Changes to medical training introduced since 2002 have been rushed, poorly led and implemented and are unlikely even to produce very good doctors, according to a new report.

Sir John Tooke, who chaired an independent inquiry set up by the Department of Health, said it had been a sorry episode from which nobody emerged with credit.

The new policy, called Modernising Medical Careers (MMC), was introduced without clear definition of what it was meant to achieve. Weak development, implementation and governance had made it worse. “Put simply, ‘good enough’ is not good enough,” Sir John writes. “Rather, in the interest of the health and wealth of the nation, we should aspire to excellence.”

Problems with MMC first became apparent when the computer-based application system used for selecting doctors for higher training failed this year. The Medical Training Application Service (MTAS) had to be abandoned, and the furore about it drew attention to wider defects. The report by Sir John, who is Dean of the Peninsula College of Medicine, will make uncomfortable reading for the department, and for Sir Liam Donaldson, the Chief Medical Officer, who was the main driving force behind MMC.

Sir John refused to name those directly responsible for the debacle. “The medical profession itself was complicit in MMC, and it is hard to target any individual for responsibility,” he said. The policy had failed in its key aim, which was to eliminate the “lost tribe” of senior house officers who did most of the work in NHS hospitals but were regularly denied opportunities to train to become consultants.

When MMC came in, such doctors found that they had to compete with the growing output from British medical schools and doctors from abroad allowed to work in Britain. Despite repeated warnings, the department at first ignored the problem, and its plan to introduce a policy whereby doctors’ jobs only went to overseas candidates if there was not a suitable home applicant was stymied in the courts. This meant that 8,352 foreign doctors were free to apply for posts in 2007, along with 1,500 from the EU and 11,994 British citizens.

While acknowledging the “fantastic contribution” made to the NHS by foreign doctors, Sir John said it was not sensible to have a policy which allowed them to compete with doctors trained in Britain at a cost each of £200,000 to £250,000. The department moved to rectify the situation yesterday by announcing a consultation to look at proposals for managing overseas applicants in the future.

Sir John’s report suggests that all those successful in getting a place in a medical school should be guaranteed a training place for the year after they graduate.

At present, under MMC, this is not guaranteed — which means medical graduates cannot call themselves doctor, or even work as doctors.

He also suggests that the Postgraduate Medical Education and Training Board should be incorporated into the General Medical Council, which is already responsible for the undergraduate curriculum and for registering doctors.

“The management of postgraduate training is currently hampered by unclear principles, a weak contractual base, a lack of cohesion, a fragmented structure and, in England, deficient relationships with academia and service,” the report said.

Andrew Lansley, the Shadow Health Secretary, said that it laid bare “the shameful mismanagement by the Government of junior doctors’ training. Hundreds of junior doctors still need action taken to ensure those who continue to meet the necessary standards will have the training [made] available to them.”

Ben Bradshaw, the Health Minister, said that the Government had learnt important lessons from MMC and would consider the report fully.

Explore Health News

• Swine flu

Times Recommends

• Shrinking violet Gordon turns into raging bull
• Eddie Izzard: 'I keep thinking if I do all these things she'll come back'
• Is sex for the disabled the last taboo?