Unfinished business - Proposals for reform of the senior
house grade
Introduction
1. The Royal College of General Practitioners (RCGP) welcomes
the publication of the review by the Chief Medical Officer for
England of the status and structure of the Senior Health Officer
(SHO) grade, which provides a major opportunity to improve the
quality of education and training for general practitioners across
the UK. In particular we welcome the proposals for a
programme-based approach to training and the plans for a two-year
foundation programme, followed by a number of broad-based and
time-capped specialist training programmes. We are of the view that
these proposals, if implemented, will change fundamentally how care
is delivered in the NHS.
2. We would like to highlight the key issues for the College.
They are:
- The document gives scant regard to general practice. It
is mentioned approvingly as a venue for teaching and experience
gathering for doctors intending a career in hospital medicine – but
without exploration of the costs and implications for general
practice.
- The introduction of a two-year Foundation programme must not be
used to reduce the period for specialist training for general
practice. Current College policy for specialist general
practice training is five years.
- There should be real equivalence between general practice and
other specialties, not least in the implementation of this
review.
- The College gives strong support for the introduction of
competency-based rather than time-based training and
assessment.
3. Before we address our specific issues on the document, we
wish to highlight the following more general points.
- We welcome that generalism in medicine is
recognised and valued in a way that has seldom been seen in a
Department of Health report before.
- The document contains a formal statement
about the desirability of giving all doctors some training in
general practice, perhaps through “some” training in the second
foundation year. Again, we welcome the use of the term “training”.
This is a considerable advance on previous reports, which have
tended to use the word ‘experience’.
- We are however, concerned about the lack
of analysis within the document, on the implications for doctors
intending a career in general practice or those opting for general
practice during their SHO period. General practice appears almost
as an afterthought.
- While supporting the proposal that general
practice is treated as an equal alongside other medical
specialties, we are disappointed that the consultation paper has
neglected to set out detailed proposals for the content or duration
of GP training, but we recognise that this is an opportunity for
the RCGP to fill in the missing detail and contribute fully to the
debate. General practice is the branch of medicine that will be
most involved in any proposed changes and will also be most
affected by any changes. It is essential that the RCGP is fully
consulted and that our views are recognised and
incorporated.
- To re-affirm the case for general practice being
seen as a specialty, we would draw your attention to the European
Definition of General Practice / Family Medicine, which
states:
“General practitioners/family doctors are specialist physicians
trained in the principles of the discipline. They are personal
doctors, primarily responsible for the provision of comprehensive
and continuing care to every individual seeking medical care
irrespective of age, sex and illness. They care for individuals in
the context of their family, their community, and their culture,
always respecting the autonomy of their patients. They recognise
they will also have a professional responsibility to their
community. In negotiating management plans with their patients they
integrate physical, psychological, social cultural and existential
factors, utilising the knowledge and trust engendered by repeated
contacts. General practitioners/family physicians exercise their
professional role by promoting health, preventing disease and
providing cure, or palliation. This is done either directly or
through the services of others according to health needs and the
resources available within the community they serve, assisting
patients where necessary in accessing these services. They must
take the responsibility for developing and maintaining their
skills, personal balance and values as a basis for effective and
safe patient care.”
- We strongly support the proposals to
establish two-year foundation programmes followed by a single
“run-through” grade for all specialties. We have, therefore,
referred to specialty training programmes throughout our response,
not to basic specialist training programmes. We would wish to see
an early implementation of this “run-through” grade in general
practice as this would address the issue of the current lack of
higher specialist training.
- We welcome the proposal that the
foundation years should be more generally based with the
implication that each programme contains at least one module in
primary care. We hope that basic programmes will also contain
community experience. We welcome a more general approach to
learning for the majority of hospital based specialties leaving the
more specialised areas to post CCST.
- We also welcome the emphasis that is put
on competency-based assessment. We welcome the opportunity for the
RCGP to review the current assessment system for specialist
training for general practice and to deliver a unified assessment
system working in partnership with the deaneries. There does seem
to a be need for external evaluation of current external
assessments to ensure that they are fit for purpose and that the
emphasis is on the values and attributes as described in Good
Medical Practice as well as on knowledge and technical
skills.
- The introduction of structured training
and assessment for all training grades will have a significant
impact on the workload of consultants and general practitioners.
Shorter training will mean that there will be less time to learn
through “osmosis” and there will need to be considerable
interaction between trainer and trainee. We already have excellent
examples. These have been set up through enlightened and
enthusiastic teachers. Very often, these enthusiasts are placed
under considerable personal pressure to ensure that these valuable
training opportunities are preserved.
- We would also wish to stress that there
will also be a need for consultant and GP trainers to maintain
their teaching skills. This will mean release from their clinical
responsibilities. The result will be more effectively trained
doctors with a guaranteed level of competence at CCST but there
will be loss of face to face patient time by GPs and
consultants.
- The intention that all doctors should
train in primary care is extremely welcome, however there is urgent
need to expand existing training capacity. We welcome the attempts
that have been made to relieve some pressure on general
practitioners through nurse specialists and nurse practitioners.
Training capacity might also be increased if we were able to
appoint more clerical/secretarial support for trainers so that they
were freed from paperwork.
- The balance between workplace and
MsoBodyText" align="justify">The document does not fully address
the tension between delivering the service, ensuring the quality of
training and meeting the European Working Time (EWT) Directive.
Current SHO rotas are made compliant with EWT Directive through the
addition of doctors working in almost identical posts which are not
recognised for training. If all doctors prior to CCST are in
recognised training posts there will be need for a greater number
of post CCST doctors to work during evenings, nights and
weekends.
4. We look forward to working closely with
the Department of Health to reform the arrangements for training
the GPs of the future.
Response to specific
proposals
The
five key principles should be the basis for reform of basic
specialist
5. We strongly support the five key principles described in
the report and would stress that these should be the basis of
reform. We want to ensure that training for GPs is on an equal
footing as that for all disciplines and therefore we refer not to
“basic specialist or general practice training” but to “specialist
training including specialist training for general practice”. We
wish to emphasise the need radically to reorganise the training of
GPs in order to meet the five principles. We believe that this
report presents an opportunity to re-define GP training in terms of
competencies achieved by training programmes based in primary
care.
There should be sufficient opportunities for flexible
(part-time) training.
6. We support the commitment to provide increased flexibility
for trainees. This is important because of the high proportion of
female doctors wishing to train for a career in general practice.
Flexible training is funded through a separate stream and there
needs to be a regular review to identify whether certain
specialties are more popular and evaluate why this is so.
There should be access to early and regular career
advice.
7. Regular
career advice is essential from school through to retirement. We
believe that additional resources are urgently needed in this area.
Better careers advice coupled with a review of entry criteria for
medical schools should allow better career planning and aid
recruitment and retention. Deaneries should be supported to take
this agenda forward and should become more involved in providing
career guidance at undergraduate level. There may be considerable
merit in having one national electronic site providing the majority
of careers information with local sites as appropriate. There may
also be a need for a national centre for specific careers advice,
for doctors who have had difficulty in one particular
area.
After graduating doctors should undertake an integrated,
planned two-year foundation programme of general training: the
first year equating to the current pre-registration house officer
year; the second (post registration) year incorporating a generic
first year of current SHO training.
8. We support the proposal of the “planned two-year foundation
programme’’. We believe that this programme would better equip
trainees to develop generic skills and extend and consolidate the
knowledge, values and attitudes set out in Good Medical Practice.
We would also wish to stress our support for paragraph 3.13, which
refers to “strengthening insights into the essential links between
different specialties and between primary and secondary
care.”
9. We would wish to emphasise that the general practice
element of this programme is not optional. This is a programme of
learning in general practice rather than for a career in the
discipline, and this period of foundation training should not in
any circumstances be regarded as part of the specific training
programme for general practice. It follows from this that the
beginning of specific training follows the two years of the
foundation programme, and should have the same rules applied to it
as is suggested for other specialties. The Foundation programme
should build on not revisit then undergraduate programme and it
needs outcome objectives built around competences.
10. We would welcome the requirement for all doctors to
experience general practice during the second year of the
foundation programme but recognise that there is not the
infrastructure to deliver it at the moment. The educational
experience of Pre-Registration House Officers (PRHOs) in general
practice is excellent, but, problems have been identified because
of the logistical difficulties. We recommend that in the short term
an optional period in general practice is offered. In time,
resources should be made available to extend capacity so that all
doctors will gain a better understanding of primary care and an
understanding of the patient’s journey within the NHS. The RCGP is
committed to working with deaneries to ensure that this becomes a
reality. We believe that deaneries are best placed to supervise and
quality assure the programmes and the quality of the graduates from
these programmes. During the two years there needs to be an
assessment of competence to ensure full registration. At the end of
the two years, all doctors should have received support and
guidance to help them choose the most appropriate further training
programmes.
11. We recommend that there should be an exit assessment
towards the end of the foundation period, which is the same as the
entrance assessment for overseas doctors. This could be a modified
PLAB assessment. This would ensure that all doctors entering the
second phase of (basic) specialist training would have achieved the
same set of competencies. This also would help to remove any
possible perception that overseas doctors may be of a lower
standard to UK and EU graduates. An additional benefit would be
that it would potentially introduce a national standard that could
be used for monitoring the output of UK and EU medical
schools.
After completing their foundation programme, doctors
should enter a basic specialist training programme providing a
breadth of education and training within certain broad clinical
disciplines.
12. We believe that all doctors should move from the
foundation programme to specialist training programmes, and these
should include general practice. We support the proposal that
urgent work is undertaken to explore, specialty by specialty, the
appropriateness of creating a “run-through” training grade in which
doctors would move seamlessly through training with satisfactory
progress checks (see later). The RCGP is ready to support this
initiative; work on how this could be achieved for GP training is
at an advanced stage. Early implementation of the “run through
grade” could offer the prospect of higher professional education
for GPs which is sadly lacking at present.
13. We
strongly agree with paragraph 3.38 “General practice should be
regarded as a specialty equivalent to other specialties”. It is
regrettable that this is not reflected across the whole
document.
14. The report envisages enough places for all SHOs completing
foundation schemes and to accommodate some EEA and overseas
graduates. We support this assertion but would recommend that a
more radical review of workforce numbers is required to ensure that
there are enough placements to meet the targets set out in the NHS
Plan for England.
15. The review should take account of the need for GP training
programmes at this level to be based in primary care rather than
rotating through time-limited SHO posts which have historically
provided poor educational opportunities for doctors training for
general practice. We recommend that specialist training programmes
for general practice are based in primary care while allowing
exposure to an increased number of different secondary care
environments which will help the trainees acquire the competencies
that they will require in their future career as GP
principals.
16. We also acknowledge the pressures there would be in
maintaining the one-to-one ratio for training and that this may not
longer be viable.
17. By absorbing existing ”Trust grade” posts into the new
grade and reviewing the working practices of doctors in the new
grade it should be possible to support innovative new ways of
providing improved care to our patients, including covering acute
admissions.
A
limited number of placements on individual training programmes
should be provided for those doctors requiring: remedial help;
support in changing career direction; or who wish to re-enter
training to prepare for competitive entry to higher specialist
training.
18. We support the proposal to create a limited number of
individual programmes designed to meet the specific training needs
of individual doctors. They should be tightly managed by the
postgraduate deans with clear entry criteria and regular assessment
of trainees’ progress. However, we recognise the additional burden
that this could place on deanery support structures.
19. It is essential that a decision not to pursue a hospital
specialist discipline is not seen as a route into general practice:
we are very clear that training for any specialist discipline is
not sufficient as training for general practice.
20. It is important that these programmes are tailored to the
needs of the learner. They should support trainees experiencing
difficulties or seeking to change career. Opportunities should also
be made available to support doctors returning to training or
practice and to facilitate entry of doctors into training
programmes from elsewhere in the EU and overseas. For the latter
group we recommend that all doctors entering the NHS should spend
an induction period to orientate them to the NHS, help them
identify their learning needs, obtain career guidance and to plan
their future training and work.
21. We also anticipate that individual programmes will be
closely monitored both locally and nationally.
Following completion of a basic specialist or individual
training programme, those trainees to progress directly to higher
specialist training should be allowed a period of grace before
leaving training.
22. While we support the suggestion that programmes
should be time-capped, the system must be flexible enough to
reflect the needs of those training part-time or whose training has
been interrupted due to illness or other legitimate reasons.
We do not believe that a “period of grace” might be granted to a
doctor to enable him or her to organise transition to the next
stage of professional development; appropriate management of
programmes should ensure that there are not hiatuses where doctors
are held up during their training waiting for jobs and programmes
to be organised or advertised. This is the standard in
general practice and, if adopted in the hospital-based specialties
should facilitate speedier entry into consultant/specialist
posts.
23. Another consideration that should be taken into account is
the difficulty a period of grace could cause in ensuring a single
entry date to training programmes with subsequent loss of
camaraderie and team spirit. Periods of grace may need to be
undertaken in locations where there is need rather than
preference.
Progress through programmes should be determined by
assessment.In the longer-term assessment should move towards a
competence-based system.The purpose of the Royal College
examinations should be reviewed and a system of external
accreditation introduced
24. We
welcome the proposal that the new Post Graduate Medical Education
and Training Board (PMETB) will become responsible for the
accreditation of all training and assessment programmes currently
organised by deaneries and medical royal colleges. We will continue
to press the case for the necessity of RCGP involvement in the work
of the PMETB.
25. There is
a need for development in the consultant and GP workforce in
undertaking workplace assessment to a uniform
standard.
26. We support the move to competency-based assessment
throughout training and as evidence of its completion. For all
medical specialties, including general practice, progress through
training should be informed by success in accredited assessment
programmes that have standards set by the royal colleges. It should
be borne in mind that medicine is a profession with a set of
professional values as set out in Good Medical Practice. It is
frequently a matter of judgement whether a young doctor is adhering
to those values.
27. The RCGP is committed to taking the lead in modernising
the assessment system currently applied to specialist training for
general practice. We have begun a review of the MRCGP examination
and training programmes and will be working with deaneries, in
anticipation of any standards for assessment programmes that will
become policy of the PMETB. The aim will be to produce a single
competency based assessment programme that is fit for purpose; work
has also begun to prepare administratively for the demise of the
Joint Committee on Postgraduate Training for General Practitioners
(JCPTGP) and the establishment of the new PMETB.
Programmes should be managed by Programme Directors,
appointed by, and accountable to, Postgraduate Medical
Deans
28. We support the role of Postgraduate Medical Deans and
their Directors of Postgraduate GP Education to manage GP training
programmes in the deaneries. The deaneries already have an
effective system for managing GP training programmes through their
networks of associate advisers, course organisers and GP trainers.
The current system is an appropriate model that could be adapted
for other specialty programmes.
Trainers should be supported and
trained
29. Trainers must be of the highest calibre and have adequate
support. In specialist training for general practice a great
emphasis has been put on the education of trainers and course
organisers; it is only recently that hospital based education
supervisers have had the same opportunities.
Key
information on programmes: the arrangements for appointment and
induction; the curriculum to be followed and the procedures for
assessment must be made available to all traineesThe appointment
arrangements to all programmes should be the responsibility of the
postgraduate medical dean. They should meet published nationally
agreed standards and practice
30. Postgraduate Deans should be responsible for the
recruitment arrangements to all programmes: foundation, specialist
and individual programmes, as they are now for PRHOs and specialist
registrars. They should be managed to published national standards
and they will need to ensure that NHS Equal Opportunities policy
and sound employment practice prevail. It should be made clear that
Directors of GP Education will run the general practice programmes
on behalf of the Postgraduate Deans. A nationally coordinated
system of matching may suit appointment to foundation programmes.
The current model for recruitment to GP training programmes in
England (and a similar one in Scotland) has proved successful and
popular with trainers and trainees. Producing effective and
appropriate detailed information, with arrangements for
appointments and inductions is very important. Information on
programmes including the arrangements for appointment, curricula
and assessment procedures should be easily accessible on the
Internet. Additional information on the number of applicants to
previous programmes and availability of specialist and GP principal
posts should be also made available to help medical students and
young doctors plan their careers.
31. We support the notion of competitive entry to specialist
programmes, but recognise that there will need to be better career
guidance and support for doctors not admitted to their first choice
programme. We also acknowledge that doctors’ choices of specialty
may change during their training, so trainees must have the
opportunity to move from one programme to another if their intended
career proves not to suit them. The process of how they could
investigate a possible career change must be made explicit.
Information must also include details of the selection process for
the new training programme and what targeted training would be
available to support their transfer. The information must be
realistic and the opportunities limited and managed by the
Postgraduate Dean.
The
SHO element of specialist training for general practice programmes
should follow a similar model to those for hospital
disciplines
32. We strongly support the recommendation that general
practice should be considered as a speciality equivalent to other
specialities. It is disappointing, therefore, that the document as
a whole does not appear to be consistent with this statement. We
welcome the opportunity to work with the Department of Health to
ensure that the recommendation is realised. We commend the European
Definition of General Practice/Family Medicine, published by WONCA
Europe in 2002 as set out above.
33. General
practice is not the combination of a range of specialties practised
to a lesser degree. It has its own characteristics and is based on
a thorough understanding of clinical medicine practised in the
context of the physical, psychological and social environment of
the patient. It therefore needs its own training programme to meet
the curriculum. Some of the training will need to be based in
secondary care, working alongside other SHOs. Exposure to the rare
but important diseases is an important aspect of hospital training
for general practice, but a greater proportion of the training
posts will need to be based in primary care learning the specific
skills of general practice.
34. Equally, each broad speciality will need to develop
its own curriculum and ensure that every trainee has the
opportunity to experience a range of patient care to meet the
curriculum.
35. If the model of the future is that all SHOs should
experience a range of opportunities to meet the competencies of an
agreed curriculum then general practice has an important part to
play in the provision of these opportunities.
36. We agree that one of the specialty training programmes
should be for general practice, but we disagree with the current
scheme whereby two of the three year training programmes for
general practice should be based in hospital. We do not support the
proposal that the minimum requirement for specialist training
should include any of the time spent in foundation
programmes.
37. We recommend that general practice is treated equally with
other specialties with a three-year primary care-based specialty
training programme beginning after completion of the foundation
period.
38. There continues to be a recruitment crisis in general
practice; continuation of the status quo is not acceptable, and
adoption of the proposal outlined in paragraph 3.41 of the
consultation document could make it even worse. Many general
practitioners completing their training feel unprepared for
independent practice as a GP Principal. Many GP registrars extend
their training by participating in innovative training programmes
organised by deaneries. These initiatives are very popular. Early
evidence indicates that extending the amount of time spent in the
GP phase of training helps the trainees develop their skills and
improve their confidence. These initiatives should also help retain
the new GPs in the area that they trained.
39. We have started work to review the curriculum for GP
training. As part of this initiative we are looking at different
ways to deliver GP training in primary care drawing on the
experience of the deaneries’ innovative schemes and training
programmes from across the world. The aim is to produce new
competency-based training and assessment programmes to better equip
GPs with the knowledge, skills and attitudes required of a GP
working in the NHS in the 21st Century.
The
provisions for basic specialist training should ensure that the
needs of non-UK qualified doctors are properly and fairly taken
into account
40. We agree. The introduction of a modified PLAB test for all
doctors towards the end of the foundation period and a compulsory
induction period for overseas doctors would assist with this
objective. There needs to be an appreciation of the career
aspirations of these doctors many of whom appear to be “stuck” in
Trust grade posts at the equivalent of the SHO level. This review
should enable us to evaluate the situation of those doctors
currently working in the NHS and help them to achieve their
aspirations. For doctors wishing to enter the UK to work in the
NHS, more accessible information on how to apply for training
programmes and a more transparent mechanism for recognising their
overseas training is required.
41. We welcome the review into the role of direct placement
schemes. It is our view that this practice is contrary to the
principles of competitive entry and transparency and should
cease.
42. We also believe that the NHS has a moral duty to support
the development of health care in less-developed nations. Specific
training programmes should be organised that reflect the
educational needs of doctors wishing to spend time training in the
UK with the aim of equipping them with knowledge and skills to
return to make a contribution to health care in their country of
origin.
It
is proposed that urgent work is undertaken to explore, specialty by
specialty, the appropriateness of creating a ”run-through” training
grade in which doctors would move seamlessly through training with
satisfactory progress checks. This could not be implemented
immediately. Given the needs of the service and the availability of
training places, the need for application and competition prior to
progression should be explored
43. The RCGP is ready and willing to deliver a “run-through”
training grade. While we recognise that ‘run-through’ programmes
will need to be introduced gradually on a specialty by specialty
basis, we believe that this is a significant opportunity to
modernise GP training, to improve recruitment to the specialty and
help deliver the NHS Plan workforce targets.
44. We would ask that there is a long-term evaluation of any
changes. If doctors reach consultant even earlier they will need
effective career pathways as consultants and support and
development in their early years.
45. We support the proposal that “provided that
appropriately defined entry and exit points for each programme and
means of assessing progress through the programme, it could become
unnecessary to expect a doctor to change grade during a programme
or to link a particular programme to a grade.” We have
initiated a review of curriculum and assessment procedures to
support the move to the new system. We are prepared to look
radically at the current rules e.g. the need to have one trainer
per GP registrar in order to deliver increased capacity
quickly. We are committed to working with the deaneries to
deliver new GP based training programmes in accordance with any
standards that will be introduced by the PMETB.
The
arrangements for awarding a Certificate of Completion of Specialist
Training (CCST) should be changed. New and shorter higher
specialist training programmes should lead to the award of an
earlier CCST for those satisfactorily completing training in the
”generalist” elements of a specialty. At that point a doctor should
be able to apply for a consultant post in their chosen specialty –
say general internal medicine or general
paediatrics.
46. We
support the proposal to shorten specialist training and to remove
the term “Consultant” and replace it with “Specialist”. However, we
would not wish to see this proposal used to re-introduce the Senior
Registrar grade.
47. Shorter, more general CCST programmes should be based in
secondary care with release to tertiary and more importantly
primary care to gain special expertise.
48. This
proposal would bring the UK more in line with the EU. We would then
be able to demonstrate that completion of specialist training for
general practice would lead to the award of a certificate that is
at the same level as other specialties and compatible with the
spirit of the SHO reform document. While the length of the training
programmes for any specialty should be flexible and determined by
the ability of the doctor to acquire pre-determined competencies we
recognise that the current situation where only one year is spent
in the GP setting is inadequate. Reform and modernisation is
required; this review should be the stimulus for that
transformation.
A
review of the role, educational support, professional development
and career opportunities and pathways for non-consultant career
grade doctors should begin in the autumn
49. We support an urgent review of the non-consultant
career grade. There are many disillusioned doctors in this
grade who do not have access to support for their continuing
professional development. They should be given the
opportunity to develop and access targeted education and training
programmes to facilitate their entry onto the specialist or
generalist registers. This move would initially require additional
resources, both financial and human, but it would contribute to
patient care and help the Department of Health achieve the
workforce targets set out in the NHS Plan. The RCGP is
committed to working with the deaneries to build on the success of
the Trust-grade/SHO post conversion initiative to facilitate
doctors through targeted training into general practice principal
posts.
50. It is important to remember that this is not a homogeneous
group of doctors. Some doctors prefer to work in a career grade
without the responsibility of consultant status. Other doctors have
not been able to enter their preferred speciality as a trainee and
would prefer to work as a non-consultant career grade rather than
move to a less popular speciality. It is also important to clarify
which tier these doctors are working on.
Other Issues
Research
51. It is important that in reviewing the training of GPs, we
do not forget the need to attract GPs into academic positions. We
must ensure that there is flexibility in the new system to allow
exposure to academic general practice. A number of the deaneries’
innovative schemes allow trainees to experience teaching and
research while attached to academic departments. Attracting newly
qualified GPs into academic general practice can help because
combining academic and clinical posts can improve the recruitment
and retention of young practitioners and involvement in education
and research improves morale and should aid the retention of
established practitioners.
Dentistry
52. There are many parallels with medical training both in the
secondary and primary care arenas. We believe that dental training
should follow a similar set of principles to medical training
because there is considerable overlap of the educational and
training processes.
Funding
53. The report questions whether 100% of SHO salaries in
England should be funded from the education levy, as is the present
case for PRHOs and specialist registrars (and all grades in
Scotland). We believe that the Department of Health should
ensure that all medical training grades should be 100% funded by
the Multi-Professional Education and Training (MPET) levy.
The move would help to cut down bureaucracy, empower deaneries to
ensure an appropriate balance between education and service.
It would also go a long way to address the imbalance between
cash-rich Trusts in the South and less well-funded ones in the
North of the country.
Timescale and implications for service
provision
54. Any reform of SHO training will inevitably have an impact
on service provision. We believe that improving the quality of
training programmes should have a positive effect on service
provision in primary and secondary care. The transition should be
managed to maintain current levels of service provision, while in
time moving to a new system for training in all specialties to
deliver better-trained and better-motivated doctors more
quickly.
55. The introduction of the proposals will, however, coincide
with the implementation of the European Working Time Directive.
This will in itself be a major challenge. The proposals should free
up thinking about how care is delivered by doctors and other health
care professionals, act as a stimulus to change outdated work
practices and to explore creative ways of working, making better
use of the skills within teams. New training programmes should
maximise opportunities to learn with other doctors training in
other specialties and other professional groups.
Annex E
56. We would support the Postgraduate Training Programmes:
principal pathways diagram. However, it should be amended to make
clear that GP training must have three years after the foundation
years. We would reject the use of the words “2 or” in the diagram.
On the issue of Higher Specialist Training Programmes we would wish
to see that there must be some, albeit small at first, programmes
for general practice.
Conclusion
57. We believe that there is a big opportunity to make a real
difference to how health care is provided by taking the
opportunities offered by the reform of medical training. The RCGP
is ready to work in partnership with the Department of Health,
postgraduate deaneries, and our sister royal colleges to ensure
successful implementation. However, as currently drafted, the
proposals do not have sufficient regard to the discipline of
general practice and its training structure. In particular, we
believe that there needs to be a clear statement that any time
spent by trainees in general practice during the foundation
programme should not be eligible to be counted as part of
specialist training for general practice.
Acknowledgments
We wish to acknowledge the work of the Chairman of the
College’s Education Network (Professor Steve Field) in preparing
this response, and also contributions from members of the Education
Network Steering Group and from:- Dr Tina Ambury, Dr Justin Allen,
Ms Mitzi Blennerhassett, Dr Elizabeth Brain, Dr Simon Brown,
Professor Mike Carmi, Surgeon Rear Admiral Ralph Curr, Dr
Christopher Hand, Professor Jacky Hayden, Mrs Eileen Hutton, Dr
Bill Irish, Dr Helen Stokes-Lampard, Dr Tony Mathie, Dr Geoff
Morgan Dr Catti Moss, Dr Orest Mulka, Professor Mike Pringle, Dr
Bill Reith, Dr David Sales, Professor Dame Lesley Southgate, Dr
Andrew Spooner, Dr Alastair Thompson, Dr Alex Williams and Dr Paul
Wilson.
[1]The European Definition of General
Practice/Family Medicine, WONCA Europe, 2002