NOTWITHSTANDING the perceived bias against general practice in medical schools, there is a fundamental and self-perpetuating problem in the selection of students into medical schools.

There is a problem of the few students from less privileged and rural schools entering medical training, and thus being happy to return home to work. There is the increasing problem of large numbers of privately educated students, usually from an urban background, who have no experience or knowledge of rural life, who marry each other, and would never conceive of working anywhere other than in Scotland's cities. There is a problem in Edinburgh and St Andrews of large numbers of students from English public and grammar schools who return home immediately after graduation, and are essentially a wasted resource to Scotland.

Glasgow university medical school intake is by majority very local and students will want to work close to home.

The fundamental problem in the provision of rural medical services is that the selection policies of medical schools favour students from private schools, many from England, and city schools. Ultimately doctors, like most people, are parochial and favour from whence they, and their partners, have come. Thus on graduation the majority of junior doctors wish to train and eventually work local to their origins, or in city practice. This is compounded by the more recent actions of up to 20 per cent of Scottish medical graduates, and an increasing number of GPs and young consultants moving abroad.

A generation ago new medical graduates were pluripotent and most spent a few years trying out specialities before committing to a specific career. Now very junior students are deciding their lifetime speciality in years 1-2 of a five-year course.

The selection process for speciality, non-GP, training is now at a UK national level and is points based. Points are awarded for membership of societies, presentations and research publications. All of which used to be post graduate requirements. Students who do not produce at medical school have little hope of catching up, so they specialise far too early. Thus general and rural practice is disadvantaged very early in medical school.

Furthermore student selection is by university academics who tend to select students from similar social, school, geographical and academic backgrounds as themselves, again to the detriment of rural and GP services. Often they have no knowledge of the wider Scottish geography or school environment. The bias against GP careers in the wider country is thus self-perpetuating.

A move away from academic research, and higher social class and schooling, and more local selection of medical students would help produce more doctors keen on general practice in the whole of Scotland, not just in the areas of social privilege in the cities.

The Royal Colleges can little effect the problem, as has been demonstrated over recent years by the failure of their rural and remote training initiatives.

Gavin R Tait,

37 Fairlie, East Kilbride.