It is desirable that trained specialists provide as high a proportion of medical care in hospital as can be arranged. Training doctors well takes less time than training them badly. Once well trained, they can work as autonomous specialists.
One of the perverse incentives of the past was that it was cheaper to load duties on to junior doctors than to employ other people to do them. This is now vanishing, and medical training and patient care are improving as a result.
The massive expansion of the hospital management structure, dealing almost solely with the alleged internal market, is also funded out of the total NHS coffers. It is a better target for redistribution than the changes in medical staffing and training which are necessary to respond to changes in society and medicine.
Dr ADRIAN MIDGLEY
Chairman, Exeter Division
British Medical Association