While I understand and agree with the long-term aim of increasing training time in the GP setting for GP trainees, I am unable to agree with some of the conclusions drawn by Goldie and Morrison.1
First, the training received in hospitals by GP trainees does not occur in isolation from the general practice setting. Within our vocational training scheme for example, during the time that our trainees are in their hospital placements our main focus is on putting their experiences into the general practice context. Furthermore, in our local deanery, all trainees do 6 months in GP practices prior to their final ST3 year, and this means that members of each small group are grounded with the perspective of the world they are preparing to enter. The socialisation and cohesiveness of the STs within their small group of GP trainees seems much more important than the more transient bonds formed while on hospital placements.
Second, obstetrics aside, I am sure that there is benefit to be gained by training in many hospital jobs as it allows the building of more specialist knowledge in commonly encountered general practice problems, for instance in sexual health, ENT, or dermatology. This knowledge is subsequently disseminated through peer learning to other members of their vocational training scheme small group and to the practices they work in later.
Finally, quality assurance of hospital posts means that the hospital leads for all our jobs are visited on a rolling cycle. We discuss with our hospital colleagues how our trainees can make the most of their time in hospital training experiencing, for instance, following a patient through a primary to secondary to primary care journey, understanding what makes a good referral from the hospital point of view, and viewing the primary care interface from the secondary care perspective. Given that commissioning is likely to lead to a more focused examination of the grey area between what can be done in primary or secondary care, fully understanding the boundary from all sides is likely to put us in a much stronger position to be able to manage it to the profession's best advantage.
Leaving aside the economic and logistical arguments of how to base training fully in primary care, arranging service provision in hospitals, or longer training in general practice, I strongly support extended training for GP STs within a primary care setting. I would, however, anticipate that an extra training year in the GP setting after completion of MRGCP would alleviate many of the concerns raised.
- © British Journal of General Practice 2012