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EURACT Position on Specific Training in Europe

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The qualification to become a general practitioner / family doctor in Europe should continue to be through a common training programme. It should only be awarded after an agreed period of postgraduate study following undergraduate education and internship. This unified training programme is currently defined in Title 4 of the EU Directive. The reasons for this single path way to qualification are that the standards of qualification to be a general practitioner should be uniform, the quality of training consistent, and standards for patients guaranteed. A single entry standard is also administratively more simple.

However the current period of training demanded by the Directive is too short and the standard of entry consequently too low if only the minimum training period is applied. In particular the length spent in a general practice setting is insufficient to equip the modern general practitioner for the wide variety of tasks now expected. Evidence for this can be drawn from the fact that most states now exceed the minimum requirements of Title 4. Frustrations have arisen however, as they can only insist on these higher standards in training programmes for their own health systems. Further evidence for the need to raise the standard can be drawn from the production of the Consensus statement by UEMO in 1995, after a wide consultation exercise with experts from all over Europe. This suggested that lengthening the programme, and shifting its emphasis to a primary care setting is urgently required. Furthermore it must be recognised that the primary care physician has an increasing role with many more tasks in the evolution of health care in Europe; this has been emphasised by WHO in its statement on the development of family medicine in Europe. Finally there is the persisting illogicality of the locus of the major part of the training being an institutional setting, when the job itself is carried out in the community. The need for improvement in the training for general practice on a European level is now becoming urgent.

The creation of new professional development programmes for qualified general practitioners, in order to develop the discipline further, is to be encouraged. It also will encourage an academic career progression for newly qualified general practitioners. However the use of the word "specialist" for such qualifications can cause confusion, and listing them in a separate Title in the Directive will cause further confusion and runs the risk of splitting the discipline. In particular such qualifications should not be used to impede free movement by recognizing and using Title 4 qualifications only for incoming doctors. Finally urgent work is required to determine the competencies needed for the single entry standard for general practice in Europe, and the competencies and training that are needed for any further qualifications. It is urgent for the development of training and the protection of patients that Directives on the training programmes of all doctors move away from the current time based definitions and towards definitions of skills and competencies required.

The status of general practice/family medicine as a discipline is a major cause of concern, both in universities and in other areas of national and international health care systems. This lack of status has driven many of the moves to register newer and longer training programmes as "specialists", in order to defend the place and increase the status of general practice. Although understandable in the national context, this causes problems for the discipline internationally. The key here is to work together to improve the status of general practice / family medicine as an academic discipline throughout Europe.

EURACT Council recommends that:-

• the training programme and qualifications needed to work as a general practitioner in Europe should remain unified in one Title of the European Directive.
• the current training standard required as a minimum in Title 4 of the Directive is too low and requires amending urgently, at least in line with the UEMO Consensus statement
• initiatives to develop general practice further by developing higher professional development courses should be encouraged. However this should not be at the expense of improving the entry standard as a general practitioner. The training programmes for such higher qualifications should be listed in the same Title as the entry qualification.
• efforts throughout Europe must be made to increase the status of general practice as an academic discipline.
• further work is urgently needed to determine the range of tasks and the skills and competencies needed to be acquired during vocational training for general practice to meet the health care needs of the citizens of Europe.