Medicopolitical Digest

Specialist registrar grade will start on 1 DecemberPrimary care is unequally funded, claims reportJuniors given advice on lodging charges

BMJ 1995; 311 doi: (Published 04 November 1995) Cite this as: BMJ 1995;311:1233

Specialist registrar grade will start on 1 December

  1. Linda Beecham

    The health secretary has confirmed that the specialist registrar grade, which was recommended in the Calman report on specialist medical training, will be introduced on 1 December in general surgery and radiology. Mr Stephen Dorrell said in a written parliamentary answer last week that the main specialty commissioning date would be 1 April1996 and he envisaged that all specialties would have begun the transition process to the new grade by 1 April 1997. Detailed guidance will be issued shortly to regional postgraduate deans so that they can organise the changes in the training programmes.

    The minister reported that training standards would be overseen by the new specialist training authority of the royal colleges, which would be established shortly. As well as maintaining standards the authority will be responsible for awarding the new certificates of completion of specialist training.

    Obtaining the certificate will entitle the fully trained doctor to be admitted to the specialist register, which will be kept by the General Medical Council. There will be other routes to the specialist register for existing NHS consultants and for doctors who have followed an unconventional but acceptable training pathway. The GMC will continue to have the statutory duty of coordinating all stages of medical education. These proposals were contained in a consultation paper on the implementation of the Calman report issued in April (BMJ 1995;310:1156-7).

    Mr Dorrell said that there was no need to increase NHS funds to pay for the changes but he was considering the need for short term investment in additional training programmes to enable trusts to be able to recruit extra consultants.

    The proposed timetable for introducing the new grade has already been criticised by the BMA's Junior Doctors Committee, which believes that it should not be introduced hastily to meet the requirement of the doctors' and dentists' review body, which will be asked to price the new grade, or before agreement has been reached on terms and conditions of service (7 October, p 954).

    Primary care is unequally funded, claims report

    A weighted capitation formula for funding primary care would have a substantial effect on the distribution of general practitioners in England, according to a report from the Centre for Health Economics at the University of York. In Equity and Primary Care Karen Bloor and Alan Maynard conclude that the south, particularly the south west, would losewhile the north would gain resources. They say that such a solution would probably require radical changes in the general practitioner contract, perhaps replacing it with franchises for primary care which are let to multidisciplinary teams of providers. Any changes would have to be carefully evaluated to ensure that the general practitioners' gatekeeper role was maintained.

    Funding for hospital and community services has been varied by weighted capitation or population profile since the late 1970s under the Resource Allocation Working Party (RAWP) formula but this has not been the case for primary care and the paper's authors have applied a RAWP type formula to the primary care budget in England. By taking the age profiles of regional populations and adjusting resources according to average health expenditure by age group Bloor and Maynard show that the former South Western region would have lost 14% of its 1990-1 funding while the Northern region would have gained 9.6%. Varying resources by average use of health services by age group produced similar results and would have led to the loss of more than 300 general practitioners in the former South Western and North West Thames regions while the North Western would have gained 371 and the Northern 218.

    Equity in Primary Care is available from the Publications Office, Centre for Health Economics, University of York, York YO1 5DD, price pounds sterling5.00.

    Juniors given advice on lodging charges

    From April 1996 the rate for lodging charges for hospital junior doctors will be negotiated and agreed locally and the BMA's Junior Doctors Committee has prepared advice for doctors and local negotiating committees.

    There is no longer a centrally agreed upper limit for the charge set out in the national terms and conditions of service, and, although the JDC objected to this, it has secured several concessions which it hopes will ensure that junior doctors are not overcharged.

    Doctors who are compulsorily resident as a condition of employment are entitled to free accommodation so the arrangements apply only to juniors who are voluntarily resident. In future, lodging charges will be increased by the same percentage and at the same time as the increases in pay.

    The guidance explains the situations under which charges can be reduced--for example, for doctors who are voluntarily resident but required to stay overnight in hospital as part of an on call rota or partial shift system--and employers must abide by these provisions; gives advice on the standards of accommodation which doctors can expect; and sets out the conditions whereby charges can be increased. Junior doctors cannot be expected to pay backdated arrears.

    BMA members may obtain further information from local offices.

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