David asks a subtle question which opens up much reflective thought. Do
I give credit to the RCGP? If you are asking me to say yes or no I have
no hesitation in saying yes. If you are asking "is the RCGP solely
responsible for the rise in GP standards?" a reasonable person would
have to answer no. If you further ask "have all the actions of the RCGP
been beneficial to general practice?" your reasonable GP in the Vauxhall
Vectra would again have to say no. But if you change the word "solely"
to "largely" and change the "all" in the second question to "most of", I
personally would respond yes.

The RCGP, do not forget, was not created out of thin air or by the
government. It was formed by a high minded group of ordinary GPs who
wanted to improve standards in general practice, to establish an
academic and training basis for general practice and to raise the status
of the profession vis-a-vis hospital doctors (who, in the '50s, were all
too often of the Lord Moran persuasion so far as GPs were concerned).

All of these tasks have been achieved, but not so completely as we would
wish. And there's the rub. General practice has been transformed out of
all recognition compared to the creaky set-up in the 1950s, but it still
does not have the status or power of hospital medicine. Or for that
matter, the high tech appeal of hospital medicine so far as ministers
are concerned. There are very few GP academic posts compared to
consultant academic posts, for example. Those GPs who have managed to
achieve an academic career have often been very distinguished, but
frequently at the cost of their credibility as working GPs. Of course
these are the voices that the government listens to but the profession
doubts...

The development of vocational training for general practice was an
outstanding achievement and GP training, along with the standards set
for training practices, remains the RCGP's jewel in the crown. However
it is a jewel that is now subject to official statute and is largely
independent from College structures (although the College remains
closely involved).

I believe the College lost both credibility and part of its raison
d'etre in the late 1980s and early 1990s when it was perceived to side
with a reforming government against the profession. It accepted
legislation to impose vocational training but without RCGP membership
being a condition of appointment as a GP. I believe that this was a
crucial error, because it made membership professionally irrelevant in
terms of being appointed a principal while control of vocational
training became independent of the structures of the College (eg through
Faculties). It meant that the MRCGP, since it was not essential, became
less rather than more important. But the fatal error was to establish
the principle that professional standards were to be enforced through
direct legislation and through the DOH rather than through the College.

So we are now in the position that the College has little or no direct
power over GPs and decreasing influence. Since it has no power, and most
GPs are sceptical about its activities and pronouncements, it is not
surprising that few want to become involved in it. The reason why I
nevertheless continue to support it is because I think that without an
active and powerful RCGP, general practice will lose whatever
professional and academic credibility it still has, and GPs will simply
become "primary care health maintenance operatives", following
procedures, protocols and targets laid down by the DOH and its expert
groups such as NICE through PCTs.

But who cares? I'll be retired by then. I hope they don't reduce my
pension.

Toby


In message <02f601c4df75$593a30d0$0700a8c0@djdesk>, David Jobson
<[log in to unmask]> writes
>
>> By and large these [GP standards] have improved
>> beyond recognition over the last 50 years (since the Collings report and
>> foundation of the RCGP), mostly through the efforts of enthusiastic GP
>> innovators.
>
>Are you giving the credit to RCGP Toby?
>

--
Toby Lipman
General practitioner, Newcastle upon Tyne

Chair, Northern Faculty Board, Royal College of General Practitioners

R&D lead, Newcastle upon Tyne Primary Care Trust

Tel 0191-3880254 (home), 0191-2437000 (surgery)

Northern and Yorkshire Evidence-Based Practice Workshops

http://www.eb-practice.fsnet.co.uk/