Expansion depends on rigorous control of numbers in training and non-consultant career gradesBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6977.470 (Published 18 February 1995) Cite this as: BMJ 1995;310:470
EDITOR,—Stephen Brearley identifies the principal influences on the duration of training for junior doctors in Britain: the rate of entry to and exit from the training grades.1 He does not, however, consider fully how those rates may be varied and regulated.
The rate of outflow from the training grades is influenced mainly by the number of consultant posts. If purchasers wish to buy more or better quality services they must finance more consultant posts—unless, that is, trusts employ other doctors at lower salaries. Staff grade posts are subject to a regional and national ceiling of 10% of the number of consultants. Some trusts have appointed career grade or training grade doctors to non-existent grades or to unauthorised staff grade posts.
Where trusts comply with national staffing agreements the rate of increase in the number of consultants has been much greater than average. In the old East Anglian region, during the 12 months to September 1994, a 7.8% increase in consultant posts occurred. In this region the regional manpower committee has continued to meet and to regulate staff grade posts. A representative of trust management is a full member of the committee, and clinicians, including junior doctors, vigorously vet all applications for new posts, rejecting those where a consultant post would be appropriate. In other regions manpower committees have been disbanded and trusts ignore national staffing agreements.
There can be no restriction on doctors from the European Union coming to Britain to work, so the number of posts available at the preregistration house officer and senior house officer grades is in fact the main regulator of inflow to the training grades. Regional task forces and postgraduate deans have been given the responsibility for regulating numbers of senior house officers, with any increases to be a last resort after all other mechanisms to achieve the targets for hours under the new deal have been exhausted. Information from junior representatives on regional task forces suggests that in some regions deans or chairpeople of task forces have authorised senior house officer posts without consulting junior members of the task force and without insisting that all the targets under the new deal be met for the new posts. This has not been the case in East Anglia. Expansion in the number of consultants can be driven by a rigorous control on the number of posts in the training grades and non-consultant career grades. The proposed Advisory Group on Medical Education, Training, and Staffing must be matched by a subregional body with power to regulate numbers of non-consultant staff.