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He added: “If you want to provide a hospital service 168 hours of the week, staffed to the same degree throughout, then we’re going to need more consultants going forward.”
This is beginning to be achieved, as the number of students training to become doctors has expanded over the last ten years, as medical schools were allowed to take on more pupils. However, this benefit is still some way off due to the lengthy training process needed to produce consultants.
Protecting research
Whilst seeking to promote consultant- led care, Prof Stephenson warned: “It’s very important if we move, as we wish to, towards a predominantly consultant- delivered service and a 7/7 hospital, that that’s not just achieved by foregoing teaching and training and research. These are absolutely crucial to discovering treatments for tomorrow’s patients and training tomorrow’s doctors. If we just squeeze those out, it would be very bad for the NHS and for UK patients.”
The expansion in numbers of doctors in training would allow these other vital components to be protected, whilst delivering more care at the front line, he added.
Simply rearranging doctors, leaving gaps in research and training, would be a “big mistake”, Prof Stephenson said. “The UK is at the forefront of biomedical research, we punch above our weight. That’s good for UK patients and good for UK plc and I don’t think the Government would want that threatened.
“Our training has a very high reputation around the world, people come both as undergraduates and as postgraduates to train in the UK medical system and again I don’t think we want to risk that.”
Towards self-sufficiency
The UK has historically recruited large numbers of doctors from overseas, since the beginning of the NHS. Prof Stephenson stated: “I think it’s wrong that the UK, as a developed first world country, should be relying on doctors from countries that need them. We should be self-sufficient.”
Due to the expansion of UK medical schools, the NHS currently graduates around 7,000 doctors per year. There has been a big increase in recent years, but the number of graduates is only now beginning to catch up with demand.
“When those young doctors complete their training and come out we will be much closer to being self-sufficient,” he said. “Because the NHS bears the cost of training those doctors after they graduate there’s a feeling that we can’t just have a free market. It’s always been a fixed number of places and the universities don’t have any leeway on that. If we haven’t been producing enough doctors, it’s been because the number of places have been kept down, rather than because too many people want to do it.”
Prof Stephenson suggested that this over- subscription could be as high as 2:1 people applying to places available.
Substituting doctors recruited from overseas for those trained in the UK means the NHS would have to pay the same amount, and although moving to a 7/7 service could be more costly to set-up, the benefits through productivity, fewer patients occupying hospital beds and fewer errors mean that it is “not at all clear that it’s more expensive”.
Evidence, not enforcement
The report combined evidence with opinion to provide compelling confirmation
that consultant-delivered care provides significant benefits, yet the AoMRC is clear that changing current policy was outside its remit. Pay and working conditions for consultants must therefore be considered as separate issues from the benefits that a consultant-led system could offer.
Prof Stephenson said: “We were very keen that this report wasn’t dismissed simply because it was seen as us arguing for doctors to be employed on certain conditions or rates of pay. We’re saying that we think there’s evidence that fully- trained doctors in the NHS will do better.
“But it’s not for us as an Academy of Medical Royal Colleges to say what their salaries should be or what their terms and conditions are. The proper bodies to decide that are the employers and the BMA as a trade union, but it’s certainly not for us to try to dictate the conditions they should be employed on.”
Various bodies are already working to consider the shape of future training. The Centre for Workforce Intelligence is looking at how to plan the workforce of the National Health Service, one of the largest employers in the world, and is taking evidence and data from the royal colleges to inform this.
Prof Stephenson concluded: “I think it’s very timely.
“With all the turbulence going on with the NHS reforms and the emphasis on local autonomy and FT status, we should try to review the evidence that supports patients seeing a fully-trained doctor.”
Prof Terence Stephenson
FOR MORE INFORMATION
tinyurl.com/AOMRC-Stephenson
national health executive Mar/Apr 12 | 27
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