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Government to fast-track other medical professionals swapping over to general practice

Extra places are to be created on GP training courses to allow doctors who wish to switch from another medical speciality to be fast-tracked into the profession.

Setting out its 2015/16 mandate to Health Education England (HEE), the Department of Health said it should also work with RCGP to ensure any doctor wishing to make the switch has their training, experience and expertise accredited and recognised in doing so.

The DH said that ‘HEE will work with the RCGP and the GMC to ensure that action is taken to… allow doctors from other specialties changing to a career in general practice to have accreditation and recognition of their prior training, experience and expertise and therefore facilitate a more rapid progression to becoming a GP’.

It added: ‘Places on GP training courses will be created over and above current numbers specifically to facilitate this initiative.’

The development, aimed at attracting more medical professionals into general practice, is one of a number of instructions from the DH for 2015/16 also including a commitment for four-year training programmes for GPs to piloted from August 2016.

The mandate said: ‘GP training must produce practitioners with the required competencies to practice in the new NHS. Medical Education England accepted the educational case to extend GP training to four years and the DH is supportive of this in principle subject to further consideration of the economic case and affordability…

‘Working with the General Medical Council and the four UK Health Departments, the first new programmes should be piloted in the training year commencing in August 2016.’

The document also says HEE should:

  • ensure a minimum of 3,250 trainees per year (equating to approximately half of the annual number of trainees completing foundation training and moving into specialisations) are recruited to GP training programmes in England by 2016;
  • support an increase in the number of GPs returning to work after a career break for family and other reasons;
  • proactively support GPs in training to be able to work part-time for family or other reasons;
  • include compulsory work-based training modules in child health in GP training;
  • develop a bespoke training course to allow GPs to develop a specialist interest in the care of young people with long-term conditions for introduction by January 2016 (including
  • identifying key training issues to improve the care of young people with physical or mental illness during transition from childhood to adolescence);
  • ensure that training is available so that there can be a specialist GP in every CCG trained in the physical and mental health needs of armed forces veterans by summer 2015;
  • continue to support the inclusion of compulsory work-based training in mental health (including dementia) in GP training;
  • continue work with the Royal College of Psychiatrists to further enhance bespoke training courses to allow GPs to develop a specialist interest in the care of patients with mental health conditions.

GPC trainee subcommittee chair Dr Krishna Kasaraneni welcomed the plans to allow other doctors to swap to become GPs, saying this would ‘undo some of the damage’ from standardising GP training in 2007.

He said: ‘General practice should be a very diverse profession and doctors from different speciality backgrounds coming in to it can make a positive difference, so this is certainly welcome and long overdue.’

He also welcomed the commitment to four-year training pilots, for which some local education managers have already begun setting aside funds, but questioned whether the Government’s plans for attracting new GP trainees went far enough.

He said: ‘It’s hard to get doctors in training to join us in general practice when GPs are being pushed to the limits up and down the country. You cannot solve workload without the workforce and vice versa’.

Health minister Dr Dan Poulter said: ‘I am pleased that we have greatly increased the number of posts for trainee doctors in general practice’.

Readers' comments (33)

  • HMG really underestimates the intellect of medical professionals, doesn't it - it actually sounds so puerile that you can't even be angry with this silly banter :)

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  • In the interests of equality, transparency, candor and fair mindedness i wonder if the government might fast track general practitioners wishing to swap to other specialities!!!!!

    I really am fed up to my back teeth with general practice in blighty and this might be a way of postponing my imminent emigration!!!

    Perhaps if old dave, gideon and jeremy funded a few weekend remedial classes for a month or two i might be able to turn my old hand at a wee bit of brain surgery?? perhaps for all those a holes in whitehall they might allow me to perform some colorectal surgery? Come on it cant be all that hard can it?? im sure politicians know far more about medical training than respected experts in various medical fields who have been telling us recently that VTS needs to be extended to 4years!!

    This new scheme is what we were able to do prior to 2007 when the whole system changed to the nMRCGP and compulsory VTS with the racially discriminatory csa!! The system we were told back then was broken, despite producing many fine gp's via the old mrcgp and summative assessment. My how these things come full circle...........

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  • This was all possible before MMC. What are the architects of this doing now? Who would have thought not all potential GPs were assembly line drones for 1size fits all run through training!

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  • So what will be the carrots to attract doctors to general practice?

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  • There is no accountability on parts of those who suggest short sighted changes in the NHS. General practice and the NHS is suffering due to certain people who always know how to fix the problem but are no where to be seen few years down the line when the problems get even bigger. The GP land has become unattractive for many reasons: low moral, falling income, mounting paperwork , increasing regulations, ever changing goalpost, target driven work, diminishing support services, lack of long term vision, media bashing of the GPs, and a lot more. Unless these issues are tackled I can not see how the general practice can become a healthy profession for doctors wanting to become GPs.

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  • Desperate. When will someone realise patients aren't patients half the time, just needy souls brainwashed by media in a nanny state. We don't need more GPS. We need less 'patients'.

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  • so surgeons fed up with the NHS will switch to GP, get MRCGP then go to Australia. sounds like a plan!

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  • This comment has been removed by by the moderator

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  • Have national advertising campaigns telling patients not to attend GP with cough for 1 day no matter how chesty they think it is, and get rid of access targets which perversely encourage access for non essential problems and clog up the system.

    No more see GP for letter, any other crap no-one else is willing to do, and make hospitals actually see and fix patients not just run a test and say it is normal so not my problem, back to you.

    Once done then the stupid workload issues and pressure will reduce and allow GPs to be GPs in a safe environment and then the exodus will slow, once being a GP is not the equivalent of wanting a hole in your head.

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  • I am retraining and have been subjected to the humiliation of being sent all the way back to ST1. Unpleasant when you've become senior in your specialty already. You get treated like the "lowest common denominator" as the myth that HP trainees must be going for the soft option is all pervading in hospital. I switched because I thought I would get better control over my working patterns and more autonomy and more variety in clinical work. This would all for in better with my young family. I feel angry and let down by the RCGP, the 'government' of the day and the BMA, GPC who have been as effective as a toothless tiger in preventing the denigration of Primary Care. I plan to stay the course and either take my CCT abroad or simply return to what I did before with a wealth more general experience and a new found respect for all of my colleagues in primary care who slog away tirelessly despite attempts to break them.

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  • I feel angry and let down by the RCGP

    I plan to stay the course and either take my CCT abroad


    You sound like you've learnt the two most important lessons of General Practice already.

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  • ok let's get a reality check

    have a look at this

    https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/308513/shortageoccupationlistapril14.pdf

    it is the official careers shortage risk

    it lists shortages (doctors) in;

    emergency medicine,
    haematology,
    old age psychiatry,
    paediatrics
    anaesthetics
    general medicine specialities delivering acute care services (intensive care medicine, general internal medicine (acute),
    emergency medicine (including specialist doctors working in accident and emergency))
    rehabilitation medicine
    psychiatry
    paediatrics

    now interestingly general practice is not included.

    now i'm not the brightest in the bunch but that list is pretty all hospital services ! so where are you going to get the staff/mugs to cross over when conditions in general practice are set to get worse?

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  • some ideas to solve staff crisis

    - abolish and fire all staff from nhse, cqc, monitor i.e. all freeloading quangoes

    - get rid of revalidation

    - crown indemnity for all doctors

    - take the savings to recruit doctors

    watch as staffing levels rise !

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  • Will nick some of these ideas for the Pulse election manifesto (if you don't mind...)

  • oh i should add

    - renegotiate pensions

    67/70 is to old

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  • The guys who wrote that document push pens for >100k. They are almost poets and their creativity knows no bounds. So revel at their marvellous works which to us mortals make no sense.
    After the elections another creative politician will be re-writing the old poem which will still not make sense because the level of their integrity and intent is really dubious.

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  • I think this completly devalues our profession
    To suggest that any other doctor (of whatever speciality) can quickly retrain as a GP suggests that what we do is not worthy of any specalist skill.
    At first glance this might be considered a useful sticking plaster for the GP crisis - but ultimately it risks destroying the profession by undermining our worth.
    I do not note any similar programmes to quickly retrain as a psychiatrist , surgeon or physician.

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  • These people are idiots.Do they think that our colleages in speciality training dont read the press and dont know what a mess we are in.Why do they think people in thse grades will start all overt again and become the hospital rota fodder we have all been.As I said idiots (or clutching at straws).

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  • Editor's comments

    Will nick some of these ideas for the Pulse election manifesto (if you don't mind...)

    don't mind at all

    I will come up with more ideas and post them for you :)

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  • I agree with Kieran Kelly. This proposal is retrograde and downright insulting to GPs.

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  • Dear Editor

    sorry 'bout long post but just having ideas with no thought will allow politicians to bat the issues
    away. if you want a debate you need 'meat' to the
    argument.


    - ABOLISH ALL QUANGOES (CQC, NHSE, NICE, Monitor etc)

    why?

    there are no cumulative figures on the cost of these quangoes but my guess is the total cost are in the hundreds of millions. the question is are any of them cost effective or deliver? they are just monitoring structures that feedback and present data designed to coerce doctors to adapt their care to political or cost related initiatives. If anything they get in the way of primary care. If you take the case of antibiotics
    prescribing it has gone up more in secondary care
    so why are GPs being scapegoated. The astute will
    argue that these quangoes are about quality -
    really - where is the evidence? Let the patient be
    the driver of quality and use existing complaints
    structure to drive local quality. In addition all
    these quangoes are basically saying 'we don't trsut
    doctors so they need to be monitored' - again
    really? I've just received 100% positive feedback
    and recommendation from my patients with zero
    complaints - and I happily ignore the quangoes out
    of principle. Believe me if there was a serious
    error my head would be on the chopping board. None of these quangoes are involved in providing front line care and it is my opinion that they are just
    vehicles for minor 'politicians' to develop their
    career and final salary pensions whilst avoiding
    the actual job of seeing patients. Get rid of all
    of them. Also I would like to add that they are
    state employees who don't see patients - so I would
    be pretty miffed if the staff are getting final
    salaries.


    - GET RID OF REVALIDATION

    I have just spent 2 weeks preparing for appraisal
    (including writing up, online modules etc). I
    believe this is about the average time GPs are
    spending. I've passed appraisal with flying
    colours. It is a total tick box exercise and a
    complete waste of time. Another political exercise
    in incompetence. So why have it? It's to spot poor
    care and stop another shipman? really? Ticking
    boxes isn't going to stop a clever individual from
    committing a crime. But the process is so badly
    thought out that we have revalidation criteria, a
    local criteria and yes a CQC criteria (i just found
    out from a locum agency that although i meet the
    revalidation criteria and local criteria i don't
    tick the CQC criteria). Get rid of revalidation -
    it provides no useful purpose and costs us valuable
    clinical time. 2 weeks = 560 lost clinical
    encounters. Appraisal on the other hand is useful,


    - CROWN INDEMNITY FOR ALL DOCTORS

    why?

    the government wants us to work 12 hrs seven days a week. the government (some spokesman prof something or other) i recall also stated we need to move away from paying higher rates to staff at the weekend as it was damaging the NHS. OK explain that to the MDU and they will say OOH - pay more. So if you want staff to work these shifts offer indemnity. If you want GPs to work in a&e offer indemnity. As a
    matter of principle all doctors should be offered

    it.


    - PUT FORWARD A BETTER PENSIONS DEAL

    The argument given for the fact that the over 50s

    got a better deal is that they worked hard in the

    past. I agree but things are harder now so why are

    not younger doctors being offered the same deal?

    - REFORM GMC

    we have to apologise if we do something wrong. What about the GMC? If a doctor is wrongly accused and innocent (a good example is Dowley vs Giles) then the GMC should issue an apology to the doctor and the doctor should be compensated. The attitude of the GMC is 'We know you are innocent, don't do it
    again, and it's part of the job'. There should be
    legislation allowing doctors to counter sue.
    As far as I can tell although there have been
    massive changes elsewhere the GMC is one institution that seems immune. Nobody - doctor or public is happy with the GMC. It would also be nice as consistent within the law that we are innocent until proven guilty.


    - REFORM RCGP

    we have a shortage of doctors and although the
    government is denying it there are 'problems' with
    GP recruitment. Ok so if there are problems with
    recruitment you would look at the body responsible
    for training and certifying? Now what have they
    done - firstly they managed to upset foreign
    doctors, then they can not decide how to improve
    the process. I have a friend who did his medical
    training in the UK - he then went to New Zealand
    (yes I know a 'backwater' country) and worked as a
    GP Partner in a private practice for several years.
    We did a training course together and he trounced
    me on the tests (ok not by much). But he is a very
    clever guy, passionate physician and desperately
    wants to work as a GP. He was told when in New
    Zealand don't worry come over you are on the
    register. However, When he did arrive he was given
    a&e work. Did he get any help from the RCGP or the
    BMA or the deanery. No he was told to 'f' off and
    stop bothering them. So it's ok for a GP from the
    UK to work anywhere in Europe and travel to other
    countries but it doesn't quite work the other way.

    This is gross incompetence. I would start by
    transferring the exams to the care of the RCP as
    they seem to know what they are doing and fire all
    middle management and above at the RCGP. To be
    honest apart from the exams I don't think the RCGP
    have anything to add to primary care.


    - EXPLORE ALTERNATIVE MODELS OF HEALTHCARE


    Given Simon Stevens 5 year plan with all the fancy
    various new models you might think this request is
    a bit silly but bare with me. all the reports i have read suggest that in the mid-term the NHS will be unaffordable period i.e. the GDP requirement
    will be unacceptable to the electorate / state. At
    this point we will have a private service (it is
    the only logical alternative). I think the plan is
    to keep the NHS going long enough to allow
    absorption of GPs into a salaried system - first
    salaried to the state then the private sector. This
    is bad for current GPs. Since the article is
    focusing on recruitment wouldn't it be great if GPs
    are allowed to debate the issue and come up with
    our own ideas. We grassroots GPs should
    have our say. By politicians, BMA, RCGP pushing us out it results in disengagement and many doctors I know just don'care any more. They do the locums for the money and invest in property whilst looking for an exit. If we were given a proper say in our future it would provide the re-invigoration that the profession needs.

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  • Thank you

  • sorry to whinge on (i'm off today and it's raining outside so i don't have anything better to do!)

    but some of the ideas mentioned - DO NOT COST A PENNY

    - ABOLISH ALL QUANGOES (CQC, NHSE, NICE, Monitor etc) -> cost savings £100 millions -> use the money to fund doctors/NHS staff

    - GET RID OF REVALIDATION
    28 million (based on my calculation of 50 encounters a day x 14 days x 40000 GPs) encounters for FREE!

    - REFORM GMC
    again the stress and lost productivity due to GMC failures results in lost patient contact.


    - REFORM RCGP
    the money saved by GPs by scrapping RCGP could pay for a locum (for a half day). A good deal.


    - EXPLORE ALTERNATIVE MODELS OF HEALTHCARE

    we may just come up with an idea that saves the NHS (or not) ?

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  • Great Idea????
    I remember the last time when General Practice training was in the doldrums, about 20 years ago. At that time it seemed that the only people applying for training were those who wanted to leave hospital practice. My memory is of lots of stalled hospital doctors, often of a dogmatic surgical background, who could not progress up the career ladder in hospital having spent years at registrar / staff grade level deciding to move into general practice. They were so set in their way that they were untrainable in the holistic GP style of management involving the patient in their own care. In those days the interviewing was at practice level (they were exempt from the 2 years hospital by virtue of their "experience"). All I can hope is that they are weeded out by the deanery's interviewing process (but with all the political pressure to increase numbers I am not sure that they will be)

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  • Clearly no intent to attempt top retain doctors already working as GPs. Dumping the usless timewasting obstructive parasitic organisations such as the CQC and the appraisal/revalidation farce would save money and encourage us to stay on.
    Endless bullying bureaucracy continues unimpeded and our pay is falling as expenses rise.

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  • It might also be worth reforming GP so that those that have recently completed GP training like myself are actually lured to stay on. I have managed to secure a training post in hospital, however I pretty much need to start from a post FY2 level! If we simply 'fastrack' people from other specialities this will devalue our profession...former neurosurgeons will not have access to same day CT scans, surgeons will not be able to avail of same day USS scans, and the ability to balance risks and diagnostic uncertainty is a skill unique to GP, a skill that takes years to develop and something that many of my secondary care colleagues lack..
    ..I know of at least 3-4 other GPs switching to Radiology, medical training & A+E. None of these specialities have had them 'fasttracked', why should we?

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  • usual completely misguided tosh..the usual misguided nonsense scheme trying to band aid the problem they have caused by their arrogant neglect and total incompetence....no doubt another idea from the bum polishers at the serial failed quango called nhse..a disgrace to the nhs.
    i seriously advise for it to be wound down and the money saved put onto patient care..also there would be more time saved for clinicians burdened down by their absurdly bureaucratic bullying top heavy foolish burdensome nanomanagement.
    why would any dr in their right mind work in the current dreadful and worsening conditions in general practice.?

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  • anonymous 8.31,
    I have been through this. I used to cry because of the humiliation from the ward staff. VTS trainees were for venflons only. In good faith, I did not want a short cut to GP training, so I did full VTS, how I regretted, which I still do.
    I had only 2 consultants who respected me and supported me because of my previous speciality and age. When re training, one is much elder in age from peers.

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  • Anyone can fast track or do NVQ from open university to be a GP. Why not? After all GPs are not doctors.
    Gps are paying a heavy price for their own deeds of good will, being over contact with patients, lack of confidence in saying the magic word "NO",

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  • Being a GP trainer, I have to say the worst trainees were the disgruntled Surgeons/orthopods/ENT surgeons/Anesthetist who moved into GP land as they were not progressing. Their limited medical knowledge was immense and they were clearly dangerous. Only the previous medics had any idea because 80% of GP is medicine and they had some idea of looking at the person rather than an organ. This is a dangerous step. Because of our years of experience in General practice, We could not do 1 year training in Radiology/urology/surgery/orthopedics/peads and be a consultant, so why the hell can it work the other way? The daily mail reader might think they can do it, but any doctor on the ground knows our secondry care colleagues with their on organ speciality would not last one hour in general practice seeing a child, an adult an elderly person, a gyne case and a psych case one after the other. Listen to the Grass roots!

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  • Steven Martin,
    Agreed this is down right insulting to GPs. However, at least it has come from the government. The insults GPs get from hospital FY1/ FY2 in their first 6 months of training is even worse. The next time I get this I will write a complaint. Surprisingly, when we as GPs speak to specialists, the response is different.

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  • Sorry mate, most doctors do have brains! Why would someone want to change specialities? Er, there is something called GPVTS you know and people have not been applying to it. Duration of training has nothing to do with it! Fast track or not, no wannabe GPs here!

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  • I am not surprised with the current workforce crisis in GP world.
    We all have to blame the RCGP for this current poor state of affairs,by implementing the racially biased CSA exam and getting GP trainees out of the system and spoilt the careers of lots of aspiring GP trainees. (though RCGP still thinks CSA is a very fair exam).
    Now government thinking of fast tracking other specialty into GP's when they realised very late that not many newer medical graduates would like to be GP's in future.
    It looks in couple of years time that government might say that you could practice as GP's when you just finish medical school.changing goal post all the time.

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  • Chaand you have a duty to us as GPs and to patients. Clearly NHS GP is broken.

    You should be speaking to medical insurance companies concerning developing a national private health insurance, working out premiums and processes.

    Then carry out a ballot of GPs on mass resignation from the NHS and a move to the new system

    The NHS can always contribute a co-payment if HMG and DOH wish this

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  • At risk of contradicting all the above, actually I think there is a bit of a potentially good idea in here.In years gone by, if you were doing some specialty and then saw the light and decided that actually GP was the best and most fulfilling career option, you could count some of your previous hospital experience towards the hospital part of the training.
    Nowadays, this is very variable, particularly when you have had career breaks such as maternity leave during your hospital training.
    There is little point in asking someone who has been a hospital registrar in medicine, who may already hold MRCP, to do another SHO job in a team where they had just been the registrar (honestly, this has happened) as part of a VTS because they refused to recognise the previous experience - or in fact because they refused to say whether this experience would be recognised or not, so the registrar in question had to decide whether to take the risk, or to do the SHO job again in any case.
    Would it not make more sense to do the other hospital based specialties (paeds, gynae, psych), and instead of the medical SHO job to have the extra 6 months spent in general practice as a registrar?
    What is really missing is not a fast track system per se, but a flexible system to allow some common sense to prevail.
    It is daft to make a specialist from another area do a whole VTS scheme, including junior doctor jobs they have already done.
    And some people do genuinely see the light, by the way. It's not just the failure to progress that pushes hospital docs into GP land. Plenty of cases of GP being low status option in med school, so they go through a specialist training and get so far before they come to the realisation that actually GP is a much more interesting option...
    I would actively welcome someone who has done something a bit different first, and has a bit more life experience behind them.

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