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A faulty production line

GP training rota has turned me into a dinosaur

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I was alarmed this week to discover that I’ve turned into a dinosaur. Life comes at you fast; one minute you’re a regular down-with-the-kids GP-blogger-about-town, the next you’re a lumbering sauropod, swamp grass dangling from your slack jaw as you stare dumbfounded at the approaching meteorite. The figurative asteroid in question, and the cause of my sudden metamorphosis, is the new GP registrar timetable produced by NHS Employers.

I realise that I’m now an extinct reptile

I realise that I’m now an extinct reptile of the order Ornithischia, but just look at this damn thing. To fit the terms of the new junior contract, the concept of a GP registrar doing a normal working GP day has been chucked out the window. Instead, we now prepare our juniors for a professional career in general practice with a timetable that three days out of five sees them already home watching Fifteen to One before nursery assistants and milkmen have even clocked off yet.

We’re told that it’s just an example, but even utilising the secondary brain in my armour-plated sacral region I can’t figure out a way to provide a trainee enough hours of face-to-face patient interaction to pass the CSA without either a) breaking the contract (leaving the training practice liable to heavy fines) or b) departing totally from the traditional GP workday (meaning the trainer, who is obliged to provide ‘immediate’ clinical supervision during surgery, will be forced to do the same). Other iterations I’ve heard suggested include not coming in before 10 each morning or only turning up at work three days a week. ‘Has the world gone MAD?’ I bellow plaintively into the unheeding Jurassic twilight.

I hope any trainees reading this don’t misunderstand me here; I’m not arguing for exploitation. I just think it’s important that training gives you a genuine feeling of what the actual job is like, and these new rotas fail to do this, meaning your first experience of real GP working hours will be post-qualification, without the support of a training practice. Sorry if this sounds patronising. What can I say? I’m fossilised here.

But furthermore, this whole situation seems to have been imposed on training practices without any input at all from GP trainers, either in contract negotiation or rota design. With rumours of a 30% funding cut in the offing, I’d argue that’s not a sensible way to treat people. Unless you want GP training to end up, y’know, extinct. 

Dr Pete Deveson is a GP in Surrey. You can follow him on Twitter @PeteDeveson

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Readers' comments (18)

  • Healthy Cynic

    Further death of partnerships. We are not preparing registrars for that or even for salaried posts. We are preparing them for part time locums.

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  • This is entirely due to saving money. It is nothing to do with the junior doctors. If the registrars work less then they can be paid leas. That's it- their already short training can go and hang. To the morons in HEE GP Training looks expensive - but as I have said before - wait until you see the alternative.

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  • To be clear to 10:54, this rota was designed to be cost neutral and has a lot more safeguards and time off in lieu/extra pay clauses built in.
    It will not save money and this was never the intention. I suspect if anything it will cost more, especially with the appointment of guardians etc.

    Don't get me wrong, it looks like an absolute catastrophe but as usual for the NHS it also looks like an expensive one.

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  • When is debrief? In the middle of the trainer's afternoon surgery?

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  • Completely agree with this piece and hilarious comic turn of phrases - GP registrar.

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  • As an ST1 trainee you might not be surprised to here that I like the look of the proposed timetable. Not just however so that I can satisfy my itch to catch 15 to 1 twice a week!

    I don't think working longer hours improves the learning experience. Nor do I believe that trainees need to demonstrate stamina for the job by matching the work load of the senior partners. Most have us have worked greuling rotas in A+E and acute medicine in the busiest times in the history of the health service.

    I think trainees will develop better with more time to learn and reflect and not by not suffering burnout and loss of morale that many on this forum demonstrate.

    I do not think longer training and more hours necessarily leads to more knowledgeable and competent doctors.

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  • Couldn't have said it better myself. Sadly I think this will make many of us consider whether on balance training is worth continuing. I genuinely can't see how this could fit with our normal practice working day and I'm not prepared to throw up the entire practice's working practice in the air. Sad times for the future of the profession.

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  • I am genuinely amazed at all the negativity about a 40 hour working week with protected teaching time. A lot of GP's saying it doesn't prepare trainees for the 'real world'. Here's a thought, maybe the 'real world' could improve? Yes, yes, it's a profession not a job, etc, etc, but on the one hand we have talks about mass resignation and 'crisis' and on the other hand, when something comes along to make training as a GP more attractive (and, dare I say it, may make future GP's more insistent on an appropriate work-life balance), it's all grump-grump-back-in-my-day-blah-di-blah. Furthermore, the 'old' contract also had a 40 hour working week and three educational sessions, so that is not even new! The ignorance about this fact just shows how routine trainees working for free out of goodwill has become. And as for training time, it's also a well-known problem that as GP trainees when you do your hospital posts you are considered second-in-line to the trainees of that speciality working alongside you and that you are there largely for service provision (granted not all are like this). This would be where I suggest making the changes if there is concern about reduced face-to-face GP-relevant patient contact. Please people, get on side with making things better for qualified GP's, partners or not, rather than complaining about it being too cushy for trainees!

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  • Sadly Kathleen the real world is not improving and is showing no signs of doing so... Until it does, I can only see that this way of working is ill preparing our future workforce for what it will inevitably face....

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  • I'm an ST3.

    The current system gave me enough time to see enough patients to pass my exams.

    As for not being prepared for "what the actual job is like", I am reminded of a quote by Marcus Aurelius: "Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason which today arm you against the present."

    Don't worry about my future, I can accept responsibility for it.

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