This could mean that junior doctors would continue to work excessive hours, and fewer patients than planned would see consultants.
Junior doctors' hours cannot be cut further without expanding the numbers of consultants and other doctor grades on a scale that 'would be difficult to afford within current resources', ministers have been told. Staff-grade doctors, a report notes, are 'a cheaper option than appointing a consultant'.
The conclusions of a working party chaired by Dr Graham Winyard, the deputy chief medical officer, yesterday brought an angry reaction from junior doctors' leaders and a denial from Brian Mawhinney, Minister for Health, that any decisions have yet been taken.
The British Medical Association's junior doctors' leaders urged Dr Mawhinney to 'stick to the new deal'. Dr David Wrede, chairman of the Hospital Doctors' Association, condemned the report, stamped 'management in confidence', as 'completely unacceptable'.
It meant that while junior doctors worked excessive hours, 'instead of more patients being seen by consultants as under present plans, more will be seen by the sub-consultant grade of staff doctor. It will lead to a two-tier specialist system in Britain and that is not in the interests of patients, high quality medicine or the profession itself.
'This undoes everything that has been agreed before - the new deal for juniors, achieving a balance on consultant and junior numbers and the Calman report - and I cannot believe that (the Secretary of State for Health) Virginia Bottomley, who put so much weight behind the new deal, will accept it.'
The report does recommend that consultant expansion be sustained. And on the staff grade, the report does not actually recommend abolishing the 10 per cent ceiling. It says, however, there was 'no agreement' about its future within the working party, and the requirement to get junior doctors' hours down had 'greatly increased pressure' for more staff-grade appointments.
It warns that there are difficulties in maintaining manpower controls when trusts have the freedom to vary the terms and conditions of staff. And while there were worries about possible exploitation of staff- grade doctors, the report notes they are 'a cheaper option than appointing a consultant'.
On junior doctors' hours, the report recommends that the promised improvement for next year - which would have cut junior doctors' contracted hours from 83 to 72 - should not take place.
Dr Mawhinney promised no decisions would be taken until meetings had been held with doctors' leaders.Reuse content