Clinical assessment

July 17, 1998

We agree that it is not possible to forecast the need for additional doctors in the National Health Service in isolation from other health care professionals (THES, July 3). The Campbell report's recommendation of an increased intake of 1,000 medical students was conservative and took into account other complicating factors.

There is a crisis now. We are short of doctors and nurses in today's NHS. It is difficult to recruit to general practice, to trainee posts and to consultant posts. There are difficulties recruiting nurses to specialist areas. Loss of doctors and nurses from the NHS, altered work patterns, shorter working hours and early retirement are contributing to a situation that is deteriorating rapidly and will harm aspirations for a modern, dependable, improving NHS.

Alan Maynard rightly points to the importance of the extended role of nurses, but also points to the "nice crisis" that is emerging in the market for nurses. Without better pay and well-constructed clinical careers, recruitment and retention are unlikely to improve.

The Campbell report should be implemented as soon as is practicable, but we recognise the need for caution beyond the additional medical student intake. Medicine, nursing and health care are changing rapidly. It is impossible to predict accurately the need for doctors or any of the health care professions even 10 years from now. The number of doctors must be continually reviewed, and this must not be in isolation from the workforce needs of the NHS as a whole.

Turning to the article by Michael Rees, we want to correct the impression that we have been inactive since the publication of the Richards report on the future of academic medicine.

The Council of Heads of Medical Schools and the Committee of Vice-Chancellors and Principals are working with the Conference of Postgraduate Medical Deans, Academy of Royal Colleges and the NHS Executive to protect the interests of aspiring clinical academics during their clinical training. We are seeking information on problems that have arisen. We support the recommendation made in a recent report by the Royal College of Physicians about a pool of national training numbers for clinical academics in training. CHMS will soon produce a report that makes recommendations about the training and education of the clinician scientist.

We are talking with the NHS Executive about the concept of the "academic medical centre". In addition, the Higher Education Funding Council for England and the NHSE have established two task forces - one to look at the research assessment exercise and clinical research, a second to focus on resolving competing pressures of research, teaching and service delivery on clinical academics.

The response from ministers to the Campbell report will follow publication of the comprehensive spending review. We are pressing hard to ensure that quality, not price, is the key criterion for judgement of any future bids for additional students. Universities must not shoot themselves in the foot by cut-throat financial competition - that would be a disservice to universities and the quality of health care for the 21st century.

Cyril Chantler, chairman, Council of Heads of Medical Schools Kenneth Edwards, chairman, Committee of Vice-Chancellors and Principals, medical committee Tony Butterworth, chairman, Council of Deans and Heads of UK Faculties of Nursing, Midwifery and Health Visiting

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