A unique collaboration between the UK and China is set to benefit GPs of the future – and their patients – by identifying the real challenge of Chinese GP training system and driving forward improvements in clinical training.
This unique project, being led by academics and educators at the University of Nottingham is using the experiences of patients, educators and trainee doctors themselves to recommend improvements to primary care training in both countries. Different from other ‘training China’s GP’ programmes, the project team undertook a 4 month in-depth exchanges in Nottingham and Ningbo, providing a detailed understanding from the grassroots level.
And, it is hoped, it will assist in addressing the serious shortage of GPs in China, which has been a focus of Government healthcare policy in the country in recent years.
The UK and China share a number of public health challenges, particularly chronic diseases in an ageing population, such as diabetes, dementia, heart conditions and respiratory conditions. Furthermore, how to attract the right medical students to enter the GP training system strategically is always difficult and not well addressed.
The partnership between the Evidence Based Healthcare Centre at University of Nottingham Ningbo Campus (UNNC), Health Education England, the national leadership organisation for education, training and workforce development in the health sector, and Ningbo First Hospital is to help equip new general practitioners to meet these challenges and provide the highest standards of care.
The initiative – the first of its kind in the world - is being led by Dr Prit Chahal, Honorary Assistant Professor in the School of Medicine at the University of Nottingham and Associate Postgraduate Dean at Health Education England.
Dr Chahal said: “China has recognised that one very effective way of improving its wider healthcare would be by developing its primary care system. It is now looking to the UK as a model on which it can base the training of the general practitioners who will be crucial in delivering that system.
“However, the impact of this research is going to be felt in both countries – there are things about our system of training which could also be improved, so it’s about an exchange of ideas with the ultimate aim of raising the quality of healthcare for the ordinary citizens of both countries.”
In China, only 15 per cent of doctors are general practitioners, compared to the UK where around half of doctors who qualify become family doctors. But looking behind the numbers, there are cultural barriers that the project will be also be looking to overcome, in line with Government reforms aimed at tackling the issues.
Compared to their UK counterparts, Chinese GPs have very low status – both among their patients and their healthcare peers – and are comparatively poorly paid. Many current medical degrees do not include general practice training but, as a result of current attitudes, of those doctors who do train as GPs only a small percentage ever go into practice.
Many patients have little confidence in GPs and an ingrained mistrust of local clinics, which often suffer from a chronic shortage of qualified doctors, preferring instead to bypass these and go straight to the hospital. As a result, these are ay crisis point and are struggling to cope with the numbers coming through their doors.
Government backing
In recent years, the Chinese Government has been driving the development and transformation of its healthcare service, with a particular focus on enhancing primary care. It has committed to increasing access for the Chinese population with a goal of two to three general practitioners per 10,000 people or 300,000 by 2020, and to five general practitioners per 10,000 people or 700,000 by 2030.
In 2016, an Expert Committee for Education and Training of General Practitioners supported by the Ministry of Health, under the administration of the Chinese Medical Doctor Association, was established. Its remit is to provide advice on policies relating to the education and training of GPs in China, to establish basic standards and the evaluation of GP training and to inspect training centres.
As part of this national landscape, the Nottingham-Ningbo initiative is aiming to play a key role in helping to drive up standards in general practitioner training and education and has developed an exchange programme for GP educators. This programme will be focus on quality and capacity building, rather than numbers of training participants, which will help the local hospitals to build up its GP training system organically.
Two GP educators from Ningbo First Hospital spent two months in England interviewing their British counterparts, trainee doctors and patients and UK educators have recently repeated the process in China.
Dr Chahal added: “We have seen there is an open door spirit in terms of Ningbo colleagues wanting to help trainees to become the best doctors they can be by developing first class education and training programmes, which is encouraging and fills us with optimism for the future.
“The partnership is already starting to deliver some promising results – we have recently had a meeting with the senior medical chief at Ningbo First Hospital and offered an outline of some quick-win, short-term gains that could be implemented fairly swiftly and some longer term plans that could start to bear fruit within one to five years.”
This programme may also open up opportunities for UK healthcare organisations and businesses who want to enter the China market.
Dr Huang Kai, the project member from Ningbo First hospital said: “This new exchange model enabled young general practitioners from both countries to learn through the real world experience, significantly deepening their understandings of both systems and improving primary care training.”
Dr Ruan Liemin, Director of Ningbo First Hospital added: “This exchange is just a start, we hope more general practitioners from Nottingham and Ningbo could obtain valuable experience and knowledge through this collaboration platform in the future.”
The Evidence Based Healthcare Centre was established at UNNC back in 2015, with the support of the Ningbo Healthcare and Family Planning Committee.
It comes as part of a wider initiative, Nottingham Health China led by the Faculty of Medicine and Health Sciences launched in 2016, which is working to increase the amount and quality of research taking place between UK and Chinese healthcare institutions by forging new relationships between UK and China-based researchers and clinicians. A number of healthcare initiatives are being developed at different stages including lung cancer and hearing science.
It is focusing on a number of topics including nursing and midwifery, mental health, medical education, healthcare software, epidemiology and other key areas of need.
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