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At the heart of general practice since 1960

Pay for the privilege of training GPs? Practices will vote with their feet

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I’ve done the maths. GP trainers up and down the country have done the maths - and most are coming to the same conclusion: we’d give up training.

The cause of such alarm? The latest business plan from Health Education England, reported in Pulse, detailing proposals for a triple whammy to be levied on training practices to ‘remove their unfair advantage’. The Department of Health wants training practices to foot the bill for half the GP trainee’s salary, lose the current trainer’s grant (worth £7,600 per year and intended to meet the costs of training) and pay a ‘placement rate’ for the privilege of having a trainee.

It doesn’t take long to work out that the numbers don’t stack up. Over the course of a training year, a really good full-time trainee would average around 250 appointments per month, but this has to be set against the time the trainer has to invest in their training. Appointments need to be taken out for tutorials, joint surgeries, blocks put into the trainer’s surgery in order to provide proper supervision - all in all this adds up to around 100 appointments lost per month, leaving a net gain to the practice of 150. GP trainees start at £50K - who is going to pay £25K per year, plus an undetermined placement fee for 150 appointments a month? A salaried GP would be a far more reliable and cost effective alternative.

And this is for a good trainee. Where a trainee is struggling, failing exams, unable to speed up their consulting, lacking confidence and constantly needing support…the equation starts to look even less favourable. Training practices have no say over the quality of trainee they receive, they do not advertise for a trainee or have any opportunity to interview them - they take whomsoever they are given. Which employer would accept paying £25K a year salary for an employee without having the right to interview?

What the policy wonks at the Department of Health frequently don’t seem to realise is that general practice is made up of small businesses that will make their own decisions. If they say: ‘Do this or lose all your trainees’, a training practice can just answer: ‘OK then, we’ll lose all our trainees’. Trainers don’t just do it for the money, but neither can training operate on purely altruistic principles - it has to benefit the practice or it just doesn’t make sense.

If there is a mass resignation from GP trainers, what happens then? We have 16 GP training rotations on our patch, so not only would this have a huge impact on those trainees who wish to enter general practice, but there are departments in our local Trust that would come to a standstill. GP trainees make up almost all the junior doctors in paediatrics, and most of those in several medical specialties as well as psychiatry and obstetrics and gynaecology. If half of GP trainers across the country stopped training, what then?

The resignations may not stop at GP trainers. I work as a programme director for our local training scheme. I love the job, but I have enough trouble as it is trying to find places for GP trainees. This would make it nigh-on impossible and I am quite sure it would tip me over the edge; I would leave anything to do with training. My patients would be delighted to find I was available for them once more on a Thursday.

The irony is that this is coming from a Conservative Government, yet they seek to ‘remove any advantage there may be to a practice that takes trainees.’ I thought the very essence of conservatism was to reward those who work hard and try to improve their situation? Apparently, however, the two years of training in order to become a trainer, the hours of work involved in obtaining a post-graduate Certificate in Medical Education now required by most deaneries, the annual peer review and dreaded workload involved in the five-yearly renewal of the licence to train - all this investment of time and effort, should not give any advantage to a training practice. I wonder if they would say the same to Virgin Care about making any profit?

The idea is barmy and the implications for the future of general practice would be enormous. It’s too barmy to really happen isn’t it? Isn’t it??

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68

Readers' comments (13)

  • This is a recipe for destroying General Practice, as no GPs will be trained. I have just invested a year of my time in doing iMAP, not to mention the minimum financial cost of £2530, with the express purpose of becoming a trainer. This plan would effectively scupper any chance of my partners being interested in training. I must admit to being more than a little annoyed...

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  • 'it has to benefit the practice' - well that says it all really doesn't it! I am sorry but some trainers really do abuse the training process. the trainee simply becomes an unpaid locum in certain surgeries. if you are an img and have failed the csa then you are simply told you need to see more patients/do EXTRA visits. the so call support of trainers is invisible in those situations. Some surgeries cant function without trainees -they need them. All this talk of how it is done for the benefit of the trainee is nonsense. the government has clued up to this.

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  • The last comment is very unfair,I work in a large training practice and our trainees are very well supported and have tutorials virtually everyday. If they have any difficulties we give them extra support and they are debriefed after all their surgeries. We do not see them as an extra pair of hands and would not be able to afford to carry on training if this proposal is taken forward. In addition to the triple whammy who would be responsible for funding the maternity leave which the majority of our female trainees seem to take?

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  • @9:51. thanks for your comment. sadly trainers such as yourself are in the minority where i and others are. Look at the failure rates of imgs for csa. why arent trainers kicking a fuss about that. many of the affected trainees report lack of support from their trainers and after being used have things documented against them in their eportfolio. You cant blame the trainees for everything. There is a problem in GP training and it needs to be dealt with

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  • Rachael Mackay

    In complete agreement with Dr Brunet, this surely can't happen... Bonkers!

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  • I have put on hold plans to become a trainer for my new surgery until this mess clears.

    instead this year I am going to do an occupational medicine diploma to improve this aspect of the practice. I was really looking forward to training and giving back to the profession from what I had received.

    Do we make some money out of training yes we do, however I can make a lot more doing other things.

    this targeting of the future of general practice is causing major problems and the government needs to rule on this immediately as to which way they are going on this one.

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  • its bonkers that more than 50% of imgs fail the csa but i dont see lots of you complaining about that....

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  • I thought the government wanted to train more GPs not less!! This surely would cut the number of training practices drastically, to 9:23 do you really think that if the practice were paying you £25 k you would get an easier ride, then you would really have to be worth the money!

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  • I was really lucky that the practice I was at truly treated me as supranumery. I had no problems asking for leave, organising courses or other learning opportunities.

    I am now a partner at the same surgery. Unfortunately we will be stopping training if this is introduced. Those that will accept trainees are those who make a business case for having them, meaning they will not be supranumery and not benefit from the quality training I had.

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  • One of the problems with trainees is the inconsistency. Some excellent trainees would be worth the 25k, others provide little benefit for the practice and the practice would resent paying for them. Practices would find it difficult to fund trainees that are assigned to them, rather than those selected by a surgery.

    Even with good trainees, there is a huge difference between the service they can provide between the start of the year and the end of the year so their appointments cannot all be taken into workforce planning.

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