Doctors called to account for grip on consultants' posts

THE MEDICAL establishment was under pressure from the Government last night to explain why Britain has virtually ignored EC laws governing the training and qualification of doctors for more than a decade.

Kenneth Calman, the Government's chief medical officer, told leaders of the medical Royal Colleges to report on current arrangements and criteria for specialist medical training and 'how they relate to EC requirements' set out in directives passed in 1977.

The order came at the first meeting of a high-level working party at the Department of Health, convened to overhaul specialist medical training to bring it into line with EC law. It would involve the biggest shake-up of medical training for half a century. A confidential document leaked to the Independent in June revealed the department had accepted complaints from the EC Commission that Britain's system was 'unlawful and discriminatory'.

The EC's intervention could scarcely have been more embarrassing for Virginia Bottomley, Secretary of State for Health. She chairs her first EC health ministers meeting in November.

Despite the advent of EC specialist certification in 1977, intended to foster the free movement of fully trained doctors across member state boundaries, the UK continued to operate its own system of specialist accreditation. Few doctors are promoted to consultant positions, the gateway to private practice and the possibility of a share in nearly pounds 100m a year of NHS 'merit money', without the accreditation awarded by the medical Royal Colleges.

Dr Calman, the working party chairman, also asked consultants' leaders to inform the group on how current procedures governing the appointment of NHS consultants square with the requirements of the EC directives.

Consumer groups are not included on the working party, but it will meet representatives of patients' organisations during its six- month inquiry. It will also hold talks with private health care organisations such as Bupa and PPP.

The EC complaints to the UK followed protests about discrimination from doctors who trained in other EC states. One involved Uccio Querci della Rovere, a lecturer in surgery at Padua University before coming to practise in the UK in 1979. Although he had EC certification, he was forced to start at the bottom of the career ladder. A decade later he had to abandon his private practice after PPP withdrew recognition from him.

The training overhaul threatens to cause deep divisions within the medical profession. Britain's 25,000 junior doctors favour breaking the virtual monopoly enjoyed by the 16,000 consultants by introducing a single specialists' grade and one training grade. Training periods would be cut from 10-15 years at present to between 6 and 8 years.

Fully trained and qualified specialists would work more on equal terms with consultants, and would be able to establish private practices.

The members of the working party were named by the Department of Health as: Sir Robert Kilpatrick, president of the General Medical Council; Professor Norman Browse, president of the Royal College of Surgeons; Professor David Shaw, chairman of the General Medical Council education committee; Stan Simmons, chairman of the Conference of Medical Royal Colleges; Dr Trevor Bayley, postgraduate dean, Faculty of Medicine, Liverpool University; Dr Edwin Borman, chairman of the Junior Doctors Committee of the British Medical Association; John Chawner, chairman of the Central Consultants and Specialists Committee of the BMA; Sir Colin Dollery, dean of the Royal Postgraduate Medical School; Dr Martin McNichol, chairman of the Central Middlesex Hospital NHS Trust; Bob Nichols, chief executive of the Oxford Regional Health Authority; Paddy Ross, chairman of the Joint Consultants Committee; and Dr Alistair Scotland, medical officer for North East Thames regional health authority.

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