The future general practitioner: out of date and running out of time.

In the late 1960s a Royal College of General Practitioners' working party produced a job description for the 'Future General Practitioner', together with an educational programme for vocational training. Despite the perceived success of vocational training, general practice remains academically disadvantaged compared with hospital medicine. Most general practitioners (GPs) have no contact with research or academic general practice, few achieve higher degrees compared with hospital consultants, and there are few academic posts in general practice. Junior doctors perceive general practice as offering less intrinsic job satisfaction than hospital medicine and recruitment is falling. Registrars who have completed vocational training are reluctant to commit themselves to general practice and often drift away from it. Schemes with an academic content, designed to retain doctors in general practice, have been well received but there are few career posts in academic general practice. Primary care groups and clinical governance will radically change the nature of general practice. GPs will no longer be at the centre of the primary health care team. Primary care trusts, serving populations of 100,000 or more at multiple sites, will still employ doctors but much of the traditional GP workload will be undertaken by nurses. Present day vocational training produces GPs without the skills that future 'community generalists' will need. Their training will be longer and their careers more structured than at present. They will use evidence-based practice routinely and be experts in information management, interpreting and managing complex diagnostic and therapeutic problems in the context of rapidly changing health technology.