Health training shake-up urged

PRESSURE for the reform of training and appointment of consultants will increase further today with the publication of a report urging fundamental changes in the structure of the medical profession.

It says intensive training of junior doctors would enable them to become specialists within six to eight years of qualification, rather than the 10 to 15 years necessary to achieve consultant status at present.

The central change put forward by the report from the National Association of Health Authorities and Trusts would bring Britain into line with the rest of Europe, an issue at the centre of a High Court action.

Consultant training is also under the spotlight of a working party under Kenneth Calman, the chief medical officer, set up by the Department of Health after it accepted European Community criticism that Britain's system was 'unlawful and discriminatory'.

Last week the Monopolies and Mergers Commission launched an inquiry into consultants' fees after complaints that guidelines on charges issued by the British Medical Association had forced up costs. A Norwich Union Healthcare study, due out next week, will show that almost 40 per cent of the cost of private health care is swallowed up by consultants' fees.

Today's discussion paper, Medical Manpower: Training and Hospital Career Structure, is primarily concerned with the changing structure of the National Health Service brought about by the introduction of trust hospitals, the Government's commitment to reducing junior doctors' hours, and the need to bring Britain into line with the rest of the EC.

To avoid the need to increase the number of junior doctors if their hours were cut, the paper suggests the health service move to a system where cover is provided by specialists.

Two new career-grade posts would be created, which would allow doctors to become specialists at 31, seven years earlier than at present. They would spend between 10 to 15 years in this grade before becoming senior specialists.

Senior specialists could be appointed to head departments, but it is envisaged that they would have a major responsibility to educate and supervise those in training grades. The paper argues that the proposed changes would require only a redistribution of expenditure.

Brian Mawhinney, the Minister for Health, said: 'We are currently looking at many of the same issues in consultation with the medical profession and the NHS.'

Medical Manpower: Training and Hospital Career Structure; NAHAT, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ; pounds 8 members, pounds 12 non- members.