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Training place cuts are catastrophic for patients

From Dr Arun Sharma

Joint PEC chair, Barking and Dagenham PCT

Open letter to Professor N Jackson, Dean of postgraduate general practice education, London deanery

It is with considerable dismay I note the decision by the London deanery to defer the innovative training programme due to start in August.

In the Barking, Dagenham and Havering scheme there are 14 training places. Of these, six are in Barking and Dagenham. There will be one GPR placement in August 2006 in Havering. There will be no placements in Barking and Dagenham. The outlook for February next year seems almost as bleak.

We have worked hard in this PCT to increase the number of trainers over the last few years. There was dismay and exasperation when we heard about the cuts to GPR places earlier this year. To then hear that the ITP posts had also been withdrawn has left us rather bemused.

We are now beginning to wonder whether there is any connection in the London deanery with GP workforce planning.

When such questions have been raised in the past, fingers from the deanery have pointed to the Department of Health and from the department to the deanery. I am not particularly interested in the details of the clearly dissociated relationship between the two, but I can tell you that the effects on patient service delivery are profound and potentially catastrophic.

Health minister Lord Warner is of the view that, as Barking and Dagenham is an 'under-doctored' area, the department should increase capacity by encouraging large private sector companies to provide primary care services.

The expectation that the private sector will be able to parachute in doctors to provide local services is woolly thinking which does not cut any ice with local primary care experience.

The assumptions do not stack up for several reasons. First, all our experience is that local GP registrars tend to provide for 90 per cent of new GP appointments.

Second, the nature of general practice requires a stable long-term presence of

GPs for the service to work most

efficiently – a challenge for corporate

private providers.

Further, the department's line on out-of-hospital care with a shift of services into the community rings rather hollow with us, as the planning for the medical workforce over the next few years seems particularly precarious.

Local GP workforce planning is crucial where local training schemes, the deanery and PCTs need to address the future GP workforce needs.

Regretfully, I fear we are seeing more nails driven into this coffin – whether the deanery holds the nail and the department strikes the hammer or vice versa is a moot point.

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