Deaneries around the country are drawing up plans to cut specialist trainee posts over the next three years.
Health authorities describe a 15% reduction in the national training budget - a loss of £650 million a year - between now and 2014, the Sunday Telegraph claims.
In some parts of the country, this could translate into the number of training places for surgery, trauma and orthopaedics falling by a third.
The official line is that the cuts are necessary to avoid unemployment in future and to try to ensure deaneries are training doctors in appropriate specialties to meet NHS requirements. But many suspect it is about cost cutting.
While some fear there is oversupply in the surgical specialties, others believe that the demands of the Working Time Directive mean that doctor numbers must be maintained.
Mr David Mahon, a surgeon working in Musgrove Park NHS hospital in Taunton, told BMJ Careers that the South West Deanery was facing a 14% reduction in the budget for trainees. He believes the cuts will fall disproportionately on some of the larger specialties, such as medicine and surgery, where there is greater room for manoeuvre.
“This is unprecedented,” said Mr Mahon. “Trainee numbers have increased year on year for as long as I can remember. My specialty is going to be harder hit than many other specialties.”
He also warned that a loss of trainees would lead to hospital staffing problems and would mean “either spreading the remaining doctors more thinly, which is potentially dangerous; using consultants, possibly unnecessary and definitely expensive; or using non-training grade doctors or non-medical staff”.
Papers drawn up by the strategic health authority NHS East of England describe a net loss of more than 500 clinical training posts, suggesting that nationally the cuts could amount to more than 5,000 jobs.
The SHA which covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk warns that the public sector is moving into a period of sustained economic recession, with “significant implications” for the NHS workforce.
There are 6,800 training posts available for doctors graduating from medical school this year - a significant increase on previous years. In future, GP numbers are set to grow at the expense of hospital doctor roles.
The Department of Health confirmed it has been reviewing specialty training and specialist numbers to ensure they are appropriate for future demand.
It follows Conservative claims that significant numbers of clinical posts are to be cut.
Getting the number of trainees right has always been a problem - one needs more when a specialty is expanding, then less to maintain a steady supply when the specialty has reached a ’steady state’, and fewer if a specialty is in decline (or changing).
However, it seems that some of our politicians (and their civil servants), together with some ‘medical politicians’, cannot grasp a few simple sums:
One needs 3.5 doctors(EWTD ‘compliant’) to provide ‘24 hour cover’ (excluding holidays and sickness).
3 doctors doing 48hrs p.w (EWTD) leaves 24hrs ‘uncovered’!
If doctors were working (on average) 60hrs p.w prior to EWTD, then one needs 20% MORE doctors just to provide the SAME service!
If one spends 5yrs in ‘training’ and 30 years ‘trained’, then one needs only 1 trainee per 6 trained doctors to maintain the status quo!
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