A revolution in the making: a suggested model for training NHS doctors.

I believe that the NHS is in need of a revolution. The service is struggling to provide the correct balance of specialists and generalists to meet the complex and multiple demands of today's patients. Suffice to say, a successful future NHS needs a flexible, adaptable workforce with the right skills and in the right numbers for the population's medical problems. Service provision must be patient centred and clinical career trajectories need to attract doctors into the community. I envisage an NHS that provides efficient and holistic patient care at each point of contact. In addition, I want to work in an NHS that looks after me, as a doctor, considering my needs to train flexibly, to pursue my career interests, and to raise my family. I want to utilise my skills and my training; fulfilling my clinical and academic potential in a career flexible enough to allow the opportunities for this. a proposal for change Here, I present a proposal for change but, in the first instance, I would like to consider the concept of 'expert medical generalism' as per the Royal College of General Practitioners' projects of recent years. It is certainly correct that it takes great skill and training to undertake the role of the expert generalist well and that this role is central to joining up a patient's problems in a holistic fashion. However, the expert generalist cannot always provide the detailed specialist knowledge a patient often requires and, as such, there will always be a need for sub-specialist knowledge. Fundamental to my proposal is the idea that expert generalism and sub-specialising are not mutually exclusive. Indeed, many GPs have portfolio careers and develop skills in addition to their regular GP work. Thus, first imagine that all care is community-based unless acute or in-patient care is needed. Newly-qualified junior doctors train for a year each in the community and in hospital. Following this, trainees enter either general practice (community generalism), hospital practice (acute and in-patient generalism), or stand-alone training (for example, anaesthetics). The number of training posts in each specialty is concordant with predicted patient need. The community and hospital generalists are trained and assessed by their respective educational bodies on expert generalism in the community or acute/in-patient fields, thus achieving generalist qualifications. Community and hospital colleagues may continue to develop expert generalist careers or additionally train in a sub-specialty. Sub-specialising trainees would work in a team, …