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Thursday, March 4, 1999 Published at 18:10 GMT


NHS may squeeze out essential specialists

Not all doctors who qualify can find a consultant job

Up to 350 fully qualified obstetricians and gynaecologists could be made redundant due to a lack of jobs, according to a report.

The announcement comes as two royal colleges prepare to put forward their recommendations to improve levels of care in maternity units.

They believe they can cut the number of deaths in otherwise healthy babies by a half.

Central to their proposals is the the creation of another 215 consultant posts.

Why the problem exists

However, a report by the British Medical Association (BMA) says existing jobs are under threat.

It says up to 350 fully-qualified obstetricians and gynaecologists will have to leave the profession if the government does not act soon.

The BMA believes there are too many trainees coming through for the 50 or so new consultant posts available each year.

The problem centres on a bottleneck when doctors complete their specialist training.

Professor James Drife of the RCOG explains the root of the problem
Each year the Royal College of Obstetricians and Gynaecologists (RCOG) allocates a certain number of training places using projections of manpower needs, based on previous years' requirements.

The trainees then spend at least five years learning their specialty at the expense of the NHS.

At the end of their training they get a certificate of completion of specialist training (CCST), which allows them to compete for specialist posts.

However, the expansion of the consultant grade projected a few years back has not materialised - meaning when doctors get their CCST there are no consultant posts available.

Those doctors who do not get the few jobs going are left to languish in limbo or search around for alternative careers.

Scale of the surplus

The BMA estimates that by May 2001 there will be 500 fully qualified obstetricians and gynaecologists competing for 50 posts a year.

[ image: Doctors could have to start training again]
Doctors could have to start training again
The end result will be 350 redundancies, forcing doctors to either retrain - costing the NHS more money - or leave the NHS - wasting the earlier investment.

Dr Fiona Kew is joint deputy chair of the BMA's junior doctors committee, which produced the report.

She said: "This is a quite scandalous situation at a time when there is a problem with the quality of maternity services in the NHS and a desperate need for more consultants in obstetrics and gynaecology.

"These doctors have been trained by the NHS at a considerable public cost and now they are being abandoned by the NHS."

Professor James Drife, junior vice-president of the RCOG, said it was an alarming situation.

"We are very concerned about the doctors and for a long time we have seen the problem coming and we've been pointing out to the NHS that the problem's there."

He said it was an awful situation for doctors fresh out of training.

"The prospect (of retraining) is an absolute nightmare because every aspect of medicine now requires specialist training," he said.

There are other options such as specialising further in fertility or cancer medicine available, he added.

Improving standards of care

The RCOG, in association with the Royal College of Midwives, is due to publish staffing guidelines for maternity units on Tuesday.

It comes in response to a report two years ago that claimed babies were dying from inadequate care, Professor Drife said.

The problems identified included communication failures, inadequate training and failure to spot problems when doctors were just starting.

Professor Drife said: "The number of deaths of babies that are otherwise healthy but die during birth is about 600, of which half could be saved by better care we believe."

The new staffing report is the RCOG's response, he said, and will include recommendations to the government.

Chief among these will be that a consultant should be present in all but the smallest labour units at all times during the normal working day.

This will entail the creation of at least 215 new posts, Professor Drife said.

"Our primary concern is to provide the standard of care a woman can rightfully expect from the NHS," he said, "but we hope that this, along with natural wastage, will take up the slack," he said.

A report by the Commons Health Committee this week also signalled a need for an expansion in consultant posts to accompany an increase in medical training places.

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