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Gold, incentives and meh

Advertisement for 'unqualified GP' post temporarily removed after outcry

The Challenge Fund pilot that invited FY2 doctors to apply for positions in GP practices has pulled its job advert ‘for editing’ after the RCGP called for urgent clarification over the use of untrained GPs.

Shropdoc said it was ‘sorry for any confusion’ caused by the advert for a community physician to provide the ‘full spectrum’ of GMS consultations.

But the doctors’ cooperative said the advert had now been taken down for editing and ‘will be re-posted in due course’.

The RCGP called for urgent clarification from Health Education England (HEE) after learning that FY2 doctors without specialty training were being recruited.

The successful candidate was expected to work across GP practices in Shropshire and Staffordshire as part of its Challenge Fund seven-day GP access pilot.

Candidates for the job, paying between and £30,002 and £39,693 depending on experience for a 40-hour week, needed to have ‘completed at least foundation year two’ but would work as a ‘senior member undertaking the full spectrum of GMS consultations’, the advert said.

The advert, titled ‘Prime Minister’s Challenge Fund community physician’, said: ‘This is an exciting opportunity for fully registered medical practitioners, having completed at least Foundation Year 2…

‘You will be based in a variety of practices in Shropshire and Staffordshire and will work as a senior member undertaking the full spectrum of GMS consultations, frail elderly experience both in practice and the community, educational attachments with SSSFT Dementia Service, and urgent care sessions via Shropdoc.

But concerns were raised over the level of training the community physician would receive, whether they would be supervised in their work and whether they would need a Certificate of Completion Training (CCT).’

RCGP chair Dr Maureen Baker wrote on Twitter: ‘Re “community physician” role. Asking @NHS_HealthEdEng 4 urgent clarification. Training or not? Supervision? CCT 4 independent work.

GPC education, training and workforce subcommittee chair Dr Krishna Kasaraneni said ‘crucially, these are not training posts’ and that the ad could ‘mislead doctors who may see this as a GMC accredited training programme’.

He said: ‘Only qualified GPs can provide certain types of care and we need to ensure the quality of patient care is protected and maintained…

‘These posts cannot be seen as a sort of replacement for GPs. The only way to meet rising demand and alleviate pressure on services is to address the funding and recruitment crisis crippling general practice.’

But after being approached by Pulse, Dr Russell Muirhead, Shropdoc chairman, said: ‘We are sorry for any confusion that has been caused as a result of this job posting, which was unfortunately released prematurely before final sign off by the senior directors. The advert has now been taken down for editing and will be re-posted in due course.’

He said the post was ‘a new development… aimed at doctors having completed FY2 posts who seek further experience in primary care before applying for specialist training in the normal way’ and stressed that the programme consisted of ‘supervised roles’.

He added: ‘This is not a specialist training position but does include education and training in elderly care and dementia via a university diploma course….

‘The aim of this initiative is to introduce and promote general practice and community care to newly qualified doctors at a time when doctors choosing to enter general practice is falling.’

A job description, still available, said the candidate will ‘make professionally autonomous decisions’ and determining the ‘best course of action or treatment’ based on their professional medical knowledge and that the community physician would be ‘accepting accountability for those decisions, seeking supervision and guidance as required’. They will also be expected to ‘prescribe or supply and administer medication and treatments’.

The position also involved two educational sessions a week with Keele University and Health Education West Midlands, which are ‘offering modules in dementia, frailty, health informatics, clinical effectiveness, leadership management along with access to the British Geriatric Society Diploma’, the advert said.

Readers' comments (46)

  • Do I detect the BMA + RCGP being sidelined,time to stand up and be counted.

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  • Vinci Ho

    So this is 'Darth Vader's dark force new Jedi'.
    Desperate measure
    Mini staff grade Jedi??

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  • I expect their salary will just about cover their indemnity costs

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  • do the patients know there arent seeing a fully qualified GP but a FY2 trainee.
    If they turn up in scrubs they will be believed to be fully qualified!
    For the trainee's: are these even classified as training posts?

    physician assistants
    community physicians
    community assistants
    OOH assistants
    OOH physicians
    community staff grade

    can create many posts

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  • Don't fret- it's just another layer that will end with 'speak to your GP.'

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  • Vinci Ho

    May the farce be with you.....

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  • At least working as Community Physicians, one may learn real medicine at the workplace and not waste the time learning about Consulting Skills and other such crap.

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  • So they are mainly going to be let loose on elderly and very frail people..let's hear it from their representatives, families and friends. Are they going to be obliged to declare their trainee status or deceive people into believing theya re properly qualified....the fuss over nurse practitioners palls into insignificance compared with this insult

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  • Words fail me.

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  • Why all the fuss?It's not as if you're asking the FY2 to do neurosugery.It's only general practice for goodness sake.Who can say when GP training ends:2 years,3 years,5 years...or never ending.These are all arbitrary lines in the sand.FY2 trainees are still doctors and by being out in the community they'll gain actual experience and if they aren't sure they can always refer like normal GPs.

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  • 4.20- this isn't fuss this is outrage. Because they need proper supervision and they need proper training. Apart from the meagre salary this is a dead end job leading nowhere. i HOPE THE DEFENCE ORGANISATIONS MAKE IT IMPOSSIBLE!

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  • I have to admit as a GP member of Shropdoc I held my head in my hands when I read this. Its a disaster waiting to happen - for GPs, for patients and for the poor people recruited to these posts - if any are daft enough to touch with a bargepole.

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  • If the GMC is seroius about protecting patients they will be hauling the members of SHROPDOC who dreamed up this nasty little advert before their tribunals.

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  • There are already numerous FY2 posts in general practice. These (should) involve significant supervision. This advert is pitched at doctors who have completed at least FY2, but there is no guarantee they will have any general practice experience. It also hints at a greater level of responsibility. I did my first FY2 in GP and I did not consider myself at all a "senior member" of the practice team at all. The thought of junior doctors with little to no experience being considered such and left to get on with the job is disturbing. Good to see RCGP seeking clarification - will await this with interest.

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  • F2s certainly work in GP but to my knowledge always in triainig practices and under the direct supervision of a named clinical superviser with an edicational superviser above that.

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  • Is this the new plan for F2s who fail the asessments to get on to GP training programmes? Because they are the only doctors for whom a job like this makes any sort of sense. And these doctors need more supervsion, support and training than anyone else!

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  • could this possibly be the beginning of a turn against the so called "leadership" such as RCGP AND BMA (I say this with a rather large pinch of salt because they've shown very little leadership in the last few years)
    If so it serves them right; bringing in "trainees" to fulfill this role is again "watering down" the expertise required to fulfill previously assigned roles -such as GP/ geriatrician;

    This of course would never have been allowed to happen if the " leadership " had maintained a united profession with its members interests; now if this is as it looks a way the doh might be using to bypass the bma/rcgp etc and make them even more irrelevant and of course bring in cheap labour to fulfill a job!!

    perhaps im reading this incorrectly however and like they keep saying at the RCGP "its never been a better time to become a GP"??

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  • If this is allowed why do I need to revalidate ?

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  • More the merrier.

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  • To anon 4:20. These Drs have had no training in General Practice. The law states they may only be on the National GP Performers List if they are fully trained or are in training in an approved training practice.

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  • Bob Hodges

    To Anonymous | GP Partner | 13 July 2015 4:20pm

    As for lifelong learning, GP training may not have an 'end', but it sure as hell has a START, and this isn't it.

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  • To Anonymous GP Partner @ 4:20 pm

    Oh dear!! And you are a GP? And a partner?

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  • absolutely outrageous
    dangerous stupid and completely 100 per cent unacceptable

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  • So you don't need training in general practice hey..any Dr will do? What's the point of the MRCGP exam then? Is the only doctoring that really matters the stuff that happens in hospitals? ...fill primary care with low grade Drs? - primary care is simple?..training isn't needed??

    If I hadn't done the structured training I'd done before I became a GP I'd be completely and utterly lost. You don't have the luxury of a referral letter when random bod No. 7 of today's 40 patients (age 0-120) rocks up in your 10 minute appointment with ANY potential diagnosis ranging from 'completely well' to 'impending and imminent death' and everything in-between. The only person in that room for 10 minutes is you and the patient ...you better get the plan right or someone will suffer. No particular training needed?? WTF!

    I pity the poor fools who will take up these jobs. They've no idea the risks they will be exposing themselves to. The people employing them have no idea what general practice is either. Medical indemnity fees will have to reflect this.

    The result of a poor training in primary care is more work to will have to be done in hospitals. People will turn up there later and more of them will end up in A&E. Haven't we got enough folk in A&E already?

    Exactly the opposite of the current model seeking transfer of work out of hospitals into primary care.
    I don't understand ....its lunacy.

    But this isn't a centralised plan is it...it's an unintended consequence of the ongoing undermining and underfunding of general practice.

    None with half a brain is actually steering the NHS are they ...it's a sinking ship steaming full speed into the nearest ice burg. USS Healthcare-Megacorp is waiting for the call to come pick up the survivors when the ship finally goes under.

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  • The advert has been pulled. Somebody needs to resign.
    Innocent SHROPDOC members - sort it out and don't dice with patients or attempt to exploit junior doctors again.

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  • From what I see here in these headlines day in day out, I think that whatever is imposed on british general practice, however stupid and ill thought out, it will be pushed through regardless;

    its blindingly obvious that what the professionals think is not important; this is just a further extension of the "de dkilling" process we see in british society to get the job done on the cheap--- nurse practitioners in hospitals performing surgery, endoscopy and calling themselves consultants. health care assistants and community volunteers performing nursing roles, teaching assistants becoming teachers, community support officers becoming police officers.

    If all you do is come on these forums and moan, but don't take any real action, then this will keep on happening..... its high time more and more of you said no and stopped doing all the little extras and freebies that have led to all of this; refuse to cooperate with the local CCGs, stop taking any out of hours shifts; resign your partnerships and locum instead, retire/ emigrate.... whatever you have to do but stop bloody moaning for goodness sakes!!

    you're not dealing with rational, sentient beings !!! they'd get you to work for free if they could and they do most of the time rely on your goodwill to keep this dysfunctional system going. If you turn the other cheek here folks your about to get smacked even harder!!

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  • It depends on whether you regard general practice as a speciality or not. The RCGP have been doing their utmost to make the job more worthy with their exam and GMC edicts, and then there's appraisal and re validation so that we can have proof of our worthiness .

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  • @Anonymous | GP Partner | 13 July 2015 10:37pm
    Very true ...worthiness. Lols

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  • But in days one by, before GP training was devised, any registered doctor could do GP locums.

    Surely a doctor is a doctor- what are all these GPs getting so precious about. After all, general practice is the dumping ground for those who couldn't cut it in hospital medicine, isn't it...

    Anyway, who needs training in how to manage uncertainty, all the hidden agendas, the full spectrum of medicine outside of hospital, the differences between hospital medicine and community medicine, management of chronic diseases that never make it to hospital, and so on.

    Why, we could solve the GP crisis in a stroke if we did away with GP training altogether and employed 5000 docs who have completed F2 to do the same job unsupervised.

    Honestly what's all the fuss about?

    [tongue FIRMLY in cheek here, in case anyone missed my humour]

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  • Fine if its a supervised position designed to geve junior docs a tast of GP and encourage them in to the fold.
    Not fine if its a long term thing with the plan being for them to act as GPs without the qualifications and experience and without supervision. That would be downright dangerous for patients and it would downgrade primary care to something between at best a triage service and at worst a game of health care Russian roulette for patients. It would worsen the recruitment problems and probably lead to worse pay and conditions due to being undercut by trainees, keeping us on tube drivers wages, although I thing some salaried GPs earn less than this per hour now.

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  • Took Early Retirement

    Ah! Now I know where a lot of the "5000 extra GPs" will be coming from!

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  • Does anyone believe that £30k is a reasonable salary for a frontline doctor?

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  • What's surpising in this? You only get what you deserve.
    If people are not happy with doctors( read as highly skilled professionals, coming from the top 10 percent of school students, working hard for nearly 10 years before becoming fully independent practitioners) and think GPs are overpaid, they can very well see any Tom, Dick or Harry with few years of obsevership in medicine.
    Unless the society starts to respect people for their knowledge and hardwork, things are not going to improve.
    Having said that there are plenty of places in the world, where hard work is recognized and I strongly advise junior doctors/ F2 not to fall into dangerous traps like this and spoil their future.

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  • Why can't doctors without CCT be clinical assistants to GPs in the community? while college is promoting the concept of PAs so vigorously??
    After all, patients still get to consult a doctor who has as much or more training and education compared to non medical autonomous practitioners?

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  • This situation could have been averted had it not been for power hungry PCTs and NHs in collaboration with GMCMPTS removed practising,well qualified GPs on spurious grounds.They were helped in this by BMA and medical defence bodies that did not use Employment law to protect their members.
    If NHS will swallow their pride and call back GPs whom they had referred on spurious grounds to GMC MPTS for even providing Good Samaritan care for their patients;such events could still be remedied.
    NHS in collaboration with GMCMPTs have denuded GP numbers.
    There was an excess of qualified GPs 4 years ago according NHS North Central's medical director,calling for resignation of a practising GP.This is the real situation of GPs now with severe shortage of Gps
    They have made their bed and are sleeping in it,to the suffering of public.
    NHS have with GMC MPTS proved irresponsible in their behaviour to the public

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  • What is all the fuss about. If 111 call handler with 2 week training is allowed to give advise, and to even recomment a doctor what to do, why not FY2 to work as GPs? They have a medical degree and have gone to medical school.

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  • soon they will be getting in volunteers with no training

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  • Peter Swinyard

    I think I am going to be an independent practitioner in brain surgery.
    After all, I have a medical degree and some 36 years of experience as a doctor.
    How hard can it be to deal with just one organ instead of everything as I have done for 31 years?
    Surely some FT would employ me to make autonomous decisions and do treatments. I can read a "how-to-do-it" book as well as anyone and come from the era of See one, Do one, Teach one and often had to miss out stages 1 and 2.
    Bring me your meningiomas, folks. I think I'll start there.

    Or to put it another way, don't dump unsuspecting FY2s in the sh1t - they need experience in general practice but to do the job properly need 20-30 minute appointments and a supervisor on site with protected time for discussion. Suddenly a trained GP looks like good value.

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  • Bertie

    Good leadership is crucial at all levels of primary care which includes good planning and authorisation of job advertisements. The scenario is an indicator of the desperation in some areas of primary care.

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  • Don't Worry - Private companies running NHS contracts are well ahead in this game.

    They no longer even bother to have GPs in my area - even salaried GPs are too expensive and erode into their profits too much.

    They just sacked the most of the salaried GPs and replaced them with Nurse Consultants, leading Nurse Practitioners, supported by Practice nurses and HCAs, as well as converting the receptionists into extra HCAs.

    I'm fairly sure if Physician's assistants were available they would be employed too. Potentially pharmacists could also be used in the cost cutting, at the expense of using GPs in GP practices, reducing the quality of care is irrelevant to these providers as only the bottom line counts.

    The remaining salaried GP sees all the stuff that the non GPs feel unable to handle.

    Most of the patients are from ethnic minorities and many don't speak English, so most turn up thinking they are seeing GPs and don't understand that the person they have seen is less qualified than the FY2 doctors suggested above who at least have a medical degree and some post graduate experience.

    Impossible that NHS England is unaware of this reduced quality of care, going against all the tendering crap that was deemed worthy of winning the bid, but now they have the contract - all the promises thrown out of the window, and Key performance indicators fudged to make it look like an adequate service is being provided, and NHS England look the other way.

    That is how Shrop-Doc thought they could cut huge costs by paying 30-40,000 for a doctor to do a job for half the price of a decent qualified GP. So much waste when they could just not hire a Dr at all and get away with Inter-professional working, and staff skill mixing.

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  • @4:15 you are correct. The collective that won the PMCF is out to make as much profit as possible and there are worse involved than Shropdoc-they are one of the more professional partners! Unfortunately there seems to be nothing anyone can do to stop this roller coaster. A certain practice in Staffordshire has been using FY2 and med student for years to see their patients-you can never see a partner, yet on the day access excellent. However highest referral rate in CCG-funny that and this model is a blueprint for roll out

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  • It will be interesting to see SHROPDOC's "corrected" advert. If it is very different it will betray their original intention.

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  • Doesn't matter what the advert says it's what happens in reality

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  • There are many practices using FY2 and ANPs to substitute for GPs and save money. What is very noticeable is that these tend to be the lowest qualified GPs doing this who are themselves disinterested in good quality care and form that group who clearly entered medicine for the financial aspects only

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  • I see nothing wrong with FY2s who are supervised working in practices(but not OOH services).
    The need to increase the GP Doctor count will need a change in GP training to encompass "on the job training", supervision and formal education.
    This is the only way we will be able to have sufficient doctors available in General Practice.

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  • I think it's quite clear and transparent really. Motto being get everything done on the cheap. If you view it like this primary care will be first line, ANP, PA, junior Dr's and then GP's prior to consultants. GP'S will become salaried posts. Slowly charges will be introduced as per Dentists. workload will increase +++.
    The other more interesting aspect is amalgamation of health and social care budgets while reducing social care funding will lead to these new boards and the politically savvy Councillors and their minions, clawing this back from the 'ring-fenced' healthcare budgets. so whole system care will be provided by who.....,yes GP'S in the new cheap and crap primary care system.
    unfortunately CCG'S run corruptly by local 'fatcats' filling their pockets and companies coffers while not acknowledging the reality of how Primary Care is about to be broken down beyond recognition. If monitor knee of some of these practices then most CCG's relevant people would have sleepless nights.

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