Primary Healthcare in tile UK (Scotland)
In 1948 the government introduced the National health Service which allowed all its citizens to free medical care paid for out of taxes. In primary care, the government took on the responsibility of providing a general practitioner for everyone. Patients are allowed to select the general practitioner of their choice. The general practitioner is an independent contractor with the government, in that he cannot be directed to either where he works or to how he works. He is paid per head of the population he looks after (capitation). On average a general practitioner will look after between 1700 and 2400 patients. Remote and rural practices are smaller and the doctor's income has to be boosted towards the average. There are additional payments to doctors but these are rather more complicated. The average general practitioner in the UK makes about: £45,000 to £50,000 per annum. Most doctors in the UK work in groups of 2 to 10 and have practice nurses, secretaries and receptionists. They pay the wages of the primary care team but are reimbursed. Many doctors work from health centres for which they pay rent but are reimbursed. Some own their own premises. Prescriptions are free for children up to the age of 16, pregnant woman, old age pensioners, patients on income support and patients with some chronic conditions. Otherwise a prescription costs £5.90 per item, paid to the pharmacist providing the drug, Laboratory tests are free.

Secondary care is also free and hospital doctors and nurses are salaried. Patients requiring hospital care as either in-patient or an out-patient have to be referred by their general practitioner unless they present themselves to Accident and Emergency. There is some private practice in the UK.

Training for General Practice in the UK
All medical students are trained together as undergraduates for 5 years - 3 years preclinical learning the basic sciences and 2 years clinical mainly based in hospital. Following this training they obtain the degree of M.B.Ch.B. They then work for one year as a House Officer - 6 months as a physician and 6 months as a surgeon but they can now choose to do general practice for 4 months during this period. On completion of this programme they register with the GMC and are allowed to treat patients and prescribe. There then follows a period of vocational training in the specialty of their choice. In the case of general practice this is for 3 years - 2 years in hospital-based specialties such as accident and emergency, obstetrics and gynecology, geriatrics, general medicine, psychiatry, pediatrics etc. and one year as a general practitioner registrar (trainee). During this year the registrar works in a training practice and is the responsibility of one of the general practitioners in the practice, the trainer. This practice is usually a group practice but not always.

Training of the young general practitioner is supervised by the regional director of postgraduate education. There are 5 such regions in Scotland. The regional director is supported by associate regional advisers who are usually trainers with a special interest in training. Regional directors who have their own budgets appoint training practices and advise registrars of the opportunities in their region. The registrar however applies directly to the trainer for a vacant post which is often advertised and is selected by the trainer from the applicants. In Lothian region there are 70 training practices. Regional directors also organize all formal post-graduate education for registrars in their regions such as half day/whole day release programmes, lectures, visits to hospitals etc. Most of the work undertaken in the half-day release is in the form of group work. At the end of the year most registrars attempt the MRCGP exam run by the Royal College of General Practitioners. They also all have to pass a succession of tests known as Summative Assessment before they are fit to be a principal in general practice.

Country coordinator for Scotland:
Dr. E.R. Seiler
30 Spylaw Bank Rd.
Edinburgh, EH 13 OJG
Telephone/fax:+44 131 44 11 386
E-mail: ronald@seiler.knet.co.uk

Mackenzie Medical Centre is the General Practice clinical arm of Edinburgh University
Department of Community Health Sciences. The practice functions as much as possible as a
normal NHS GP surgery, caring for approximately 5600 people living in the surrounding area.
The practice is situated in the city centre.

Patients live in the city centre and in the south-east sector of the city. This is an area of mixed demography, with some areas of high deprivation.
Eight doctors work within the department (6 principals and 2 assistants). 5 principals have a part-time commitment to the practice, spending the rest of their time on teaching and research.

We have a full-time GP registrar on 12-month attachment to the practice. The registrar takes part in the weekly half-day release vocational training scheme.

The practice has an attached team of nurses - Health Visitor, District Nurse, Practice Nurse and Treatment room nurse. We also have attached Social Worker and Occupational Therapist, Community Psychiatric Nurse, and Speech Therapist. There is a full-time Practice Manager and administrative team, including full-time secretary and computer-operator

The practice building is part of Edinburgh University and was opened in 1982. It was fully refurbished in 1999.

Accommodation can be provided by the University. Rooms are available in the nearby student accommodation block - Fleming House. Charges start at £22 /30 for single/double room.

We would be happy to accept a Trainee/Registrar for a two-week attachment to the practice. Preferred period for the visit would be after September 2000.