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Call me prejudiced, but surgeons make the worst GPs

Jobbing Doctor takes a sober look at how the influx of GPs from other specialties has harmed the profession.

Jobbing Doctor is also a Jobbing Course Organiser. Over the years we have had our titles changed and our job description altered, but my role is pretty much as it was 19 years ago when I became a course organiser: to turn a callow and inexperienced young doctor into a GP. An independent, ready-to-run-a-practice GP.

I think I can look back in satisfaction with what I have achieved, in that there really isn't a local practice that doesn't contain someone that I have trained. Now three of my protégés are fellow course organisers as the scheme has grown from eight people to 64 people.

Like everything else in life we have had a fairly wide spectrum of people to look after, and I have certainly had my share. One of the most memorable moments was when I was asked to train a man who turned out not to be a doctor at all, but a former operating theatre technician from another country. I found him brash and arrogant and rude, and had major concerns about him, which was compounded when he started to become seriously overfriendly with one of the female doctors.

As I was contemplating what action to take, he vanished from my scheme, and I was later to learn that he wasn't medically qualified at all!

There have been others who have had serious attitude issues as well. These people are much more difficult to manage than those others who struggle, and it does seem to me that, once people are accepted onto Vocational Training Schemes, they are guaranteed to finish, however much their shortcomings have come to the fore.

One group I have had the biggest difficulty with is those who have spent a significant time in one specialty, and then have moved over to general practice. Most of my problem registrars in the last 20 years have come from this group. Here I need to add an important caveat: I have had a number of people in this group who have done well and have gone on to make very successful GPs, including two former consultants.

But the issue here is about selection, and selection has been influenced by political imperative. The worst case was when the political promise to train an extra 2,000 GPs meant that the entry criteria were so watered down, that it seemed like anyone with a medical degree and without a criminal record was admitted to the Vocational Training Schemes.

The ramifications of this decision continue to be present today where we have, in my view, some seriously underperforming doctors who are not driving the quality of general practice up. This is compounded when I hear that they want to be training practices. I suppose people might say that I could be demonstrating prejudice, insofar as I have made my mind up about these doctors early on in their training, and they might have changed. I need to be sure I do not fall into this trap.

The worst ones are, I'm afraid, those who switch from surgical specialties to general practice. I don't know why, but it is too consistent to be a chance happening. I do wonder whether other course organisers around the country have observed this, or maybe it is just local to my little patch.

I doubt if my misgivings can be acted on, and that those who tick the right boxes are able to train in the future.

But for the future of good general practice we ought to be able to say to some doctors that they are not good enough to be GPs.

Jobbing Doctor