letters

I am amazed that you publish Alan Maynard's fiction about medical staffing - in this case, the claimed over-supply of obstetricians and gynaecologists (Looking askance, 11 March). His claim that over-supply is the responsibility of an unaccountable royal college getting its sums wrong is nonsense.

Five to six years ago, under a different government and a different management regime, the college was asked to produce applicants for posts that carried far greater obstetric responsibilities at consultant level. Six years later, these trainees are on the market but the government has changed, policy has changed and health authorities and trusts are not minded to put their money into this improvement in the quality of service after all - hardly the college's fault.

Until March 1997, all royal college manpower planning had to recognise that there had been five years of consistent consultant expansion in excess of 5 per cent. In the first year of the present government this expansion rate fell to 1.7 per cent - but Professor Maynard thinks that the royal colleges should possess a crystal ball.

The past few years have seen tremendous improvements in the quality and delivery of gynaecology services, with far less dependence on inpatient services and a substantial shift away from theatres towards outpatient departments. This saves trusts' money but adds enormously to the pressure of work and the demand on consultants in their outpatient sessions. Trusts are ignoring the outpatient pressure, looking at the lighter pressure of demand on theatre services and failing to recognise the pressure in consultant staffing plans. They are simply relying on existing consultants to take on more outpatient commitment, but there is a limit to what can be done without some increase in staffing.

Finally, and fortuitously, we have the 48-hour working-time directive, soon to be implemented for career-grade doctors. This will require the 128 hours spent living and sleeping in to cover the obstetric service to be counted as working time. The higher cost, particularly severe in obstetrics, will put a greater call on consultant time and have a beneficial effect on consultant appointments (whenever the directive begins to operate), due to the current major fall in trainees.

What Professor Maynard should remember is that it takes a minimum eight to nine years to train junior doctors after graduation, and that for most of that time there is year-by-year pre-programmed training required by the Calman reforms. The colleges cannot be expected to predict massive swings in government policy as the result of a change of government. Instead Professor Maynard should show some sympathy for those who complete their training and find themselves the innocent victims of politicians' whims.

Professor Roger Dyson

Director

Clinical management unit

Keele University