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Gold, incentives and meh

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)

  • Come on, GPs, stop bashing the trainees. I finished my GP training over 15 years ago, and have been a partner ever since - but have never worked "full time" in GP - because I work well over a 40 hour week in my part time role, and I couldn't cope with much more, having family and a husband who is a hospital doc.

    We need to be inspiring the next generation of GPs and supporting them. In order to learn, they DO need time to reflect - and to read the books (probably all on the net these days, but you get the point), and to concentrate on analysing consultation techniques to enable them to work more effectively and efficiently at the end of it.

    Rather than overworking them during training, what we should be doing is offering mentored full and part time salaried posts to recently qualified GPs who feel they need a bit of extra support when they are making the transition from registrar to independent GP.

    And we shouldn't forget that even once qualified, you are not really alone, as there will always be other GPs and hospital docs to talk things through with. So to all the trainees out there, when considering practices, one of the key things to look for (and ask about) is how the GPs discuss difficult cases with each other. This tells you a huge amount about practices!

    PS Gloucestershire are advertising in the BMJ at the moment for GPs within 5 years of qualification, offering full and part time salaried posts, rotating through in more than one practice, with mentors. This should be what we do in all geographic areas, not just the leafy shires.

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  • The biggest laugh of all is how they say the average working week is 40hours.

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  • I think that the GP registrars timetable is fair. It is GP partners who have an unfair working day due to their having a contract with NHSE which should be abandoned. andIt is not the registrars fault they have accepted and signed this. It is outrageous that salaried GPs have 'model contract' BMA contracts clearly stating that a session is 4.1 hours, and are then routinely expected to work 6 hours !
    Do not blame registrars for their entirely reasonable contract. We need to act with solidarity to improve our days.
    P.S. if the registrars havn't seen enough patients during this time, the training should be expanded. Exploitation of Doctors needs to stop.

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  • I see this in quite simple terms. We are contracted to provide a service from 8am to 6.30. These days are long and usually intense. How can we possibly prepare the next generation of GPs if they are finishing their days between 3pm and 16.30. And don't get me onto to having have time back for OOH sessions! I'm with Pete on this one

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  • 40 hours are quite enough. Lets all go home abit earlier and refuse to cover til 630 I say. yes as a locum im always the one staying til 630. do I like it no. more than 40 hours = not enough time for a life and work takes over. if the trainees are used to normal then they may stick up for this once they qualify rather than plodding on working too long banging on about enough hours at the coal face and adequate training and being a professional means working long hours seeing patients at a dangerous rate etc. 40 hours is more than most people work and quite enough esp ecially for a supernumary trainee who needs to be doing bookwork as well

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  • GP's were warned about this when the contract was in dispute. Did you do all you could do to help it

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  • We must remember that the young doctors won't get their full pension until they are 68.
    It will be impossible to sustain the pace of the old partnership model for that length of time without burn out. I envisage that most doctors will be only able to tolerate this length of service on a part-time basis, in a salaried role, with regular changes of employer that enables respite from the millstone of continuity of care.

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  • Yes well said training GP's
    As a GP partner, I have seen the ritual abuse of trainees. Everyone thinks trainees are only abused in hospitals, but ignore that this is occurring in GP land.
    Some ST's have been doing 8+ sessions a week.. no training sessions, (the record being 10 sessions in a week, far more work than any GP partner) another has reported just 2 tutorials per month.
    A South London Deanery Educationalist said at a fairly recent training conference- first you give the trainee praise, then you give them an 'excremental sandwich' writing this phrase on the flipchart. No spelling mistake ,the Deanery attitude stinks, speaks for itself. The RCGP and BMA act as onlookers, do-gooders, writing how cruel the world is to us, adopting an antiGMC and antiCQC stance. After all, if a GP practice is a negative environment to be in and the Gp's are struggling themselves, why force GP trainees to become like them, be trained in their image?

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