Intended for healthcare professionals


Vocational training for GPs should be community based

BMJ 1995; 310 doi: (Published 24 June 1995) Cite this as: BMJ 1995;310:1674
  1. Jamie Bahrami
  1. Regional adviser in general practice for Yorkshire Department of Postgraduate Medical Education, University of Leeds, Harrogate HG1 5AH

    EDITOR,—Trevor J Bayley's editorial on the unified training grade leaves the impression that, after nearly three years of lengthy debate, countless meetings, and working parties, we are still no nearer a solution than we were in 1992.1 Although undoubtedly an expansion in the number of consultants is a prerequisite for the successful implementation of the grade, I believe that the main obstacle is our traditional habit of trying to introduce change without upsetting the status quo. For instance, the assumption that all those with a certificate of completion of specialist training will seek employment only in NHS hospitals or will want full time employment is open to debate. Furthermore, many of the expected difficulties would be overcome if we were to grasp the nettle of knowing staffing requirements in each specialty. The widely held view that this is impossible needs to be challenged.

    The question of doctors who qualified overseas and want specialist training in Britain, though important, in reality is a red herring. It should be possible to create appropriate educational opportunities for such doctors without necessarily interfering with the implementation of the new grade. I also suspect that in many hard pressed specialties such doctors would be very welcome.

    Bayley's comment about securing specific hospital posts for those in vocational training in general practice is important. Indeed, since the publication of the Calman report serious concerns have been expressed about the possible impact of the scheme on vocational training. A consensus is now emerging, however, that vocational training might become more community based, with a greater flexibility of educational opportunities than previously envisaged.2

    It is now time to implement the scheme and modify it in the light of experience. After all, the European medical directive was agreed in 1975.


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