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RCGP reviewing whether MRCGP exam is ‘fit for purpose’


As a GP very near retirement I have the advantage of historical perspective even though I am not currently involved. My concerns are more about the content of general practice than the method used to assess it. The exam has been obsessed with the consultation for decades, quite appropriately two decades ago, but (though still of vital importance) less central now that the content of primary care has shifted so much. Dealing with complexity is now the most challenging aspect of primary care and the importance of the GP role as conductor of the diagnostic/therapeutic/caring orchestra needs to be moved to the epicentre of the MRCGP exam. This involves holism in the traditional sense, but with the addition of ensuring the unified working of the other health and social care professionals to avoid gaps in care, wasteful overlap or, worst of all unknowing clash of incompatible interventions. The challenge of therapeutics has never been greater, and cannot be totally relegated to pharmacists or nurses or hospital specialists. The only person with the complete therapeutic score on his/her desk with a knowledge base to evaluate it is the GP. And this means that GPs need to have a much more extensive knowledge of therapeutics than has previously been necessary. Team working has always been a characteristic of quality primary care, but teams are now bigger, more diverse and often multi-sited and multiagency. Taking global responsibility for the patient, especially those who lack capacity, is essential to avoid fragmented care, and the GP is the obvious and most appropriately skilled person to take this role. But so doing requires formal continuity of care, which is under threat from part-time and casual working health professionals. Organisation of practices so as to provide continuity of care in the face of discontinuity of staffing is one of the most pressing problems. It is achievable but requires sophisticated practice management and an ethos of joint working. Out of hours care has become a black spot in primary care, a casualty of underfunding, privatisation and the loss of GP direction. Quality has suffered, and the lack of investment in academic study of out-of-hours care means that there is little evidence that can direct the organisation and provision of service. Yet the use paramedic response teams in this area leads to waste, unnecessary hospital admission and poor quality holistic care. General practice must aim to take back control of this area of care, and the membership exam needs to recognise its importance. These are difficult times for general practice, but if we are to preserve our discipline, which is capable of providing high quality patient-sensitive, effective and efficient care at remarkably low cost, my successors need to focus on the areas of care that generalists are most suited to provide. We must also ensure that the high standards of the MRCGP exam are relevant to the job description of sort of GP needed in the future.

Posted date

03 Aug 2017

Posted time