opinion

The press is full of the woes of 350 doctors, qualified to fill consultant posts in obstetrics and gynaecology, who, poor dears, find there are no NHS posts available to them. Because of their - and their royal college's - errors, they are demanding that the NHS Executive forces trusts to hire them so they can practise their marvellous skills and keep themselves in the style which they lust after.

The government is unable to meet these unreasonable demands. The Department of Health is neither funded nor empowered to act as a ministry of social security which protects healthcare professionals who make bad career choices.

People in other sectors who are unfortunate enough to find their skills unwanted (for example, coal miners and skilled workers in manufacturing whose jobs have been systematically eradicated during the past two decades) have had minimal compensation.

Why should 350 would-be O&G consultants be treated differently? They and their college have wasted time and resources in producing people whose skills are apparently not needed in the NHS.

This waste is a product of the remarkable structure of workforce planning.

The royal colleges are not open to rigorous scrutiny, and they have a financial incentive (fee income) to examine as many people as possible. Surely they, as guardians of their incipient consultants, should plan the production of trainees more carefully? Even if trusts were very co- operative in such forecasting, there would be errors, with 'surpluses' and 'shortages'. The medical profession's response to the former is 'create new jobs now!' and to the latter, 'raise pay now'.

If planning is to be improve, it should not involve simply the extrapolation of trends and the use of 'desirable' doctor-population ratios which tend to be the norm in this area.

There have been considerable practice changes in obstetrics and gynaecology - for example, with increased use of specialist midwives and less unnecessary testing. Such changes are an essential part of workforce planning, have significant implications for estimating demand, and have traditionally been ignored.

The 'crisis' in obstetrics and gynaecology will be followed over time by a glut of anaesthetists and doctors in other specialties. Some argue that many of these gluts will be absorbed by the creation of a consultant- led service and the consequences of clinical governance which, by removing clinicians from direct patient care, creates a demand for more doctors.

Such optimism is uncosted, just like the Calman proposals for the replacement of trainees by fully qualified consultants. Such partisan advocacy will distort NHS finances and patient care. Dream on if you like, dear docs, but get real soon please, especially as government wheezes and reforms have consumed most of the growth money for the next three years.

The management of the workforce continues to be amateur and costly, dominated by the profession which fails to plan its human resources activity and then defends its progeny regardless of cost. In obstetrics and gynaecology, the normal

six-month period of job protection after qualification has been extended to 18 months, due to selfish college advocacy and the generosity of the taxpayer.

Better career guidance and workforce planning are needed. There is, according to the British Medical Association, a 'shortage' of 1,000 GPs. Surely the government should oblige the Royal College of General Practitioners to offer these unemployed O&G specialists fast-track training in general practice?

If such re-skilling is declined, the doctors should bear the economic consequences. If the RCGP cannot be flexible, its officials should be de-gonged and state subsidies withdrawn from its wine cellars.

The policy problem is that, once a doctor goes up one specialty avenue, it is difficult for them to change career and re-train. As ever, the obstacle to this is the structure of the royal colleges. Perhaps it is time to leave them in their listed edifices and transfer the control of a reformed and more flexible postgraduate training system to one national body?

The colleges control the curricula of specialisms, the duration of training, and the exams, which often include a failure rate of 50 per cent. The high failure rate indicates either that the training process is poor and/or the colleges are restricting entry to increase their public and private incomes.

To whom are the colleges accountable? The Charities Commission appears to be more concerned with their finances than whether they are meeting the terms of their charters. If the commission is so feeble in the execution of its value for money role, a new national body

co-ordinating the colleges, with considerable lay membership, may be appropriate.

After decades of resistance, the colleges are adopting reaccreditation as if they had invented it: there is nothing like the enthusiasm of the recent convert. The content and openness of these processes need to be as rigorous as they are democratic and open. Every effort should be made to ensure the good old boys of the medical mafia do not capture such a body.

The machinations of 350 would-be O&G consultants, their college and a supportive section of the media are as crazy as some episodes of Yes, Minister.

The government needs to translate this behaviour into a thorough reform of specialty workforce planning and the training and education of the medical profession.

Better national regulation of the colleges is an essential part of this - but unlikely, as the government is terrified of the boys from Jurassic Park. See cover feature,

pages 20-22.