Medical manpower and the career structure: a new approach.

A change in the ratio of trainees to consultants is necessary: despite being the agreed policy of the profession and DHSS, existing central planning machinery has failed to bring about its implementation. There is no reason to suppose that central methods can ever achieve the desired ends without intolerable constraints on the liberty of doctors. Freedom for individual groups of consultants to negotiate local changes in manpower coupled with inducements to both them and the authorities would seem to provide a promising approach that has not yet been adequately debated for explored. In the nature of it such an idea is unlikely to be attractive to central bureaucratic organisations, whether governmental or professional.