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GPs buried under trusts' workload dump

HEE to push for five-year GP training pilots in every deanery area

Exclusive Every deanery area should run a pilot for five-year GP specialty training, Health Education England's head of primary care has told Pulse in an exclusive interview.

Professor Simon Gregory, HEE's deputy medical director of primary and integrated care, said he would ‘ideally’ like to set up a five-year training pilot in every deanery area following the pilot set to be trialled in Tower Hamlets.

This will include the current three-year training but will be solely in general practice, and trainees will 'automatically' be enrolled in a two-year fellowship at the end of it.

The RCGP has been pushing for extended GP training for years, but has previously been knocked back in its attempts to extend training to four years. 

However, Professor Gregory told Pulse that he plans to rollout extended training. He said: ‘Our plan is to have 13 or 14 pilots. Ideally, I'd like one in every deanery area, I'm having discussions on those at the moment. This is really exciting.’

He added: 'Why do you train people for 18 months in a hospital?  Often, they're not even learning much about general practice, they're providing service in the hospital, but that's the way it's currently funded.'

Health Education England splits into 13 regions for specialty training.

Professor Gregory said that spending five years in one area allows more likelihood for trainees to 'fall in love' with the area and ‘have an affinity’ for it.

He also said the extended training is advantageous to the area as trainees can ‘adapt’ to the needs of the local population.

He said: ‘These days people go into medicine but by the time they've qualified, they're often in relationships. They don't want to be moving around the country. The chance of a job that's five years long in one area, that means that you can take out rent and not have to move every six months like my daughters had to do.

‘It wins for the doctor themselves, but it wins for the area. If we take that one in Tower Hamlets, that means they can adapt the training programme to what Tower Hamlets needs but also I think if people are there for five years, they're more likely to fall in love with the area and have an affinity for it.’

He continued: ‘There's going to be seven people starting next year in FY2 [in Tower Hamlets]. They're going to do a year of FY2 in the community. They'll do three years of GP training and then the fellowships automatically at the end of it.’

NHS England recently announced the rollout of voluntary two-year fellowships for newly qualified GPs by March 2020.

NHS Tower Hamlets CCG chair Sir Sam Everington said: 'In some ways, I’m not surprised because the feedback I’ve got from so many people is "we want it here too".

'There’s a whole raft of rationale behind it. There’s recruitment and retention, which is key, but also the strength of the training. We think this will greatly improve the training the doctors get because of the continuity.'

Sir Sam said there is no fixed idea of how many trainees will join the pilot until they advertise.

He said: 'It’s going to go ahead, but we’re not quite sure when it’s going to start, probably February or August next year. There are still some things to be sorted out. There’s lots of enthusiasm to get started as soon as possible but there are practical things – but we’re racing ahead.

‘We don’t know how many there will be until we go out and advertise. But certainly, wherever I’ve been speaking, there’s a lot of interest from trainees.

‘There’s a massive attraction of being in one place for five years, so you don’t need to be moving every four to six months. And secondly, you get the continuity of – I would call it – being with a family for five years.'

Readers' comments (16)

  • I can see the attraction of geography-based training for general practice, but I am concerned about the quality of medical/surgical knowledge available from purely GP-based training.

    As a GP with 30yrs experience, I rely on a daily basis on the knowledge I accrued from hospital practice and specialty training.

    In fact I would say that most of the core skills which now underpin my practice as a general medical specialist were learned in hospital practice, then later developed over years in the community.

    I think it is a mistake to assume that medical training in hospitals is not relevant to general practice. Medicine is Medicine, with a number of steep learning curves along the way.

    The key medical/learning and experience from hospital training is easily transferrable to the GP environment, where we learn to adapt our practice in light of community/family/psychosocial factors. Almost all GPs I've spoken to agree that their practice benefits from the mutual insight gained from having experience from the hospital perspective.

    We need GPs to retain a high degree of medical/surgical knowledge and I sincerely doubt that wholesale transfer of GP training to the community will be able to achieve this.

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  • This is more about Great Yarmouth etc than Tower Hamlets. Extended training has run into the buffers so many times before nevertheless it would be churlish not to welcome another attempt.

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  • The government desperately wants more so-called “trainees” (the quality of the training is very questionable in my experience) to do the NHS’s donkey work. Nice timing now that the number of FTE GPs is falling....who are they kidding.. If they get their way it will take a total of no less than SEVEN years post qualifying as a doctor to become a GP. I am not aware of any country in the world where it takes a total of 7 years of continuous assessments and exams to become a GP

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  • Completely agree with the above . General practice requires having a honed skill of finding needles in haystacks . In order to 1st identify the needle it helps to have seen one previously,which is what occurs during specialist rotations. E.g.In 25 yrs of practice I have seen the rash of meningococcal septicaemia 3 times thankfully all in the hospital setting.
    There is also a danger that if GP training is solely in general practice a bigger schism will develop between primary and secondary care, both believing the other doesn't understand the pressure on them . Just as secondary care trainees benefit from time in primary care, future GPs benefit from appropriate placements in secondary care.

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  • I agree with the general principle however it is important to be able to recognise an ill patient. Time spent in A+E is very important. Agree that attachments eg ortho are useless and just service commitment.
    The last 2 years should be spent learning practical skills of use in the community.

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  • More shuffling the deck chairs mmm,glug slug glug too late.

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  • I took on GP training because I wanted to be a GP, but also because I wanted to pay off my student debts earlier than my hospital colleagues, as well as settling into a permanent job sooner. 5 years is excessive, unless we go back to the olden days of pick n mix 6/12 jobs where you could try out different specialties before committing.

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  • Any extra time should be devoted to a) acquiring full range of practical skills to enhance your practice: minor surgery, IUD, nexplanon should be universal and b) a mini MBA so that GPs have an understanding of running a small business with one customer.

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  • Couldn't disagree more, and agree wholeheartedly with Nick Mann et al. In an age where hospital docs are specialising earlier with less generalist experience, the role of GP should be to become the expert general physician of yore with a broad clinical knowledge which requires experience. I was fortunate to come to general practice from being a medical registrar and barely a day goes by that I am not grateful for that. We hear endless whinging that the younger docs are too trigger happy to refer, but that is no surprise when their experiential learning within specialties has been so brief, even more so since the (much needed) working hours directives were implemented.
    To place the onus on 5 years of GP training seems ludicrous - yes, 5 years may be a good idea, but that should consist of 3 month rotas in medical specialities - the learning curve is steepest at the start, and a stint in endocrinology, cardiology, dermatology, renal medicine, gastro, neurology coupled with a "proper" MRCGP more akin to the other MRC exams would produce well rounded, erudite and confident GPs of the future

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  • 5 year of being underpaid rota fodder,mmm don't think so anyone bright enough to do medicine in the UK needs to do another degree and have a life rather than have a star monopoly strip them of it.Do something else.500 GPs a year and accelerating cannot be wrong.

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