Hospital doctors face training shake-up

The Government is considering legislation to curb restrictive practices in the medical profession that should have been banned under EC directives issued in the mid-1970s.

A Department of Health working party is preparing to recommend an overhaul of specialist medical training and certification to widen the pool of doctors who can practice as consultants.

Dr Kenneth Calman, the Government's chief medical officer, is understood to have concluded that legislation is needed as part of the shake-up to meet EC complaints that British practices are 'unlawful and discriminatory'.

Doctors from other EC countries find their qualifications are not accepted in Britain, and many UK doctors' careers stagnate because they are refused the necessary accreditation.

Documents obtained by the Independent show the General Medical Council and the medical royal colleges have conceded the case for shorter, more intensive and better-supervised periods of training for junior doctors.

Instead of spending between 10 and 15 years in 'training' - virtually every hospital doctor below the grade of consultant is considered to be a junior - doctors would take six to eight years to achieve independent specialist status. Some sources believe it could cost up to pounds 200m to implement the shake-up. Managers in the National Health Service, as well as junior doctors, are anxious to see more streamlined training and a more even spread of the workload among hospital doctors.

The bulk of hospital treatment is carried out by juniors working on average a 75-hour week, often without adequate supervision.

In a submission to the Calman inquiry this month, the General Medical Council accepts that the two-tier system of specialist qualifications should be abandoned.

Despite the advent of EC specialist certification in 1977, intended to foster the free movement of trained doctors across member state boundaries, Britain retained its own system.

Some doctors who trained and qualified in other EC countries have had to start their careers from scratch on moving to Britain.

British accreditation is, in effect, a pre-requisite for appointment to most hospital consultant posts and, in the experience of most doctors seeking to work in the UK outside the NHS, to private practice. Accreditation has been criticised by junior doctors for the complex and apparently arbitrary criteria used to award it.

After the Independent disclosed the European Commission's letter of complaint against the UK last spring, the Department of Health established the training review under Dr Calman's leadership.

British civil servants in Brussels have admitted, in correspondence with the EC Directorate for the Internal Market and Industrial Affairs, that the UK is in breach of the medical training directives.

At least three doctors have legal actions pending against the Department of Health and the medical training bodies, in which they are seeking damages over the non- recognition of EC certificates.

In its submission to the working party, the GMC accepts that the EC Certificate of Completion of Specialist Training must become the benchmark for judging a doctor's suitability for independent specialist practice.

Doctors awarded the CCST would be marked out in the medical register with the letter 'T' by their names.

Under pressure from the Office of Fair Trading to help the public to identify fully trained specialists, the GMC used 'T' indicators in the Medical Register for the first time last year - but only against the names of doctors with UK

accreditation.

In the document submitted to the working party, the GMC accepts that specialist training can be completed earlier without lowering standards.