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Why general practice is seen as the easy option

Jobbing Doctor introduces 'Lazy Lennie' and 'Noisy Nancy' and asks why GPs demean their own skills by allowing them to complete their general practice training.

A few years ago, a political commentator with extremely strong views about education wrote a book called ‘All shall have prizes'.

It was a critique about modern education policy that caricatured the way in which all pupils were supposed to be supported and allowed to progress, and no-one should fail.

At the time I regarded Melanie Phillips' views as typical right wing ranting, and dismissed it as such.

However, within any trenchant position there is more than a soupçon of truth.

I was reflecting on this when I recently attended a conference of general practice educators where we were talking about how to deal with those doctors who were failing. It seemed to me that there was little wish to fail some people outright, and people were wanting to bend over backwards to allow people to get through.

Over the last three years, in my region, only two doctors have not succeeded in general practice training.

This whole thing troubles me, as there are clearly some very weak characters who are undergoing GP training. We do have the usual mixture of people, and generally we do all right with them, but there are still people who I worry about.

There is Lazy Lennie. Lennie wants to get the minimum done, and so he sits in the corner with his mates and doesn't contribute. His e-portfolio is scanty, and superficial, and he likes making jokes at other people's expense. He is very ‘blokey', affable and a good mixer, but disruptive.

There is Surgeon Steve. Steve has tried his hand at surgery, but didn't do too well in the exams and upset the senior surgeons. He ends up going into general practice - he regards it as easy and needs little effort - and looks at many problems with a surgeon's brain: very black and white. Surgeon Steve is a nightmare.

We have Dithery Deirdre. Deirdre is never certain of anything and is chronically unsure of herself. She doesn't say anything during the teaching as she is frightened of sounding stupid, and keeps changing her mind.

There is Noisy Nancy. Nancy has a foghorn mouth, and is always ready with an opinion. She is critical of the teaching, and is dismissive of any teaching process that isn't PowerPoint and consultant led. Her pet hate is role play.

Clearly these characters are caricatures of real learners, but in their own way they are all difficult to teach and make for problems during teaching. They all expect to pass, because nobody has failed in the past.

I am sometimes surprised that people do not respect the education that they get more. I don't quite know why this is, and I think it may partly be due to the fact that general practice is still looked down upon by many in the hospital sector. It is regarded as ‘easy' by many, and this is not helped by those who have failed in the hospital sector being allowed to progress in the GP sector.

We should be willing to fail people. There should be a way in which we can say to them ‘you're not good enough to be a GP'. There are probably around 20 people in my locality who I don't feel are good enough to be GPs, and that is based on the feedback from the hospital trust and the PCT. But they still carry on, and by us letting them do so we are demeaning our own skills.

Every time we pass a marginal candidate we store up problems for the future.

All shall not have prizes.

Jobbing Doctor explores why general practice is seen as the easy option