With recent discussions about giving GPs recognition on the specialist register, in line with hospital consultants, there has been a lot of chatter about equivelency of consultant physicians vs GPs, MRCP vs MRCGP. I think all of this has missed the point. General practice has changed beyond recognition over the past 20 years, with more complexity, more diagnostic and treatment responsibility and tougher clinical governance than ever before. And, according to Professor Bruce Keogh, there is more to come over the next 20 years.
When you look at ‘time served’, like an apprenticeship, then yes, GP training of three years does not appear on a par with three years CMT plus three or more ST training. But MRCP and MRCGP cannot be compared fairly – they are testing different skills for different scenarios in different environments. They are equivalents, tested at much the same time.
Should we then consider ‘First 5’ as an equivalent to speciality training, the time to develop and hone the specialist diagnostic, patient management, professional behaviours and service management skills needed at consultant level?
The only difference I see between GP training and development compared with hospital physician training is the personalised, self-directed approach as a ‘First 5’ GP vs the proscriptive, directed, portfolio-flogged approach of hospital speciality training. Politicians, planners, lawyers and registration bodies are so reliant on reproducible, measurable data to prove competency that a free-flow, non-examined, experience-based form of training is hard to stomach. But is it any less valid for the function it performs?
And ultimately, the message we hear from Professor Keogh and others is that medical care is likely to move more into the community arena, the realm of primary care. The clinicians that will be taking more overall responsibility for that care need to be appropriately recognised and afforded equal parity to hospital clinicians in the eyes of the medical world, legal system, politicians and the public.
So I say that experienced GPs are consultants in all but name and formal recognition – primary care consultants.
