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New GP certification rules could create a two-tier profession by allowing some doctors to bypass stringent performance assessment, writes Ian Cameron.

The Postgraduate Medical Education Training Board (PMETB) has ruled that doctors from overseas and those who have taken 'non-standard' training posts in general practice will not have to sit summative assessment.

Yet prospective GPs going through three-year training in approved UK posts will still have to do so.

GPs warned that the PMETB's decision to alter past policy, made as the board took over certification on 1 October, could lead to falling standards and a 'great schism' in the profession.

The BMA said there was a danger of creating 'two populations' of GPs and damaging public confidence.

Dr Hamish Meldrum, GPC chair, said he was concerned about quality assurance of doctors and patient safety.

He said: 'We're worried about the unfairness of the PMETB's decision. I will be seeking discussion with the minister on this.'

Dr Roger Chapman, former joint secretary of the Joint Committee for Postgraduate Training in General Practice, the body the PMETB replaced, said the vast majority of past applicants had sat summative assessment, even if they were not legally required to.

Dr Chapman, a GPC member, said the joint committee had hoped the PMETB would legally enshrine summative assessment as a requirement when it took over.

'Initially its own lawyers advised us it would be possible, but the PMETB took subsequent legal advice and has left a great schism in general practice,' he said.

'At best it's untidy, but it's also unfair that arguably the doctors who have least to prove are those who have to demonstrate their competence.'

A spokesman for the PMETB said its legal advice had maintained that doctors who applied to the PMETB under article 11 ­ the equivalence route ­ could not be 'required' to undergo summative assessment.

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