In times of stress and adversity it is always worth revisiting the past, not least to see how we can learn from it. Often we make small changes, which at the time seem sensible, but over the years have the cumulative effect of creating a stifling environment like the overcluttered homes of our grandparents.
We’re locking doctors in and removing flexibility
We now need to declutter. Begin to tidy out the overpowering, burdensome flotsam and jetsam – and in the context of general practice, this is the training processes for GPs. Despite the recent good news about increased funding in the General Practice Forward View we are still finding it hard to recruit to our GP training posts.
There are obviously well-rehearsed reasons for this, but I also wonder whether we need look beyond recruitment of medical students and retention of established GPs and examine whether our training regulations and the rigidity of the systems we have to qualify as a GP are acting as barriers to doctors already in training.
Diverting from hospital jobs
This is especially pertinent given the junior doctors’ dispute. It might be that many will rethink a career in hospital practice and will jump out of hospital into general practice. Their loss will be our gain and we should be ready to welcome hospital refugees into our fold. And before anyone shouts at me, I am not talking about ‘dumbing down’ our profession or making it the specialty of last resort – far from it. General practice will be strengthened by doctors trained in other branches of medicine, just as it was in the past.
Compulsory vocational training has been the single most important aspect of improving the quality and standards of our profession – and I was one of the first beneficiaries of this. But from a flexible process where the young (or not so young) medical graduate could meander through different specialties, gaining experience, competence and knowledge along the way, we now shoehorn doctors who are barely out of medical school into training programmes that will determine their entire professional lives.
Deep down I always knew I wanted to be a GP (influenced by my late father, himself a singlehanded GP) but I also knew I was excited by what I had seen and learned during medical school and house jobs. As with many newly qualified doctors, I wanted to show off my newly acquired skills. I wanted to prod and poke and stick tubes into patients and run for cardiac arrests and tell stories of medical heroism. After training in accident and emergency, then completing a senior house officer (SHO) medical rotation I decided to do psychiatry, for no better reason than I was interested in Freud. Finally, after realising how much I enjoyed every job, it dawned on me that my vocation was generalism.
But instead of having to start from scratch and take entry examinations just to be allowed to restart training as a GP (as medical students have to do today), I was able to fill in the gaps. I completed six months in obstetrics and gynaecology and then 12 months as a GPR (having my first baby in between).
The negative effect of the removal of the SHO role, which allowed experimentation and individually structured training, and its replacement with the Medical Training Application Service, means we’re locking doctors in and removing flexibility. This will be compounded by the new junior doctors’ contract, which risks removing pay related to duration of training and will require those who want to change specialty, potentially to come to general practice, to drop down the pay scale and takes no account of what they already know or have done.
In addition, GP training should be extended, something I fought hard for as RCGP chair. Three years might be enough to become competent, but it’s not long enough to become confident. Freeing up routes of entry and accreditation criteria, allowing for transferable skills, knowledge and experience into general practice and allowing longer and more personalised training should only be a good thing. It would (re)grow the pool of additional expertise in general practice.
This can only be positive for GPs, for patients and for the NHS.
Professor Clare Gerada is a GP in south London and former chair of the RCGP