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Back to the future

Will the GPs of tomorrow be dumbed down or skilled up? The future of GP training's looking decidedly uncertain, says the Jobbing Doctor.

Will the GPs of tomorrow be dumbed down or skilled up? The future of GP training's looking decidedly uncertain, says the Jobbing Doctor.

I have tried to look into the future, as I was talking with some colleagues yesterday about the future of general practice training.

The Jobbing Doctor has, for a long time, been a course organiser. I remember when I started I had about eight people on my scheme, and that was deemed at the time to be very successful. I had to chisel out of hospital departments some posts that could be allocated to GP training, although the consultants weren't very keen because they wanted to have people in post who were interested in their department as a career.

I look back on that time fondly as the scheme reflected my personality, and I was able to have a great deal of autonomy in how things were run. I was regarded by the deanery (or whatever it was called then) as a professional, and I could set my own standards for appointing people to the scheme, and design and develop my own rotations.

Halcyon days indeed!

Now we are regulated and directed to within an inch of our professional lives. The curriculum, appointments, reviews, allocations are all controlled centrally, with very little flexibility for people going through the training. It does not allow for creativity or professionalism.

Nevertheless, I love my post as a course organiser. I can look around my patch, and can see people I have trained in virtually every practice in my locality, and I know there are my protégés in practices all about the region. That is a wonderful legacy, and one that I am proud of.

I was thinking of this when I had my discussion with my colleagues recently. I was asked to say what I was most proud of as a course organiser. Although we now have a scheme of more than sixty doctors and four course organisers, I have been the only (and latterly the lead) course organiser for my patch for the last 19 years. My predecessor did it for 15 years. So I am most proud of being a worthy successor to a man who I regarded as an icon, and a mentor.

Enough of the past, however; I want to look at the future, which is rather mixed. On the one hand, you have the Tooke report (which I would imagine is beginning to gather dust in some office in the Department of Health). This wants to celebrate the professionalism and specialism of general practice, and looks to a future of longer training (five years, not three) - with the majority placed in general practice. This is a comprehensive, well thought through and appropriate report.

On the other hand you have almost every other trend which is pointing to a dumbing down agenda. The rise of the ‘practitioner' is a classic example, with the latest manifestation is untrained people manning a phone line and making diagnoses and recommending treatment. The increasing use of physicians' assistants (a very dangerous move, in my view) and nurses in doctors' roles mean that there is a very mixed message coming out to Jobbing Doctors.

What do people want? Do they still want primary care delivered by their family doctor? Or do they merely want a consumerist service that will give them exactly what they want and when they want it? They need to decide.

When I have a final year medical student come to talk to me, do I say to them that if I had my time again, I would do pretty much the same job?

Five years ago, the answer would have been a definite 'yes'.

Right now, I'm not quite so sure.

Jobbing Doctor

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