Editor—Since 1976 the Joint Committee on Postgraduate Training for General Practice has presided over the standards of vocational training in general practice in the United Kingdom. Despite the committee having a relatively low profile compared with the two other competent authorities in the United Kingdom (the General Medical Council and Specialist Training Authority) its influence extends well beyond general practice. It is responsible for approving training posts for intending general practitioners in hospitals and primary care and has tried to improve training for senior house officers in all disciplines.
Unfortunately, its low profile has been reflected in the value and support afforded it by the government. Its crucial role in ensuring quality training is now threatened.
In 1997 the committee's outgoing chairman, Denis Pereira Gray, opened discussions with the Departments of Health over remuneration for the three officers. A proper rate was set for these posts, and the minister of health gave support in principle. Meanwhile, ad hoc arrangements ensure that some financial recompense is available to the officers from other, inappropriate sources. The activities of the Specialist Training Authority and General Medical Council are supported by charges on doctors. The joint committee has no power or inclination to charge for its certificates.
For many years the government has supported standard setting by medical royal colleges in the form of a grant in aid. In 1975 the Royal College of General Practitioners decided to transfer all general practice grant in aid to the joint committee and to supplement it with a matching sum. The grant in aid for general practice compares unfavourably with that for other disciplines. In 1995 (latest available figures) standard setting costs for the United Kingdom's 33 000 general practitioners were supported by a grant in aid of £58 725—in stark contrast to the £48 649 and £38 532 for 2900 career grade pathologists and 750 ophthalmologists respectively.
A 1998 government review of grant in aid praised the committee's efficiency and frugality.1 Its financial problems now threaten its core regulatory functions.
Despite the voluntary return in 1998 of unused funds because of an unfilled post, the Department of Health requires a reduction of 7.5% in budgets for the year 2000-1 (or over 10% if pension contributions are taken into account). Consequently, with cramped premises, barely sufficient staffing, and increasing statutory responsibilities, the committee is faced with reducing its services.This government demands quality in the NHS and looks to its competent authorities to mediate and promote it. Ironically, this very quality is now endangered by the government's shortsighted parsimony.
References
- 1.NHS Executive. Review of the central funding of the medical royal colleges in respect of training related activities and clinical audit. Leeds: NHSE; 1998. [Google Scholar]