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

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

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

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

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

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)

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)

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

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)

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

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

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

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

Further information from www.bradfordvts.co.uk Intending Trainers’ section Practice Managers’ section www.yorksandhumberdeanery.nhs.uk/general_practice/