Picking the brains of the Royal College of GPs

... Who were kind enough to send me a lengthy and very detailed response to my enquiry about GP training on eating disorders. (As a background to their function, the College says: "The Royal College of GPs (RCGP) has the role of setting standards for GP training. It does this by setting the curriculum and assessments for training, both of which are approved by the General Medical Council.") Here is what I feel is the most relevant part of their reply to me...

The actual delivery of the training is organised by the postgraduate medical deaneries, each of which covers a specific geographical area. Although the College and deaneries work closely together, they are independent of one another.

The assessments that GPs-in-training must complete include a combination of external examinations which are set by the college and assessments that are performed in the workplace (i.e. the practice and hospital), incorporating assessments of performance and patient and colleague feedback. Once the trainee has passed these assessments they are awarded MRCGP qualification and their Certificate of Completion of Training (CCT), and can then enter independent practice.

Once a trainee has received their CCT and become a fully qualified GP, they are expected to maintain their knowledge and expertise by a process of life-long continuing professional development (CPD). All doctors must undergo an annual appraisal and must re-apply for their licence to practice every 5 years, a process known as revalidation. This process requires the doctor to demonstrate that he or she has kept up-to-date and has undertaken activities to improve the quality of his or her practice. It also includes a review of significant events, complaints and compliments received.

Although the curriculum sets out the skills and knowledge required, the RCGP is increasingly concerned that the current three-year training programme for GPs, which has remained the same duration for over 30 years, provides only limited opportunities for those doctors to receive specialist-led training in mental and child/adolescent health.

GPs-in-training must therefore pick up these skills in general practice settings which takes both time and good quality supervision.

It is not widely known that currently only around 50% of doctors-in-training for general practice have an opportunity to undertake specialist-led mental health or in child health training placements (e.g. based in hospitals or specialist mental health services) during their three-year GP training programme, although this experience can be invaluable if properly focused.

This is significant to the care of patients with eating disorders, of course, as adolescents are disproportionately affected by these conditions and the long-term community-based relationship with the GP is especially important for diagnosis and treatment of mental health problems.

In response to this, the RCGP has proposed that specialist-led mental health training and paediatric training should become a mandatory part of an extended, four-year core training programme for all new GPs.

This proposal forms a central part of our educational case to roll-out an enhanced four-year GP training programme across the UK. The RCGP’s educational arguments have received broad support by patient organisations and professional bodies but now requires implementation and funding – we are currently working up detailed implementation and economic plans with DH and other stakeholder organisations to enable this, although it will ultimately be a decision for the Governments in all four nations.

This work is scheduled to be submitted to Ministers this summer, for their decision late in 2013.