Date Published: 1 April 2008

Patients deserve an NHS where care is led by consultants and GPs (BMA Scotland)

Health News from Scotland, United Kingdom (UK).

BMA Scotland today (Tuesday 1 April 2008) said that patients deserved an NHS which delivered safe, cost-effective care led by highly trained consultants and GPs. The BMA also warned against the creation of a ‘sub consultant’ grade which, it claimed, could be established as a ‘cheaper alternative’ to consultants.

Writing in response to the Scottish Government’s consultation on the Tooke Recommendations, which consider the reform of medical training under Modernising Medical Careers, the BMA highlights a number of factors which will have a direct impact on the medical workforce such as the reduction in the number of trainees, part-time working and the application of the 48 hour European Working Time Directive in 2009 to doctors in training. This means that more consultants and GPs will be needed to fill the consequent service gap left by fewer numbers of medical trainees.

Dr Peter Terry, chairman of the BMA in Scotland, said:

Accurate medical workforce planning is notoriously difficult to achieve and I welcome the Government’s efforts to involve organisations like the BMA in its discussions. However it is important that we plan a workforce that will deliver the best care for patients rather than one based on cost.

It is a common misconception that consultant or GP care is expensive, but if you look beyond the ‘unit cost’ of a consultation, it is clear that they deliver incredible value for money. The average cost of a GP consultation is around £25, considerably less than the comparator cost of other primary care consultations. Meanwhile, the salary cost of a consultant is offset by increased efficiency and a reduction in unnecessary investigations, unnecessary follow-up appointments and diminished admission rates.

A consultant-delivered service is also safer for patients. A constant theme of reports into adverse incidents is the recommendation for increased consultant input, especially in emergency cases.

One of the most worrying elements of the Tooke report and the Scottish Government’s consultation is the discussion around the creation of a ‘sub consultant’ grade of doctor. These are doctors who are considered to be trained to a level where they are judgement safe, but not to the level of our current consultants. This policy appears to be driven by a desire for a cheaper alternative to the consultant to fill the service gap. Our patients deserve better.

Specialist training should deliver doctors who are able to practice autonomously as consultants and GPs. If the training is not delivering doctors to that standard then rather than introduce a new grade of doctor, the standards of training should be reviewed.

In order to have a sensible debate on the medical workforce, it is time for the value of consultants and GPs and their integral role in the healthcare team to be recognised.

Source: British Medical Association.

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