Speedy action - and more planning time - is needed if scheme is to recover

Published: 03/10/2002 Volume II2, No.5825 Page 17

Overseas clinical teams were, by now, supposed to be treating hundreds of patients and cutting waiting lists. But someone has clipped the flying doctors' wings (news, pages 4-5; focus, page 16). The question is: who?

Some say that the cause is opposition by consultants anxious to protect their private practices. Doctors' talk of maintaining standards and patient safety is, they say, a smoke screen. Others blame the NHS's lack of capacity to support the teams - pre-operative preparations and post-operative support. But the few places in which the schemes have been established have overcome these practical difficulties, so it would seem that they are not insurmountable.

Pragmatic observers shrug and point out that these things take time and that the Department of Health's original timetable was simply not realistic.

The successful schemes were based on pre-existing relationships in which the doctors concerned knew each other, and they were accepted locally before 'outsiders' were brought in. And they took longer to set up than the two months allowed to 'first movers'.

Privately, government sources are very bullish. They believe that the scheme is revealing the poor productivity of some British medics in a way that is hard to counter. 'We are learning an awful lot, ' one senior figure toldHSJ - a glint in his eye. The government is determined that the programme will continue, and pressure will be maintained on managers to get arrangements in place. Coming hard on the heels of similarly defiant noises about the proposed consultant contract, it is easy to feel that the government now feels the time is right to challenge the medical establishment over productivity.

But action on overseas teams is needed - and fast - if the NHS is to maintain international credibility. One company has already pulled out of talks and others may follow. Several of those invited to bid for work say they have put in time, effort and money and then heard nothing. Health secretary Alan Milburn has made it clear that he wants overseas providers to feel confident that working for the NHS is a sustainable and attractive option. On that front, there is much work to do. l