Published: 06/05/2004, Volume II4, No. 5904 Page 32 33

Ambitious targets for consultant recruitment have been amended, but the NHS denies that the goalposts have been shifted. Sally Mesner reports

The number of consultants working in Britain's hospitals is set to fall short of NHS targets by up to 1,500 if current levels of growth do not show a marked acceleration (news, page 9, 22 April).

NHS human resources director Andrew Foster admits that if the figures continued to increase at the current rate, there would be a shortfall of 1,000-1,500 consultants by the end of 2004.

The NHS plan set a deadline for consultant numbers to be increased by 30 per cent by the end of 2004, compared with the 1999 baseline. The priorities and planning framework, which sets out the government's programme for a rapid expansion of the NHS workforce, states that by 2004, compared with 1999, there should be 7,500 more consultants and 2,000 more GPs.

But Department of Health staff census figures published in March showed that only 72 per cent of the target number of consultants had been achieved - an increase of 5,429 - by September last year.

However a new DoH report, NHS Workforce: consultants and GPs at 31 December 2003, which incorporates new growth figures between September and December last year, shows a 6.5 per cent improvement (467 consultants).

'A lot of people have been putting in a huge effort to boost recruitment, ' says Mr Foster.

'What we do not know [yet] is how much progress We have made in the last six months of the financial year.'

Hospital Consultants and Specialists Association northern regional manager Dr Joe Chattin says the fact that the government is issuing another report on staffing targets only months after the last one is a symptom of the 'culture of target achievement'.

'The government wants to make a difference and everyone is behind that 110 per cent, but the system can't produce consultants at the speed it requires, ' he says. 'It is scrambling to deliver the news, trying to wring as much good news from its reports as it can.'

He believes that the target for consultant numbers was overambitious. 'Hitting the target of 30 per cent growth by 2012 rather than 2004 would be more realistic, ' he says. 'University places are not sufficient to meet the target, and we can't homegrow that number of consultants in the time set.'

He also says the problem had been exacerbated by the termination of the European specialist medical qualifications order's transitional arrangements for providing intermediary training. The scheme was set up to help experienced doctors, largely from overseas, get the qualifications they need to become consultants, but was terminated in 1999 because the existing legislation only gave a limited timescale for doctors to apply.

'The government promised to look again at this legislation and reopen the scheme, but so far it has not fulfilled that promise, ' says Dr Chattin.

Just a year after the NHS plan set the target of 2,000 more GPs and 7,500 more consultants by 2004, a new figure was set in Labour's 2001manifesto. This sets a significantly different target: 10,000 more doctors (consultants and GPs combined) by 2005 and 15,000 by 2008.

Mr Foster says this means that the NHS plan target hasn't been replaced, just reviewed.

'This is not a case of shifting the goalposts; It is shifting forward the timeframe, ' he says.

He adds that the perceived shortage of consultants was not as bad as it seemed.

'We now know the way that the target was originally constructed was not as helpful as it could have been, ' he says. 'The objective is to increase capacity within the NHS.Waiting lists are coming down quite dramatically and we are getting more people out of hospitals and into primary care.

You have got to look at the context of the whole service, which is expanding rapidly.

'At the time of the NHS plan, waiting lists for operations were to be reduced by 18 months. That was achieved. Now, the target we have for the end of March is for nobody to be waiting for more than nine months. I am pretty confident we will hit that mark.

That is quite an improvement.'

But BMA international chair and central consultants and specialists committee member Dr Ed Borman alleges that the new 2005 target does not just shift the goalposts, but relocates them entirely. 'The government would do well to stop making promises like this that are unhelpful and meaningless, ' he says.

'We need to de-politicise the NHS in a big way and get a clear message out to the service that increasing consultant numbers is a priority. The new target would seem to be a climbdown.'

Asked why the NHS was failing to reach its target for consultant recruitment, Dr Borman answers: 'The NHS has been understaffed for many years.

There is going to be a lag period from deciding to increase staff numbers to implementation. It takes a minimum of 13 years to take someone through medical school and then to consultant level.You can't turn on a tap overnight.We will not see an improvement until 2010.'

He continues: 'I think the 2004 target was a good aspirational goal to go for, but the government is going to have to deal with the difference between aspiration and reality. Some things you can't achieve even if you throw money at the problem.'

According to Dr Borman, the new GP and consultant contracts will exacerbate the shortfall enormously.

'Consultants are working beyond 44 hours on average at the moment. If their hours are reduced, as the contracts suggest, someone, somehow has got to make up the shortfall, ' he says. 'In terms of waiting-time performance and getting procedures done it may well have a significant impact, losing many hours of consultant work.'

Dr Chattin says the new GP contracts, which came into force this month, will tempt juniors away. 'The 'golden hellos' that GP contracts offer will divert doctors away from becoming consultants, ' he explains. 'And GPs will no longer be responsible for out-of-hours work, whereas consultants will always be on call.'

According to Dr Borman, the UK needs to step up international recruitment in the short term to boost consultant numbers. 'We need to make it attractive for people to come to work here, ' he argues. 'But we also need to stop people leaving. Lots of people are leaving the UK for North America and Australasia because they've had enough of the NHS.'

Dr Chattin adds that setting such ambitious targets does not work. 'They are trying to rush things, ' he says. 'Measures such as foreshortening postgraduate training to produce consultants more quickly are false economies that will ultimately lead to a less capable workforce.

'We can only grow our workforce in a prudent way. That means working on making careers in medicine more attractive to school-leavers and, ultimately, accepting that we may just have to wait.'