An emergency review of the appointments system for junior doctors is being dominated by government apparatchiks, leading doctors claim in a letter to The Times today.

The system and attempts to rescue it are a fiasco, write Morris Brown, Professor of Clinical Pharmacology at Cambridge, and more than a dozen leading specialists, as doctors prepare to challenge the outcome of the review in court.

The hearing, which begins on Wednesday, will seek to have the computer-based Medical Training Application System (MTAS) declared so unfair as to be an abuse of power. It is expected to take two days.

Victory for the doctors would leave the Department of Health, which has apologised for the debacle, in confusion.

In their letter to The Times, Professor Brown and colleagues say that MTAS has so far failed every task, and the review set up to rescue it “has become top-heavy with DoH apparatchiks”.

The issue, in the Times letter and later today in court, is whether it is fair to allow doctors in England, who have already spent ten years training, a single interview to determine their futures.

There are about 32,000 junior doctors applying for about 20,000 posts, which they will take up in August. Nobody knows the exact figures, nor how many of the applicants come from outside the UK. The doctors are mostly in their mid to late20s, and are applying for “run-through” training posts lasting five years, which would end with them ready to apply for jobs as consultants. Hospitals that pick the wrong applicants will be stuck with them for five years, so finding the right ones is crucial.

Applicants who fail to get a run-through post will not necessarily be unemployed but their careers will stall.

To get a doctor to this stage costs the state £250,000 in education and training costs. The potential losses would easily exceed £1 billion if, say, 5,000 UK-trained applicants gave up medicine or decided to go abroad.

One official, who did wish to be named, blamed the department for a failure to match the expansion of medical schools to an equivalent growth in training posts.

This year, the difficulties are compounded by a failed attempt by the department to exclude foreign graduates. Under European law it cannot exclude EU graduates, but relatively few of them apply. The key is graduates from outside the EU, traditionally one of the mainstays of the NHS.

The department attempted to cut off these applicants by saying they would need work permits. A challenge in court by the British Association of Physicians of Indian Origin (BAPIO) was rejected, but leave to appeal was granted. Pending the result of that appeal, the department was forced to allow nonEU doctors to apply in the first round of selection.

Thousands more found another way round, by joining the “highly skilled migrant” programme. They qualified for that by virtue of already working in the NHS as, for example, senior house officers. As a result, it is estimated that between 10,000 and 11,000 of the applicants for the 20,000 posts originate from outside the UK and Europe, maybe half of them through the highly skilled migrants programme. Nobody knows quite how many, nor do the application forms enable hospitals to distinguish home from foreign applicants.

So who is in charge? “Nobody is,” said the official who spoke to The Times. “The system was developed in isolation from workforce planning. So it was impossible to find any one person who would ask: ‘Will this work?’ .”

RemedyUK, the pressure group bringing the action, hopes the court will say the process is unlawful, but expects a solution to require negotiation.

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