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Why I believe GPs need two more years of training

GPs need two more years of training and more flexibility to allow them to learn the art as well as the science of medicine, argues Professor Clare Gerada.

I am now reaching the tail end of my career, one which for the most part has been in general practice, having qualified in 1982, the year compulsory GP vocational training was introduced. As a newly qualified doctor I felt the need to visibly demonstrate my newly acquired skills and knowledge – put tubes into people, take blood, stitch them up – basically be heroic and ‘doctorish’.

I meandered through Accident and Emergency and the Whittington Medical SHO Rotation but then paused. What did I want to do? During quiet periods in my final post (yes, we had them then), I would sit in the hospital library and read the British Journal of Psychiatry. I was fascinated by what I read and psychiatry became the clear answer to my question. I applied for and got onto the Maudsley registrar rotation and spent two happy years moving around different subspecialties.

But there was a big problem. All the placements I had been on – whether as an SHO in respiratory medicine, child psychiatry or drug dependence – I had loved. I realised something that I had known since my childhood spent watching my father in his local practice, that I wanted to be a GP.

In order to become a GP at that time, one had to satisfy the Joint Committee on Postgraduate Training for General Practice (JCPTGP) requirements, which included completing four six-month placements, as well as a year in general practice, within a seven-year period. Prior training could count and while organised vocational training schemes were in place, many doctors were able to mix and match and create their own.

This allowed doctors to switch from one hospital career to general practice or, as in my case, take time to decide to become a GP. It also allowed for a longer period before qualifying as a GP and for me these extra years of training have been invaluable. Over the years my additional skills, knowledge and experience have allowed me to become a general practitioner with special clinical interest in drug/alcohol misuse, to lead a national mental health service and given me extra confidence in the consulting room.

General practice is the hardest of all the specialities but has the shortest training. Every speciality and subspecialty relies on the GP knowing what to do, when to refer and how to care for patients once discharged from their care. GPs have to care for the whole body, not just one aspect of it. To survive and thrive a lifetime in general practice I believe that we need to have several strings to our bow. Newly qualified GPs, with only three years of post-Foundation experience might have the competence and knowledge to do their job, but I do not believe three years is sufficient to instil in them the confidence they need.

As chair of the RCGP I successfully made the case for four years of training, but even this was a compromise on the five years we originally asked for. I rarely say that we need to go back to a past age, and rather than going back to the days of the JCPTGP I would propose that we maintain the three years of what we have now, but add an extra two extra years of training.

This would allow GPs to gain confidence, not just in general practice but in other clinical, managerial or leadership areas. These five years would be completed within a 10-year period, giving doctors the flexibility to take time off for family or other reasons or simply to spread their training over more years.

I would also ask for the uncoupling of VTS, at least enough to allow doctors such as myself who chose to become GPs later on to be able to use prior experience, and provide greater flexibility in completing the requirements. Instead of squeezing examinations into three years, trainees could spread them over five years or even longer.

I believe extending training this way is essential if we are to enable our future GPs to learn the art as well as the science of medicine.

Professor Clare Gerada is a member of both RCGP and BMA councils and medical director for the NHS GP Health Service. 

The fee for this piece has been donated to The Louise Tebboth Foundation, established in memory of Louise Marson (nee Tebboth), a Bermondsey GP who took her life in January 2015. The Foundation aims to provide financial assistance to projects and services which support the mental well-being of doctors in England and Wales and initiatives assisting the bereaved families of doctors who have died by suicide.


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Readers' comments (16)

  • It's not so much about the length of training, but instead the 'quality'. Future GPs and family physicians elsewhere in the world are far more involved in outpatient clinics, rather than being used as an extra pair of hands on the wards. Future GPs, rather than just future consultants, should rotate rapidly for short periods of times, such as six weeks, through multiple specialties just working in outpatient clinics. By rotating every six weeks to a different outpatient clinic a doctor could cover 15 to 20 GP relevant specialties within two years. Working on the wards is less relevant for general practice. When I was in Canada young doctors would run the outpatient clinics with the consultant sitting in, watching and assessing them. Currently In the UK GP formal training does not allow doctors to rotate through all specialties. So one tends to learn once qualified as a GP through outpatient letters coming back to general practice. That is a valid way of learning and keeping up-to-date, but it would be nice for newly qualified GPs to have that experience from the start rather than having to learn later on the job.

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  • I agree with you completely Claire and would advocate at least another year's training to allow for adapting to an ever changing spectrum of work.

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  • well said. Today I see a new ST3 starting with a centrally imposed rota that bares no resemblance to that of a working GP. The trainee thinks it"s is crazy as do we. The profession seems to be impotent and lost all control in the most basic of areas.

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  • Should be 4 years; ideally first year in GP then 6 x 4 month attachments in hospital specialties and then a final full year back in GP. However the likelihood of this happening seems remote...trusts need 6 months service provision posts to fill and their voice is louder.

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  • good plan

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  • I think this is a great idea especially for foreign medical graduates who need more time to pass The CSA exam.

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  • Council of Despair

    the first poster missed an important issue - if the rotation is 6 weeks they may miss out if they take annual leave - but I see your point. Let's stop them from taking any annual leave.

    there may also be a case to extend training to 40 years as there are a lot of specialities to cover and also lot's of other areas such as boiler repairing, anti-malware coding, fire alarm reviews, reviewing safety of tower blocks etc etc

    we have to do CPD for appraisal so why not have a continious training period which could be used for appraisal. Also think of the cost savings as GP trainees are cheaper than salaried GPs. You can then give them their certificate when they reach 70 years of age. By this time the FMGs should have had enough time to pass the CSA ?

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  • Even when I qualified 15 years ago, 3 years were barely adequate. You were able to extend it in hospital practice but not in general practice. I feel trainees need more exposure to making decisions. In our era we were much less supported and probably made more independent decisions (that possibly compromised patient safety as it was beyond our expertise) but we had significant exposure both in hospitals and in GP. Nowadays, depending on previous training, the majority will not have made many decisions on managing a patient themselves until they are alone in GP. A significant minority struggle with this and need more time to develop this skill and are slower to move to shorter consultation meaning they have less exposure to patients in numbers and I often feel they need more time and exposure to the numbers of patients which cannot be achieved in the current 40 hour week. I feel that the current system is better, safer and must stay but this does mean training needs to be longer. Just as foundation year is longer than the previous house officer year, I feel all training needs to be extended to allow more exposure to patients and decision making.

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  • It has come to my attention that some trainees are still capable of independent critical thinking despite several years of RCGP training;this dangerous freedom of thought must be eradicated. Training will continue for as long as it takes. And you will all continue to pay college fees for as long as it takes.

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