Professor Clare Gerada correctly points out that the ideas brought to this editorial are not new.1 Nonetheless she encapsulates the reasons behind the current crisis most succinctly. Is it not time to move away from the early divergence of GP and general medical trainees and make training more collaborative from the start? The Medical Act2 may need revisiting but there would be the potential to achieve the following objectives:
Skills largely dormant in medical trainees (uncertainty, shared management plans, and so on) would become ingrained while GP trainees would develop more confidence in general medicine;
Those trainees destined to become GPs would have enhanced clinical skills and decision making;
Some trainees may have the motivation and sufficient skills to take dual qualifications;
Mutual respect (currently at a low ebb) would be restored. Each would understand the role of the other and frustrations such as the ‘inordinate expansion of the GP role’ referred to by Professor Gerada would be less likely;
Creation of intermediate teams would be facilitated; and
Such flexibility may even encourage recruitment.
Professor Gerada correctly points out that GP training is too short and that exposure to general practice by hospital doctors is long overdue.1 I would argue that the latter should be integrated into the training programme and not viewed by the medical trainees as a ‘box to be ticked’. The concept of generalism is seen as important by the Royal College of Physicians too but addressing this need does not appear to be joined up with the Royal College of General Practitioners.3 The current model utilises GPs in extended roles working within secondary care.4 However, these roles are often bespoke and usually lack a formal training structure.
Since evolution seems to have ground to a halt, is it time for revolution?
- © British Journal of General Practice 2021