General Practice

Is general practice in need of a career structure?

BMJ 1998; 317 doi: (Published 12 September 1998) Cite this as: BMJ 1998;317:730
  1. Glyn J Elwyn, senior lecturer (,
  2. Simon A Smail, director of postgraduate education for general practice in Wales,
  3. Adrian G K Edwards, lecturer in general practice
  1. Department of Postgraduate Education for General Practice and Department of General Practice, University of Wales College of Medicine, Cardiff CF4 4XN
  1. Correspondence to: Dr Elwyn

    With nearly 1000 vacancies for general practitioners in the United Kingdom in 1998,1 the recruitment problem—exacerbated by early retirement by doctors keen to leave a discipline under pressure—is high on the professional agenda. Recruitment to general practice depends on acceptable and appropriate training. Bain has suggested that role models for the training of general practitioners in Britain are still stuck in a time warp of the 1970s, when the first training scheme started.2 The government, however, has deemed that primary care is to become the steering force of the NHS again. An imbalance exists therefore between the strength needed to steer the NHS and the potential lack of structure in general practice training.

    Summary points

    • The training for general medical practice in Britain is outdated and based on a requirement to spend two years in hospital posts and one year in a training practice

    • All other disciplines require a professional college standard to be achieved either at entry or during training but general practice has no entry criteria

    • Training should occur in the context of general practice so that the generalist registrar becomes the equivalent of the specialist registrar, integrates with the multidisciplinary team, and has protected time for professional development and research

    • Flexibility to allow part time training or moving areas without incurring undue penalties would be important

    • Postgraduate directors should control the training resources and form contracts with training practices and hospital departments to deliver a practice based generalist registrar scheme

    • The career structure after training should be reorganised to allow development of educational, research, and managerial roles within practitioners' NHS responsibilities

    Current educational and career framework

    Specific training for doctors to become general practitioners was first implemented in the 1970s. The scheme that was finally accepted (the vocational training scheme) comprised two years' experience in a variety of approved senior house officer …

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