Now that the lack of GPs applying for and in training has been acknowledged, NHSreality would like to consider what “celestial” training should consist of.
Given that short term we will likely be importing doctors for the Regional Health Services, especially the less popular and rural areas, governments might like to consider how to give such imports short term contracts so that they can be replaced when we have done the training of our own….
In many countries a general internship programme goes through a number of posts of six weeks each. In the UK these F1 and F2 (Foundation year 1 & 2 – just after qualification) have 3 month posts. This they have much less diversity of training than the 6 week post interns, but less depth. Depth of training however does not matter as much as breadth… at this early stage.
When it comes to GP training, for 3/4 years after their F1/F2 posts most trainees around the country (except the North-West with 3 month rotations) have 6 month posts. They too are training to be generalists, BUT their jobs are courtesy of specialist departments such as medicine, paediatrics, obstetrics, orthopaedics, A&E and psychiatry. Few of them get Dermatology, ENT or Eye experience. It should be possible to give GP trainees a 6 week rotation for the one or two years that they have in Hospitals. There is no sign of this happening or being planned. The greatest omission is Psychiatry, which is part of over 40% of GP consultations, especially on Friday afternoons and at weekends and Out of Hours. To train as a GP without a Psychiatry post of at least 6 weeks should be impossible. (James Lyons et al. in the Sunday Times 18th Jan 2015 report a Labour report which says: Mental health failings cost £3bn – IMPROVING treatment for patients with mental health problems could ease the NHS crisis and save the country £3bn a year, research has revealed. ) Improving brains by breast feeding is also important, and (Janathan Leake in the same paper reports “Baby’s brain begins in its mum’s booty –Straightened out: riddle of female curves“) and begs the question of deserts based rationing for non breast feeders!
One of the main reasons for the inertia is the need for service by the departments which, all across the regions, are manned by GP trainees as juniors. The good ones have learnt all they need from their post in six weeks, and are then an extra pair of hands, when they could be furthering their training. With in service assessments via portfolio, on line learning, video consultations and Multiple Choice questions there is no reason for extra training beyond 6 weeks unless they fail assessments. A flexible 6 week option at the end of their hospital training could cover both this, and assuming no failures, a desire for more in depth training, perhaps to qualify for a diploma or extra certification.
Governments need to give power to GP departments over their Deanery for GP training. There would need to be a period of warning before implementation, during which sufficient Doctors and GPs are trained. This is beyond the thought patterns of most politicians as it is 10 years, so Nick Clegg, here’s your chance to establish the Liberals as the party with the fundamental structure of the Health Services at it’s heart.
PR would help to get political support, as would appointing graduates rather than undergraduates, and from every school intake area of the country, and training them in their communities rather than the ivory towers of the city universities.
NHS will produce more GPs to ease pressure on hospitals (the traditional pressure reason for provision, not better all round training)