The shortage of doctors and locums is affecting care and causing immense stress to remaining staff. As it is managed at department level, the scale of the problem may not be fully recognised, writes Richard Marks

The problem is the design of the Modernising Medical Careers structure for doctors, which has no mechanism for replacing staff between annual recruitment cycles.

The shortage has been compounded by the synchronisation of end-dates of hospital jobs. This has effectively abolished a labour pool of doctors between jobs.

A further complication is the rigid distinction between "training" and "non-training" jobs. Many junior doctors are unwilling to take a non-training job because of the perceived stigma attached to it.

So the announcement by the Department of Health this week that in future there will be multiple recruitments over the year is welcome. There is also a need for jobs that run for periods other than 12 months. Six- and 18-month jobs have advantages at different stages.

In the short term more doctors need to be recruited from abroad. Unfortunately Canada, New Zealand, Australia and the US are all facing a shortage of doctors so are likely to be chasing the same potential doctors. We need to look at ways of competing with them.

Dr Richard Marks, RemedyUK