There has to be a complete review of the training of GPs. It just does not make sense to hand four years of GPs’ training to a hospital while we give them only one year in general practice.
If a junior doctor wanted to train as an anaesthetist, and was told to spend four years in general practice and one year training as an anaesthetist, how would we expect that doctor to feel?
I believe medical graduates should have the option to be GP trainees right from FY1. Five years’ training based in general practice for newly qualified doctors would offer many advantages. As GPs, we could provide personalised training; they would have the same GP training practice/mentor for five years. They would also have continuity of care with patients – impossible when they are moving around every four to six months.
And the training would be comprehensive from day one. Seeing 20 patients in a morning provides a concentration of learning. Similarly, if a student wanted to learn about a specific condition, I could find four patients with it and ask one of them if they are willing to have a chat with the student.
If they need training in hospital specialty areas, they should do it from a general practice perspective. In dermatology, for example, a trainee could sit in on an outpatient clinic for a week or two. If they needed training for maternity, they could spend a week in the labour ward.
As well as this, allowing trainees to live and work in the same place for five years would create great support and stability. This is a major positive. In 1989, I led the junior doctors’ campaign to reduce the working week to 72 hours from 84. So I was surprised when the recent junior doctor contract became a dispute. Juniors told me stories of moving house and job frequently, feeling unsupported and generally demoralised.
The option of primary care-based training for newly qualified doctors could be one of the solutions to a stressed junior doctor workforce.
Such a change would also be a meaningful move to parity between generalist and specialist training, at a time when an ageing population means a far greater need for generalism in primary and secondary care.
At the same time, it will make sense for the taxpayer. Health Education England estimates training in general practice is a third cheaper than in hospital. A huge amount of work has shifted into primary care – the majority of diabetes and heart disease is handled in that setting now, as is basic paediatrics. Most consultations take place in primary care, making it easier for trainees to learn in general practice.
Also, we need to ask if our graduate and postgraduate training is fit for a world where the internet can equip patients with medical knowledge, complex care is expanding, and technology – such as online GPs or remote monitoring – will take over many of our tasks.
But most importantly, it is time to show confidence in ourselves as trainers of future GPs and base the five-year training in general practice rather than hospital.
Dr Sam Everington is chair of NHS Tower Hamlets CCG