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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)

  • Look PULSE you are really starting to upset me.....at the top of your page it says "This site is intended for health professionals only"....yet you persistently allow the misuse of this site by "bogus" GPs/AKA Daily Mail Journalists and others. We both know this and I have historic "evidence" of this...come on we are good friends so please just get rid of these "pathetic loser" journalists. Open debate within the profession is one thing but being stalked by bloody tabloid journalists is another...........

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  • I'm wondering when doctors will be asked to pay for their own postgraduate training as well as their undergrad courses?. This should ensure British doctors are never out of debt!

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  • I know quite a few GPs who decided to become trainers.And the reason?To downsize whilst filling in the income shortfall with the training grant.It may be cost neutral for the practice but its a winner for the trainers.

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  • So this is war.
    We need as a profession to realise that we are in a long and drawn out war with governments. We need to understand this is all part of an orchestrated campaign to destroy general practice and not just another isolated skirmish.
    Recent financial settlements especially the last have all been aimed at cutting off the life blood to the front line.
    CQC, revalidation, CCGs and structural changes have been imposed to weaken morale and professional cohesion and demote professionalism to an anachronism.
    The abusive and biased press reporting of the profession has been orchestrated to reduce the value placed on general practice by patients who in repeated surveys have been shown to be very happy and satisfied in general with the primary care services the receive.
    We now have a plan to reduce and finally cut of the supply of the very professionals who man the service.
    It is time for our professions leaders to take stock and point out to the public exactly what is going on and exposes them to the unstated but obvious final outcome of farming out all medical care to the cheapest provider and then to face multiple NHS 111 fiascos but eventually, having lost traditional providers in the war, the only option will be throw more and more money at the private sector who will bt then be in control, yet experience worse and worse care.

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  • Peter Swinyard

    Welcome to Planet Zog, all those who think this is a good idea.
    The cost of training a GP in a practice is already more than the training grant if you add in the extra 5 days study leave needed by a trainer (locum cost £3500), the loss of trainer and other GP clinical time in supervision of the trainee, the preparation time for tutorials and the protected time for tutorials etc etc.
    Yes, a good trainee can give back some clinical service in the later part of their training but a challenging trainee can take an inordinate amount of partner and trainer time for support and supervision.
    This is another barking idea from those who would destroy general practice.
    Most financially astute practices (would you want to be trained in a financially incontinent practice?) will withdraw from training.
    An idea to be left on the hillside of Delphi.

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  • I agree that training practices who are already struggling will simply stop providing the service , but you never know , they might fix that problem with yet another contract imposition !!

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  • I assume anonymous 8:53 and 9:02 don't bother to claim their training grant? Or perhaps they do. or more likely they are not a training practice! We lose at least half a day a week from our trainer, so the grant does not even cover the cost of replacing these appointments. Add to this the extra time the trainer spends above and beyond this and.. well you get the picture

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  • Why stop at General Practice? Surely our consultant colleagues also benefit from having junior doctors on their teams. A small deduction from consultant salaries to cover their reduced workload only seems fair- say 10% for each Foundation Year doctor, 15% for an ST1, and an extra 5% for each additional year's experience to a maximum of, say, 50%. What reasonable person could possibly object to that?

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  • As a partner in a training practice I love having trainees around. They energise the place, make me review the tutorial subject and think about how I practice. BUT I have to pick up the slack for tutorials and training protected time and it puts an enormous strain on the practice. The service commitment and the payments into the practice do not adequately cover the financial and workload costs. And the holier than though do it for love/ doctor -teacher comments- get real 'sorry Mrs Jones Dr X is teaching so cannot see you and there's no extra Dr to cover as there's no money to pay for one.' Happy patient? mm!!!! they could wait 6 months for when the trainee may be able to deal with them! We're withdrawing from teaching due to the workload anyway, this just makes the decision more valid.

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  • Taking 2 trainees at a time, 1 x ST1 and 1 xST3 there is a slight advantage if a competent ST3 in the final 6 months its about 1 or 2 sessions a week.
    I think we do a good job of course if we were to exploit them..........!...get found out be stopped from training or.....stop training because I am not sure my partners would find it worthwhile and I couldnt blame them. Frankly it would make life a lot easier.
    As above "fuckwittery" not too sure about the language but agree with the sentiment OR.....does this only apply to ST4's?

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