Doctors may be forced to cede professional ground to nurses and other groups of staff as part of the price of a 20 per cent expansion in medical student numbers, the government has hinted.
Announcing an increase of 1,000 medical school places to be phased in by 2005, health secretary Frank Dobson said last week that the move would 'give the NHS the doctors it needs'.
But he warned: 'In parallel with the phased increase, the government will seek to engage the medical profession and others in discussions about the future shape of the healthcare workforce.'
These discussions would include 'such issues as productivity and skill substitution'.
Mr Dobson's announcement meets the main recommendation of the Medical Workforce Standing Advisory Committee, which predicted last November that future demand for doctors would rise by between 1.4 and 2 per cent a year.
It said an increase of 1,000 places 'would not produce a domestic over- supply by the year 2020 under any realistic scenario', but advised that the NHS should move towards 'self reliance'.
At present, 24 per cent of doctors are not UK-trained, a proportion that has risen in recent years and looks set to rise further as the NHS recruits to fill 7,000 new medical posts also announced by Mr Dobson last week.
Doctors' leaders welcomed the expansion in medical student numbers - with the British Medical Association calling for a new medical school to be set up.
Chair of the BMA junior doctors' committee Mark Porter said: 'Currently more than half our newly qualified doctors are from overseas. It seems morally wrong to continue to poach them from developing countries.'
Colin Smith, chair of the BMA medical academics' committee, said Mr Dobson's decision to phase expansion 'reflects the fact that the government will need to find substantial new resources to provide high-quality education'.
Daniel Atkinson, chair of the BMA medical students' committee, added that 'current schools are full to capacity and there is a limit to the number of students any patient can be expected to see'.
The Department of Health said most extra student places were expected to be in England and Wales, with little change in Scotland and Northern Ireland.
Criteria for deciding which institutions will benefit will include their relative costs, the current geographical spread of places, and quality.