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GPs go forth

GPC to push for ‘radical overhaul’ of 'outdated' GP training

The GPC has demanded that the NHS fund leadership, business and management  courses for GP trainees as part of a ’radical overhaul’ of GP training.

The motion by the BMA’s GP Committee at the LMCs Conference in Belfast, called for GP trainees to spend more time in general practice and less in secondary care.

It also called for all FY2 doctors to spend time in general practice, and an overhaul of the e-portfolio requirements.

All parts of the motion were passed in a tight vote.

Dr Justin Copitch, a GP trainee who proposed the motion, said: ’Most of you here are GPs so tell me, are you seeing the same type of patients, doing the same work, with the same computers? Is the business essentially the same? No, it is not. So why are we training the same we did?

’It is said that all foundation doctors should do a block in the community to ensure that everybody, even if you’re not going to be a GP, knows what is involved in primary care. Exposing people to GP will also increase recruitment, retention and promote GP by choice, not chance.’

’My colleague had to do six months as an SHO in that specialty as part of her GP training as that was the job she got. What a waste of time.

’We propose GP training to stay in general practice for the entirety. Just like now, 18 months will be in general practice, but the other 18 months is split. Trainees visit clinics or visit specialties related to their special learning needs.’

Dr Francesca Silman who opposed part i of the motion said: ‘Sometimes its only with hindsight you realise what you lose out on. It’s only two years since I qualified as a GP and like the trainees I spent 18 months suffering on the wards of a hospital. but I do think I learnt things on those wards that you just can’t learn anywhere else. In one of my jobs we were doing palliative care, end of life care plan on a weekly basis. In GP it just doesn’t come up enough, and when it does, you are responsible.’

In favour of the motion was Dr Rami Eliad from Hertfordshire, who said: ‘Having been a trainer since 1998, this has been one of the most rewarding and sustaining part of my work as a GP. I’m very proud to see, what we called trainees, now registrars. However, with the new contract, the increased perplexity of general practice of both clinical and managerial, I question whether we are training our GP registrars for their future jobs.’

Dr Fiona Sanders, however, said: ‘Lets not throw the baby out with the bath water. Yes trainees do need more time in general practice but surely that should not be at the expense of getting valuable hospital experience.’

BMA GP trainees subcommittee co-chair Dr Zoe Greaves said: ’It’s not enough to leave training with clinical competence alone.’

She added: ’We need to be clear in what the words of this motion are saying. They are not saying they do not need any experience in hospital, and I don’t think anyone on the committee, or trainees would say that but we need the right experience in hospital that will help us when we return to the community. If we were asking a surgeon to spend half their training in general practice, they would be appalled.’

Motion in full

That conference recognises GP training is outdated and needs radical overhaul. We call upon GPC to work with relevant stakeholders to:

(i) push for GP trainees to be predominantly based in general practice with set time to attend secondary care for learning opportunities

(ii) overhaul the e-portfolio requirements to ensure it is equitable across the UK

(iii) learn skills vital to modern GPs such as leadership, business, and management through funded courses

(iv) ensure all FY2s have a community placement amended to: ensure all FY2 have a fully funded community placement

Readers' comments (8)

  • I agree with Drs Silman and Sanders. Cross-discipline training contributes enormously to our clinical and nuanced understanding of specialties.
    It helps to build our knowledge and skills as specialised generalists. We are first and foremost doctors. I still relate back to my hospital learning, every single day.

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  • Go Rami go!!

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  • Interesting debate.

    "Dr Justin Copitch, a GP trainee who proposed the motion, said: ’Most of you here are GPs so tell me, are you seeing the same type of patients ?"

    Yep--everything else might change; but the patients are exactly the same as when I started 30 years ago!

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  • Vinci Ho

    I see potential caveat of (a) opposing for the sake of opposition and dissatisfaction of the current vignette of misery (b) swinging the pendulum from one extreme to the other (c) fitting one size to all .

    All these times , we are debating merely about the nature and substance of this GP training programme which , in the perspective of lifetime ongoing education , represents only a small part in my opinion .
    Politics, economics(hence , management )and hard core medical knowledge are , in fact , converging to one entity of expertise in a rather unique system like NHS general practice. The education has to be continuing consistently after the 3, 4 or 5 years of so called fundamental training . Instead , I see colleagues falling off a high cliff free-falling after this training period with much less guidance ( certainly not NICE guidances!) which direction they should go . Appraisals , these days , are plainly serving the purpose of rubberstamping for revalidation at the end of a five year period . As I always stress , expertise is one of the four resources vital to us and am rather disappointed of the shortsightedness in how we should train careee general practitioners.......

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  • Repeated radical change at all levels has got us where we are today's more radical change is going to sort things?? No point sorting training until the job is sorted.It is s**t and no radical change since 2004 has sorted that it has just got worse.What was the definition of insanity again, ah yes doing the same thing over and over again and expecting the outcome to be different.Welcome to the UK,another meaningful vote anyone!

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  • GP training in secondary care should only be for short periods, six to eight weeks, in the majority of clinical OP clinics where the trainee consults patients with a Registrar or above monitoring the trainee in the same room. So up to eight clinical areas can be covered in a year and twelve to eighteen over two years, more than enough. Then another year in General Practice. GP training has been done like this in Canada. Note NO ward work.

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  • All primary care doctors have trained in and worked in secondary care, few secondary care doctors have been exposed to actually working in primary care. I think all doctors should spend a period practising in primary care, this would improve understanding of the complexities of the speciality, benefit future communications and ultimately this would lead to better patient care.

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  • Training does need to be overhauled. The current membership exam is not fit for purpose. I see trainees with very little knowledge pass AKT by just doing practice questions, but they are completely ignorant on actually managing chronic diseases (the bulk of our work). The pass rate is close to 80% (for UK grads) for this exam which is much higher than the pass rate for other college membership exams. The RCGP are accepting mediocrity to try and solve the numbers crisis. The WBPA part of the exam is not held up to scrutiny as it is expecting the trainer to flag problems, which presents a whole headache of other problems. Our patients are being failed by churning out under qualified, underexperienced GPs. The answer is to extend training, and more, not less hospital posts. And sort out the membership exam, so it is a proper test of competency and ability.

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