Medical schools and the National Health Service are drifting apart and need to re-examine how they work together, says the latest in a long line of reports on their relationship.
University Clinical Partnership: A New Framework for NHS/University Relations , from the Nuffield Trust, argues that university clinical centres should be set up to bring together education, service and research.
John Wyn Owen, secretary of the trust, says: "This tripartite mission has been described as a three-legged stool that falls over if all legs are not balanced on the ground."
And the problem is an international one.
David Blumenthal, professor of medicine and health-care policy at Harvard Medical School in America, writes: "Hospitals must endure the cost and inconvenience of accommodating research and teaching; medical schools must cope with the requirements to improve service and constrain costs of care, tasks that appear to many faculty at best tangential to their true missions of expanding knowledge and educating health professionals."
Some United States universities have solved these problems by selling their teaching hospitals to non-academic companies, says Professor Blumenthal.
The centres recommended by the Nuffield Trust would be virtual, allowing the NHS and universities to develop shared objectives.
A survey of medical schools and teaching hospitals carried out by the trust in 1998 found that "the absence of an explicit shared agenda was the most cited obstacle to developing closer working".