Letter: What the health service can afford

Sir: I was surprised to read Gerald de Lacey's attack (letter, 27 June) on the BMA for being frank about the reasons why trainee surgeons do not always get the supervision they should. In last week's British Medical Journal, the medical director of Dr de Lacey's own hospital, Northwick Park, chronicles the impossibility of maintaining services and standards with the current level of resources.

Doctors have a responsibility to describe the reality of hospital life, however unpalatable the facts may be. That does not mean that we condone them. The internal market is responsible for the pressures which lead NHS trusts to cut corners and reduce standards, which is why the BMA opposed it and why we shall be heartily pleased to see it dismantled.

Under the current contracting arrangements purchasers have proved unwilling to recognise anything other than clinical work. They have refused to meet the costs of training junior doctors. Since trusts have been required to increase their activity by 3 per cent each year without additional resources, it has inevitably meant that some aspects of training have been sacrificed to the demand for ever greater throughput.

The BMA is in no doubt that junior doctors are not in post primarily to meet service needs but to learn. In our submissions to government on a replacement for the internal market, we will be lobbying hard for a structure which recognises that hospitals have to provide training for junior doctors and other professionals as well as having to treat patients.

J N JOHNSON MD FRCS

Chairman, Central Consultants and Specialists Committee

British Medical Association

London WC1