Editorials

New system for GP recruitment

Should be fairer and more educationally relevant

Classified supplement www.bmjclassified.com

It is still less than a quarter of a century since vocational training for general practice in the United Kingdom became compulsory, though informal training is as old as medicine itself. The present arrangements, which require registered medical practitioners to have two years' experience in certain specialties and a year of vocational training in a training practice, were satisfactory for most trainees who graduated from British medical schools. The arrangements lacked flexibility, however, and as new developments in general practice arrived, some cracks started to show. As a result directors of postgraduate general practice education have now taken full responsibility (including budgetary responsibility) for managing vocational training. ^{1 2}

One of the biggest cracks appeared with the advent of compulsory summative assessment.³ A registrar who failed the process had to be referred to the secretary of state before an additional period of training time could be alloweda cumbersome process. The new arrangements delegate this responsibility to directors of postgraduate education in general practice, which is sensible and welcome.

Linked to this is budgetary control. The money for general practice registrar training used to come from General Medical Services funds (the Red Book), but this budget has now been transferred to the medical and dental education levy. This will give directors the ability to enable general practice trainees to train flexibly and will also allow doctors who have acquired rights as European Union general practitioners to have a period of orientation training before starting practice in the United Kingdom. It will also enable periods of refresher training for doctors who have been out of practice for some time. These measures can also only be welcome, particularly if the government hopes to achieve its target of attracting 2000 new general practitioners by 2004.⁴ It is obviously more cost effective to attract existing doctors back to practice than to train a new generation from scratch.

Racisim must be eliminated from recruitment procedures
Another important and welcome effect of the changes will be to improve the recruitment procedures for general practice registrars. Fair recruitment continues to be a problem for the NHS. Graduates from the United Kingdom of Asian origin, for example, continue to be rejected from "good" practices in ethnically homogenous small towns on the grounds that they wouldn't fit in. The involvement of postgraduate deaneries should help avoid such racism, ensuring that appointments are made on the grounds of merit alone. One of the first signs of this new regimen appears in the classified supplement this week in the form of advertisements for all the available vocational training places in England (www.bmjclassified.com). General practice trainers from individual practices will still play a part in the appointment process, but they will do so within the influence of the more formal setting of the director's office.

BMJ