Choosing what is best for you in general practice
Dr Terry John discusses what the new GMS contract means for GP career development, what loose ends still need to be tied up, and whether it will it live up to its promise of adaptability
Education is the one activity that continues throughout a GP's career. All GPs need to keep up to date and are therefore responsible for their own education. Some are involved not only in educating themselves but also in delivering education to others. When nGMS was delivered, doctors made favourable comments on the structure of service delivery and the methods of remuneration. But will the new contract clarify the strands of education available within the profession and will it improve the ability of doctors to educate themselves and others?
What structures are already in place within the new contract?
The issue of protected time for all GPs' study has been a controversial one. Our secondary care colleagues by and large have protected time built into their contracts but GPs have always had to negotiate this with their colleagues.
Some practices have devised holiday entitlements for partners which included a specified time set aside for study leave. This was particularly useful during the reign of PGEA but now that PGEA is gone, the need for some doctors to take a week off for dedicated PGEA learning has disappeared.
The new PDP structure which allows doctors to examine their educational needs and to satisfy them in a variety of ways calls for greater flexibility. An element for protected time has been built into the global sum but in the fierce debate on the capacity of the global sum and the insufficiency of MPIG, GPs have found it difficult to disentangle the quota involved.
The appraisal process is under scrutiny by the CMO in the wake of Shipman. For now, appraisal is still being funded with separate streams for those who are appraisers and for those who are being appraised. But sessional doctors still report a lack of clarification in the support they receive for appraisal activity.
Prolonged study leave is still available. Two payments are possible. A GP can have an education allowance to fund the activity and a contribution towards the cost of locum cover. Details on how this all works exists in the statement of financial entitlements.
What about sabbaticals?
GPs have also asked about the possibility of sabbaticals. In England, a sum of just over £8 million was included within the national PCT administered funding stream to cover this. GPs need to discuss a wish to do a sabbatical with the director of postgraduate education. As details are still being worked out, they may only be possible from next year.
What about those doctors actively involved in teaching?
'GP educators' is the title given to tutors, advisers and associated deans. In 2003, their arguments hit home. After negotiations with the Department of Health, a remuneration structure was put into place which was far more satisfactory than previously. There was no such luck this year for GP trainers.
Detailed evidence was put to the Review Body and the GPC negotiators undertook heavy lobbying of the department to improve remuneration. The annual trainer's remuneration is just over £6,000. In view of the fact the trainer has to assist the registrar through all the components of summative assessment, to supervise out-of-hours exposure and, most recently, to undertake registrar appraisal, this is not enough.
However, the department continues to advance the outmoded mantra that a GP registrar is 'an extra pair of hands' and has set its face against an increase. The GPC has decided not to let this rest and is in discussion with other bodies, including the GP Education Directors, prior to launching another campaign.
There are other areas in which GPs involved in teaching are becoming even busier. The workload in terms of remedial registrars, pre-registration house officers and extended training GP registrars has increased.
In the near future, the implications of modernising medical careers will mean that increased numbers of doctors will have exposure to general practice in their second foundation year. There will therefore be a greater call on GP teachers and a need for a clearly demarcated method of remuneration.
The new contract promised that GPs should be able to adapt their careers to suit their aspirations. In terms of educational activity, we have some structures in place, for example GP educator activity, although there is a need for further strengthening.
Other structures, such as sabbaticals and GPs with special interests, are in the process of development and we will need to ensure that what is finally decided is acceptable to the majority of GPs.
Finally, there are areas such as the training of GP registrars where the established structure is sound but the future of the activity has been put in doubt. Why? Because the Government refuses to recognise the energy and dedication put into its delivery.
This is a summary of a GPC position paper 'The nGMS contract and careers: a view from the educationalists'
The new contract and major GP career strands
Generalist status is highly appreciated within general practice, not least by patients, who value personal care, continuity, and the holistic approach. The new contact has to ensure that generalist GPs have adequate ongoing training within the physical, psychological and social arenas.
A huge growth area. The concept is still evolving and there have been various attempts throughout the country to develop skills that are fit for practise. The RCGP and the deaneries are developing methods by which doctors will be adequately trained for services required by their PCT, and the GPC is in discussion as to how best to involve local and national factors in remuneration.
Any GP employed by a practice, a primary care organisation or an alternative provider of medical services. The term includes assistants, associates, GP retainees, flexible career scheme GPs and returner scheme GPs. Both employers and employees need to ensure the terms and conditions pertaining to continued professional development and study leave are agreed before contracts are signed.
Terry John is chair of the GPC's education and professional development sub-committee