's biggest health boards risks losing junior doctors unless improvements are made to the training they receive.

Junior medics having to take on the work of more senior staff is among a lengthy list of have been raised by their youn colleagues in NHS Lanarkshire.

Two years after high death rates prompted an urgent review of services in the region, and experts were sent in to help the struggling board, officials have raised "significant concerns" about the "pace of progress" dealing with junior doctor training issues.

The General Medical Council (GMC), which monitors training standards along with NHS Education for Scotland (NES), has now put each of the three hospitals in the region under enhanced monitoring separately.

Dr Alistair Cook, director of medical education for the board, says in a report presented to the NHS Lanarkshire board: "The extent of the concerns identified and reported on by NES is now a major focus of attention for chiefs of medicine and other senior staff at each site, with the risk of the withdrawal of approved training status if satisfactory progress is not delivered within acceptable timescales."

Loss of training status would be a major blow for hospitals in the region as junior doctors play a key role in delivering patient services.

Dr Christopher Sheridan, chair of the British Medical Association’s Scottish Junior Doctors Committee, said: "If they were to lose approved training status the majority of the trainees would have to be located in other hospitals to complete their training and the local health board would need to see how they staff their service... That could potentially be quite serious for the hospital. It could involve patients being diverted to other hospitals while it is all sorted out. It is something that luckily doesn't happen very often at all."

Dr Jane Burns, Divisional Medical Director for Acute Services, said:

“The NHS has historically been dependent upon doctors in training to make a significant contribution to service delivery. Alterations at a UK levels, such as the European Working Time Directive, Modernising Medical Careers and changes in immigration rules, mean that we increasingly need to look to develop models of care that have other healthcare professionals take on the duties previously undertaken by doctors in training.

“NHS Lanarkshire has made good progress in developing such staff including Advance Nurse Practitioners and Physician Assistants. These roles are a major enhancement to multi-disciplinary team working. In the areas where they have become well established, such as critical care and neonates, as these staff are permanent, and not subject to rotation, they have produced significant improvements in the consistency of care provision. It also results in an added benefit of providing enhanced training opportunities for the doctors in these service areas.

“We are continuing to build on the development of these enhanced roles for staff and to roll out this model of care across the specialties.

“Patient safety is the primary concern."

Following the rapid review of Lanarkshire services which took place in 2013, the health board was advised to pay more attention to intelligence about junior doctor training as "an indicator of wider patient care issues".

The GMC surveys junior doctors UK-wide about the quality of their training and the latest results for Lanarkshire show a number of departments scoring well below average.

Junior doctors training in general surgery in Monklands Hospital, Airdrie, raised a list of concerns through the survey including "issues with induction, workload, adequate experience, local teaching, clinical decision-making and incident reporting."

According to health board papers, officials who visited Hairmyres Hospital in East Kilbride in June were also told by junior doctors training in medicine they had not noticed "any tangible progress" dealing with problems affecting their training - a key issue being frequent changes in their duties.

At Wishaw General, the papers show junior doctors pursuing medicine have reported some improvements to officials although concerns were raised about them covering shifts intended for more senior medics. Issues affecting elements of surgical training at Wishaw were so grave staff were asked to produce an immediate action plan.

Scottish Labour MSP Margaret McCulloch, who represents central Scotland, said: “Losing approved training status in Lanarkshire hospitals would make the medical recruitment crisis worse and it would have wider consequences for patient care. The health board know they need to improve training and support for doctors but they are clearly not making enough progress. Hospitals in which there are consultant shortages, high reliance on locums and long waits in emergency rooms are hardly ideal places for junior doctors to train. We cannot go on like this."