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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)

  • Hussain Gandhi

    A move like this will only reduce the number of training practices across the country and make training even more a challenge.

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  • That's it then-the final nail in the coffin......Jeremy Hunt is a genius at causing the collapse of General Practice. Or is he?? Waiting in the wings are his private equity friends etc...trouble is to make a profit out of GP land, they would have to exploit some poor Dr from somewhere like Kazakstan for a salary of £20,000/year put up in communal buildings away from his family and doing 18 hour shifts....

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  • Bob Hodges

    No practice will seek to become a training practice if they have to pay. Many, including my own will stop training.

    End result - no GPs

    This is one of the most stupid ideas is a very rich seam of absolute fuckwittery from the uber-admin droids at NHSE.

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  • The word doctor means to teach.It's our moral duty to impart knowledge to our younger inexperienced colleagues.Its callous to ask for money just to "incentivise" us.

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  • teaching should be done for the 'love of teaching'. It's always been a nonsense to give money for training. Too many poor and inadequate GP's hide behind teaching and being involved in training.

    Training needs to have less formal requirements and some of the un-evidenced nonsense that has crept into the MRCGP needs to be removed i.e the current CSA structure.

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  • Hussain Gandhi

    The money is not to 'incentivise'. The training grant doesn't even cover the cost of lost appointments and time taken to perform the training particularly with the number of formative and summative assessments needed. For most practices training is either at a loss or cost neutral. Demanding practices pay for the trainees further just makes training even less cost effective. At a time where income reducing and workload increasing it will mean practices might have to stop training in order to allow effective management of the day job. Less training then leads to less GPs. Difference between GP and hospital is that hospitals run on junior doctors. Practices do NOT.

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  • This proposal will make GP training an unattractive proposition to many practices.

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  • What fiscal 'benefit' is he seeking to exploit? A properly managed registrar is at best cost neutral and the only benefit the practice might expect is an enhanced reputation for good quality care and training. This does not translate into £££s.

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  • I agree with Bob Hodges and Peter Davies. NHS GP practices are already cash-starved. If they now have to pay up to 50% of the trainee's salary for the 'benefit' of having a GP trainee seei patients, then many practices will pull out of training. Better to pay for a fully qualified GP. This will have severe impact on the number of GP training practices for GPs in training=no new GPs. Instead Brits will be seen and treated by EU GPs as we are unable to find training practices for our own and EU GPs do not need MRCGP or UK GP training to treat NHS patients.

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  • Training practices have been paying for trainees for years through the low level of trainers grant and the increasing burden of bureaucracy heaped upon trainers.
    I wondered how long before the government finally found a way to completely destabilise General practice and here it is. Practices will stop training and therefore the much needed expansion in GP numbers to support shifting of care will be just a pipe dream. practices, under significant stress and at maximum capacity currently will start to fail. No wonder new doctors do not see General Practice as the career direction for them.

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