The government's overhaul of medical training is likely to leave trusts as cash-strapped as the consultant contract, according to a leading London teaching hospital chief executive.

Providing cover for consultant trainers and trainees' time out of trusts is just one of the major indirect costs trusts will face when they start implementing the Modernising Medical Careers programme, Guys and St Thomas' foundation trust chief executive Sir Jonathan Michael warned.

MMC is a radical reform of postgraduate medical education that will see doctors undergo a two-year generalist foundation programme before entering specialist practice. The first foundation programmes are due to start in August.

Speaking at an NHS Confederation annual conference session on the doctors' schooling reform, Sir Jonathan said that the Department of Health had not learned from the lessons of the consultant contract and were being unrealistic once again about implementation costs.

'There is an assumption at the highest level that somehow this will be largely cost neutral. That is unlikely. What is more likely is we have something like the consultant contract where the financial assumptions are borne out to be optimistic, ' he said.

On the same theme, the head of the Modernising Medical Careers programme, Professor Alan Crockard, said he 'was aware of the possible destabilising effect' on district general hospitals and asked chief executives to 'let them know' what you 'want in your DGH so we can work it into the planning for the curriculum'.

Sir Jonathan also called on chief executives to engage with the process that had hitherto largely been confined to a technical discussion among medical professions.

'Are we ready? Have the NHS services and providers properly engaged? We, as organisations, cannot sit back and ignore this. What is being proposed is very logical and necessary, and my concern for the quality of training of staff is the same as it is for the quality of patient care they are providing, ' he said.

DoH director of workforce Andrew Foster told HSJ that his team had modelled the costs thoroughly with the postgraduate deaneries and had made money available on that basis. However, he added that if anyone else 'has come up with some different figures I would be very interested to see them'.