After much fanfare and public debate the RCGP team, including COGPED representation, appeared before the Medical Programme Board of Medical Education England to present the educational case for change.
The case was strongly supported by other specialty colleagues, in particular the Royal College of Paediatrics and Child Health and the Royal College of Psychiatrists. Sir Terence Stephenson representing the RCPCH spoke of the pressing need for GPs to have structured exposure to paediatric care under specialist supervision to enhance their skills as well as confidence in recognising and managing the ill child. Dr Sue Bailey of the RC Psychiatry recognised the level of responsibility for mental health provision currently provided by GPs and the need for experience under specialist supervision to enhance this care as the NHS changes.
One of the keys elements that has, so far, received little attention is that of ‘enhanced' training. The focus of discussion has been the extra year and how it will be delivered. The educational case as presented and accepted to Medical Programme Board was, essentially, to ensure a ‘GP facing' programme for all GP trainees throughout their training period. Surgeons and physicians don't expect anything less yet it is often difficult for GP trainees in their early years of GPST to retain a ‘GP focus' in the face of hospital service commitments. The aspirations are simple:
· Early exposure to general practice
· Guaranteed outpatient experience in relevant specialties
· More GP-orientated teaching through all posts
· Paediatric and mental health posts, or placements that will enhance the required skills
· Opportunities to develop and practice management and leadership skills
But all need to be in place to meet the spiral of learning and development of competence described in the RCGP paper.
So where does this leave us? There are significant hurdles still to overcome.
The Board of Medical Education England will need to be satisfied that the decision of its Medical Programme Board can be supported by appropriate implementation plans. From there the Department of Health will need to review the economic aspects of the proposed changes – both the costs and the medium- to long-term benefits to the NHS - so that it can support its agreement in debate with the Treasury. These are going to be challenging discussions in terms of both the current economic climate and the structural changes being made within the NHS in England.
Alongside this the RCGP, with COGPED, will need to discuss the proposals and their implications with the relevant bodies in the devolved nations.
Scotland already has four-year GP training in some areas. This is widely acknowledged as being different to the current proposals, the ‘extra year' is essentially a year of hospital posts that do not fit with the RCGP model within the educational case.
Wales and Northern Ireland both face their own financial and implementation challenges but all the devolved nations are committed to unified specialty training in all specialties to ensure that trainees are not disadvantaged wherever in the UK they train.
The educational case is predicated on a minimum of 24 months based primarily in the GP setting under the supervision of a GP trainer. The Medical Act currently requires us to undertake a minimum of 12 months in approved hospital specialties.
The extra year within the educationally accepted four year programme will be delivered, through the GP Schools of postgraduate deaneries, in a mix of hospital and GP/community posts and placements that meet the requirements of the GP curriculum and are ‘best fit' to local service arrangements. The BMA Junior Doctors committee was assured that all posts will be subject to GMC approval and will be educationally driven within service delivery.
This will set GP Directors and Heads of School a significant challenge that is already being addressed through COGPED.
Dr Barry Lewis is a chair of COGPED and a GP in Rochdale