An increase in the number of consultants, both absolutely and as a proportion of all hospital doctors, has been the central recommendation of every investigation into medical manpower and training since the early 1970s. Yet, the effect of all of these reports on consultant expansion over the past 25 years has been imperceptible. Despite repeated calls for a growth rate of 4% a year the actual rate has remained close to 2%, almost exactly paralleling growth in the overall number of doctors working in the NHS. The latest figures from the health departments show no change or possibly a slight worsening, with an increase of only 1.9% in the number of consultants in 1992-3. In the same year the number of senior registrars increased by 4.2% and senior house officers by 5%. Appointments to the staff grade increased by 50%.

Quite apart from the need to ensure a smooth progression of young doctors through postgraduate training, ensuring the efficient use of their skills, the demand for consultant labour is growing inexorably. The number of patients treated in NHS hospitals continues to increase. The patient's charter, numerous local additions to it, and the …