Shake-up in training for doctors promised: Changes will lead to more patients being seen by fully trained staff

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THE GOVERNMENT yesterday paved the way for a revolution in hospital staffing which should allow more patients to be seen by fully trained rather than junior doctors.

Dr Brian Mawhinney, the Minister for Health, announced that the Government is accepting 'in full' the recommendations of the report by Sir Kenneth Calman, the Chief Medical Officer, that junior doctors' training should be improved to allow them to reach consultant status in seven rather than the present nine, ten or even twelve years.

He also promised to honour next year's cut in junior doctors' hours while launching a wholesale review of how medical staffing policies are decided in the National Health Service.

The biggest ever shake up in doctors' training should see many more specialists treating patients as the ranks of Britain's 19,000 hospital consultants expand to provide a consultant-based service rather than one in which trainees are used as pairs of hands for many years. That will, however, mean 'fundamental changes' for consultants, who will have to do more on-call in teams.

But Dr Mawhinney warned that there would be 'no overall increase in NHS resources' to pay for the Calman report's recommendations. The service will have to 'absorb any additional costs within existing budgets', he said in a speech in London last night.

Instead of the 'rapid increase in consultant numbers' over five years recommended by Sir Kenneth, Dr Mawhinney implied a much slower rate of change. Moreover, ministers want to encourage NHS trusts to set their own terms and conditions for staff.

To a large measure the change in Britain's hospital staffing structure is being forced by European Union directives. But health authorities are beginning to insist in their contracts that patients are seen by consultants, and NHS trusts are being encouraged to expand consultant numbers by evidence that specialists incur fewer medical malpractice cases than juniors.

Dr Mawhinney scotched fears that the Government would abandon next year's planned cut in junior doctors' hours. 'It is simply not right that young doctors should be asked to work for extremely long hours. After all, it is not in the interests of patients,' he said.

Dr Mawhinney is also to examine how future decisions about medical staffing are reached as the NHS becomes more devolved.

The British Medical Association in principle welcomed Dr Mawhinney's moves on consultant numbers and junior hours, but said the package 'did not add up. Without more resources and central direction we do not see how these proposals can work.' Both needed more money and central direction, yet the Minister of Health seemed to be saying neither would happen.

NHS nurse numbers have fallen by more than 27,000 since 1989 while the annual pay bill for NHS managers' pay has trebled to pounds 530m, latest figures from the Department of Health show. Alan Milburn, Labour MP for Darlington, said the service was being strangled with 'expensive red tape'; an extra pounds 1.5bn has been spent on employing managers, administrators and clerical staff in the past four years.