The JCPTGP: the passing of an era

On 30 September 2005 the medical regulatory body with a famously forgettable acronym, the Joint Committee on Postgraduate Training for General Practice, was gently and sadly laid to rest.

GP educators universally referred to this UK-wide organisation, which for a generation held pole position in quality assurance of general practice, as the ‘Joint Committee’. It was, however, never accorded its alphabetic or historical seniority when bracketed with its sister organisation, the Specialist Training Authority (STA); both being competent authorities for assuring medical training under the European medical directives (specialist training under Article 3, and general practice under Article 4).

The JCPTGP was a unique body that brought together not only the then divided tribes of general practice (it was a joint committee between the Royal College of General Practitioners [RCGP] and the General Practitioners Committee [GPC]), but also had representation from GP education directors, postgraduate deans, specialists, doctors in training, the Departments of Health and, latterly, the laity.

The leadership of the JCPTGP alternated between chairmen appointed by its two parents, the RCGP and GPC, and had two medical joint honorary secretaries, one from each. Its signal achievement was to unite disparate medical organisations under a single banner of excellence within general practice and it was always known for the quality of its quarterly debates.

Unlike the STA, the Joint Committee had to survive on a grant-in-aid from the Department of Health (often remitted late and well into the financial year) together with a donation from the RCGP to support its standard-setting function.

The Joint Committee, in contrast to many specialist medical royal colleges developed a respected methodology for quality assurance that was economic with the resources of the organisations it inspected. Rather than examining every individual medical post, the JCPTGP inspected deaneries and their systems for ensuring quality GP training, and only sampled the posts within them. This was held up as an exemplar by many, including successive Chief Medical Officers (England) and contributed to limiting the ‘inspectionitis’ that many within the NHS feel reduces time for patient care.

Over its 30 years of existence the Joint Committee achieved two other major breakthroughs.

The first was the refinement of its regulatory powers with the introduction of new Vocational Training Regulations in 1998. Until then, if the JCPTGP determined that training for embryonic GPs was deficient, and it has to be said that this was almost exclusively within the hospital training component, its only power was to de-recognise the general practice training within an entire deanery, what we used to term ‘MAD’ — mutually assured destruction.

The 1998 amendments allowed the JCPTGP to de-recognise individual hospitals, hospital jobs or practices within a deanery and the ultimate sanction of ‘MAD’ was overnight transformed into our ‘stiletto powers’ allowing remedial action at the correct level.

The second major breakthrough was the introduction of summative assessment of training, under the same amendments to the regulations, in the teeth of opposition from elements within the GPC. Until that date, a doctor's general practice training was entirely experiential — if the doctor had undertaken certain prescribed medical jobs, he or she gained a certificate by default, without any test of competence.

Summative assessment tested consulting skills usually by watching a video recording of the doctor at work with real patients, technical skills, and examined written evidence (usually by conducting a clinical audit). It also tested the ability to apply new knowledge learnt over time as assessed by the trainer. Variations to these criteria developed, but all were mapped to the General Medical Council's document Good Medical Practice.¹ For nearly the past decade, therefore, the JCPTGP has been able to say with confidence that GPs practising in the UK are at an assured standard of clinical skill, and has presided over increasing standards for both practice and hospital-based trainers.

The irony of the demise of the JCPTGP is that it has not come about because of any intrinsic deficiency in its own operations, it is more to do with perceived difficulties within the STA, where the influence of different specialist medical royal colleges was seen to have possibly compromised best regulation. The government decreed in 2000 that both the JCPTGP and the STA were to be unified under the banner of the Postgraduate Medical Training and Education Board (PMETB), which went live on 30 September. While setting up its new structures and policies during its heretofore ‘shadow’ existence the PMETB has shown a worrying tendency to ignore the Joint Committee's working experience developed and honed over time, but the most obvious change for GP registrars will be the imposition of certification charges as it has been decreed that unlike the Joint Committee, it must be self-financing.

I am privileged to have been the last JCPTGP chairman from the GPC stable (1997–2000) and am pleased to be able to pay tribute to those who have contributed to the proper operation of the regulation of general practice training over the past three decades. Katie Carter, our Registrar since 1997, and her small and dedicated staff have stuck to their posts over 5 turbulent years and hand on to PMETB, if it chooses to receive it, an efficient, economic and slick operation. Justin Allen and Roger Chapman (joint honorary secretaries from the RCGP and the GPC) worked tirelessly until the very day of decommissioning, and my successor, John Toby from the RCGP, has ensured that the interests of general practice have remained high on the agenda of medical training.

We now face a new era with Modernising Medical Careers and a new unified regulator, the PMETB. What is certain, however, is that the history of achievement by the JCPTGP gives these new initiatives the very best chance of success in enhancing the training of young doctors. If they fail, they will have been profligate with the proud tradition of excellence and endeavour they have inherited from a JCPTGP that represented the very best features of cooperative working and mutual respect among doctors and lay members who worked tirelessly towards public protection and best training.