Finance, not learning needs, makes general practitioners attend courses: a database surveyBMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7104.353 (Published 09 August 1997) Cite this as: BMJ 1997;315:353
- T S Murray, director of postgraduate general practice educationa,
- L M Campbell, assistant director of postgraduate general practice educationa
- Correspondence to: Professor Murray
- Accepted 3 February 1997
The 1990 contract for general practitioners in Britain includes a postgraduate education allowance which is paid as part of the statement of fees and allowances.1 We reviewed the attendance of general practitioners in the west of Scotland at accredited meetings over five years since the allowance was introduced.
Methods and results
In the west of Scotland a database records all courses and attendances at accredited meetings.2 General practitioners can also join an educational scheme for one annual payment which entitles them to attend as many courses as they wish for no extra cost.2 We abstracted data on all doctors attending accredited sessions between 1 April 1991 and 31 March 1996 and on who provided each meeting.
There were 1832 general practitioners in the region. The mean number of sessions attended was highest in 1990-1 at 14.2 and fell to 12.7 in 1995-6. This reduction was almost entirely accounted for by a reduction in health promotion sessions.
The number of doctors subscribing to the scheme where one annual fee is paid fell from 1130 in 1991 to 796 in 1996. Subscribers attended more educational sessions than non-subscribers (table 1). The greatest difference was in courses on service management. The pharmaceutical industry provided 121 courses in 1991-2, rising to 328 in 1995-6. During this period there was a 21% drop in the number of meetings accredited (from 1514 to 1193). Attendance at meetings sponsored by the pharmaceutical industry rose from 1.0 to 2.1 for subscribers and from 1.5 to 4.8 for non-subscribers.
The number of general practitioners subscribing to the annual fee scheme fell over the study and currently accounts for just under half of the doctors in the region. Subscribers attended more courses than their peers, and the reduction in the number of subscribers resulted in fewer courses being provided by the scheme. However, there was a large increase in the number of courses provided by the pharmaceutical industry. Courses provided by the pharmaceutical industry meet the same accreditation standards as other courses but are mainly lectures. Most are on disease management in areas where the provider has a commercial interest. These meetings are provided at no cost to those attending.
In 1995 pharmaceutical meetings made up almost half of non-subscribers' educational attendance. The level was much lower for subscribers, which may be because their attendance is more likely to be related to their learning needs. Once general practitioners have subscribed to the scheme their decision to attend a course has no further financial implications; cheaper and free courses may seem more attractive to nonsubscribers, who pay as they go. A recent study in Northern Ireland showed that sponsored meetings attracted more participants than non-sponsored meetings.3
One of the aims of the postgraduate education allowance was that general practitioners would buy courses suited to their needs and that providers would arrange courses in response to these market forces. A centrally organised scheme where there is a guaranteed provision of the required number of sessions with the opportunity to attend additional sessions at no charge seems to have attractions as the costs are limited.
The uptake of continuing medical education in general practice was greatly affected by the educational changes in the 1990 contract.4 5 These changes stimulated a considerable interest in education and resulted in an increased variety of courses. Our evidence suggests that financial considerations, rather than potential learning gain, may be affecting doctors' choice of courses. A change in the system whereby expenses for education would be directly reimbursed would improve education by removing financial considerations.