European Union Title III/Title IV
Introduction
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The proposal for a Medical Education Standards Board (MESB)
and the development of a new regulatory regime for general practice brings
this issue to the fore. The debate revolves around the relative merits of
using Title III and Title IV of EU Directive 93/16/EEC for GP training in the
UK. Title III relates to the training of Specialists and Title IV to General
Practitioners or Family Practitioners. Currently, all GPs in the UK are
trained under Title IV.
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Title IV is far more prescriptive than Title III by laying
down what is required in training, such as a three-year period. Title III is
far less prescriptive. Those qualifying under Title III obtain a CCST or the
equivalent.
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All EU countries should acknowledge Title IV for their
General Practitioners. However, because of perceived deficiencies in the
training under Title IV (and because the EU has so far not supported a number
of improvements) three EU countries are refusing to allow doctors qualified
under Title IV to work within their social security systems and are moving to
qualification under Title III.
Benefits of Moving to Title III
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The main benefits of moving to Title III may be summarised
as follows:-
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GPs would be accorded the, apparently, higher status which
is accorded to specialists |
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There would be freedom as regards training requirements
under the EU regulations which is not possible under Title IV – and increasing
the length of postgraduate training to the equivalent of other disciplines
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It would be possible to exclude those who remained under
Title IV |
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It is in theory possible with a CCST to move from one
specialism to another |
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It would encourage a trend in Europe to evolve general
practice into the speciality of family medicine
Disadvantages
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The main disadvantages would be as follows:-
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It could create a two tier General Practice profession in
the UK with a need for a new regulatory mechanism |
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This could be divisive among the GP community |
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The move would take a very long time to achieve |
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The claimed freedoms, which are only available under Title
III, are in fact available under Title IV to a large extent.
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It is unclear if a move to Title III would gain the support
of the UK Government and it would also require modification of the
profession’s views on a generalist register.
Other Issues
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The EU is considering taking infraction proceedings against
the countries that intend to move their GP/family doctor training under Title
III. This is likely to be an early issue for consideration by the proposed
Medical Education Standards Board.
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The advent of the General Practitioner Register, which is
signalled with the introduction of the MESB, will in part solve the problem.
That register will control entry to General Practice in the UK and thus anyone
seeking entry to that register will have to satisfy the MESB as to their
suitability to General Practice. This would avoid those who hold CCSTs seeking
to enter UK General Practice without any further controls.
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The major issue in the past has been that of divisiveness
and creating a two tier General Practice profession in the UK.
Views of the Education Network
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On considering the factors, the Education Network saw that
ultimately, a move to Title III appeared to be the best way forward. This
would however depend on a number of factors including:
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the introduction of the General Practitioner Register
andthe advtion of other bodies, not least the Joint Commitent of the MESB and
the policy stance it will take |
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the legal position as it unfolds in the EU |
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the positee and GPC and domestic issues concerning workload |
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The conclusion was therefore that there is not a case for
supporting an immediate move to Title III but that when these issues are
clearer, then there is a case for moving to Title III for UK GP training. |
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This ideally should involve wide debate among the
interested parties not least the College, the Joint Committee and GPC and that
is the basis on which the Network suggests that this issue should be taken
forward.
Position adopted by Royal College of General Practitioners
Council in March 2002
That there is not a case for supporting an immediate move to GP training under
Title III, but on the introduction of the GP Register, wide debate on the
issues should continue.
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