KEY ISSUES
  (We note that the inquiry covers England only).

  Inadequate consultant expansion: Substantial reforms in specialist training have resulted in doctors spending a shorter time in the training grades, and this requires more intensive tuition. More structured training for juniors takes both junior staff and cosultants away from direct patient care. In addition, an increase in patient throughput and the introduction of the internal market have also become part of the changing consultants' work pattern. The increase in the number of consultants has not been sufficient to absorb the extra workload. The problem is compounded by an increase in the number of consultants seeking early retirement from the NHS.

Supporting documents:* Note from the BMA's Career Progress of Doctors Committee on early retirements. (Appendix 1).

  Recruitment and retention crisis in general practice: Particular difficulties have arisen in recent years following a period of constant change and rising workload in general practice. A further issue is the increasing numbers of non-prinicipals, the majority of whom will be part-time.

Supporting documents: BMA's General Medical Services Committee Medical Workforce Medical Workforce Task Group Report February 1996. (Appendix II).

Medical Workforce Planning: Report by the GMSC's Medical Workforce Subcommittee. April 1998. (Appendix III).

Report of a Special Conference on Workforce Problems held in May 1998. (Appendix IV).

Extract from SCOPME Report on the Educational Needs of GP Non-principals. (Appendix V).

  The need to train more doctors: The Association has supported the recommendations of the Campbell Committee for an additional 1,000 medical students.

Supporting documents: Report of a BMA press conference on 17 June 1998. (Appendix VI).

Note from the BMA's Career Progress of Doctors Committee on medical school numbers. (Appendix VII).

  Problems with national strategic planning of medical workforce: Some of the current shortages can be attributed to failures of the national strategic planning mechanisms. In particular there has been a lack of funding for national initiatives and objectives, together with a weakening of central controls. Trust freedoms have led to a proliferation of posts in "non-standard" grades.

Supporting documents: Medical Workforce Planning: Report by the BMA's Health Policy and Economic Research Unit. December 1997. (Appendix VIII).

Non-standard Posts—Career and Training Grades: Analysis by the BMA's Junior Doctors' Committee of Posts Advertised in the British Medical Journal. November 1997-May 1998. (Appendix IX).

Correspondence between the Chairman of CCSC and the Minister for Health. (Appendix X).

Memorandum by the BMA's Career Progress of Doctors Committee on planning of the medical workforce. (Appendix XI).

  Reliance on doctors from European and other countries: The Association would wish to see the NHS moving towards self-reliance in medical training and staffing, but there are indications that the trend is in the opposite direction.

Supporting documents: Memorandum by the BMA's Career Progress of Doctors Committee on reliance on overseas doctors. (Appendix XII).

  Junior doctors' hours of work: One in six juniors is still working in excess of 56 hours a week, mainly due to increased intensity of work. This is despite an agreement which should have been implemented 18 months ago.

  Medical Academic Staff: There are particular problems over recruitment and retention of medical academic staff. In 1995 the Committee of Vice Chancellors and Principals of the Universities of the United Kingdom identified 54 vacant clinical chairs in universities with medical schools, 20 of which had been vacant for more than 12 months. A number of factors are at work, these include fears over pay and conditions, uncertainty over career structure under the Calman training reforms, financial problems in universities, particularly those arising from the Research Assessment Exercise, the conflicting demands of teaching, NHS service work and research.

Supporting documents: Evidence submitted by the BMA to the Richards Enquiry (February 1997). (Appendix XIII).

Memorandum by the BMA's Career Progress of Doctors Committee on recruitment of medical academics. (Appendix XIV).

  Measures to improve recruitment and retention in the medical workforce.

Supporting documents: Memorandum by the BMA's Career Progress of Doctors' Committee on improving conditions. (Appendix XV).

*Supporting documents not printed.

June 1998.