Doctors' protests mark start of training review

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A FUNDAMENTAL review of specialist medical training begins today, amid protests from junior doctors over lack of consumer representation on the body appointed to recommend changes.

The overhaul was ordered by Virginia Bottomley, Secretary of State for Health, after European Commission complaints that the UK medical authorities had been operating 'unlawful and discriminatory' training and accreditation practices since 1977.

The Department of Health will today name the 12 members of a working party set up under the chairmanship of Kenneth Calman, the Chief Medical Officer, to prepare a blueprint for bringing the UK training system into line with the provisions of EC directives passed 15 years ago.

The working party will be dominated by leaders of Britain's medical establishment. Sir Robert Kilpatrick, president of the General Medical Council, Stanley Simmons, chairman of the conference of medical Royal Colleges, and John Chawner, consultants' leader of the British Medical Association, are expected to be among those named as members of the working party, which meets for the first time today. The lay element will comprise three regional health authority managers.

Junior doctors, who argue that the training overhaul has far- reaching implications for NHS waiting lists and quality of patient care, are angry at the absence of a consumer voice on the group.

Edwin Borman, chairman of the BMA's junior doctors' committee and the only junior likely to be appointed to the working party, said those most affected by the changes ahead were not being adequately represented. 'We are concerned to see this body looks into all aspects of medical training and the way in which medical care is delivered in Britain. It is essential that patients' interests are reflected in this process.'

The Hospital Doctors' Association, a smaller juniors' body, complained that the working party was made up largely of representatives of the same bodies that have brought about the crisis in medical training: 'It's like putting the Stock Exchange in charge of an inquiry into insider dealing,' David Wrede, HDA chairman, said.

The EC directives were intended to bring about mutual recognition of specialist medical qualifications, fostering the free movement of doctors and the right to work in any EC country.

But the UK medical training bodies continued to operate their system of specialist accreditation in tandem with the EC scheme. Few doctors in the UK are awarded NHS consultant posts without specialist accreditation from the medical Royal Colleges.

Junior doctors, who work an average 83-hour week, complain that the rules governing accreditation are arbitrary; that the 10 to 15- year specialist medical training required in the UK is excessive; and that consultants provide inadequate supervision of trainees.

Last December, the High Court ruled it was 'perverse' of the medical training authorities to grant EC specialist certification to Dr Anthony Goldstein, a Harley Street rheumatologist, but not UK accreditation. Dr Goldstein, 39, returns to the High Court on Friday to pursue a judicial review of the Government's failure to fully implement the EC directives.