The RCGP Council once again discussed this week the prospect of extending GP training to at least four years. Reasons put forward included that a longer training programme could improve reputation and enhance the training received. I would, however, argue that this would not necessarily be the case.
Currently training to be a GP or indeed any specialty doctor is a bit like going on the seemingly never ending moving walkways at the airport. Young, naïve 18-year-old you decides they want to go on flight, pays their fees and boards the travelator complete with baggage. During this time you may glance wistfully at those shopping in duty free or chilling in the business lounge. However, once you’re on the travelator, unfortunately there’s no way of getting off. Children can distract you and the baggage may become harder to carry but still, on you go, moving forward no matter what.
What would this extension really add?
There is, of course, the odd occasion between travelators where you can pop off (FY3 year anyone?), change destinations or even decide to take the emergency exit. For most, however, the next travelator is an inevitable step having already come so far.
There are several issues with this structure. Firstly, when passengers reach the end of the travelator they may struggle to find direction and walk independently, having been passively carried and protected for so long. Secondly, it does not allow lateral movement, keeping the passenger on a fixed path. I would hence argue the shorter the travelator the better; no one wants to spend longer on the travelators than they need to, they are just a means of getting to where you want to be.
The question is, what would this extension really add? The very nature, and indeed beauty of general practice is its unpredictability. Even GPs close to retirement will see new concepts and presentations. The rapidly evolving evidence base and technology means practice is changing all the time. So shouldn’t training have more focus on equipping trainees with the skills and ability to problem solve and continuously develop throughout their career? There obviously needs to be a basic safe level of clinical knowledge but I would argue that the three years already achieves this; unless of course there’s been a huge rise in First 5 lawsuits that I’m unaware of. GP is not the same as a specialty like surgery where the aim is to become competent in performing operations by practising hundreds of times. There is much more of an art to what we do, that to an extent, no amount of added years of training could prepare us for.
I would suggest that instead of extending training further it would be prudent to look at ways to improve what we already have. Some hospital posts use GP trainees for service provision which adds little value to their future work; from a personal perspective I had a cracking time in O&G doing C-sections, I’ll obviously be doing hundreds of these as a GP? Given the differing speciality posts undertaken by trainees there is also a lack of consistency so is this really what we should spend 50% of our training time doing?
A short training programme is a big attraction to the speciality with the scope to be free and finally be able to take control of one’s career after three years. Whilst I appreciate general practice is currently by no means the holiday sought at the airport (holiday to hell some might say?) it does allow movement, flexibility and a much welcome end to the travelator. Extending this process seems an unnecessary and in many cases, an unwanted change. In a recruitment crisis focus should be on quality and relevance of training, not quantity.
Dr Sarah Merrifield is a GP leadership fellow in Yorkshire