1. Becoming a training practice
Maggie Eisner
Training Programme Director, Bradford GP Training Scheme
November 2010

2. Things to consider Benefits to practice
How does someone train to be a GP?
How is GP training organised?
Infrastructure for training practice
Trainee’s timetable
Roles of practice team members
Trainer’s time
Part time trainers
Salaried doctors as trainers
Patients

3. Benefits to practice Helps with recruitment of GPs
Trainer’s educational skills useful for the practice
Improves trainer’s morale and makes burnout less likely
Keeps all doctors in touch with new developments
Financial benefit = trainee’s salary paid, trainer’s grant
‘Kudos’ of being a training practice
Stimulus to maintain clinical standards and standards of record keeping
Deanery may support improvement to premises (Nov 2010 – very unlikely now!)
Extra pair of medical hands

4. How does someone train to be a GP?
5 yrs medical school, 2 yrs Foundation Training, then 3 year GP training scheme including GP posts and specialties (eg paeds, psych etc)
18m in GP, of which 6m in year 1 or 2 and 12m in year 3;
Teaching in GP posts
On-the-job teaching and after-surgery discussions
Tutorials in practice from trainer and others
Group tutorials (Weds lunchtime)
Half Day Release (Tues pm)
Courses, e g Induction, Family Planning
Assessments for nMRCGP(recorded on e portfolio)
Applied Knowledge Test (machine marked exam)
Clinical Skills Assessment (simulated surgery exam)
WorkPlace Based Assessments incl COT (observed consultations), CBD (case based discussion), DOPS (observed procedures), MSF (multisource feedback), PSQ (patient satisfaction questionnaires)
Regular meetings with Educational Supervisor (another trainer, or TPD) to check progress
ARCP panels once a year to formally assess progress and recommend Deanery re awarding nMRCGP and CCT

5. How is GP training organised?
National system, overseen by PMETB which has criteria and requires a timetable for each post
Regionally by Yorkshire and the Humber Deanery
Locally by Training Programme Directors with administrators Sofya Loren and Safina Akhtar at Field House, BRI

6. Infrastructure for training practice
Room for the trainee to consult
Records summarised to Deanery standards
Library – only a few books needed, should be up to date
Video camera
Commitment by whole practice to be an educational organisation
(one-off grant paid to new training practices, after trainer successfully appointed)

7. Trainee’s timetable Induction programme at start
7 surgeries per week (start with long appt interval and gradually reduce to 10 mins)
Timetabled debriefs after surgeries
Home visits – not usually more than 1-2
½ day with trainer – teaching and assessments
½ day private study
HDR Tuesday 2 – 4.45, group tutorial Weds 1 – 2
15d study leave in 6m (usually HDR + 1w, can use discretion)

8. Roles of practice team members
Trainer
Pastoral care
Support during surgeries
After-surgery debriefs
Tutorials
Assessments
Practice manager
Employment of trainee: WYCSA forms, management of trainee’s employment stuff
Teaching about practice management
Other doctors
Clinical supervision for trainee (support during surgeries, debriefs) when trainer absent
? Timetabled for debriefs
? Tutorials
? Assessments (DOPS, COT and CBD)
Practice nurses
DOPS (esp cervical smears)
? Teaching (esp chronic disease management)
Receptionists
Making appropriate appointments ( e g not booking patients in for things a particular trainee can’t do, e g joint injections or smears)
Patient satisfaction questionnaires
Consent forms for video sessions

9. Trainer’s time Intending trainer Established trainer
3 x 2 day seminars at Deanery, or 4 x 2 day modules for Cert in Med Ed
Sessions with mentor
6-24 HDR sessions in 6m
Some Trainers’ Workshops
Established trainer
Min ½ day/week protected time with trainee
Time for debriefings
Occasional HDR sessions (paid)
Trainers’ Workshops (monthly Tues lunchtime, 1/2d x4/yr, annual 2 day Time Out)
Deanery seminars (TQA every 3y)
Other stuff e g Recruitment, ARCP panels, Educational Supervision (paid)
Recommended 5 days’ extra study leave for continuing development as educator
After 1st year as trainer, protected time for meeting with Educational Supervisees (2 in trainee’s 1st 6m, then 1 every 6m) (paid, but not well)

10. Part time trainers
For FT trainee, need explicit, agreed arrangements for trainee’s supervision & debriefs when trainer not there
For PT trainee, ideal to work the same days but often hard to arrange
If PT trainer and PT trainee work different days, best to have another practice doctor consistently involved
PT trainers need same amount of extra study time etc as FT trainers

11. Salaried doctors as trainers
Increasing trend
If salaried doctor is the only trainer in the practice, important to involve them in practice decisions affecting training
Need support of partners and PM when there is potential divergence between business and educational interests

12. What about patients? Most like the idea of helping young people learn
Some conflict of interest between patients’ needs and trainees’ educational needs
Possible problems
Some patients may only see a succession of trainees and not get properly sorted out
Other docs booked up in advance so trainee only sees patients who book at short notice (more acute illness, more trivia, less chronic disease AND some more vulnerable patients e g children at risk)
So the practice may need a policy

13. Benefits to practice Helps with recruitment of GPs
Trainer’s educational skills useful for the practice
Improves trainer’s morale and makes burnout less likely
Keeps all doctors in touch with new developments
Financial benefit = trainee’s salary paid, trainer’s grant
‘Kudos’ of being a training practice
Stimulus to maintain clinical standards and standards of record keeping
Deanery may support improvement to premises (Nov 2010 – not so likely now)
Extra pair of medical hands

14. Further information from
Intending Trainers’ section
Practice Managers’ section