Since 1981 to be able to practice unsupervised as a general practitioner in the NHS, a doctor has been required by law (The Department of Health, 1979, The Department of Health, 1997) to have a certificate of prescribed or of equivalent experience (commonly known as the ‘certificate of vocational training’. This certificate has been issued by the JCPTGP upon receipt of:
- A cover letter stating the applicants full name address and GMC number
- VTR/1 form(s) for their GP training posts and Summative assessment
- VTR/2 forms in respect of hospital posts
- Current GMC Registrations certificate
- (If training included overseas posts or posts held more than 7 years prior to the application then they also needed to have a certificate of equivalent experience).
However, there are major changes ahead in the training of Doctors in the UK. This report will deal with some of the proposals for GP vocational training over the next few years.
In ‘Unfinished Business: Proposals for reform of the Senior House Officer grade’ (Sir Liam Donaldson, 2002) Sir Liam Donaldson wrote
‘The Government accepted the recommendations in ‘A Health Service of all the talents: Developing the NHS workforce’ (The Department of Health, 2000a) to “sort out the senior house officer grade” and made a commitment in The NHS Plan (The Department of Health, 2000b) to reform SHO training. This commitment is mirrored by the administrations in Scotland, Wales and Northern Ireland.’
This has lead to the development of the initiative Modernising Medical Careers (The Department of Health, 2004) and a new age in general practice training.
Changes in GP Vocational Training
As of the 30th September 2005 the Joint Committee on Postgraduate Training for General Practice (JCPTGP) no longer exists. Its role was taken over by the Post Graduate Medical Education and Training Board (PMETB), merged with the GMC on 1/4/2010 http://www.gmc-uk.org. In its simplest form this is now the regulatory body for Postgraduate Medical training.
The Northern Deanery has recently sent information to all SO, CO and Trainers and GP Registrars advising of the way GP Registrars must now apply for a Certificate of Completion of Training (CCT). This information can be viewed at the following link:
A Postgraduate Medical Curriculum for General Practice
For many years GP educationalists have been reluctant to define a curriculum and Syllabus for GP Vocational Training, one of the arguments has been that GPs are Generalists and need to know something about everything! The time has now come to define a Curriculum for General Practice. The PMETB asked all Colleges to produce new Curricula and for their Specialities that met their criteria for training and assessment.
The College under the lead of Professor Steve Field has after a great deal of work developed ‘A Postgraduate Medical Curriculum for General Practice’. This has been published in draft form at http://www.gpcurriculum.co.uk . the College is now wishing to consult with all GP educators on the form and content of the Curriculum document as it currently stands and wishes feedback on recommendations and/or changes prior to signing of the Curriculum at College Council.
Although the document is large I would recommend you browsing some parts of it to gain a feel for its contents presentation and underpinning philosophies, and ask on behalf of the College you provide feedback should you wish (electronic feedback form is present on the Curriculum web site)
A New Assessment Process
From August 2007 Summative Assessment and the RCGP membership exam will be replaced by a single unified end point assessment, from 2006-2008 there will be a transition phase for the GP Registrars in training (although the precise mechanics of this transition have not yet been fully clarified)..
The nMRCGP exam will consist of three parts:
- Applied Knowledge Test (AKT)
This will be a multiple choice paper of around 200 items many of which will be in the form of ‘extended matching questions’ and run three times a year
- Clinical Skills Assessment (CSA)
This will be organised nationally in an assessment Centre and will involve Objective Structured Clinical Examination stations and simulated patient consultations.
- Work place assessment
The exact nature of the assessment tools to be used in the work place assessment have not yet been finalised, but it will include an Enhanced Trainers Report a draft copy of this report can be viewed at:
http://www.oxford-pgmde.co.uk/gp/nMRCGP.html (follow the link under work Based Assessment)
Other external assessment tools will be used to assess the GP Registrar within the work place assessment, as yet a decision of the final assessment tools to be used has not been made, but several assessment tools are being piloted in several Deaneries throughout The United Kingdom. These include:
- Audit Tool
- Multi source Feedback tool
- Patient Satisfaction questionnaire tool
- Referral Letters tool
- Significant Event tool
These can all be viewed on the Dundee University Website at the link below (click on downloads on the webs sites banner):
Changes in how we train and assess doctors for a career in General practice are upon us. They will, I hope improve the quality of those doctors coming into Vocational Training through the Modernising Medical Careers Programme (MMC), and will lead to the provision of a more qualified doctor at the end of vocational training fit for the purpose of practicing General Practice in the early 21st Century.
Although on paper the changes appear huge, I believe in the Northern Deanery we are well placed to take up the challenge they undoubtedly produce. But it will require commitment at all levels including the Postgraduate Director of General Practice Education, Associate Directors, Scheme Organisers, Course Organisers Trainers, administrative staff and GP Registrars.
If you look at the documents I have mentioned you will probably recognise that we are already doing a lot of the work within our Deanery. These documents, I feel, put a structure upon this work, and clarify our aims and objectives in producing Quality doctors for the future of General Practice.
- SIR LIAM DONALDSON (2002) Unfinished Business: Proposals for reform of the Senior House Officer grade.
- THE DEPARTMENT OF HEALTH (1979) The National Health Service (Vocational Training) Regulations.
- THE DEPARTMENT OF HEALTH (1997) The National Health Service (Vocational Training for General Medical Practice) Regulations.
- THE DEPARTMENT OF HEALTH (2000a) A Health Service of all the talents: Developing the NHS workforce.
- THE DEPARTMENT OF HEALTH (2000b) The NHS Plan: A Plan for Investment A Plan for Reform, (England). London, The Stationary Office.
- THE DEPARTMENT OF HEALTH (2004) Modernising medical careers. London DoH.
Associate Director, Northern Deanery