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At the heart of general practice since 1960

What's left to cut?

Jobbing Doctor is an educationalist as well as a General Practitioner. Some of my time is spent looking after the education and training of the General Practitioners of the future.

Jobbing Doctor is an educationalist as well as a General Practitioner. Some of my time is spent looking after the education and training of the General Practitioners of the future.

Occasionally, we meet as a group from several schemes and look to see how the future of General Practice is faring. Jobbing Doctor is not, by nature, a theorist or deep thinker and I prefer my teaching to be much more impulsive and hope that the others that help me will be able to keep the Jobbing Doctor on message.

I suppose the teaching is relatively straightforward: there is a huge amount of really good teaching material these days at our fingertips, from books and much from that hundred-headed beast, the internet. That really doesn't change much.

The one thing we can guarantee on our scheme is that things will always be changing. That is the nature of the beast, that our political masters will see change as a force for good and a demonstration of their worth. Change is good, they say.

But it rarely is, I'm afraid, as one mystifying decision after another gets handed down to us from on high by whichever Moses happens to be descending from Mount Sinai. Start the first training year with a four-month stint in General Practice to orientate people in their new career? Excellent idea. We do this for two years. This year, that is the wrong approach (apparently); they should do it for six months in the second year. All change.

Managing general practice education is not only fraught with constant structural change within the process, but is - like in ancient Egyptian times - subject to macroeconomic changes. In the Bible the seven years of plenty were followed by seven years of famine.

We have had seven years of plenty, with stable budgets and increasing numbers of people on our schemes (Jobbing Doctor looks after more than 60 in his patch); we are now facing seven years of cuts.

I understand that everyone has to take a share of cuts in these impending straightened times. The problem is, there are relatively few areas to cut. You can try and run Vocational Training with fewer educators. After all, people time is quite expensive. We have eight doctors per educator session: can that be increased so that we have fewer teachers and more learners? That is possible, I suppose. As the oldest teacher on the scheme, I might be expected to fall on my sword. But my scheme is the most cost-efficient in the Region already.

Another way to do things is to change the style of teaching. Facilitated small-group learning is a very powerful way of educating people. But it does require numbers on the ground. We could switch to e-learning (cheap) or move towards a large lecture format (the most cost-effective way of learning).

Finally we could take an axe to the study leave budget. In their GP Registrar year (ST3 as we now call it) the budget for study leave is £300 per learner per annum. This generally will pay for around two thirds of one course. The rest (along with examination fees going into the thousands of pounds) will have to be paid for by the doctors themselves.

Options are limited, and there isn't much fat to be cut.

So today, instead of talking excitedly about educational theory (if that is possible) we are going to be talking about how and where we can tighten our belts and preserve what is best in General Practice training.

It is not an enjoyable prospect.

Jobbing Doctor Jobbing Doctor Quote

The one thing we can guarantee on our scheme is that things will always be changing.

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