Briefing

The numbers of newly trained general practitioners are at their lowest ever levels, according to the recently published 1998-9 report of the Joint Committee of Postgraduate Training in General Practice (JCPTGP). Although the total number of applications was up, the number of new certificates issued was 4.5% lower than 1997-8. Although 4.5% may not sound like much, the downward trend has been present for a decade, and if it continues is certainly sufficient to result in a long term shortages of general practitioners. There is little analysis of the reasons for the trend, but one additional section in the report may be relevant. Last year the government admitted that general practice training was subordinate to the need to furnish hospitals with a ready supply of senior house officers. Committee members were apparently angered by the refusal of the then health minister, Alan Milburn to increase the length of general practice training at the expense of hospital training “because it would have an undesirable impact on the service needs of trusts.” This surely isn't news to anyone in general practice, though it is doubtful whether there is much will to sort it. Still, the view that the proper place for training in general practice is general practice has a certain respectability; and no doubt some enterprising primary care provider would be willing to compete for registrars by offering a shorter or non-existent component of hospital training, were the regulations to permit it. For the moment it is clear that those qualified in general practice move in a seller's market - which should encourage robust negotiations for improved working conditions, all the while keeping a weather eye on competition from nurse-led services such as NHS Direct.