GPs- Quarter of patients can’t book in advance 12 million Pound survey finds

A quarter of patients still cannot book advance appointments with their GP – more than two years after Tony Bliar promised to solve the problem. The results from an “unfair and biased” £12m survey of more than two million people about services at their GP surgery found doctors are still manipulating their appointments system to hit targets.

Bliar was challenged during a televised debate in the run up to the 2005 election over the system which rewards doctors for seeing patients within 48 hours but means many prevent advance bookings to leave slots open for urgent cases.

He promised to resolve the situation but the survey results unsurprisingly show there has only been limited success.

The survey released by the Department of Health this week showed the vast majority of patients are happy with their family doctors.

In a blow to Stalinist Brown’s call for more GP surgeries to be open on Saturdays and late in the evening, few patients in the survey wanted this. The vast majority, more than eight in ten, said they were happy with their surgery’s opening hours.

Dr Laurence Buckman, chairman of the British Medical Association’s General Practitioners Committee, said: “It seems only four out of every hundred patients want practices to open on a weekday evening, and seven out of every hundred on weekends.

“It comes down to a workforce issue. The danger is that switching normal opening hours away from the daytime to evenings and weekends might please some patients who are out at work all day, but would take appointments away from those who use their local surgery most – patients with long-term conditions and parents with young children.

“All patients are important but we must not penalise the most needy among them.”

The survey findings show the majority of patients say they can apparently get through to their surgery on the phone satisfactorily, can book an appointment quickly and with the doctor they want.

Of those who wanted to book an appointment more than two days in advance, a quarter could not.

Dr Buckman said the findings had confirmed what other studies had shown and questioned whether spending £12m on the survey.

The results also showed that small practices often in rural areas outperformed large urban GP surgeries.

The news will dismay new Health Minister Lord Ara Darzi who advocates super-GP surgeries with up to 20 doctors and serving a population of around 20,000.

Other results showed most patients are being offered a choice of hospital when they are referred to a specialist, in line with labour’s stalinist policy.

The full results of the survey including regional breakdowns can be found at Labours £12 million GP survey

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/24/ngp124.xml

Health Direct pointed out last year that labour was wasting another £12 million Pounds of our tax payers money on this shambolic GPs survey and that the results were hardly likely to be earth shattering. In the intervening period we even managed to receive THREE questionnaires- which further undermines the credibility of this money burning exercise.

On 27 Nov 06 Health Direct posted: £12 million GPs survey to cut doctors funding
when five million patients will next year be asked to fill in a questionnaire which will ask, among other things, whether they have been able to secure an appointment within 48 hours, as the Labour government has promised.

The British Medical Association condemned the poll as unfair and biased, and accused the Department of Health of adding questions that had not been agreed. Most GPs accept that they are unlikely to score 100 per cent and so they will see a reduction in funding.

PFI- Time to set the record straight claims FT

Off balance sheet accounting has a long and often dishonourable history. Just think of Enron. The Treasury now has a chance to fix one of the most inconsistent and problematic examples of its use, in the way the private finance initiative is accounted for, by using the introduction of International Financial Reporting Standards as a chance to bring all PFI projects on to the public balance sheet.

Britain, and many other countries including Canada, Japan and Australia, use PFI to pay for infrastructure. Instead of paying a contractor to build a school, the government will pay to lease it over 30 years, transferring some management and operating risk to the builder. The question is whether that 30-year lease commitment is a debt, in which case it should be on the balance sheet, or not.

The UK’s answer to this question has been inconsistent, to say the least. Most transport PFIs are on the balance sheet. Many hospital PFIs are not.

The result is a deep-seated public suspicion that disguising debt, and not advantages from transferring risk or better private sector management, is the real reason for for using PFI.

The labour government now has a chance to correct that impression, and allow private finance to show its genuine advantages, when it adopts IFRS in April next year.

IFRS says that most PFI projects should be off-balance sheet for the private sector. The logical consequence is that the public sector should put PFI on the books: the alternative – assets floating in the ether, owned by nobody – is intolerable. The Treasury should embrace, not resist, such an interpretation.

There will be consequences. First, as much as £30bn in off-balance sheet leases may be reclassified as borrowing, causing the government to break a self-imposed rule that limits public sector net debt to no more than 40 per cent of gross domestic product. But that, too, could be an opportunity: to replace increasingly discredited fiscal rules.

Second, in future new schools and hospitals will mean debt on the balance sheet, and there is a risk that the perception of indebtedness may lead to a fall in capital spending. It would be unacceptable – and bear out all the criticism of PFI sceptics – if major infrastructure projects such as London’s Crossrail suddenly became “unaffordable” because of new accounting standards. It will be up to the government to increase capital budgets to compensate for any such nominal changes.

After years of debate it is time for the test: put PFI on the balance sheet, and let it live or die by its merits as a financing technique.

From
http://www.ft.com/cms/s/f0aa9658-3bd9-11dc-8002-0000779fd2ac.html

Health Direct has long noted the tendency of stalinist Brown to flip flop on his financing policies, now we may have some consistency and clarity rather than fudge and obfuscation.

MTAS disaster- Labour’s botched NHS plan

The Medical Training Application System (MTAS) junior doctors appointment fiasco still produces fury in the medical profession. Why? And how did labour’s defective system get passed in the first place?

When Sir Liam Donaldson, the chief medical officer, published his annual report last week, he found himself having to justify not resigning over the bungled junior doctors’ appointments system. “The implementation in some respects went wrong,” he conceded. “But the responsibility was very widely distributed.”

His justification, coupled with an apology, followed widespread denunciation of the system by delegates at the British Medical Association’s (BMA) annual conference last month. A motion calling for his resignation was overwhelmingly passed, while the BMA’s then acting chairman, Sam Everington, condemned the “scandal” of thousands of doctors contemplating leaving medicine or going abroad.

The sustained level of anger may surprise those outside the profession who thought the Medical Training Application System MTAS fiasco was resolved in March, when the then health secretary, Patricia Hewitt, announced that it was being abandoned in its current form and promised every junior doctor an interview in their first-choice area.

MTAS had been problematic because the unpiloted computer system, which aimed to appoint junior doctors centrally, was deeply flawed, with problems such as application forms giving too much weight to Labour’s caring sharing touchy feely “creative writing” and too little to academic achievements and clinical experience, and too little consistency to the shortlisting process.

But junior doctors, and their senior colleagues, remain angry and unhappy about the debacle. One in five juniors affected is feeling increasingly suicidal and 94% have felt higher stress levels during the six months covering the application and interview process, according to research published in the British Medical Journal online. Hospitals have been told to be on suicide alert.

Much of this fury is due to the mismatch between training posts and applicants, and the uncertainty this is causing. Department of Health (DH) figures reveal that doctors are chasing 18,391 training posts – with 29,193 applying for 15,600 in England.

A total of 2,320 posts will be on offer in a second round of applications, but at least 12,000 eligible junior doctors will remain without posts and will instead have to seek work abroad, leave medicine, or remain in staff-grade jobs, which will not allow them to become consultants and are often seen as career dead-ends.

The problem is most intense for the more senior doctors in the most competitive areas of surgery: figures released by the DH earlier this month show that 713 orthopaedic surgeons, 885 general surgeons, and 206 plastic surgeons were without training posts at the end of round one. For would-be surgeons, the chances of getting a training post are as slim as one in five for general surgery, or one in six for orthopaedics.

Doctors are also angry that, with most jobs supposed to start on August 1, they face a scramble to apply for the remaining training posts available in round two, or for vacant non-career jobs.

The second round of interviews has been extended to the end of October, and every junior doctor still applying is supposed to be guaranteed employment until that deadline. But there are no promises that this will be in their existing hospital, or even in their existing trust.

Huge uncertainty has surrounded even those who have received jobs, with successful applicants only recently being told in which hospitals they would start. With deaneries such as London covering all of Greater London, Kent, Surrey and Sussex, and the East of England deanery covering Essex, Suffolk, Cambridgeshire and Norfolk, huge logistical problems have been arisen in terms of arranging accommodation and childcare.

Childcare problems

The profession wants to retain women, who now account for 60% of those entering the profession, but they are being forced to abandon their careers to keep their families together or because of childcare problems.

Andrea Siggers, a GP with a one-year-old son, has had to give up her job because her husband was unable to gain a training post in emergency medicine in Wessex, but gained one in the south-west. And Katharine Augustine is having to move to Southampton, with her 19-month-old son, to pursue a training post in radiology, while her husband takes up his cardiology post in Bristol.

With a second baby due in January, she says: “There are no other job options, and I need to be in continuous employment to get maternity pay. This process is forcing apart many families.”

Crucially, the ongoing fiasco will affect not just junior doctors but also patients. Morris Brown, professor of clinical pharmacology at Cambridge University, says it is unlikely hospitals will become “chaotic” at the start of August, but warns that clinics and elective surgery will be cancelled – with an obvious impact on waiting lists.

Brown, a leading critic of MTAS, is more concerned about the long-term impact on the quality of medical care and clinical research. A poll he is conducting suggests that the system, which gives the same weight to a PhD and to a two-day course that can be attended by paramedics, disadvantages the most academically able.

The relative absence of posts for the more senior junior doctors also means the experienced will be shunted into non-career posts, while inexperienced colleagues entering at a lower level will become the consultants of the future. That is compounded by the shortened training offered under modernising medical careers (MMC), the new system to which MTAS relates – and by the European working time directive, which, from 2009, will reduce junior doctors’ hours to 48 a week.

Then there is the long-term impact on the NHS of a demoralised group of doctors, stuck in dead-end jobs, and no longer feeling a strong sense of vocation.

So how did this catastrophe in workforce planning happen? In part, because, with all applications for training under the old system drying up last autumn, an unprecedented number of doctors applied under MTAS. As Donaldson, the original architect of MMC, admits in his report: “The number of doctors … was larger than anticipated.”

The number of junior doctors had burgeoned since the NHS Plan enabled a rapid expansion to allow the NHS to meet new targets. But, with NHS deficits being felt from 2005, hospital trusts then began to cut back jobs and training posts.

Andrew Rowland, of the BMA’s junior doctors committee, says that, when it came to MMC and MTAS, there was a lack of engagement between the bodies involved in workforce planning – individual trusts, deaneries, regions and individual specialities on a national level.

Richard Marks, programme director in anaesthetics for north-central London, says programme directors – the people with experience of the actual numbers needed for each region – were left out of the loop.

“The hierarchy seemed to be that Lord [Norman] Warner [the health minister, who retired in December] wrote to the deaneries for numbers required, the deaneries asked the trusts, and trusts then told the programme directors – without anyone asking the departments what was needed.” Strategists were planning 10 years ahead, but were not sufficiently engaged with the number of doctors currently in the system, he adds.

Meanwhile, it is these doctors, and their future patients, who will suffer.

From:
http://society.guardian.co.uk/health/story/0,,2133622,00.html

On 30 Apr 07- Health Direct wondered whether amongst all of thier fiascos the
Conntender for the greatest of all Labour’s NHS failures- the Junior Doctor application system
The crisis that is leading highly qualified junior doctors to head abroad is the result of one of the National Health Service’s all-time great administrative cock-ups. It is has left 30,000 junior doctors bitterly disillusioned and angry. But it also has big potential implications for patient care.

Do you feel happy to entrust this shower to keep all of your personal medical information- let alone the ID cards safe?

Johnson blocks new wave of private health clinics

The health secretary, Alan Johnson, yesterday vetoed plans for a third wave of independent sector treatment centres to compete with NHS hospitals.

In a break with Tony Bliar’s drive to expose the health service to the challenge of market forces, Mr Johnson said local NHS commissioners should adopt a more pragmatic approach to treating patients on the waiting list for tests and operations in England.

He will allow them to buy extra capacity from the private sector if they need it to meet targets on waiting times, and can show it provides value for the taxpayer. But he told the Commons health committee: “There will be no need for another national independent-sector procurement … There will not be a third wave.”

The government had been committed to spending about £4bn on the first two waves of treatment centres – fast-track clinics that were to carry out 2m routine medical procedures on NHS patients.

Mr Johnson was presented with plans for a third wave when he became health secretary last month, but he refused to endorse them.

To underline the change, he scrapped contracts with Atos Origin in the north-west and south-east of England, accusing the company of failing to deliver in time. Mr Johnson said: “Where independent sector providers are not offering good value for money or high-quality patient care … we will terminate [their contracts].”

From:
http://society.guardian.co.uk/health/story/0,,2134811,00.html

Health Direct gives a cautious welcome to the Health Secretary’s apparent decision to back the NHS rather than waste money on third party pfi projects.

C Difficile and hospital bugs remain a problem

The number of cases of the potentially dangerous Clostridium difficile (C Difficile) is thriving, figures show. A review by the Health Protection Agency showed hospital MRSA cases had fallen by 10% in the first three months of 2007 compared with a year ago. But rates for C. difficile, which mainly strikes the elderly, rose by 22% this quarter.

Some NHS trusts complained that targets – both clinical and financial – were hindering the fight against infection.

In a separate survey carried out by the Healthcare Commission – an NHS watchdog – some 45% of the 155 trusts said time targets for treating patients in A&E; were getting in the way of infection control measures.

These figures represent a very small proportion of the 10 million inpatients that the NHS treats in hospitals every year.

Pressure to move patients to any available bed rather than the most appropriate bed or an isolation ward was one reason cited for the difficulties.

A further 36% of trusts said they were having problems combining investment in cleaning with financial targets, while 88% said their limited IT infrastructure “was restricting their ability to draw important lessons from incidents of infection”.

The survey was carried out in May 2006, and the watchdog noted that a number of practices – particularly regarding individual staff objectives for bringing down infection – had changed.

But Healthcare Commission chief executive Anna Walker added: “We cannot afford to lose momentum. Trusts should be asking themselves what more they can do to protect patients and the public from healthcare associated infection.”

The National Audit Office has estimated that these infections cost the NHS as much as £1bn each year.

Between April 2006 and March 2007, there were 6,378 cases of MRSA infections reported, compared with 7,096 for the previous year, the Health Protection Agency (HPA) said.

Meanwhile, there were 15,592 reported cases of C. difficile in patients aged 65 and over in England in the first quarter of 2007. This represents a 2% rise when compared with the same period last year, but is 22% higher than the previous quarter.

The HPA says this rise can be explained by the fact that higher numbers of vulnerable people are admitted to hospital at this time of year.

Liberal Democrat health spokesman Norman Lamb said the government had “spectacularly failed” to halt C. difficile.

Shadow health secretary Andrew Lansley called the figures “the tip of the iceberg, because they do not include the number of infections in people aged under 65”.

From:
http://news.bbc.co.uk/1/hi/health/6913873.stm

On 2 May 07 Health Direct posted that Deadly NHS superbugs continue rising with C difficile again up when more hospital patients in England are getting the deadly Clostridium difficile bug, figures show.

Health Protection Agency (HPA) data showed 55,681 cases were reported among over 65s in 2006 – up 8% in a year. MRSA cases continued their downward trend, but they are not falling quickly enough to meet Labour’s target next year.

Patients Association spokeswoman Katherine Murphy said: “Too many people are dying from these infections. We must learn from other countries such as Holland which have got infection rates close to zero.

Anger over NHS plan to give addicts iPods

Drug addicts are to be offered gift vouchers and prizes on the National Health Service under plans by the labour government’s medicine watchdog NICE to encourage them to stay clean.

The National Institute for Health and Curbing Expenditure (NICE) will recommend the system of inducements, which could enable clinics to offer televisions and iPods as prizes, to tackle the burgeoning drugs problem.

But patients denied drugs for blindness, Alzheimer’s and lung cancer under Nice rationing are likely to accuse it of wasting public money.

Katherine Murphy, of the Patients Association, said: “Why should these people with self-inflicted problems be given priority over people who have a genuine illness? Some people with genuine disease are being forced to sell their homes for the medicines they need.”

Under the guidelines expected to be published by Nice this week, heroin and cocaine users will be given the financial rewards if they test free of drugs. The scheme is inspired by one already operating successfully in America.

The range of financial incentives is likely to include vouchers, which start at £5 but increase in value each time the addict tests negative. Typically, there would be three tests each week and therefore three chances to gain vouchers of increasing value. Drafts of the guidance suggest giving addicts who test free of drugs tickets for a draw to win prizes worth up to £100.

Research by the University of Connecticut found cocaine and methamphetamine users stayed drug free for longer when they had the chance to win prizes such as telephones, stereos, DVD players and televisions.

Every time addicts gave a negative drugs test they were given tickets for the draw. They “earned” an increasing number of tickets for every week that they remained drug free.

Those who endorse financial rewards for addicts argue that any money will be recouped because those who stay clean will make fewer demands of the NHS.

From;
http://www.timesonline.co.uk/tol/news/uk/health/article2116323.ece

NHS Choices criticised over out of date, utterly dishonest, trite and patronising information

NHS Choices the Department of Health’s new £14 million “flagship” website contains GP practice information which in some cases is at much as six years out of date, Health Direct and EHI Primary Care has learnt.

Doctors claim the new multimillion Pound NHS Choices website, developed by Dr Foster Intelligence together with LBi and Sapient, contains incorrect information on GP surgeries including inaccurate opening hours, out-of-date information about partners and errors on practice staff and clinic timings.

At the same time listings of primary care trusts, mental health trusts and strategic health authorities have become much more difficult to find on NHS Choices compared with the old nhs.uk site, according to NHS staff.

The new chairman of the BMA, east Yorkshire GP Dr Hamish Meldrum, this week also criticised the site’s ‘health profile calculator’ which enables individuals to identify the top five conditions they would be most likely to be hospitalised for by putting in their sex, gender and postcode.

He told the BBC such general information would not help people but may cause information overload for patients and create additional anxiety.

He added: “ We all share the desire for patients and the public to be as well informed as possible but this is gimmicky and over simplistic and may cause unnecessary worries.”

Dr Trefor Roscoe, a GP in Sheffield, said the public were in danger of being “grossly misled” by the information on GP surgeries on the NHS Choices website. He told EHI primary Care: “According to the site we still open on Saturday morning which we last did about six years ago.”

A check on the information contained on ten surgeries around the country by EHI Primary Care discovered that at least a third contained errors such as out-of-date opening times or partner listings.

Dr Mary Hawking, a GP in Bedfordshire, said she had complained about inaccurate information on the old nhs.uk site and that although she felt the new NHS Choices site provided some additional information there were errors, including a map of her home town which she claims is at least six years out-of-date.

She added: “The information on GPs is still inaccurate: it doesn’t list clinics, opening hours are inaccurate, most have no facilities or clinics listed, and the list of staff is grossly out of date: in other words I suspect this was taken, unchecked, from NHS England UK.”

From:
http://www.ehiprimarycare.com/news/item.cfm?ID=2838

When the Department of Health launched the NHS Choices website on 25 Jun 07 in NHS Choices labour wastes £14 million on another useless website Health Direct questioned the logic for the site.

Patients are being asked to rate and comment on another NHS services website launched which they launched last week. The Department of Health is ludicrosly comparing the NHS Choices site to tripadvisor.com, which publishes travellers’ holiday reviews.

Heath Direct notes that the Blog Doctors goes further. NHS Choices is described as thus: I have just spent ten minutes looking around NHS Choices and, as you would expect, I hate it. It is utterly dishonest. The last ten years has been about removing patient choice, not increasing it.

The lifestyle advice the site gives is trite and patronising, and at times downright offensive.

http://nhsblogdoc.blogspot.com/2007/06/girls-just-arent-turned-on-by-man-boobs.html

NHS manager’s payout is nearly £1m

An NHS manager has been given a redundancy package worth almost £1 million in what was described as “a lottery win rather than a payout”. David Johnson, the former head of a regional strategic health authority, was one of about 70 staff who left the organisation when it was abolished as part of a restructuring programme.

The 50-year-old received a package worth £899,810 including salary and pension arrangements. The reorganisation was supposed to save £250 million a year in administration costs. However, the NHS is thought to have spent at least £320 million on redundancy packages to those who have lost their jobs.

The Royal College of Nursing is concerned that NHS managers are creaming off large sums of money in settlements that should be spent on patient care.

When the North and East Yorkshire and Northern Lincolnshire Strategic Health Authority, where Mr Johnson worked, was abolished the average payment was £24,725 to those who took redundancy and £48,191 for those who took early retirement.

Robert Goodwill, the Tory MP, condemned the settlement awarded to Mr Johnson. He said: “Most people will look at this and say this is a lottery win rather than a payout.”

Mr Goodwill, who represents Scarborough and Whitby, in North Yorks, said he understood Mr Johnson was entitled to the payout under the terms of his contract. But he criticised the contract itself and the multiple reorganisations of the NHS that lead to high-profile job losses.

Mr Goodwill said: “How do I explain these payouts to people who can’t get their Alzheimer’s disease drugs, or they can’t get drugs for conditions causing blindness?”

A spokesman for the Yorkshire and the Humber Strategic Health Authority, created last year in the merger of three regional health authorities, including Mr Johnson’s, said administration staff had lost their jobs in order to save money.

In a statement, he said: “Yorkshire and the Humber SHA were set the target of reducing management costs by £6.8 million by 2007-08.

“A programme was undertaken to reduce workforce numbers, including a recruitment freeze and redeployment of staff within the NHS.

“A number of compulsory redundancies and early retirements formed part of this programme. This incurred one-off costs in line with national terms and conditions for NHS staff. All payments relating to individuals were based on their age, pay scale and length of service.

“By the end of the next financial year the savings to local taxpayers will exceed these one-off costs. These savings will then continue to accrue each year.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/13/npayout113.xml

Given the current climate of tony’s cronies- Health Direct asks if there any relationship between David Johnson the NHS lottery winner and Alan Johnson the NHS boss?

Hospital cases treble since labour’s extended drinking pub hours laws

Overnight visits to hospital emergency departments for alcohol related problems have trebled since the introduction of new licensing laws, according to a scientific journal the Emergency Medicine Journal. The EMJ has published research showing that significantly more people have needed hospital treatment for alcohol-related issues since pub hours were extended in November 2005.

The study analysed data from St Thomas’ hospitalin central London across two months, before and after the licensing act was introduced. St Thomas’ has one of the largest emergency care departments in the UK.

The study showed that in March 2005 there were more than 2,700 overnight visits to emergency care and 3 per cent – 70 of them – were alcohol- related. But in March 2006 this had risen to 3,100 overnight visits of which 8 per cent, or 250, were alcohol-related.

“The increase in alcohol related problems we have recorded is the opposite of the effect the legislation was designed to produce,” said Dr Alastair Newton, consultant at the emergency department of Guy’s and St Thomas’ and one of the authors of the report.

“Our data suggest that the new legislation has also failed to achieve its intended improvement in public safety and reduction in alcohol-related crime and disorder,” he added.

The study showed the number of visits as a result of assault associated with excess drinking doubled and the number of associated hospital admissions almost trebled over the period.

Everyone over the age of 16 who attended the accident and emergency department between 9pm and 9am and who had been drinking was included in the audit.

The overhaul of the drinking laws in England and Wales in 2005 extended the hours pubs were allowed to remain open and enabled some establishments to serve alcohol round the clock.

Critics of the system have voiced concerns that the liberalisation of drinking hours will only fuel the country’s binge drinking and anti-social behaviour problems

The study’s authors called for longer term assessments to help police and health workers deal with the effects of alcohol.

From:
http://www.ft.com/cms/s/26c9f30a-3590-11dc-bb16-0000779fd2ac.html

Junior doctor shambles threatens the NHS- eminent Doctors

Last week a labour ministerial statement confirmed that almost half this year’s applicants under the junior doctors’ career and appointments system have had their careers in UK medicine abruptly cut short.

This stark fact was transmuted by the subsequent press release into “good news”, because 85 per cent of available jobs will be filled by August 1. Even if this obfuscation of jobfill with appointment rates were true – and we believe it is a gross overestimate – it fails to acknowledge that a 15 per cent vacancy rate is ten times that of previous years in most specialties.

Alarmed at so many posts being vacant on August 1, the Department of Health gives trusts two weeks to manage what the hugely expensive national competition failed to achieve in six months.

Before August, trusts are ordered to find somewhere to shuffle 10,000 doctors for three months until the current crisis is past, and these doctors can then be quietly lost from the NHS for ever.

Our poll shows that one third of the 4,000 who have not found jobs as doctors are among our very best graduates, with either a first-class degree or distinction.

This cull of the best happened because the best graduates naturally apply for the most competitive posts and the new system randomly limited half of the applicants to just one interview.

This new career structure is a top-down straitjacket forcing doctors to choose immutably their area of training merely two years after qualification. Hundreds of doctors now face transportation for seven years to posts geographically remote from their families.

Although the professionalism of doctors will save the NHS from chaos in August, the NHS cannot be saved in the long term from the consequences of culling 30 per cent of our best doctors. Some flexibility and free market in posts must be reintroduced into training and appointments.

Those discarded this year should be guaranteed the right to compete again on a level playing field for the next rung up on the career ladder.

MORRIS BROWN, Professor of Clinical Pharmacology, Cambridge
PETER BARNES, FRS, Professor of Respiratory Medicine, Imperial College
NICHOLAS BOON, President Cardiovascular Society
NICHOLAS BROOKS, Past-President Cardiovascular Society
JOHN CAMM, Professor of Clinical Cardiology, St George’s Hospital
MARK CAULFIELD, Professor of Clinical Pharmacology, Queen Mary London
ANGUS DALGLEISH, Professor of Oncology, St George’s Hospital
JON FRIEDLAND, Professor of Infectious Diseases and Immunity, Imperial College
JOHN GIBSON, Professor of Respiratory Medicine, Newcastle
ASHLEY GROSSMAN, Professor of Endocrinology, Queen Mary London
TONY HEAGERTY, Professor of Medicine, Manchester
HUMPHREY HODGSON, Vice-Dean, RFUCMS
JUAN CARLOS KASKI, Professor of Cardiovascular Science, St George’s Hospital
CHRISTOPHER KENNARD, Vice Principal, Charing Cross Hospital
KAY-TEE KHAW, CBE, Professor of Clinical Gerontology, Cambridge
JOHN LAZARUS, Professor of Clinical Endocrinology, Cardiff
STAFFORD LIGHTMAN, Professor of Medicine, Bristol
JIM McKILLOP, Professor of Medicine, Glasgow
PETER McCOLLUM, Professor of Vascular Surgery, University of Hull
JOHN MONSON, Professor of Surgery, Hull
STEPHEN O’RAHILLY FRS, Professor of Medicine and Biochemistry, Cambridge
MARK PEPYS FRS, Professor of Medicine, RFUCMS
RODNEY PHILLIPS, Professor of Clinical Medicine, Oxford
PHILIP POOLE-WILSON, Professor of Cardiology, Imperial College
JON RHODES, Professor of Medicine, Liverpool
JIM RITTER, Professor of Clinical Pharmacology, Kings College London
BRIAN ROWLANDS, President of the Association of Surgeons
NEIL SCOLDING, Professor of Neurology, Bristol
JAMES SCOTT, FRS, Professor of Medicine, Imperial College
RAJ THAKKER, Professor of Academic Endocrinology, Oxford
DOUGLAS TURNBULL, Professor of Neurology, Newcastle
ROBERT WILCOX, Professor of Cardiology, Nottingham
MARK WILES, Professor of Neurology, Cardiff
LORD WINSTON, Emeritus Professor of Fertility Studies, Imperial College London

These eminent medical professional signed their letter at:
http://www.timesonline.co.uk/tol/comment/debate/letters/article2093366.ece