There can be little doubt that GP vocational training has been one of the unalloyed success stories of the NHS in the last three decades. It is hardly surprising that training has raised standards, based as it is on an apprenticeship model that ensures each registrar several hours of one-to-one teaching and mentoring from a highly skilled GP trainer every week.
With the government's well-intentioned GP recruitment drive getting under way, and the sensible introduction of a foundation year into postgraduate medical education, GP vocational training should be enjoying a boom. Demand for more trainers should be ensuring higher status and better incentives to attract new teachers into the burgeoning deanery schemes. However, this does not appear to be happening. Instead, the very nature of vocational training is threatened.
The shortfall in trainer manpower available for the rapid expansion in registrar numbers has resulted in proposals for drastic modifications in teaching and training methods. Within the Leicester, Northants and Rutland deanery, training practices that have hitherto accommodated one or two registrars are being told to prepare for up to six simultaneous registrar placements. This would involve a constent throughput of one full-time career registrar and one foundation year trainee for each qualified trainer in a practice that might also be expected to accommodate medical students and innovative training post registrars.
Such an influx, with a varied skill mix requiring close monitoring to ensure safe service commitment as well as huge educational resources, would inevitably overwhelm the apprenticeship model of training. Proposals have therefore been put forward to adopt an entirely untried method of joint tutorials and mutual learning among mixed groups of registrars, with the trainer having a more distant, supervisory role.
It is possible that, despite the lack of space and manpower, these methods may have some success, but to replace a well tried and tested method with one that has not been piloted seems foolhardy. The apprenticeship model works because the close trainer–registrar relationship not only facilitates assessment and the acquisition of knowledge and skills, but also encourages the transference of enthusiasm and high professional standards.
It is tragic that the excellent intentions driving these changes may come to destroy one of the cornerstones of high-quality NHS primary care, just because they are being put in place too quickly. If enough time could be made available to recruit and skill the extra GP trainers required, the increase in registrars could be accommodated without losing the essence of an educational system that has served us well. There is a major risk that educational standards will fall and that training will become less attractive at the time when we desperately need trainer numbers to increase.
It is likely that postgraduate deans are as suspicious of the innovations as many trainers, but having accepted the task of implementing the government's plans, they are not in a position to voice their concerns publicly.
Perhaps it is time that trainers and course organisers made their voices heard before irreparable harm is done.
- © British Journal of General Practice, 2004.