Becoming a training practice

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 • 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 • www.bradfordvts.co.uk • Intending Trainers’ section • Practice Managers’ section • www.yorksandhumberdeanery.nhs.uk/general_practice/ • Intending Trainers’ section