BMA urges caution over five-year GP training programme

The BMA has called for caution over plans to launch a five-year GP training programme based almost entirely in primary care amid concerns that it could limit the breadth of trainees' medical experience.

GPonline revealed earlier this year that former BMA chair and London GP Sir Sam Everington was developing a scheme offering trainees a five-year general practice posting ‘straight out of medical school’, which could launch in the next ‘one to two years’.

The scheme, which Sir Sam says he is developing alongside Health Education England (HEE) and the GMC, would reduce significantly the amount of time a GP trainee spends in hospital posts.

Currently, medical graduates who want to become GPs complete a two-year foundation programme across a variety of medical environments before starting a three-year specialty training programme for general practice - half of which takes place in approved hospital posts.

GP training

According to Sir Sam - who chairs Tower Hamlets CCG in London - the programme will equip family doctors of the future with core primary care skills such as practice leadership, managing multimorbidities and team working.

However, BMA GP trainee subcommittee chair Dr Zoe Greaves warned that the programme could prove limiting for trainee GPs. She said: ‘We welcome any scheme that gives trainees more hands-on experience in primary care. That said, GP trainees also learn a great deal from well delivered secondary care experience, so the balance must be finely struck.’

Her words echo concerns raised by several GPonline readers, one of whom described the scheme as a ‘huge mistake’.

Workington GP Dr Angela Peel-White said that 'every working hour of every day as a GP' she used skills learned while working in hospital as a senior house officer or registrar.

She wrote: 'Huge mistake! Our profession should be widening out and primary care should be seen and recognised for what it is - one of the hardest branches of work - a specialism in itself which takes into account the spectrum of the full field of work.

‘If you want the best gatekeepers they should have the widest possible range of experience - not the least.’

Another reader wrote: ‘Knowing who and what is available in secondary care because you have trained together is, I think, incredibly important, as is the relationship between those in primary and secondary care. How is good communication to be fostered by working and training separately?’

GP workforce

Highlighting Sir Sam's comment that the programme would ‘significantly shorten’ the time it takes for trainees to become ‘really supportive’ to the primary care workforce, Dr Greaves warned that GP trainees must not be used to ‘prop up’ struggling practices.

‘Any discussion about GP trainees being ‘supportive’ to the primary care workforce should also be approached with caution,’ she said. ‘Trainees are just that, and should not be used to prop up practices struggling with staffing when their focus should be on learning – we would be incredibly concerned to hear of this happening in any setting.’

She added: ‘While it is imperative that GP training is more focused on primary care, there is much to consider and we will be monitoring the progress of this scheme with great interest and look forward to seeing how it could more broadly benefit the training of future GPs.’

Pilot launch

The pilot GP training scheme could begin across seven pilot sites in East London by 2020/21. Sir Sam has predicted ‘enormous demand to accelerate the pilot across the country’ after the initial launch.

'The younger generation want something different,’ he said last week. ‘They want portfolio careers, they don’t want to sign leases, increasingly they don’t want to be burdened with all the complexities of partnerships, they want to do different things, they want a family life. They want all these things and rightly so and it’s up to us to come up with a model that is fit for the next generation of doctors.’

A GMC spokesperson said that although it had not yet received a 'detailed proposal' for the new training programme it was 'supportive of initiatives which could help to strengthen our GP workforce through education and training'.

‘All curricula changes must meet our standards and requirements for approval, to ensure they are educationally robust and support the needs of doctors and patients,' the spokesperson added.

HEE executive director of education and quality and national medical director Professor Wendy Reid said: ‘Health Education England is always looking for innovative ideas to improve recruitment to general practice and as outlined in our draft workforce strategy, we stated we would investigate options around GP training in the future.'

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