Sir: Criticism has been levelled at the 'medical establishment' because training of doctors and their specialist registration in the UK appears to be out of step with EC regulations. Your health services correspondent, Judy Jones, in reporting the establishment of a working party by the Government's Chief Medical Officer to report on specialist training in relation to EC requirements ('Doctors' protests mark start of training review', 1 September), reiterates several errors of fact in her description of the arrangements.

It is true that EC specialist certificates are granted for minimal levels of specialist training; doctors in the UK have been able to apply for these since 1977, although few have done so. Those certificates allow doctors in Europe to be paid at specialist rates by the social security systems in EC countries.

It is also true that 'accreditation' offered by British Royal Colleges to trainees who have been through recognised training programmes has generally been given after a longer period than that required for EC certification.

It was, of course, designed for a different purpose; to indicate the sort of training recommended for consultant practice in the NHS. It is not true, however, to state that few doctors are promoted to consultant positions without 'accreditation'. About one third of recently appointed consultant physicians were not 'accredited' at the time they were appointed.

It is the advisory appointments committees, set up locally by employing health authorities, which determine whether applicants have been suitably trained to take on the particular clinical work that is required by that particular hospital or authority.

The accreditation system has been used as a convenient mechanism simply to convey information about the type of training individuals have received and which has been designed specifically for the type of medical care provided in NHS hospitals, but it is not obligatory nor necessary for appointment to consultant posts.

The length of recommended training periods from registration as a doctor varies between specialties but is up to nine years including general training. A review of training programmes by the Joint Committee on Higher Medical Training during the last year or so will result in a reduction in this time. It should be made clear that the 10 to 15 years quoted in your column is the time some individuals may have to wait before a suitable consultant post becomes available to them.

In practice, it is the availability of vacancies, not the recommended length of training programmes, which determines the time trainees have to wait. There is a considerable need to increase the numbers of consultant posts in many disciplines to improve care, to reduce waiting lists and to develop new services. The royal colleges have pressed hard for an increase in consultant posts and this, more than any proposals about length of training programmes, would reduce the time young doctors have to wait to obtain such posts.

Clearly there is a continuing need to examine training programmes in the UK, in the light not only of EC regulations but also, and more importantly, in the light of the health-care needs of our patients. This the colleges are continuing to do, but it is important for all concerned to be aware of the clear facts which should inform the debate.

Yours sincerely

L. A. TURNBERG

President

Royal College of Physicians

London, NW1