Letter: Short of consultants

Sir: Jeremy Laurance reports ("Crisis in obstetrics looming", 7 May) that over the next three years the NHS is set to lose up to 400 specialists in obstetrics and gynaecology because there are no consultant posts available for them. He rightly points out that the failure to employ them flies in the face of recommendations to increase obstetric cover on labour wards and improve safety for both babies and mothers. Similar problems are building up in other specialities including anaesthetics and renal medicine. Unfortunately, there is a risk that the wrong solution will be chosen, that training posts will be cut rather than consultant posts expanded.

Yet Jeremy Laurance's report coincides with a warning from the National Audit Office that the NHS faces a bill of more than pounds 2bn for patient litigation, of which obstetric litigation forms a significant part. Complaints about poor care usually arise because there has been insufficient time built into the contact between doctor and patient. Consultants are called away from clinics to attend to emergency admissions. The relentless pressure to reduce waiting lists and shorten patient stays means that doctors are working at an unsustainable pace. Medical accidents, personal tragedies and expensive litigation are the inevitable result.

The solution is inescapable. We must expand the pool of consultants. More consultants mean more hands-on care by the most highly trained and experienced doctors. It means better supervision of junior staff and better quality of care for all patients. The Government must instruct NHS trusts to expand the number of consultant posts, thereby investing in prevention rather than spending billions mopping up the consequences of excessive pressure on hospital staff.

Dr PETER HAWKER

Chairman, Central Consultants and Specialists Committee

British Medical Association

London WC1