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There is an increasing emphasis on multi-professional education and a new development is the setting up of an organisation called the NHS University. This has to be called the NHS-U at present as it has not been through the appropriate legal processes to be granted the title of “university”. It is hoping to provide personal development courses for all NHS staff, from cleaners to consultants. It has been given lavish funding, but is coming into conflict with other higher education providers, and made a play to take over postgraduate medical education. This has not progressed recently, but as it has the personal backing of the Prime Minister, it is not going to go away!

Our Secretary of State for Health resigned earlier this year, for “personal reasons”. This phrase is usually used before some scandal breaks, but so far he seems to have been squeaky clean, and nothing has emerged. He had been in post since Labour came to power, and has been responsible for many of the structural changes in the NHS, and probably felt in need of a break.

The new GP contract was launched shortly before our last meeting, to be voted on by all GPs. As I mentioned last time most doctors would have faced a significant drop in income, given the figures that were presented. The vote was postponed and whole thing renegotiated; my colleagues from our union, the GPC, had several all night sessions, and looked very frail! However the negotiations were successful and the contract was voted in by a substantial majority. The main change is that GPs can negotiate three levels of service – core services, additional services (such as chronic disease management to local guidelines) and extended services (providing special services such as cardiac clinics). Some GPs will only work at the first level, the majority at level 2, and some at level 3. For the first time the responsibility for out-of-hours provision has been moved away from GPs to their management organisations, and most, if not all, will opt out of this by April next year. We are currently trying to get teaching recognised as a level 3 service, but this is low on the priority list for most management organisations.

Basic Medical Education

As I mentioned last year, as part of the continuing drive to increase the number of doctors, there are new medical schools being created, particularly for a 4-year graduate entry programme. Students who have completed a science based first degree can apply for places in one of these new schools. As they are predominately clinically based they will increase the pressure on placements in general practice for medical students – in my own area new student placements will represent a 30% increase in numbers, a welcome development but not without its problems.

Specific training

The new management structures for postgraduate medical education in England, the Workforce Development Confederation, was created in 2001 (the one for my area was only created in April 2002). During this year there have been major attempts to abolish them, and merge them with what are called Strategic Health Authorities. These have responsibility for health care provision and one could see a major conflict of interest developing in which money for education could be diverted to prop up failing services. Fortunately a degree of wisdom has prevailed and local arrangements can be continued if they are working well; which is useful for us in this area because the processes are working very well indeed.

The reorganisation of SHO training continues to be developed, with pilot programmes being established all over the country. There are many organisational issues to be resolved, not least of which will be our capacity in general practice to provide educational placements for medical students, doctors on foundation programmes, as well as those commencing specialist training for general practice, undergoing innovative training programmes based in general practice but with experience in secondary care, and their final general practice placements. The organisation of British training practices may have to change radically to adapt to this new situation.

I am planning a new style of GP training scheme in which two years will be spent in the training practice and only one year in further hospital-based training. It will be designed to follow on from the two-year Foundation Programme we are developing here in Leicester. I will keep you posted on progress as it will not be starting until August next year.

Continuing professional development

The new general practitioner contract is also going to change the funding arrangements for CPD. The GP Directors no longer have responsibility for quality assuring CPD programmes, and the move towards practice based learning and personal learning plans continues apace. The appraisal process is now established with an annual interview being carried out by trained appraiser. However there is little quality control and the GP Director has been given responsibility for this process; another poisoned chalice! The link with the identification of underperformance is still unclear and a major source of dispute; particularly unclear process by which patient viewpoints are to be incorporated, as they are currently not part of the appraisal process.

What have I done for EURACT?

Since our meeting in May most of activities have been concerned around EURACT centrally rather than nationally. I represented you at the European society executive in Ljubljana where we also had a general meeting, and meetings with presidents of the other two networks and with the organisers next year's conference in Amsterdam. Apart from that my time has been taken up in preparing for this conference and council meeting.