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GPs buried under trusts' workload dump

GPs battling to stay up to date

By Daniel Cressey

Evidence-based medicine is among the mantras of today's NHS and one that each week spawns several forests-worth of guidelines, journals and prescribing alerts.

Not surprisingly, GPs are struggling to keep their heads above water, with recent research showing they lag behind hospital doctors in the race to keep up to date.

Neither can GPs afford to focus only on their own knowledge. As some nurses gain full prescribing powers, the burden falls on GPs to ensure they too are up to date.

Professor Roger Jones, professor of general practice at King's College London, believes GPs' contracts have never recognised the need for protected time for education.

'The consultant contract has always recognised research and education time – the GP contract only really recognises patient contact. That is a problem,' he says.

As generalists, GPs' knowledge is expected to span the whole of medicine, but a study this month found they faced a series of problems in applying the latest evidence, from time constraints to library access.

Dr Terry John, chair of the GPC education, training and workforce subcommittee and a GP in Walthamstow, east London, says: 'There's a concern there are barriers as we move into a new era where everything is being costed and there are new streams of commissioning. We're being asked to deliver more services. It's even more important to be aware of proper evidence-based medicine.'

Without the protected time hospital doctors enjoy, experts advise that GPs need to take a structured approach to their continuing professional development. Choosing which journals to read is key – the sheer volume of medical literature makes review journals vital.

Dr Chris Cates, a GP in Bush-ey, Hertfordshire, and editor for the Cochrane Airways Group, says: 'All generalists have a lot more trouble keeping up with the literature. The Cochrane reviews are a help, as is the Evidence Based Medicine journal.'

Professor Martin Eccles, professor of primary care research at the University of Newcastle, adds: 'There is a range of resources available – Clinical Evidence and the BNF through to published systematic reviews and clinical practice guidelines.

'The second way of keeping up to date is techniques that allow GPs to keep up without realising they're doing it – like embedding reminder systems in computers.'

Primary care academics insist it is also a matter of changing GPs' whole attitude to evidence-based medicine and making it a far greater priority.

Professor David Fitzmaurice, professor of primary care research at the University of Birmingham, says: 'We have to ask specific questions – the evidence-based medicine way would be to draw questions from your clinical work and answer them.

'It's not that hard, it's just getting into the discipline

of setting aside the time to do it.'

Professor Jones would favour going one step further. 'It would be good if general practice had rather more compulsory development points than it does. Although the appraisal works quite well it's still left fairly

up to the appraisee and the

appraiser. Most other specialists in medicine have formal CME systems.'

And it is not just themselves GPs need to worry about keeping up to date. Last week Pulse reported concerns that nurses, with their new expanded prescribing role, were even less likely to have proper continuing professional development arrangements in place.

Professor Alison While, professor of community nursing at King's College London, says: 'If GPs nurture their nurses they'd probably find it's easier for them to deliver QOF points and everything else.'

dcressey@cmpi.biz

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