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GPs go forth

Q&A: Tariff proposals for GP trainees

What will the proposed training tariff mean for training practices and GP trainees?

What are the current arrangements for paying GP trainees?

As it stands, practices are reimbursed the full salary of trainees by Local Education & Training Boards (LETBs), and previously by deaneries. They are also given a £7,600 trainer’s grant per year.

What is being proposed?

The Government said in an impact assessment at the start of the year that it wants all providers to contribute to trainees’ salaries to cover the service element of their roles. The business plan from Health Education England, released on 10 July, confirmed that it aims to introduce tariffs by April 2014 to standardise how much training practices receive for providing training, and this could take the form of charging them for part of the trainees’ salaries.

How much are the tariffs likely to be?

There is no indication as yet. However, the impact assessment said the preferred option for secondary care providers was to provide 50% funding of the trainees’ salary plus a ‘placement rate’.

Has this been proposed before?

Pulse revealed last year that the Committee of General Practice Educational Directors (COGPED) was trying to convince the Government to introduce a tariff to cover the cost of final year trainees providing service in the transitional year from three-year to four-year training. The Government also mooted plans to impose a ‘training levy’ on all practices to pay for LETBs, but it later dropped this following opposition from GPs.

What does the BMA think?

The BMA says that the plans could have a drastic effect on whether practices take on GP trainees. GPC negotiator Dr Beth McCarron-Nash says: ‘It is about their training needs, not about the service needs of their practice. They remain supernumerary. It is very different to having a salaried GP, who is an integral part of the workforce. GP trainees take holiday when they want, they go on training courses and training practices do not rely on them to service provision.’

What happens next?

It is highly likely that these tariffs will be discussed as part of the contract negotiations for junior doctors and GP registrars, in which the GPC will be represented. These negotiations are likely to begin in the autumn.

What are the wider implications of the training tariff?

Dr McCarron-Nash says that practices won’t be able to afford to continue training if a tariff is imposed on them. This could have disastrous implications for the future of workforce planning at a time when the Government is falling short its attempts to recruit 3,250 trainees a year by 2015.

Readers' comments (9)

  • Bob Hodges

    Not only will practice stop training, I suspect that this will also preciptate the early retirement of experienced GPs for whom their status as a trainer is the only thing keeping them at work.

    I suspect my own senior partner fall into that category, and I have very little expectation of being able replace her should she retire given the current dearth of applications for advertised positions.

    In short, not only would it guarantee a medium to long term workforce apocalypse, it would CAUSE one in the short term almost immediately.

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  • Clearly the powers that be have no idea of a trainer's commitment, nor indeed the commitment of the whole practice team to provide a good experience for GP trainees. They cannot be considered a part of the workforce in the way a salaried GP is. This is yet more nonsense from a government that has no understanding of general practice

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  • I acknowledge that for the final 3 months of their three year training the Registrar starts to practice in an increasingly independent fashion prior to being launched into the reality of the harsh world of General Practice . Prior to that there is a huge input by Trainers and their Practices to allow the skills of the speciality to be assimilated by the Trainees . To compromise the current level of reimbursement might well result in the total collapse of the current pretty fragile Teaching environment . This plan is ill-informed and staggeringly naive, or simply stupid .

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  • there might be some good trainers but actually in a number of practices trainers are quite happy to use their trainees as locums. A substantial number of trainers have very poor knowledge about the csa and what it involves. This is seen in their frequent harsh criticism of the poor img who after excellent psqs and consultations with REAL patients and good rapport with them is told by his/her trainer that they cant communicate after a performance with ACTORS in the 'CSA'. It is about time these trainers paid for the service provision they obtain from their registrars. I am sure a lot of them will be very scared about the extra hours they will have to work as it no longer is profitable for them to use registrars as has been the case for too long.

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  • I disagree with Dr Beth McCarron-Nash. Frequently registrars are denied leave - they certainly cannot take it when they want. It made me laugh when she said surgeries don't rely on them for service provision. clearly people don't understand what registrars are going through!!!!! Surgeries DEPEND on registrars.

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  • There is such variation in the workload imposed on trainees. There are many registrars who are expected to pick up several visits even if others are present within the surgery, or negotiate leave with everyone else. Equally there are some places where the regs are treated as supernumerary and are well supported...just too great a variation!

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  • We gave up training after 30 years as we could no longer choose our trainees thanks to the centralisation of the selection process,we ended up with a disastrous East European doctor who I would never have appointed in the first was the best decision we ever made ,yes you might see a few more patients and pay a bit more in locums but there are no more stupid hoops to jump through,if they are going to charge for trainees salaries I advice all of the practices still training to drop it,PGME is a shambles in this country since the DOH got involved but I am afraid the RCGP needs to look in the mirror as well

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  • This will be disastrous. We consider our practice an 'excellent practice' to train in, yes at time registrars work hard but we spend a lot of time supervising / teaching etc.
    The bottom line is that the last 3 months of training is the only time a GP trainee is often contributing more than practices 'put in'. However if any of this goes ahead our practice will stop training - I do not know what will happen to the poor trainees already earmarked for our practice in this event!
    One of the many nails being driven through the GP coffin.

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  • Some practices are very good. But my experience as GP registrar was that you are unpaid doctor who is there to take up on call for your trainer do the visits 2-3 when other partners going home for mid day relaxation and do your trainers paperwork and blood results. For holiday you have to negotiate hard and take them on period when it is not term time as other partners need holiday for the kids. No bother the registrar also may have kids who also has term time at similar time!
    I would agree the pressure and stress has positive impact and as a GP I feel nothing is worse than what it was and have become valued member of my new team

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