The Junior Doctors Committee has called on the BMA to resist the establishment of a non-consultant career grade open to doctors who have passed their certificate of completion of specialist training.
At its meeting last week the JDC unanimously agreed that such a post would downgrade the medical profession.
Miss Fiona Kew, a specialist registrar in obstetrics and gynaecology in Middlesbrough and responsible for hours of work and manpower on the JDC, said that the idea seemed to come from the Royal College of Obstetricians and Gynaecologists as a solution to the crisis in the specialty—nearly 400 specialist registrars will never get a consultant post in the specialty in Britain. In a paper for the committee, Miss Kew said that the intention seemed to be to allow a greater proportion of care to be provided by fully trained doctors. That was an admirable intention, but this was not the way to do it.
She said that the proposal would change fundamentally the way that care was provided in the NHS, with a move towards consultants as chiefs of staff and away from the consultant based service that the BMA supported. Consultant expansion was likely to decrease as “specialists” took on more of the service work. Dr Trevor Pickersgill, a specialist registrar in neurology in Cardiff, called the idea “an absolute disgrace,” and said that there would be no future structure in training. And Dr Ian Wilson, a specialist registrar in anaesthetics in Leeds, said that it was “a quick dirty fix” on which direct action should be taken.
General practice must change
Speaking at the start of the GPC Conference 2000 in Harrogate last week, the chairman of the General Practitioners Committee said that GPs needed to promote and strengthen general practice, to protect its fundamental characteristics and ensure a service of which GPs and their patients could be proud.
Dr John Chisholm was speaking before the video link up with the prime minister and the address by the health secretary, both of whom emphasised the need for change and modernisation (p 824). The pressure for change was coming not just from the government, Dr Chisholm said, but also as a result of public expectations. He believed that GPs had never been afraid to take on new ideas. His view was that “general practice is not at a crossroads, but that it is changing and will change.”
RCGP chairman's dreams
The chairman of council of the Royal College of General Practitioners, Professor Mike Pringle, told the meeting that GPs had a much more difficult job to do than consultants and that he had three dreams—that GPs would be valued the same as consultants, that they would be treated the same as consultants, and that they would be paid as much as consultants.
The government had to be held to its commitment to injecting more money in the NHS. Professor Pringle said that he was happy that this came with a modernisation agenda but the core services had to be protected. More GPs were needed and they would have to change the way they worked. To attract better candidates into general practice the screening for entry into vocational training should be improved, the senior house officer posts need reforming, registrars should spend longer in general practice, and training should be increased to four years if educationally necessary. “If we do not address the quality issue,” he said, “we will lose patients' support.”
Professor Pringle described the question of access to GPs as “our Achilles heel.” The NHS provided an excellent service for emergencies. GPs had to pay more attention to access for what patients regarded as urgent. “We must make the case for 15 minute consultations and provide excellent out of hours care.” His vision for the future was a service that provided the best possible care to the maximum number of patients.
Consultants have concerns about revalidation
The chairman of the BMA's Central Consultants and Specialists Committee has written to the General Medical Council about the concerns that many senior hospital doctors have on revalidation.
Dr Peter Hawker says that the CCSC supports the council's intention to develop a workable system for the regular demonstration of fitness to practise linked with continued registration, and it has set out the principles on which such a scheme should be based for career grade hospital doctors (BMJ 1999;319:1140).
But Dr Hawker has told the GMC that his committee has three concerns. Firstly, revalidation must be introduced simultaneously for all branches of the profession. He says that senior hospital doctors would have no confidence in a system that was introduced piecemeal. Secondly, it should be restricted to protecting the public from those few failing doctors who fall below the line of acceptable practice. Revalidation should not include a separate assessment process that involves scrutiny of all aspects of a doctor's professional activity, including those that do not directly affect patient safety, such as teaching and management.
Thirdly, the CCSC hopes that the GMC will avoid imposing a new set of requirements on doctors that are unrealistic and impractical. For example, there is a suggestion that doctors must provide a description of everything they do, with evidence of performance. Similarly, any requirement for regular external peer review would have serious practical implications.
BMA council elections2000-2
The results of the elections for the BMA council, 2000-2, are published this week: clinical research (facing p 871), general practice (facing p 837), and other editions (facing p 815).
Figure.
RCGP
Access to GPs is “our Achilles heel,” Professor Mike Pringle told the GPC conference