Junior doctors fail to curb consultants

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JUNIOR doctors failed last night to break the near monopoly of consultants' power in NHS and private health sectors. Their proposals were voted down by the British Medical Association, despite threatened legal action from the European Commission to enforce fair competition.

The doctors' trade union rejected the juniors' scheme for resolving EC complaints that Britain's two-tier system of medical specialists' training and qualification is unlawful, unfair and discriminatory. However, the BMA's annual conference in Nottingham agreed by 115 votes to 114 to ban secret references for hospital jobs - one of the main props, trainees say, of the old boy networks that control medicine in the UK.

After a series of acrimonious and, at times, chaotic debates, the BMA also yielded to demands from leaders of 22,000 junior doctors for fixed terms of supervised training in all specialties.

Junior doctors, who work an average of 82 hours a week, often without supervision, have no formal limits on training. It can take 10 years or more before they are considered for consultant jobs, yet the 'closed reference' system means they have no automatic right to be told why they have been denied a promotion or a shortlisting for jobs. A recent study has shown that as many as one-quarter of trainee surgeons have no regular assessment or advice from their surgical tutors; they gain operating experience not from consultants but from other, albeit more experienced, juniors. EC directives implemented in 1977 were designed to ensure that fully qualified medical specialists could practise anywhere in the EC. But despite the advent of EC certificates of specialist training, most NHS employers and private health insurers continued to recognise only UK certificates of specialist accreditation, awarded by the medical Royal Colleges.

As the Independent reported last month, the Department of Health has accepted the EC view that the two systems can no longer be allowed to run in tandem and that UK practices are in breach of Community law. John Chawner, the BMA consultants' leader, acknowledged yesterday that the present system of training and qualifying specialists was 'in a mess' but he rejected the juniors' proposals to scrap the consultant-led hierarchies that run medicine in favour of specialist teams, and a single training grade. Edwin Borman, the junior doctors' leader, said the BMA had chosen to bury this problem for 15 years.