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Five-year GP-based training could start in 2021, says NHS England adviser

A five-year GP-based training scheme could start in 2021, as part of a pilot project in east London, an adviser to NHS England has said.

NHS England’s new care models adviser Sir Sam Everington said the trial will see students enter GP training straight out of medical school, rather than going into the current two-year hospital-based foundation training before entering GP speciality training.

The pilot will launch with seven juniors - one at each of the seven CCGs in east London, but could be rolled out nationally if successful, he said.

This comes after Pulse reported in June that Sir Sam – an east London GP - was working on a project with Health Education England to increase the time trainees spend in general practice

At the time Sir Sam said that GP training was ‘not fit for purpose’ and that the UK needed to ‘completely review the training that doctors do’.

Speaking to Pulse this week Sir Sam, who is also Tower Hamlets CCG chair, said: 'For the moment the whole idea is to pilot it. If the pilot is successful there would be the temptation to provide it as an option nationally.

‘There’s no exact starting date. We’re hoping it’s going to be for two years’ time - 2021.’

The first CCGs set to trial the training are: Barking and Dagenham, City and Hackney, Havering, Newham, Redbridge, Tower Hamlets, and Waltham Forest

Sir Sam said: 'The whole aim is to improve recruitment and retention. It all starts with the figure of 50% [of GP trainees] not going on to be GPs.

‘This is all about flexibility. The answer is to create greater flexibility.’

He continued: ‘It’s about bringing back the joy into training because of that flexibility and being able to develop as an individual.’

'There are lots of potential benefits. We’re looking at three, four, five year training options,’ he added.

As part of the programme, trainees would be encouraged to stay workin in the local region for five years. But there would be flexibility if they wanted to move area or change to a different specialty, Sir Sam explained.

‘The idea is you’ll have much more training in general practice, it’s about giving confidence to general practice that we can train our own – which we know we can,’ he continued.

At the moment, medical graduates set on a career as a GP must complete a two-year foundation programme before doing a three year specialty training programme. The latter normally involves 18 months in general practice and another 18 months in hospital posts.

Previous attempts to provide long-term training in a GP setting have fallen by the wayside. The RCGP had planned for four-year GP training to start from 2015 but in 2014 the proposal was axed by ministers.

Two groups are currently working to finalise the new plan - a strategy group looking at the overarching plan such as overcoming obstacles in setting up the pilot, and an operational group focusing on the detail of the training course itself.

While HEE refused to comment on the pilot project, its executive director of education and quality Professor Wendy Reid, said: ‘HEE is always looking for innovative ideas to improve recruitment to general practice and as outlined in our draft workforce strategy, we stated we would investigate options around GP training in the future.’

In October, HEE announced it had recruited record numbers of GP trainees, surpassing their target of 3,250 for the first time.

However, a survey last year by the King’s Fund found that less than a quarter of GP trainees planned to practice full-time one year after qualifying.

Readers' comments (21)

  • Spending five years being taught by "experts" in superficial medicine crammed into 10 minute slots is no answer; I dunno what is, with secondary care also being super-specialised where the inspiring methodology of thoughtful and knowledgeable clinicians is also less evident. In essence, the profession is fu~ked, where the doctors with any degree of self-awareness recognise how the working environment fosters nothing but shit#y medical practice and the losers are the patients.

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  • I think it's vital for them to have SOME time in hospital based specialties, if only to see how communication between hospitals and GPs can be improved, and to understand what the situation is like for the hospital juniors.

    5 years in GP, straight from med school is not the ideal solution, IMO.

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  • Vinci Ho

    I am open- minded about this .
    However , my motto is everything has its advantages and disadvantages. And more importantly, it is about doing the ‘right’ thing by the right ‘people’ at the ‘right’ time , ‘right’ place.
    (1)This is an unique time in our(NHS GP) history . Thanks to the politicians, they have created a ‘hostile environment ‘for all of us with undoubtedly, further uncertainties brought along by Brexit . Retention and recruitment issues are widely publicised (even my elderly mother knows about that ).
    So , if one wants to create new breed of GPs, they have to be trained to, somehow, survive this hostile environment.
    Have we got the right type of trainers ? I do not know .
    (2) One advantage of this ideology of training GPs entirely in general practice environment is to make our youngsters even more primary care orientated , hence , think , learn and behave as a primary care physician. But obviously, the other side of the coin is the risk of developing some blind spots about the actual circumstances faced by our secondary care colleagues . This is reciprocal as we tend to complain about consultant colleagues having the same unconscious bias . Obviously, certain behaviour is often about fighting for resources ( Money , Time , Manpower And Expertise) between primary and secondary care .
    (3) With all due respect,I believe that it is harder to be a ‘capable’ ( or rather adaptable) GP than hospital consultant . How much specialist knowledge we need to be a ‘good’ GP could be more ideological than realistic. Nevertheless, recognition of this issue is essential as it can potentially turn into a weakness in this new GP training programme . Ultimately, it is about how one would structure and design the chronology of the training scheme.
    (4) In addition to all the necessary knowledge for essential medical and surgical specialties, I dare to say we need to expose our youngsters more to medical politics , economics and philosophy for survival. Simply put , GPs might not be interested in politics but unfortunately, politicians are always too interested in NHS GPs. To me , it is a battle against politicians from Day 1 when I walked into general practice.
    (5) There is a Chinese saying ,’ the waves from behind are always pushing the front-waves on Yangtze River’ (長江後浪推前浪). As a front-wave myself , I am willing to put down my baggages of longing for the ‘good old days , good old ways’ and help our hind-waves to push me forward and finish the time left on my journey........

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  • Vinci Ho

    And I dedicate to all (particularly those who are disillusioned)the lyrics of this beautiful song written by Gary Lightbody from Snow Patrol ( flawlessly sung by Leona Lewis) when he was ‘down in the dump’:

    Light up, light up
    As if you have a choice
    Even if you cannot hear my voice
    I'll be right beside you, dear
    Louder, louder
    And we'll run for our lives
    I can hardly speak, I understand
    Why you can't raise your voice to say......

    Yes , we are stuck for a long time and it is time to light up and run( not away).....................

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  • Vinci Ho

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  • Dear DIMWIT prospective GP, Why would you spend 5+5=10 years in medical school and GP training to earn £60-70K (BMA salary) when you can earn £50K as PA.

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  • in 2 yrs.

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  • Looks like a thinly disguised attempt to trap young Doctors in GP before they work out how ghastly life as an NHS GP is,

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  • Took Early Retirement

    This takes us back 8 years to time when you COULD become a GP right after med school and be an assistant for years before becoming a partner.
    There is no way I could have been the doctor that I was without my time in hospital. (Terrible though the conditions were.)
    We really WILL produce then doctors who will be "just GPs". Perhaps we should re-name them "Apothecaries"?

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  • Took Early Retirement

    Sorry- 80 not 8.

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