Streamlining of doctors' training moves closer

First Edition

The Government is considering legislation to curb restrictive practices in the medical profession that should have been banned under EC directives 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 current 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 10-15 years in 'training' - virtually every hospital doctor below the grade of consultant is considered to be a junior - doctors would take 6-8 years to achieve independent specialist status. Some sources believe it could cost up to 200m to implement the shake-up.

NHS managers, 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 an average 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, the UK retained its own system.

UK 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 that the UK is in breach of the medical training directives in correspondence with the EC Directorate for the Internal Market and Industrial Affairs. 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 identify fully trained specialists, the GMC used 'T' indicators in the Medical Register for the first time only last year - but only against the names of doctors with UK accreditation.

In the document submitted to the working party, the General Medical Council accepts specialist training can be completed earlier without lowering standards.