The introduction of Modernising Medical Careers (MMC) and the regulatory framework being implemented by the new Postgraduate Medical Education and Training Board (PMETB) will bring about major changes for all doctors in training, not least in general practice (GP).1,2 As there has been longstanding criticism of elements of the GP training programme, which has been set in regulation for the past 25 years, GP educationalists on the whole welcome this opportunity to develop a new training programme which is more fit for purpose.
MODERNISING MEDICAL CAREERS
The plan consists of a two-year foundation programme for all doctors some of whom will have the opportunity to spend four months in General Practice in year two. This will be followed by entry into specialist training programmes including general practice, which will lead to specialist certification. These are being referred to as run-through programmes.
POSTGRADUATE MEDICAL EDUCATION & TRAINING BOARD
The MMC changes, in addition to the change in the PMETB regulatory framework, will provide an opportunity for general practice to develop an integrated training programme with greater accessibility in the choice and length of hospital speciality posts and hopefully provide more time actually spent in general practice. In Northern Ireland we are hoping that from August 2007, in line with other deaneries in the UK, that GP trainees will commence a training programme encompassing 18 months rotating through a variety of hospital speciality posts followed by 18 months in general practice. Selection to GP speciality training will be through a national process. The programmes will be based on the new Royal College of General Practice Curriculum and Assessment process.
THE NEW ASSESSMENT FOR GENERAL PRACTICE
The PMETB is now the competent authority for certifying that doctors have achieved a level of competence to be included in the Specialist Register and the Register of General Practitioners maintained by the General Medical Council. In 2004 the PMETB published a policy statement, Principles of an Assessment system for Postgraduate Medical Training. The Royal College of General Practitioners working closely with the National Summative Assessment Board has designed a new single assessment system (nMRCGP), which should meet the requirements of PMETB. The new process will consist of three elements, an Applied Knowledge Test, a Clinical Skills Assessment and Workplace based assessment. The Applied Knowledge Test will be available locally, the Clinical Skills Assessment will be taken in the final year of training-probably at a central assessment centre in London. It is envisaged that the nMRCGP will be available from August 2007 but there will be a 2–3 year transition period when both the old and new assessments will be available to ensure that no candidate is disadvantaged. However as it is generally accepted that the new assessment will be more popular than the present Summative Assessment and the MRCGP examination, it is hoped then the transition period may be shortened.
In line with other speciality trainees, GP trainees will now have to pay for certification. Satisfactory completion of the new assessment will not only confer fitness to practice in the UK but also provide eligibility for membership of the Royal College of General Practice.
THE FUTURE ROLE OF THE GENERAL PRACTITIONER
The role of the GP is changing rapidly. The new general medical service contract allows GPs more flexibility over their commitment to work and what they do. The creation of GPs with a special interest must build upon vocationally trained general practitioners who have developed, or do further training to develop additional expertise. ‘Caring for People Beyond Tomorrow’, the new strategic framework for the development of Primary Health Care in Northern Ireland3 has as one of its four main goals – to encompass a wider range of services in the community. We are very hopeful that development of special interests can become a significant part of a Higher Professional Education Programme for GPs in the near future.
General Practice has the potential to provide a very rewarding career for doctors in the future. It is the intention of the Northern Ireland Medical and Dental Training Agency (NIMDTA) to grasp the new opportunities created by recent changes to improve our education and training and to contribute fully to providing better health care for patients in Northern Ireland.
The author has no conflict of interest.
REFERENCES
- 1.Great Britain: Department of Health; 2003. Modernising medical careers: the response of the four UK Health Ministers to the consultation on ‘Unfinished business – proposals for reform of the senior house officer grade’. Available from: http://www.dh.gov.uk. [Google Scholar]
- 2.Great Britain: Department of Health; 2002. Postgraduate medical education and training; the postgraduate medical education and training board. Available from: http://www.dh.gov.uk. [Google Scholar]
- 3.Department of Health, Social Services and Public Safety; 2005. Caring for people beyond tomorrow: a strategic framework for the development of primary health and social care for individuals, families and communities in Northern Ireland. Available from: http://www.dhsspsni.gov.uk/publications/2004/caring/carepeople04.asp. [Google Scholar]