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At the heart of general practice since 1960

Postcode lottery still a problem

andy jones

Brush strokes

Have health ministers painted themselves into a corner on jobs?

Just bear with me a second and imagine recent Health Secretaries as artists.

Frank Dobson daubing with his hands tied behind his back, spending plans and improvements in health care constrained by prior spending agreements with Gordon Brown. Alan Milburn using an extremely small paintbrush to micromanage everything from private finance to NHS

paperclips. John Reid's broad brushstrokes ­ probably more useful for painting Richmond House than managing it.

Patricia Hewitt being thoroughly nice to everyone, in an all-encompassing consultation exercise. Art by committee.

And while they have all tried to tackle the subject of recruitment in their various styles we keep having huge logjams in training doctors.

GP trainees have faced this turmoil. Falls in deanery budgets of around £20 million last November have started to bite. The recent GP census showed the start of a fall in the numbers of GP registrars.

Many doctors want to enter GP training but it has just become too expensive for deaneries. Several hundred house officers are said to be struggling to find training posts this summer.

The duration of GP training is set to rise, with 18 months in practice ­ this is coupled with an imminent retirement bulge.

Workforce planning?

These kind of 'minor mishaps' make me wonder just how much planning goes into the medical workforce. There are huge discrepancies in numbers of doctors per head around the country.

At the start of the NHS there were twice as many consultants per head in London as there were in places like the Trent region. The gap has been reduced, but regional and teaching hospital disparities are still rife.

The GP census suggested we have an average

list size of around 1,700 patients. Statistics never

lie, so if I take my 2,400 and subtract, some

lucky Pulse reader looks after fewer than 1,000 patients!

We have had Resource Allocation Working Groups and the postgraduate deans are supposed to keep a tight reign on training numbers, but so far to no avail.

Perhaps our health ministers should spend a little less time on their political brush strokes and a little more attention on simply getting doctors into post.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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