Government policy to abolish practice boundaries has long been an issue of much concern for GPs.
Will ‘home’ practices risk becoming destabilised if their commuter patients are seen elsewhere? Will city practices be able to cope with a sudden influx of the mobile unwell? Do the IT systems exist to enable the sharing of patient records between practices? Read more »
What a difference a year makes. Rewind 12 months and GP joined 140 representatives of the 52 first wave of GP pathfinder consortia at a 10 Downing Street reception hosted by prime minister David Cameron.
I don’t imagine health secretary Andrew Lansley will have a very relaxing summer holiday this year.
Parliament has gone into recess and MPs are scurrying off to their constituencies and holiday homes as we speak, but it looks like Mr Lansley may well be spending the summer dealing with possibly the fiercest criticism yet of his Health Bill.
On Monday GPonline revealed exclusively that former shadow health minister Norman Lamb thought the Health Bill would become law easily because Liberal Democrats had been won over by the listening exercise.
However, commenters on the story thought that Mr Lamb, who had threatened to quit if the reform plans were not overhauled, was being over optimistic.
A recent GMC report has raised questions over the competency of some GP trainees and recently qualified GPs.
Feedback from the RCGP has suggested that while training standards are high, young GPs are suffering from a lack of confidence. More support and exposure to patients is suggested as the solution, particularly in paediatric medicine, long-term conditions and out-of-hours.
Seat belts, smoking, sun cream – all have been the focus of public health campaigns.
When it comes to public health, should patients be incentivised, educated or legally obliged to change their behaviour?
Earlier this month, the RCGP announced changes to the MRCGP
exam, specifically the AKT and the CSA. The
changes will take effect in September 2010.
The RCGP say that the changes made were based on extensive
review of the system during 2009 and will make the exams more relevant to real life
practice, ultimately leading to better patient care.
Health secretary Andrew Lansley’s decision earlier this week
to extend the pilots for revalidation for another year was inevitable.
Last week the BMA published a damning response to the GMC’s
consultation on revalidation, saying the system would be too expensive and
‘disproportionate’.
In this week’s issue of GP our splash also reveals that the planned
timetable for revalidation was already slipping. At an RCGP policy debate last
month, Professor Mike Pringle, the college’s revalidation lead, predicted only
1,000 GPs would submit themselves for revalidation in 2011, all of whom were
part of the pilots. Last autumn, the college suggested the number would be more
like 12,000.
In the face of such delays and such vehement criticism from the profession itself the health secretary really had no
option but to defer the deadline.
It is difficult to say what will happen now, but clearly
there are many obstacles to overcome. Revalidation for GPs does appear to be
slightly more advanced than is the case for other branches of medicine, but
even here there are still big question marks over how it will work for locums
and part-time GPs.
Most worrying for the government, I expect, will be the
overall cost of implementation. The system has yet to be properly
costed (something that won’t be possible until the pilots are complete) and it
is impossible to imagine ministers spending big on this in the current climate.
On saying that, Mr Lansley says he is committed to
revalidation and it is unthinkable that the whole idea would be abandoned. But the
GMC and the royal colleges have a lot more work to do to get the processes
involved right.
On a more positive note for GPs, there are some signs that
funding for revalidation may be made available. There is speculation in GP‘s
splash this week that the cost of revalidation may be up for discussion when
the GP contract is renegotiated next year.
But what do you think? Can the GMC come up with a
revalidation system that doctors will support and, if so, what should it look
like? And, should the government be responsible for funding revalidation and the
more costly issue of remediation as part of this?
There has been a flurry of activity around revalidation
since the start of 2010.
In January, the RCGP published its latest guide to
revalidation, which outlined plans to simplify the credit systems. The emphasis
is very much on the ‘impact’ of any learning, rather than collecting
certificates of attendance – demonstrating how learning has impacted on your
practice can double your credits at a stroke.
But, while it is becoming slightly clearer how the credits
system will work, other areas of revalidation are still shrouded in mystery.
One big concern is who will pay for remediation; a number of
GP leaders have warned that this will be the most costly aspect of
revalidation. The RCGP says deaneries and primary care organisations should pay,
but in the current climate of funding cutbacks is that likely?
Money is also a worry on a national scale. In November, GP reported that the looming funding crisis could put
the whole system at risk because of the costs involved.
The RCGP’s medical director of revalidation, Professor Mike
Pringle, seemed to share these concerns in a recent video, saying that in this
‘fluid environment’ nothing is ‘absolutely certain’.
The GMC has now approved various aspects of the RCGP’s plans
for revalidation, but it remains to be seen how the system will actually be
implemented and whether it will be as comprehensive and robust as initially
planned.
The RCGP has demonstrated considerable bravery in its
determination to create a new CPD system for GPs that attempts to reward
quality rather than quantity.
All of the medical royal colleges have adopted the
50-credits-a-year-system but only the RCGP has taken it a step further and
defined a learning credit as something more than simply a measurement of time
spent.
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