If you think education is expensive – try ignorance – Bok’s Law 1

On the one hand it might be argued that a professional should be paid well enough to fund his or her own education and training, but the professional doctor, lawyer or teacher has much less professional autonomy now. Part of the erosion of traditional professional independence in most western countries has been as a result of, or at least coincidental with, the increasing need to deliver social policy from national governments. In the National Health Service or a primary care trust there is a corporate agenda driven by national policy and the delivery of that policy is dependent upon the performance of the doctors and nurses. Thus the relationship is much more employer±employee in reality if not in law. Rising public expectations coupled with public accountability have seen the demand for consistency in performance and a reduced tolerance to mistakes and errors. Politicians as policy makers and commissioning agents have a powerful interest in the performance of professionals to deliver services they are accountable for; and the large public interest factor of cost effectiveness. In 1990 the government of the day wanted a different public health agenda to be developed and introduced a new contract for general practitioners. It set aside a sum of money within the total GP pay structure that would only be released to the GP if he or she attended 30 h of approved education per year or 25 days over a 5-year period. Whilst this contract was not negotiated, there were discussions about the introduction of the Postgraduate Education Allowance (PGEA). The then regional advisers, GP educationalists versed in educational theory and the principles of adult education, pressed for a system of personal, accredited, purposeful education. It was rejected in favour of the less expensive points collecting process (personal communication, Prof R B Berrington, Ex Chair of the Committee of Region Advisers of General Practice Education (a forerunner of COGPED), 2000 2 ). It was in effect a reactivation of an older system written into Section 63 of the National Health Service Act, whereby principals were paid postgraduate grants and seniority awards if they attended meetings. The feeling in the profession at that time, and still heard in groups of older GPs, is that the PGEA was funded with money stolen from them ± talk of new contracts cuts no ice with them. Despite the rhetoric, GPs who were only names to GP tutors and postgraduate centres appeared at meetings and claimed their points. Numbers could be counted and the policy was successful, many more doctors were attending educational sessions and politicians could even tell the public what sort of topics their doctors were learning about. Soon stories heard in the days of Section 63 meetings were again circulating. The back rows of lecture theatres were full of sleeping GPs. The bums were on the seats even if the brains were not engaged. The pharmaceutical industry realized the potential for more cost effective advertising and other commercial organizations for pro®t by arranging meetings in hotels and holiday resorts providing a powerful combination of lectures, food and fun. Whilst some of these educational events were of high quality and undoubtedly learning did occur, many were less than subtle advertising. Any signi®cant learning depended upon the happy timing of a learner's need coinciding with a provider's aim.