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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 24; 335(7629): 1069.
PMCID: PMC2094175

BMA rejects Tooke proposal for a sub-consultant grade

Doctors' leaders have rejected the idea of the NHS creating a new “inferior” grade of doctor with a specialist qualification but less expertise than a consultant.

The idea of a sub-consultant is unnecessary and would neither improve the care of patients nor save the NHS money, says the BMA in its response to the interim report from the inquiry into the reform of medical careers, chaired by John Tooke, head of the Peninsula Medical School.

Although the BMA welcomed the “excellent” work being done by the independent inquiry into the UK-wide Modernising Medical Careers programme, it questioned some of its major proposals.

The BMA's response says, “The BMA strongly opposes any proposed introduction of any post-CCT [Certificate for the Completion of Training], pre-consultant specialist grade and believes that a new grade is not necessary, nor advantageous in terms of quality of care or finance.”

Jonathan Fielden, chairman of the BMA's Central Consultants and Specialists Committee, said, “Patients deserve the best possible consultant based care. This is the gold standard which we will fight to defend and deliver.

“The creation of an inferior sub-consultant grade would limit patient care and dash the hopes of young doctors striving to achieve the best. We should continue to enhance consultant practice for the benefit of patients without destroying ambition and hope for the future.”

The BMA based its views on opinions from its internal representative committees and from a survey of its members, 737 of whom responded.

Ram Moorthy, chairman of the BMA's Junior Doctors Committee, said, “It makes no sense to spend public money to train doctors and then deny them the opportunity to reach their full potential. This grade would dumb down quality and further frustrate junior doctors' aspirations to excellence.”

The BMA also said it supported the Tooke inquiry's proposal for a three year core training programme, followed by higher specialist training, but said that this would not necessarily be the best model for every speciality.

Other key points the BMA made in its response included:

  • GPs' training should be extended to five years, as long as it remains focused on the GP curriculum, and training is relevant to doctors' future careers in general practice
  • There should be several recruitment rounds, so that doctors have more than one opportunity a year to get into training
  • A single body should regulate undergraduate and postgraduate medical education
  • The staff and associate specialist (SAS) grades should be made more attractive to doctors.


The full response from the BMA can be seen at

Articles from The BMJ are provided here courtesy of BMJ Publishing Group