Doctors' career structure to be overhauled

The training and career structure of doctors is set to undergo its biggest reorganisation, under government plans to curb restrictive practices in the medical profession and improve accountability.

Doctors' training time will be halved to between five and seven years and the pool able to practice as NHS consultants or in the private sector will be widened. The expected growth in the supply of doctors considered competent for independent specialist practice could trigger a fall in private medical fees.

A blueprint for the overhaul has been agreed by a working party headed by Kenneth Calman, the Chief Medical Officer. The European Commission, which complained last year that UK practices were 'unfair and discriminatory', will examine the proposals this week.

Dr Calman will also recommend to Virginia Bottomley, Secretary of State for Health, that a new regulatory framework should be put before Parliament this summer to enable the new training and career structure to start in 1995.

The Department of Health established the review after the Independent disclosed EC complaints last spring about the UK's two-tier system of specialist medical qualifications. Among the bodies represented on the working party were the medical Royal Colleges, the General Medical Council and the NHS Management Executive.

Despite the advent of EC specialist certification in 1977, intended to allow the free movement of fully trained medical specialists across EC boundaries, Britain retained its own system of accreditation. Three doctors are known to have legal actions pending against the Department of Health, seeking damages over the non-recognition of their EC certificates.

Accreditation is a pre-requisite for appointment to most hospital consultant posts and has been criticised by juniors over the poorly- understood and apparently arbitrary criteria used by the Royal Colleges to award it. It will be phased out under the recommended reorganisation. Instead there will be the Certificate of Completion of Specialist Training, awarded after shorter, more intensive and better structured periods in training.

Doctors now spend between 10 and 15 years in training. As a result, junior doctors are the front- line troops of NHS hospital care, delivering the bulk of medical care and working on average a 75-hour week. They often spend long periods without direct supervision or structured training.

Senior registrar and career registrar grades should be combined to help streamline training and reduce bottlenecks, the working party concluded. The conversion of some SR posts into consultant posts, as vacancies arise, will help reduce delays faced by doctors trying to move up the career ladder. Already, the number of consultant posts has been growing at the rate of 2.8 per cent a year, or by about 300 to 400, to help cut junior doctors' hours.

The Medical Register, open to public inspection, will be amended to enable easy and reliable identification of fully trained specialists.

New statutory appeals machinery might be needed to resolve disputes about registration and specialist certification.

Dr Calman, whose proposals are to be published this week, believes the changes will help deliver better services. He said: 'The purpose of medical education and training is not simply about providing jobs for doctors, but improving services to the patient.'

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