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Changes in the health service continue to grow in spite of pleas for a period of stability. This was how I started my last report and this remains true – the pleas of professionals are again ignored. A new body to supervise training is being set up, appointed by ministers, and replacing the current bodies derived from the profession. Another new initiative is a proposal to completely revise the most junior training grade in hospital (the SHO), against an impossibly short timescale – this is the grade in which those training to be GPs work and so will have a major impact on vocational training (see below).

Workforce shortages have become the major issue, with shortages for both GPs and specialist doctors, nurses, midwives, health visitors, radiographers and many more. Years of suppressing salary increases in this group of workers has had an entirely predictable effect in lowering recruitment and retention. In some parts of the country retiring GPs are proving impossible to replace, and their neighbours are beginning to refuse to take on their patients. Having taken a long time to recognise the problem, the government is putting large amounts of funding into increasing undergraduate places, and supporting postgraduate training, but is having difficulty in keeping up with retirements.

Since we last met a further investigation into the most notorious GP of all time, Harold Shipman, has been published. It indicated that he may have brought about the deaths of more than 190 of his patients, and there is strong suspicion on about 60 more. The repercussions of this will be felt for a considerable time

Basic Medical Education

An expansion in graduate entry courses is currently under way, with a four-year clinical course for those with a science based first university degree. Two universities will have completely new medical faculties for degree entrants only. New methods of determining financial support for universities, determined by an assessment of research output only, is a new threat to general practice departments, which are smaller than specialist departments, but deliver a much greater proportion of the teaching curriculum.

Vocational Training

Plans have now been published by the government on the new supervisory body for training, which will cover both specialist and general practice training. This means that general practice will lose its own competent authority, and is at risk of losing power and influence over its own training programmes. This my main concern, but another concern is that the ruling council of the new body will be appointed by the government rather than by the profession. The second major change is to the SHO grade in hospital, which is where GP trainees currently spend 18 – 24 months of their training programme. At first sight this would appear to be proposing a reduction in GP training to two years, but I am assured that this is not the intention. I remain unconvinced, in view of the desperate need to train more GPs.

Continuing professional development

The main change here is being driven by negotiations on a new GP contract, which may well remove the financial incentive for CPD, and consolidate it into a number of optional quality payments, and a requirement to have a personal development plan informed by a mandatory appraisal annually, and 5 yearly reaccredidation. The other issue which is gaining considerable momentum at present is a move towards multiprofessional learning, with all members of the primary care team attending CPD sessions together, particularly when looking at a team approach – for example to the prevention of coronary heart disease.