Just what the junior doctor ordered: The 80-hour work week is finally about to end, thanks to the EC, says Judy Jones

HARD-PRESSED junior hospital doctors, working an 80-hour week often unsupervised, are about to receive a long-overdue boost to their morale. The biggest-ever shake-up of medical training is on the horizon, bringing shorter, more intensive training programmes and a more civilised working regime.

The powerful figures that have rallied to the cause of Britain's 22,000 junior doctors and provided the catalyst for this overhaul have been not government ministers, or even professional leaders, but civil servants from the internal market directorate of the European Commission. Last spring, the Commission threatened legal action against the UK unless it took urgent steps to implement directives on specialist medical training and qualification that should have come into force in 1977.

Once described as the modern equivalents of Victorian child chimney sweeps, Britain's junior hospital doctors have always done the bulk of routine medical treatment in NHS hospitals day and night. Many have horror stories about serious, potentially fatal, mistakes or near-misses, made while coping alone and exhausted on a ward late at night and their consultant bosses were tucked up in bed.

Junior doctors can spend years marooned in training posts, professionally frustrated not by lack of competence, ability and knowledge but by the career bottlenecks that block promotion from the middle to the upper tiers of medicine.

No one with a shred of common sense would design such an inefficient system for training and employing doctors. Under the auspices of the central pillars of the medical establishment, the medical Royal Colleges - in essence, the consultants' guilds - and the General Medical Council, it has simply evolved. Juniors who complain to their consultants about the excruciatingly long hours, the clerical work, the endless list of minor tasks are still told: 'We did it, so can you.'

The traditional image of the all-powerful hospital consultant, famously embodied by James Robertson Justice as Sir Lancelot Spratt in Doctor in the House and other films of the Sixties, surrounded by his retinue of sycophantic juniors, has been scarcely dented under the Tories' NHS 'reforms'. Certainly, senior doctors have been forced to cede more power to the new breed of business-orientated NHS managers, but little has filtered down to their juniors.

Virginia Bottomley, Secretary of State for Health, whose daughter is a medical student, has taken the issue of long hours to heart and pledged more than pounds 37m over the past two years to employ more consultants and so help shorten the juniors' working week. But progress has been painfully slow. The comprehensive powers that the profession has to regulate itself, and the overwhelmingly conservative instincts of most of those who run it, combined to ensure the triumph of inertia over change.

Ever mindful of the public's continuing vulnerability to the 'doctor knows best' philosophy, so skilfully exploited by the British Medical Association, successive governments have always thought twice about picking a fight with the medical establishment. True, doctors fought the NHS tooth and nail in 1990, and lost. But their privileges and the way the profession is policed and structured have always been more the domain of doctors than of politicians.

The intervention of the European Commission was triggered by complaints from doctors trained in the member states of continental Europe who were trying to establish themselves in the UK. One was Uccio Querci della Rovere, an Italian surgeon who came to Britain in the late Seventies. Although fully trained, and armed with his EC Certificate of Completion of Specialist Training, Dr Querci found his qualifications were worthless. The British medical training authorities refused to recognise his EC certificate. Despite having worked in Italy in posts comparable to that of an NHS consultant, he had to start at the bottom of the medical career ladder in this country.

The certification scheme was intended to foster the free movement of professionals across EC borders. But the British medical training bodies virtually ignored the new EC system, introduced in 1977, and continued with their own scheme of specialist accreditation awarded by the medical Royal Colleges. Condemned by junior doctors and other critics as little more than a work permit, accreditation - not the EC certificate - remained the 'passport' to most consultant posts. With few exceptions, it is also a prerequisite for reimbursement by private medical insurers.

Last May, the EC internal market directorate complained in a letter to the Department of Health, leaked to the Independent, that the UK's failure to implement the 1977 directives and the EC certification scheme was unlawful and discriminatory. The letter brought an embarrassed silence from the General Medical Council, which is supposed to regulate the profession. Kenneth Calman, the Government's chief medical officer, was ordered to convene a working party to review the creaking legal and professional machinery underpinning training and to recommend radical changes.

The working party report, to be published by the Department of Health by the end of this week, will recommend urgent legislation to enshrine the Certificate of Completion of Specialist Training in UK law. This certificate will replace accreditation as the benchmark for identifying trained specialists. More important for patients, it will recommend better-supervised, shorter and more structured training programmes.

From summer 1995, training periods will be halved to between five and seven years. Registrar and senior registrar levels will be merged into a single training grade, and yet more consultant posts will be created. Instead of waiting until they are on the brink of middle age before being considered eligible for a consultant's job, today's medical students can expect to complete their training in their early thirties. One of the most radical suggestions for redressing the power balance between consultant and junior, however - the abolition of rank of consultant in favour of the less grand 'specialist' - has not been adopted.

With juniors working fewer hours, under more supervision, consultants may find themselves working longer and harder. Many work long and hard now, but they probably have more scope than most professional groups to dictate their own schedules and terms.

The outcome of the battle over specialist training - held largely behind closed doors - will go more than half-way to meet the juniors' concerns, if the money is found to implement it. Some have estimated that the shake-up could cost pounds 200m, although sources at the department believe it need not cost anything like as much.

The saga will also whet the appetite of those inside and outside government who have sought for years to chip away at the consultants' power bases. The much-criticised pounds 113m merit award scheme, enabling obscure NHS committees dominated by doctors to award 'bonuses' of up to pounds 47,000 a year to individual consultants, could be the next target in their sights.

(Photograph omitted)