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Training practices face paying part of GP trainee salaries in education funding shakeup from next April

Exclusive GPs could be expected to pay for the ‘benefit’ they get from having a trainee working in their practice under plans being considered by education bosses to develop an ‘equitable model’ of funding for postgraduate medical training.

In plans the GPC has warned could spell the ‘end of general practice training as we know it’, training practices may be expected to contribute to the salaries of trainees in order to help fund the increase in trained GPs needed for the future of the NHS.

The plans, contained in Health Education England’s business plan released earlier this month, will see the implementation of a new ‘national tariff’ for postgraduate medical training programmes and primary care medical education and training’ by April 2014.

But the move to this tariff of payments to those taking on trainees means practices may also be expected to foot the bill for the benefit they recieve from a trainee working for them.

In secondary care, where similar plans are due to be rolled out first, the Government’s favoured option is that employers pay 50% of the basic salary for trainees plus a placement rate, although an equivalent figure for GPs is yet to be decided.

Currently practices are reimbursed 100% of the salary of trainees by local education and training boards. They are also given a £7,600 trainer’s grant per year.

But an impact assessment produced by the DH in January this year states that the current arrangements give training practices an advantage that they should pay for.

It said: ‘The current funding arrangements for postgraduate medical training in primary care provide funding for 100% of the trainee’s salary, taking no account of whether the trainee provides any service (benefit) whilst they are training. Introducing tariffs, based on the costing exercise, will allow us to address this and remove any advantage there may be to a practice who takes trainees.’

Pulse reported last year that the Committee of General Practice Education Directors (COGPED) was in talks with the Department of Health over a national tariff for service provision by fourth-year trainees, in a bid to offset the cost of a further year’s training and persuade ministers to approve the extension.

A spokesperson from HEE told Pulse that the changes would begin to be implemented from April 2014 and were part of paying for an increase in the number of GPs.

She said: ‘We are looking for consistent ways of paying for the training and education that is required for the workforce to deliver high quality care.’

‘We’re at an early stage of considering all options for an equitable model of funding arrangements for postgraduate medical training in primary care, as is currently the case in secondary care. 

‘Furthermore, our mandate tasks us with increasing the numbers of - and training and educating - junior doctors choosing to train as GPs, which will help us to future proof the delivery of health services.’

But GP leaders fear that increasing costs for taking on a trainee will make the offer of training unviable for many practices.

Dr Beth McCarron-Nash, a GPC negotiator and a partner in a training practice in Truro, Cornwall, told Pulse that many practices would not be able to afford to provide training if the tariff was introduced and they had to contribute to trainee salaries.

She said: ‘Trainers are already saying to us that they are considering whether it is worthwhile continuing training because of workload and of the costs involved.’

‘Why would you want to continue if you are having to pay to have a trainee? Those practices enjoy the role of being a training practice, but there does become a point where it is not viable for them to continue.’

Training practices currently receive a trainer’s grant worth around £7,600 a year. However, Dr McCarron-Nash said this was ‘wholly inadequate’ for the time and commitment necessary and trainees are ‘supernumerary’ when it comes to service provision.

Although formal talks about the tariff have not yet begun, it is likely that this will form part of the contract negotiations for junior doctors and GP registrars, which are due to begin in autumn. The GPC will be represented in the talks.

Dr Krishna Kasaraneni, chair of the GPC trainees subcommittee, said: ‘I worry that this fundamentally changes the relationship between a trainer and the trainee. Currently the 18 months in GP is about training; if that’s changed to accommodate a complex calculation of service versus training then it will significantly compromise the quality of training we receive.

‘It’s no secret that GP practices are struggling across the country financially and ask them to pay for the privilege of training is not going to go down well and could spell the end of GP training as we know it.  I don’t want this training tariff becoming the straw that broke the camel’s back for general practice.’

The Government had mooted the idea of imposing a levy on all practices, including non-training practices, to pay for training, but dropped this following opposition from GPs.

The move comes at a time when the Government appears to be falling short of its target to recruit 3.250 trainees a year by 2015.

Readers' comments (86)

  • I work in an area where more than half our our Registrars are Trainees In Difficulty. The Trainers grant is woefully inadequate for the workload (and stress) involved and the "service benefits" almost non-existent!
    I have to agree with Andrew Taylor this latest crackpot idea is nothing short of a declaration of war!

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  • i think the description of a war against us is accurate. But remember where there is a structured free market primary care system, primary care physicians work hard but earn a lot better canada, australia.

    The NHS, which i hope survives effectively is being subsidized by reducing the natural levels of pay of all the doctors within its system.

    The fear should be of the fudge or continuing the blurring of boundaries where we are lumbered with the worst of bost worlds. I think we should have the NHS but if it is being removed, lets go private, not a hybrid where we're targeted at every turn

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  • Martin - it may surprise you to learn that hosptials already contribute 50% towards the basic SpR salary, and pay 100% of the on-call component. Whilst we can debate the rights and wrongs of this, GP practices are only being asked to deal with what the rest of us have had doled out for a long time.

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  • Martin
    There is probably more reason to ask consultants to pay for their trainees than GP 's , this is because a hospital without junior doctors would simply collapse but it would have little or no impact in general practice,this was certainly our case some years ago when we stop training but started again after literally being begged..

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  • Anonymous | 01 August 2013; hardly fair to compare the 'black hole' of hospitals to the tightly run and cost effective GP practices we have!

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  • ... and therefore managment at many Trusts is seriously looking at whether junior doctor training is cost-effective. And all these private providers your CCGs cosy up to do no training at all.

    We do have a moral imperative to train our successors, as well as self-interest (because we will all be old and sick one day), but with this and many other initiatives, our idiotic government is tearing down the foundations of the health service,

    And you, my CCG friends, are colluding with them

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  • As a trainer I lose one surgery a week for tutorial (3hrs). I also spend around 30 mins per day mopping up problem cases, and see the occassional problem patient. And that is with a high flying registrar. I spend around 1.5 hrs per week preparing for the tutorials, and another half hour a week on eportflio as well as a further 6 hrs reviewing eportfolio every 6 months. I have also had a problem registrar who took considerably more of my time. Then there are the courses, trainer's reappraisal, practice inspection, and then going and inspecting other training practices. The main benefit of a registrar is that if they are very good and you have a vacancy you will try and hang on to them. Financially it is a significant loss. I am in a 3 trainer practice (usually 2 registrars at a time), if we have to fund part of their salary then we will stop immediately and use the time to save recruiting a half time partner as we all head speedily for an exit from the NHS. Incidentally training medical students pays better.

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  • Peter Swinyard

    The difference, dear Anonymous 10.45am, is that hospitals have to pay their staff, and cannot run without junior doctors. The pay is not deducted straight from consultants' earnings.
    To force GP practices to pay for the priviledge of having a trainee deducts pound for pound the whole of this from the partners' pay.
    This is not a direct comparison and I can only conclude that you have no idea at all of how GP finances work.
    And PLEASE stop hiding behind anonymity. If you have something to say, man-up (or woman-up) and own up to your opinions. You are taken much less seriously without a name.

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  • You're right, hospitals cannot run without junior staff. But they could run without TRAINING them, by importing foreign graduates/jobless UK graduates into service-only posts. This is already happenening

    PS agree with Pulse's position on anonymous contributors and wish to remain that way

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  • Nobody has a problem with anonymous contributors....but why does it say at the top of the page..........This site is intended for health professionals should add that Daily Mail Journalists also use the site to impersonate health care professionals......after all that is what happens!!

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