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Table 1 CME for GPs in the UK

From: Challenges and opportunities for general practice specific CME in Europe – a narrative review of seven countries

Role of primary care within the health system

The UK National Health Service (NHS) has been funded by taxes since 1948. The use of a medical consultation, investigation and medicines is free of charge for citizens. Patients are registered via lists with practices for health care. GPs act as gatekeepers, i.e. patients usually go to their practice before a decision to refer them to a specialist or to hospital. GPs manage most diseases, including complex chronic diseases.

Legal regulations

The General Medical Council (GMC) compiles and keeps up to date a list of all licensed doctors in a region (Performers List). Since 2013, a prerequisite for remaining on this list and thus being able to practise as a doctor is proof of participation in Continuing Professional Development (CPD), which is provided in the form of a portfolio [13]. This is submitted annually and discussed with a peer (the ‘appraiser’) during an appraisal. The doctor is recertified (‘revalidated’) by the GMC every 5 years on the basis of satisfactory completed appraisals.

Published aims

Doctors are expected to complete a wide range of CPD activities [14]. The aim is to ensure that all doctors work according to the latest medical standards and knowledge and that patient care is safe. In this way, doctors are expected to refresh and expand existing knowledge, acquire new knowledge and skills, and reflect on societal changes that affect their daily professional lives.

Actual content

Specific learning objectives are not set; rather, it is up to the GPs to draw up a plan aimed at their personal professional development, supported by their appraiser. This plan serves in orientation for further training in the following years. In addition to clinical topics, topics such as research, teaching, training and practice management may also be included. As well as conferences and courses, CPD also includes audit, reading, and online research. Around 50 credits (50 hours) are expected annually [15].

Operationalisation

Since 2013, Responsible Officers have been assigned to all GPs to guide the CPD process [16]. Responsible Officers act as a link between appraisers, GPs and the GMC and make recommendations about the recertification of GPs. The GMC is responsible for issuing a national framework for recertification and making decisions regarding the recertification of all doctors.

Funding and sponsorship

The GMC is financed by contributions from doctors. GPs often meet the costs of their CPD themselves. GPs from Wales and Northern Ireland receive an annual allowance towards appraisal of 300 ₤; those in England and Scotland receive between 200 and 500 ₤ depending on the region. Pharmaceutical companies also organise and fund training events for general practitioners. In 2007, the pharmaceutical industry financed about half of all training events, including travel and accommodation [17], and this proportion has subsequently increased.

Evaluation

Since all activities - from reading to professional interaction and conferences - are part of CPD, there is little critical examination of the learning content; nor is the benefit in terms of health care aspects formally evaluated [18]. Appraisers are expected to assess the content and advise the Responsible Officer if it appears inadequate. Many events organised by pharmaceutical companies do not require formal approval and the programme is not controlled in terms of content, speakers, or advertising content (although companies are expected to adhere to a “code of conduct”).