It is hard to object to an idea as wholesome as extended training. What's not to like in a plan to invest in the next generation of GPs? When the RCGP argues the complexity of illness seen by GPs has increased, and that three-year training provides registrars with competence but not confidence, it makes a convincing case for change. But this Government places a price tag on every policy, and in this case the price looks worryingly high.
We reveal this week that the Committee of GP Education Directors is proposing that the Department of Health allow deaneries to charge out GP registrars' time during the proposed fourth year as a means of meeting ministers' stipulation that extended training should be effectively cost-neutral. Registrars would work, albeit under supervision, for the likes of out-of-hours providers and care home services. Providers would pay a fee for the cheap labour – helping the Government to cover the cost of training.
You can imagine how neat the plan would seem to ministers. They get to appear to be doing something nice for general practice, without paying anything for the privilege, and gain a ready source of cut-price labour to cover those troublesome out-of-hours shifts.
There is unquestionably an out-of-hours problem in need of solving. A Pulse investigation in January revealed a third of providers were leaving shifts unfilled, and those figures were underlined by a report this week from the Primary Care Foundation, indicating ongoing issues with staffing in some parts of the country.
But like most neat solutions, this one is much too good to be true. Four-year training is only on the agenda because newly minted GPs aren't seen as sufficiently experienced to cope with the demands of the modern job. The sensible approach would be to ease in fourth-year trainees within the supportive and educational environment of a practice. Expecting them to earn their spurs in the cauldron of out-of-hours care seems reckless in the extreme. And if out-of-hours providers are offered GP labour at a fraction of the normal price, on-call shifts will become – overnight – almost entirely the domain of the trainee
So the plan could be bad for educational standards and patients. It's also bad for doctors. When the BMA first heard of proposals for a fourth year of GP training, it warned of the potential for a new ‘sub-GP grade', undercutting salaried doctors and locums. With a tariff for trainees, the sub-GP grade will be made real. A whole tranche of GPs, who have made their livelihoods by being prepared to work the red-eye shifts, will have their livelihoods taken away.
Four-year training is a sensible proposal, but it will never be a cost-neutral one. How can training thousands of GPs for an extra year ever cost no money? The Government must accept its NHS reforms and long-term population shifts are creating new demands on general practice. It must meet those demands not with neat ideas for cost savings, but with genuine investment for the future.