Medicopolitical Digest

GPs will have to pay for retraining, minister saysDoctors need education in multicultural medicine

BMJ 1995; 310 doi: (Published 24 June 1995) Cite this as: BMJ 1995;310:1678
  1. Douglas Carnall,
  2. Linda Beecham,
  3. Jane Smith

    GPs will have to pay for retraining, minister says

    The health minister, Mr Gerald Malone, has told the BMA that costs of remedial training by general practitioners under the General Medical Council's performance review procedures should be borne by the doctors concerned. In a letter to the chairman of the General Medical Services Committee Mr Malone says, “GPs are independent contractors and are responsible for meeting their own practice costs including the cost of maintaining their professional skills and knowledge.” The minister equates the costs of remedial training with continuing medical education and says that reimbursement should follow the normal arrangements, including conferring eligibility for the postgraduate education allowance. He does not think that special arrangements should be made for those doctors who will come under the new procedure.

    Under the Medical (Professional Performance) Bill, now going through parliament, the GMC will be able to investigate cases in which a doctor's standard of professional performance was alleged to be seriously deficient. There would be four stages: screening, assessment, remedy, and, if the problem has not been resolved, sanctions. The assessors would recommend counselling, remedial training, or changes to practice commitments. The indications in the bill are that individual doctors could incur between pounds sterling6000 and pounds sterling22000 in remedial retraining costs.

    For hospital and public health doctors employed by the NHS health authorities and NHS trusts will decide whether to pay for retraining, but the government rejected the GMC's advice that it should bear the costs of retraining general practitioners. The BMA, which supports the bill, has pointed out during its passage that if the procedures are to be remedial rather than punitive the government should give an assurance that general practitioners' retraining costs would be directly reimbursed by the Department of Health. The BMA also wants the department to direct authorities and trusts to pay the full costs of retraining any doctors in their employment.

    Doctors need education in multicultural medicine

    The BMA is recommending that multicultural health care should be integrated across the undergraduate curriculum. In

    Education of theMedical Profession in Multi-Cultural Health Care the BMA points to the differences in both disease patterns and access to health care services for ethnic minority groups. A survey of deans of medical schools, postgraduate deans, and regional advisers in general practice confirmed that doctors receive little formal education in the health care of the different cultural groups.

    The report also recommends:

    • Royal colleges and the Faculty of Public Health Medicine should produce positive statements to ensure that members are suitably trained to practise in a multicultural society

    • Postgraduate deans and regional advisers in general practice should examine the provision of education and regional courses to ensure that cultural issues are addressed

    • The Department of Health should consider designating or appointing individuals with responsibility for implementing and monitoring policy on multicultural health care in the NHS regions

    • Ethnic monitoring of inpatients to provide essential data should continue and consideration be given to funding an expansion of the scheme in general practice

    • Purchasers and providers of health care should draft local policies on multicultural health care which reflect local health needs and establish standards and objectives to ensure that the needs of ethnic minority groups are met

    • Multicultural health care should form part of a checklist of required knowledge for those undergoing vocational training

    • The Department of Health's ethnic health unit should continue as a funded, flexible infrastructure for the dissemination of research results and knowledge.

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