Historical background: 40 years of change in the NHS

The Platt Report (1961) was the first in a series of documents that highlighted a workforce need for National Health Service (NHS) doctors with consultant-level competencies, but who were not consultants. Following discussion on the creation of ‘medical assistant’ posts, the first ‘career grade’ posts were introduced in 1964, with the term ‘associate specialist’ being introduced at the beginning of the 1980s and a new contract emerging 10 years later. The vast majority of these doctors had qualified overseas, were regarded as the backbone of the NHS and were even recognised in the infamous ‘rivers of blood’ speech by health minister Enoch Powell in 1968, where it was noted that they ‘have enabled our hospital service to be expanded faster than would otherwise have been possible’. Little progress was made in addressing the continuing professional development (CPD) needs of non-consultant career grade doctors until the mid-1980s, when the title ‘staff grade’ was introduced in Achieving a Balance. These doctors, as with associate specialists, were to be at a nonconsultant career grade, whose job plan was predominantly one of service delivery. However, unlike associate specialists, they entered the staff grade as a senior house officer after a minimum of 3 years general professional training, where ‘provision would be made for continuing education for this grade’. However, nearly another decade passed before the career structure of staff grade doctors was revisited. Both groups noted their lack of CPD opportunities and poor career progression. Yet, it was not until the turn of the century that the main drivers for change for both staff grade and associate specialist CPD began to emerge. The first of these drivers came from the Royal College of Physicians, which recommended that time be available in the job plan for CPD, agreement of a personal development plan, appointment of staff and associated specialist grade officers within deaneries, access to career advice and registration with the relevant specialty-specific College/faculty. In the same year, A Health Service of all the Talents noted that staff and associated specialist grades had varying qualifications and skills, were often overlooked in career progression, training and continuing education and that steps should be taken to provide a proper career structure. It was further recommended that staff in service posts should have better opportunities to enter training. The paper was followed closely by Choice and Opportunity, which recognised the opportunity for employers to maximise the potential of staff and associated specialist grades through CPD and careers support, thereby improving job satisfaction and patient care. The final turning point arrived with the publication of the Tooke Report, in which Recommendation 38 was to ‘raise the status of the NCCG (non-consultant career grade) doctors by improving terms of service and in particular by offering opportunities for training and personal development’. Later the same year, the creation of ‘specialty doctor’ posts provided a further revision to the outdated staff grade doctor contract in Employing and Supporting Specialty Doctors A Guide to Good Practice. Specialty doctors The Psychiatrist (2010), 34, 533-536, doi: 10.1192/pb.bp.110.029710