If ministers and the public want patients treated by junior doctors who are not exhausted, then - failing a big expansion in consultant numbers for which health authorities do not have the money - patients will have to be treated in fewer, more intensively used hospitals, Brian Mawhinney, Minister for Health, is being told.
The advice from the regional task forces on juniors' hours comes as a report from Dr Graham Winyard, the deputy chief medical officer, recommends dropping plans to cut juniors' maximum contracted hours from 83 to 72 hours next year.
South West Thames regional health authority has told Dr Mawhinney that merely to get down to that target with the present number of hospitals would require an extra 105 junior doctors. Reducing the work actually done - as opposed to time on call - to 56 hours, which is a second part of the target, would require 'far more' posts.
However, the region says concentrating work on fewer hospitals will help to hit targets. Cutting junior doctor hours has already been used to justify, in part, that Queen Mary, Roehampton, should cease to be a full district general hospital, and will be used to back merger proposals in Sussex and Surrey.
In the North-west, the need to cut junior doctors' hours has already been one of the factors behind merging accident and emergency departments in Wigan and Leigh, a spokesman for the Manchester-based authority said.
Dr Angela Jones, who heads the North-West Thames task force on juniors' hours, said that reducing their hours was one reason behind plans to close accident and emergency at St Albans and to cut the number of sites for maternity services in Bedford.
'We have done nearly everything that can be done to cut juniors' hours, given the consultants we have, and given that we cannot increase their numbers because of resource constraints. If hours are to be cut further . . . services will have to be provided from fewer, more concentrated sites,' she said. There were good reasons for having fewer, well-staffed units: 'There is a lot of evidence that where doctors do say 100 of a particular operation a year they become much more skilled . . . than if they only do two or three.'
Meanwhile, junior doctors' leaders are likely to consult members today on taking action over hours. Latest Department of Health figures show that last April 370 doctors in 11 of the 14 regions were still on contracts of more than 83 hours.Reuse content