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It's not often that this unreconstructed Essex boy finds himself gazing wistfully north of the M25 but such was the effect of Elaine McNaughton's editorial1 describing an innovative programme for GP speciality training in Angus. I couldn’t help but contrast life as described in the East Deanery of Scotland with that we are presently experiencing in the Eastern Deanery of England.
McNaughton rightly stresses that a meaningful implementation of Modernising Medical Careers (MMC) demands training programmes that not only provide doctors specialising in general practice with the required competencies but also are attractive enough to encourage high calibre doctors into the speciality. The programme she describes attempts to meet these challenges and provides a useful model for elsewhere. The main problem with innovation is that you have to be able to implement it and, in our part of the UK, we are hitting something of a reality gap.
Course organisers in the Eastern Deanery have spent the past 3 years busily designing their schemes in preparation for MMC and very good some of them looked too. In late August we were informed that, contrary to repeated assurances, funding had not been obtained to support 18 months in practice-based training and we were asked to re-design our schemes to include 2 years in hospital posts. The Deanery is now involved in frantic negotiations with the Trusts to ‘badge’ sufficient hospital posts and with general practice being at the end of a long queue, it's difficult to be confident that the posts obtained will necessarily be those with the highest relevance to our speciality. To add to this, we’ve also been informed that there will be no obligation for hospital-based trainees to attend their VTS educational programmes as the expectation is that their teaching will be provided within their specialist departments. Apparently this arrangement has the backing of the RCGP following their consultation with sister colleges.
We now have the frankly bewildering proposal that doctors specialising in general practice will receive the vast majority of their education and training delivered by colleagues in other specialities. Will such schemes be attractive to high calibre doctors? I very much doubt it. We might have to explain to prospective applicants that, as far as general practice training is concerned, ‘fit for purpose’ only makes sense if they accept that their purpose in life is to bide their time staffing hospitals.