Leading Article: The right medicine for better doctors

BRITAIN's doctors enjoy many privileges. They are respected as pillars of their profession and society. They are trusted to regulate themselves and are well rewarded by the National Health Service and with the perks of private practice. However, there is a cancer in this august body, which yesterday prompted a team led by Kenneth Calman, the Government's chief medical officer, to demand a complete overhaul of medical training.

Sir Kenneth's recommendations are long overdue, for the top of the profession has become tarnished by old boy networks and restrictive practices. They make it particularly difficult for women and foreign-born doctors to advance their hospital careers. Meanwhile, the NHS has been characterised by hospitals staffed by juniors who are overworked and unable to serve patients properly. Many people can recall being treated in a casualty department by a harried, tired, unsupervised junior.

This is a system from which only consultants, predominantly white and male, have benefited. By keeping their numbers low in comparison to other European countries, they have enjoyed the cream of private practice and of NHS 'merit money'. Instead of challenging these injustices and resulting poor practice, their leadership of weighty regulatory bodies has often been characterised by inertia.

Successive governments colluded in this potentially corrupting state of affairs, fearful to offend the medical establishment. The arrangement also saved them money. Fewer consultants meant a lower wage bill. So politicians publicly accepted that 'doctor knows best', even as they transformed the NHS. Only latterly has there been any genuine effort to reduce juniors' hours, thanks to Virginia Bottomley, first as Health minister and now as Secretary of State for Health.

Yesterday's report called for the biggest-ever shake-up of medical training. Its recommendations would throw out the old restrictive practices and open the door to new consultants, with standardised requirements acceptable throughout the European Community. Postgraduate training periods would be halved to seven years and sub-consultant grades would be merged.

However, the impetus for these changes did not come initially from the Government. Nor did the British Medical Association or the General Medical Council lead the assault. Rather, the edifice crumbled, largely thanks to attacks from Professor Uccio Querci della Rovere, an Italian surgeon who challenged British refusal to recognise his specialist qualifications. The European Commission subsequently warned the Department of Health that it had unlawfully discriminated against foreign-born doctors since 1977 by not recognising qualifications accepted everywhere else in the EC. With a gun against its head, the Government acted.

The moral is that some doctors are selfish, kicking away the ladder their juniors might climb. Governments have failed to ensure that the NHS has enough qualified staff. The profession must re-examine its leadership if patients are to believe doctor knows best.