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Don't take trainers for granted

It's a bit difficult to tell how seriously the Department of Health is in mooting the idea of forcing training practices to contribute to the salaries of GP registrars and foundation year doctors (Pulse, 21 September).

One suspects, like the ill-fated 'star rating system' for GP surgeries, it is an example of floating a controversial proposal which will be dropped like a hot potato as soon as its implications become clear.

What is certain is that it is impossible to separate the 'service' and 'educational' parts of GP registrar posts.

GP registrars learn in an experiential manner by doing the job in a supportive environment with the supervision and guidance of their trainers.

Trainers provide their registrars with daily on-the-job training, including support in specific situations, advice on questions, hot topic teaching, surgery reviews and out-of-hours supervision, as well as the more formal aspects of education (tutorials, video reviews, day-release courses).

Caring for patients in an educationally supported environment is not just 'providing a service'; it is essential medical education and this is why GP registrar salaries are funded centrally via the postgraduate deaneries.

GP trainers do the job because they enjoy teaching and working with future GPs at a pivotal point in their careers.

I don't know any whose motivation is financial reward or to get 'an extra pair of hands' in the surgery. The responsibility and workload, to say nothing of the paperwork, is too great for that.

However, the goodwill of GP trainers like me cannot be taken for granted, and failing to value trainers and training practices (including paying an appropriate trainers' grant) endangers an effective training system that other specialties envy and general practice can be justly proud of.

From Dr Steve Cottam, Eccleston, Lancashire

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