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Should GPs be registered as specialists?

Dr Mary McCarthy argues recognising GPs as specialists will raise their status and help recruitment, but Dr Grant Ingrams says the idea is an unnecessary distraction 

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Yes. We need to enhance GPs’ status

The work of GPs has changed significantly since the NHS first started and indeed since the RCGP was founded. Twenty years ago, GPs did what out-of-hours doctors and many European family doctors do today. They saw and treated acute undifferentiated disease. Those with chronic diseases were referred to specialist clinics or to a general physician.

The role of consultant general physician has gone, and general practice now deals with the management of chronic disease, with patients with complex conditions and, of course, with the diagnosis and treatment of undifferentiated disease.

General practice is recognised as a specialty in Canada, the USA and Australia as well as in 24 out of 28 EU states. European medical organisations have stated that recognition ought to be uniform throughout the EU. The RCGP and BMA issued a second joint statement asking for general practice to be recognised as a specialist area of medicine. The GMC stated last year that they recognised the validity of the argument but said that to add GPs to the register of specialists needs amendment of the Medical Act.

This argument is not tenable. A statement from the GMC as the National Competent Authority would do much to raise the status of GPs. The GMC argues that such a statement needs the consent of all UK governments. This consent was not needed when paediatrics became a separate speciality or more recently with emergency medicine. The feeling is that general practice is discriminated against.

Recognition may increase the recruitment and retention of GPs and persuade medical students it is the first and best medical career

For doctors leaving the UK, the GMC provides a statement to say they have ‘post-graduate medical training completed in: speciality general practice’. It goes on to say: ‘This certificate is awarded to specialist doctors under Annex V (Section 5.3.1) of the Directive… Where the above medical speciality is General Practice then the holder has met the requirements of Article 28 of the Directive.’ So it appears that the GMC is happy to recognise a GP as a specialist if they are leaving the UK but not if they are staying. The GMC should publicly acknowledge that all GPs, whether leaving the UK or staying to continue working in a floundering NHS, are specialists in general practice.

General practice is the robust base of any cost-effective health care system. Without the skills and expertise of GPs, secondary care would be overwhelmed and the NHS bankrupt. GPs deal with the whole person, medically and psychologically, taking into account family history, past problems and socioeconomic circumstances. They cope with the evolution of chronic and complex disease, co-ordinating health care and providing continuity among the fragmented threads of the health service. They are the patients’ advocate and trusted guide in an increasing complex world of care pathways.

Acknowledging them as the skilled and expert specialist generalists that they are would raise their status among medical graduates and with their colleagues in secondary care. Having a separate register for GPs implies a ‘second-class’ status and makes new graduates reluctant to enter a profession that the government and the media seem to undervalue. Recognition may increase the recruitment and retention of GPs and persuade medical students that it is the first and best medical career.

The number of GPs is falling steadily and we need something to change. Their recognition as specialists is long overdue.

Dr Mary McCarthy is a GP in Shrewsbury, member of the BMA GP Committee and vice president of the European Union of General Practitioners

 

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No. GPs should be confident in who they are

I have a confession: I am proud to be a GP and even prouder that I am a generalist. I do not want to specialise, and when having done so in the past it bored me rigid. I love the diversity of a general practice surgery – from the mundane to the sublime and back again, never knowing what challenge the next patient will bring.

The idea GPs should be considered as specialists is an old chestnut. I first remember debating this in the early 1990s in the BMA’s GP Registrars Committee: no benefit came out of it then and none will now.

So why are some GPs pushing once again for this change: what purpose do they think it will serve? Is it just a case of ‘specialist envy’, or because GPs are currently discriminated against as second-class doctors? If the former perhaps they should consider retraining. If the latter, the solution is not to try to make everyone the same, but to embrace diversity and ensure everyone is valued equally.

Registering GPs as specialists would not confer any benefit. It will not change the public or other doctor’s preconceptions or prejudices. It will not result in a pay increase, better recruitment or improvement in working conditions. It will not result in a better deal from the tabloid press.

Improving our conditions would increase recruitment, whereas changing registration would not

Perhaps some of our GP colleagues just want a change in name? If it would make GPs feel happier to call themselves a Consultant in Family Practice or similar then no change in regulations or registration is needed. The term ‘consultant’ is not protected. However, I still flinch when receiving a letter from a ‘Consultant Podiatrist’.

The brand of ‘general practice’ has been developed over many decades and is well known and loved by the public: how often do you hear patients referring to ‘their GP’ with pride in their voice? Any commercial company would be envious about our brand recognition and be astounded that we are willing to put this at risk.

The resources currently being put into the campaign to recognise GPs as specialists are ill-timed and misdirected. It would be better for all energies to be redirected towards saving general practice: campaigning to improve remuneration and reduce workload. These would increase job satisfaction and therefore recruitment, whereas changing registration would not. Currently it would seem more appropriate to register GPs as an endangered species.

GPs should be confident in who they are and should stand before the mirror each morning and chant I am a generalist and proud of it. General practice does not need to be recognised as a specialty. As Shakespeare once penned: ‘What's in a name? That which we call a rose by any other name would smell as sweet.’

Dr Grant Ingrams is a GP partner in Leicester

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Readers' comments (9)

  • Can’t polish a turd, it is what it is, an arse covering excercise in risk dumping from all quarters.

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  • LetsCutTheCrap

    Well, since it is now "3 before GP", the government/ DoH essentially have recognised that GP's are no longer the first tier of primary healthcare.
    So what is stopping them from pulling their collective finger out, amending the sodding act and adding GP's the Specialist Register with a new speciality of General Practice?
    They are simply trying to have the cake and eat it too.
    If the GP is important enough to merit a referral from the 3 before GP, then why not cut the crap and call them the Ingrated Multisystem Specialist Doctors that they truly are?
    Patients will probably find they have to listen to common sense and follow it, if this happens.

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  • LetsCutTheCrap

    eeeek typo Integrated (not Ingrated!) you know what I mean!

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  • the whole training and career structure of general practice needs a reassessment- the basic job of general practice- which for many seems to be the aspiration, clearly is no more a specialty than core medical or surgical training, but there are lots of specialty areas within in general practice which require recognition-
    training,
    health care organisational planning and commissioning
    public health in primary care,
    complex care including area such as unscheduled care, management of long term conditions, and complex whole person care, particularly of the elderly or terminally ill
    - and now increasingly,
    leadership in service provision- an area which used to be in the job description of every partner.
    it is time that these 'specialist' areas are properly recognised, given visible status and therefore provide the career aspiration clarity that enthusiastic young gp trainees require. The Royal college should take this initiative which could require major organisation change and make it a more inclusive representative authority.

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  • The hospital specialists are now responsible for such a narrow field of clinical illness it is a privilege to be a generalist. We are needed more than ever and I am against this nonsense project to make us specialists.
    The other thing I bang on about is that we need to see the whole gamut of primary care cases not just the heavy load of complex and heart sinks. A 'specialist GP' heading up a team of 'noctors' is a horrible way to work and no wonder no young GPs apply for this type of work and OOH who use a lot of noctors are really struggling to recruit GPs to this type of post. Not only do they have to cover the noctors but they also get all the exhausting stuff. This is a bad road for general practice to go down.....

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  • As Scottish GP said, you cannot polish a turd. I choose to be more upbeat about matters.Let us not forget that this is why glitter exists- the turd looks a little better with a liberal sprinkling upon it.

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  • GP, consultant, nurse, HCA, ECP,ANP, physio, etc .... all suckers abused by the NHS (best health care system in the world) . Looking for another source of income me.

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  • If all the specialists retired today, the NHS would still provide healthcare, albeit with limitations.

    If all the GPs did so, the NHS would immediately cease to function.

    Conclusion?

    Generalists are essential, specialists optional.

    Remember that with pride.

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  • Hey we could head up the
    S pecialist
    H ealth
    I ntegration
    T eam

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