Negotiations between universities and the National Health Service on medical education have been thrown into confusion by the advent of hospital trusts, Sir William Fraser, principal of Glasgow University, has warned.
Sir William, giving the Lock lecture to the Royal College of Physicians and Surgeons of Glasgow, said that medical students' clinical training had in the past been a joint operation, organised and administered by the universities, dependent on a largely informal understanding with hospitals about shared facilities and teaching.
The Greater Glasgow Health Board had annual funds to distribute to the trusts, the Additional Cost of Teaching and Research (ACTR), which was considerably more than the university was able to spend on its medical faculty.
But hospitals in the past were less commercial and independent than the trusts. It was now an open question whether health boards had to ensure that teaching hospitals taught he said. Sir William said the Government had reserve powers to ensure that, where necessary, the trusts provided medical education and research.
"But if a trust honestly believes that in order to discharge its primary function of delivering health care efficiently, effectively and economically, it should no longer involve itself in medical education, are ministers not sailing perilously close to the rocky shores on which the nationalised industries were wrecked, trying to discharge social functions and run businesses at the same time?" Sir William also asked whether the health board or the trusts were responsible for working with the university on medical education.
Nobody knew how the total amount of ACTR money was determined, and it was not clear whether it could be used for capital funding. This was of acute importance in centres such as Glasgow and Edinburgh, where there were proposals to replace major hospitals, which had teaching and research facilities, on new sites.
Further upheaval was caused by a changing curriculum, with pressure from the General Medical Council to move clinical training closer to medical science teaching.
Glasgow's medical faculty is to cut lectures substantially, with a maximum of five core lectures each week, in a new course dominated by problem-based learning in small groups. Lecturers will be trained to be facilitators for the groups.
Glasgow's curriculum planning group said teaching encouraged "surface learning" at the expense of understanding.