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Slippery slope

for registrars

'Just when you thought the deanery postal in-tray couldn't get any worse.' These are dangerous words in medicine and never have they been associated more closely with our beloved registrars.

Surely the time has arrived to question the system that governs registrar training and registration with the college. Recent changes have made the slope of teaching more acute than the north face of Everest. The truism of all slippery slopes applies as always. Enthusiastic scrabbling trainers may not aim for the top of the slope for much longer.

The RCGP has launched an initiative for training from 2007. Registrars may soon spend 18 months in practice following a more structured curriculum. They will then complete the tougher MRCGP standard exams rather than the idiot-proof summative assessment. Not stopping there, the GMC want in as well.

Flailing around

Having been completely 'yorked', by Dame Janet Smith, they are now flailing around off-stump tying to impress the Government selectors. They have suggested that if your favourite registrar ends up in front of the professional misconduct committee then you should be given the character-building opportunity to join them in the dock and explain why they know sod all about (insert any of those topics that never quite get covered on your to-do list.)

I think the traditional Jasper Carrot style calculation is probable worth revisiting here. First the positives.

Well there are none in my book. More paperwork, longer courses and seeing fewer patients in longer and longer consultations don't look like positives to me. There are no jobs for new GPs to see a patient every 20 minutes, never be on-call and discuss every case however simple in order to eliminate all uncertainty. The eight or so patients seen by a registrar a morning may be delighted with the personal service, but the remaining 20 urgent cases will still need seeing by service providers. For the negatives, just think of those all those costs in the accountant's columns.

All that paper the printer gets through zapping off summative assessment criteria, the 'yet another' new video camera that always seems to be out of date or not quite complying with the rules. The stream of thermometers and auroscopes that fall off the desk. Days off for communication skills, summative assessment modules, MRCGP preparation courses.

Trainer's days off, training the trainers on how to reflect on being trained by trainers. The list grows longer by the week.

Unrealistic ideals

By my reckoning the margin must be down to a £1 by now. We need to enter the pragmatic real world and meet patient demands with a quality service not pursue unrealistic ideals.

Unless Jurassic training guidelines, archaic funding and deanery reforms are considered, an increasing number of training practices will have become extinct waiting for the bronze age of common-sense training, fit for purpose.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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