Autumn is upon us: the days are shortening, the leaves are falling, and Facebook is overrun with photographs of your friends’ little darlings posing in their new school uniform. As a doctor in training, I have continued to associate the end of summer with new beginnings, as every August the job description on my ID badge has changed and I have inched closer to gaining my CCT and becoming, as one friend puts it, ‘a proper doctor’. This year feels bittersweet: thanks to a Fellowship, I am extending my training by a year while my VTS colleagues start work as qualified GPs. As I have watched them in their first weeks of independent practice, I have found myself wondering what exactly GP training has prepared them for.
Tomorrow’s GPs need not only with clinical competence, but also an understanding of the wider context
General practice is unique as a specialty in being delivered by independent contractors. In order for the current model of primary care to thrive in the current crisis, tomorrow’s GPs need to finish their training equipped not only with clinical competence, but also with an understanding of the wider context in which they will be working. Instead, many GPVTS half-day release schemes – the so-called ‘playschools’ that qualified GPs deride – have an obsessional focus on the CSA, with most of the year dominated by preparation for the exam. Half-day release teaching is typically learner-directed, and trainees want to talk about clinical topics. On many occasions during my own ST3 teaching sessions I saw our facilitator attempt to broach wider organisational issues when clinical cases were being discussed, only to be met by bemusement and indifference by most of the group. But is this exam fixation any surprise when every attempt at the CSA costs £1,600, and failure may delay completion of training?
The independent contractor model cannot survive without a new generation of GPs taking up partnership. But the current, clinically-focused, tick-box model of GP training is doing little to encourage this. Indeed, almost all of my newly-qualified contemporaries have taken locum or salaried roles, with partnership seen as a liability to be avoided, rather than as a goal to be aspired to. It is seemingly possible to reach the end of training despite lacking even the most basic knowledge. A chance conversation over coffee revealed that one of my fellow ST3s had never heard of the concept of a ‘session’ and didn’t understand that his salary might be calculated according to the number of sessions he worked.
Another trainee told his colleagues that he had been offered a job and admitted he had no idea how to negotiate pay. When asked whether the practice he’d applied to was GMS or PMS, in relation to the BMA model contract, he had no idea what those acronyms meant and didn’t know there was a BMA model contract. Are we not doing our registrars a disservice by sending them out into the workplace so ill-equipped?
The tools are there, if only trainees and trainers would use them. At Pulse Live Liverpool, Dr Farah Jameel spoke eloquently about the work that the GPC has done to help GPs manage inappropriate workload requests. The BMA’s ’Quality First’ initiative includes guidelines and template letters to help GPs respond to such requests. I was introduced to these templates shortly after they were released, by a GP at my practice who is passionate about resisting unfunded work. I use them frequently and find that they greatly expedite the process of pushing back against unreasonable secondary care requests. Yet most of my fellow registrars – and, sadly, many qualified GPs – have not heard of them.
In order for general practice to survive, we need training which better equips tomorrow’s GPs for the challenges they will face. Training programme directors and GP trainers must challenge trainees to engage with questions about resource allocation, rising patient demand, and requests for non-contractual services. LMCs should reach out to training schemes in their locality to promote this dialogue. Trainees must be willing to think beyond their CSA and look at the bigger picture. Primary care is under unprecedented strain, and we need a workforce that is ready and willing to fight back.
Dr Heather Ryan is a GP registrar in Liverpool. You can follow her on Twitter @DrHFRyan and view any conflicts of interest here.
