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At the heart of general practice since 1960

How contract will affect your career structure

ew would deny that the introduction of compulsory vocational training for GPs was a good thing, but it did have one drawback in that it robbed general practice of its last remnants of a career structure. Until then, new medical graduates or doctors who wanted to leave a hospital specialty went straight into 'apprenticeships' in general practice, and as they became older and gained in experience their status within their practice and their community increased.

Now, a GP may complete vocational training at the age of 25 or 26 and spend the next 40 years doing exactly the same job, with exactly the same notional status and exactly the same pay.

It is not surprising that many GPs become disaffected, bored or burned out, and need little prompting to leave the profession for jobs in which training and experience and special skills attract respect and are acknowledged financially.

This problem is compounded by the fact that GPs wishing to develop their career by specialising in a particular area of medicine pay a hefty penalty for doing so because the sessional rate for clinical assistantships and occupational health posts within the NHS does not even cover locum costs. Being a GP trainer is also relatively poorly paid, and may even cost the practice money in the early years if premises need to be altered or additional GP time provided to meet training requirements.

Until PMS was introduced, it was difficult for a GP to move between practices, and recently trained GPs who wanted to explore a variety of options before selecting a practice had little choice apart from locum work. The introduction of well-paid salaried posts in PMS practices was a big step forward for both practices and individual GPs.

Recruitment may improve

Overall, the new contract proposals for career structure in general practice appear positive, with problems being acknowledged, much-needed changes proposed, and minimal interference with those parts of the GMS contract that are already satisfactory. When placed alongside current proposals for flexible working hours and golden hellos for returners, these changes may well improve recruitment and retention.

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