Posted by: Witch Doctor | April 11, 2007

The Lost Tribes – who and where are they?



The “Lost Tribes” must be extremely important in the overall plan for MMC. They may even be the most important part of the plan.

It appears that Senior House Officers (SHO’s) are normally the ones regarded as the “Lost Tribe”

However, a second group presently known as Non-Consultant Career Grades (NCCG) are the most lost of all. They certainly should be included in the Lost Tribes. It is not very clear who they are, how many there are, and where they are working – see extracts below from DOH documents relating to Modernising Medical Careers (MMC).


” Who are included in the Non-Consultant Career Grades?

5. Even the definition of NCCGs is vague. By NCCGs we mean those doctors in hospital and community medicine and hospital dentists who are neither formally recognised trainees nor consultants. Generally speaking, we mean Staff Grades and Associate Specialists (acknowledging also that the term Staff and Associate Specialist grades (SAS) is increasingly being used synonymously with the term NCCG), Senior Community Medical Officers and Community Medical Officers and their many equivalents working on local NHS Trust contracts. Full-time Clinical Assistants and the remaining Hospital Practitioners ought to be included. A number of other groups fall into this category, not least so-called trust doctors working at SpR or SHO level and clinical fellows.

6. The general principles set out below apply to all these doctors and the move to modernise medical careers through an overarching initiative will touch all of them. Dentally qualified NCCGs have a somewhat different regulatory framework to doctors but, as far as possible, the same principles should apply to them so in this paper the term doctor generally also includes dentists. The solutions we develop ought to be flexible enough to apply to doctors and dentists working in a great variety of settings.

” How many are there?

7. Producing an accurate picture of the non-consultant career grade population – including those employed on local contracts – is not straightforward and depends on interpreted data. The published data show around 12,500 doctors (headcount) in this category, 6,500 recorded as associate specialists or staff grades and the rest as hospital practitioners or clinical assistants. Some clinical assistants are working full time as hospital doctors in which case this report applies to them. Other clinical assistants will be General Practitioners undertaking sessional work for NHS Trusts. This report does not apply to them and we do not intend to affect the current arrangements which apply in such cases.

The Witch Doctor understood that the clinical assistant contract should not exceed 5 half days per week. ie they should not be full-time posts. Whose error? In any case, are part -time clinical assistants who are not GPs to be excluded? Not clear.

8. Separate analysis shows that there are around 5,000 doctors on local contracts, for whom the equivalent national grade is unclear. Whilst many of these will be included in the above figure, a significant number are working at the equivalent of SHO or SpR level and it is very probable that some are misrecorded as SHOs or SpRs as these may be the nearest equivalent grades.

9. Of the 12,500 figure, 35% are women and 52% qualified outside the UK. If we restrict the analysis to associate specialists and staff grades, around 71% qualified outside the UK. This suggests that about the same proportion of NCCGs are women as the general population of doctors but that the percentage of overseas qualified doctors is higher than usual. And to these figures we need to add a significant number of dentists.


“Recommendation 13: Further scoping work is required to determine the
size and makeup of the current NCCG workforce.

296 respondents commented on this recommendation with the following results:
162 strongly agreed
126 agreed
6 agreed with reservations
1 disagreed
1 strongly disagreed

Key messages
There was overwhelming support for this recommendation and the following
issues were raised:

• Many respondents were rather surprised that this vital information is not already collected anywhere.

• It was universally agreed that this would be a very onerous and complex task as it is often difficult, even at local level, to accurately identify NCCGs.”

So, the Deaneries have a lot of work ahead of them to identify these lost tribes before they can welcome them to the fold. Medical workforce planners will also need to get a handle on this.

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