There is currently great confusion among hospital doctors as to how best to respond to the many changes in employment conditions that are affecting our working conditions

Thank you for publishing the draft document that gives important information on the possible future career structure for hospital doctors within the NHS. From this draft I learn that the NHS is considering creating a 'sub-consultant' career grade hospital doctor; it was my impression that previously this has been denied by the Department of Health.

Certainly there is currently great confusion among hospital doctors as to how best to respond to the many changes in employment conditions that are affecting our working conditions. The European Working Time Directive (EWTD) and the new consultant contract are reducing the hours worked by both senior and junior hospital doctors. The requirements of the new training scheme for junior hospital doctors, Modernising Medical Careers (MMC), will also cause a reduction in the service commitments this important group of doctors will undertake.

The overall result of these changes is that there is a large shortfall of work that must be filled by the hospital doctor workforce. Some of this shortfall maybe filled by reconfiguring services between hospitals to achieve more efficient ways of working or by employing non-medical staff to undertake roles that have traditionally been performed by doctors. However, it is still likely that hospitals will need to recruit more doctors to fill this shortfall, particularly to provide out of hours cover for the acute medical specialties.

The DoH must have a clear strategy for this shortfall as hospitals need to start recruiting over the next 6-24 months to meet the deadlines of August 2007 for MMC and August 2009 for the EWTD.

A fundamental aim of MMC was to ensure that doctors working within the NHS are trained to a sufficiently high standard to ensure high quality medical care within the NHS. MMC is certainly a very ambitious programme to restructure postgraduate medical education; for a hospital doctor successful completion of a specialty training programme leads to the award of a Certificate of Completion of Training (CCT).

For most of the hospital specialties this training programme will last at least seven years (foundation and run through training) which is longer than comparable specialty training programmes in most European countries. Consequently doctors completing CCT are highly qualified professionals who are well trained and can fulfil the aspirations of producing high quality medical care within the NHS.

As the DoH has previously denied that a sub-consultant grade of doctor will be created the assumption has been that the award of CCT for a hospital doctor equates to the career training necessary to work as a consultant within the NHS. If this is not the case and the career structure of hospital doctors is so fundamentally altered by the DoH this will question the whole basis of both MMC and also the new consultant contract. The aspirations of a whole cohort of hospital doctors currently in specialty training programmes will be severely dented.

The DoH needs to clarify this issue quickly so hospitals can continue to plan ahead for the challenges of the EWTD and MMC.

Dr Darell Tupper-Carey, consultant anaesthetist