Health Education England has outlined a new vision for general practice training which it says will better prepare GPs for future models of care.
The programme will have greater focus on areas such as addressing health inequalities and managing the growing proportion of patients with mental health care needs seen in general practice, HEE said.
Innovative placements, perhaps with charities, third sector organisations and services such as CAHMS will be explored, the Training the Future GP report said.
And it should include educational opportunities around improving cancer detection and referral, the report said, as well as training in the harms of overdiagnosis.
Trainees will be exposed to learning about population health and public health through a variety of initiatives and there will also be more leadership opportunities and teaching on planetary health and sustainability.
Technology will have a greater role in training with the development of a Virtual Training Academy and the commissioning of IT that will support GP trainees.
Overall the goal is to move to a flexible model of training that meets the needs, skills and experiences of the trainee as well as the area they are working in.
HEE said it would also continue to work to address issues of discrimination, prejudice, bias and specifically racism at individual, institutional and systemic levels, and to reduce differential attainment.
This includes a programme of support for overseas doctors in GP training positions.
It will include plans to ensure patients in deprived areas are able to access care, with the development of specific training offers on these issues and prioritising expansion of training capacity to areas in need.
HEE said they had done extensive engagement with patients, trainees, educators and providers in developing the plans as well as running a series of pilots.
Stakeholders said there was a need for more training in holistic and personalised care, with longer placements that enabled trainees to develop relationships with patients they were caring for.
More than 4,000 doctors accepted training places to become GPs last year, HEE said, hitting the Government target for recruits.
But the report notes that this is counterbalanced by the number of established GPs reducing their hours or leaving the profession.
HEE’s actions and recommendations for changes to GP training
1. Enhancing generalism:
- The adoption of the Enhance programme
- The adoption of longer placements
- A pilot of blended learning placements
2. Equity in training:
- Continue to support overseas doctors in GPST through the HEE programme
- Applying the recommendations of the BAPIO report to GPST
- Use of GP curriculum to highlight inequalities in care delivery and ways to address them
3. Social accountability and serving all communities:
- Support for prioritisation of areas of deprivation within primary care estate plans
- Identification of further opportunities for development of HEFT programmes
- The further development of post-CCT deprivation-themed fellowships
4. Improving the quality of training:
- Exploration of options for further reforms to placement and delivery model
- Standardisation of quality management processes in line with the refreshed HEE Quality and
- Intensive Support frameworks
- Expansion and diversification of placements following move to training hubs overseeing PCNlevel
- quality control
- Increase in use of innovative placements, including those across community, voluntary and
- digital services
5. Better wellbeing and mental health care in general practice and the community:
- The creation of new learning opportunities through NHS England and mental health providers
- The exploration of innovative training placements through charities, third sector organisations
- and other services not typically used
6. Improving cancer diagnosis and earlier detection:
- Education opportunities to engage with cancer diagnostic academics
- Training in clinical decision-making to enhance cancer diagnosis and referral
- Training in the harms of overdiagnosis
- Innovative ITP placements
7. Population health:
- Exposure to placements, learning opportunities and educational events about population
- ITP posts in public health, ICBs, community specialities and prisons
- Involving GP DiT in HEFT
- More GP DiTs doing the national Population Health Fellowship
- A dual CCT in general practice and public health
8. Technology in practice
- The development of a primary care Virtual Training Academy
- The development of a national virtual learning environment
- The commissioning and development of technology to support GP training programmes
9. Planetary health in practice
- The embedding of teaching on planetary health and sustainability in the curriculum
- Opportunities for GP DiTs to be involved in projects that support the NHS zero carbon
- Considerations on environmental impact to be routinely factored into decisions on the delivery of GP training
10. Leadership, management and strategy in context:
- Exposure to leadership opportunities during GP DiT training
- Provision of specific, relevant and ongoing leadership training
- Representation of primary care voices and patient voices at all levels of healthcare leadership
- Training in knowledge and skills to provide clinical supervision of the wider MDT, including
- other doctors
Professor Simon Gregory, medical director for primary and integrated care at HEE, said: ‘Primary care remains the foundation of universal healthcare and our NHS.
‘The world is changing at unprecedented rates and our future GPs must be equipped with the right skills and resources to meet the ever-shifting needs of their patients.
‘At this challenging time for the profession it has also never been more important for them to see the potential for a fulfilling and rewarding career in general practice.
‘This report seeks to revitalise GP training by outlining a vision for a future of sustainable general practice careers, ready to best deliver the established curriculum through quality GP training programmes and placements, delivered within available capacity.’
Health minister Neil O’Brien said: ‘It is important doctors entering general practice have the necessary skills to treat both people’s physical and mental health needs. We also need a workforce which can make the best use of technology to help speed up diagnosis and treatment.’
Dr David Smith, BMA GP trainees committee chair, said: ‘This report contains some well-intentioned ideas and initiatives, some of which will be cautiously well received by GP trainees, but overall it still skirts around some of the key pressures impacting training and general practice more widely.
‘For years the BMA’s GP committee and trainees committee has been saying that to fully-qualify as GPs, trainees need as much experience as possible in the practice, so while the fairly recent move to two years in a GP setting is positive, it’s incredibly frustrating to hear HEE itself admit that to increase this further is being blocked by lack of capacity and funding. The answer here is therefore clear: invest more in practices so they have the space and resources to do this.
‘The focus on mental health is positive, as all GP trainees have seen an increase in the number of patients coming in who are struggling with theirs. However, secondments or placements in other settings must not take trainees away from learning in general practice.
‘Trainees, like all GPs, care deeply about not only helping their patients get better when they’re sick, but being and staying healthy, so the impetus on population health, environmental health and addressing health inequalities will be warmly received by current trainees – and many will be interested in knowing more about the combined CCT in general practice and public health.
‘But these changes and suggestions must not be used to shift demand from other services that are themselves running over-capacity – in these cases psychiatry and public health teams.
‘Meanwhile mentions of frailty and long-term condition management – which make up a huge amount of day-to-day patient care – are notably absent.
‘We know our international colleagues and those from ethnic minority backgrounds continue to face barriers and face disproportionate challenges during training, so the commitment to addressing differential attainment is positive. The test will be whether this results in meaningful change that allows the brightest, best and willing to fulfil their potential in general practice, regardless of their background.
‘Technological innovation has a lot to offer both patients and GP staff, and so it makes sense to have GPs of the future at the forefront of developments in this area. But it is no silver bullet to fixing the huge workload demands on practices, and access to new platforms should not come at a cost to trainees – while we know that practices still desperately need investment in their basic IT infrastructure.
‘Every day we look with trepidation at our futures as senior colleagues wrestle with soaring demand, mounting bureaucracy and for partners, huge financial pressures, so it’s no wonder newly-qualified GPs are increasingly choosing portfolio careers and turning away from partnerships. More leadership training is all well and good, but without addressing these core issues eroding the appeal of full-time general practice, it is unlikely to change trainees’ minds. You cannot fix GP training without fixing the crisis impacting the whole of general practice.
‘There is disappointingly nothing in this paper for GP trainers – our senior colleagues who put time aside to foster the skills of the future workforce – nor improving estates so there is space for learning in a clinical setting.
‘And aside from a very short mention, there is nothing of substance on trainee wellbeing or improving morale that continues to plummet – much like our pay. Alongside all junior doctors, GP trainees wages continue to fall in real-terms – and without restoring pay to 2008 levels, trainees will continue to struggle with the cost of living and training and the NHS will continue to struggle to keep them.’
RCGP chair Professor Kamila Hawthorne said: ‘It’s important that specialty GP training evolves to reflect both changes in healthcare and society. As such, we are pleased to see the focus in this report on continuing to support GPs to become experts in delivering holistic care and recognising their individual training needs, while preparing them for the priorities of modern practice, particularly tackling local health needs and delivering high quality complex care in growing areas of need, such as mental health, new technology applied to primary care, and health inequalities.
‘What this report does highlight is the ever-growing breadth of general practice – and it’s key that as new elements are incorporated into GP, more established but still relevant and important ones are not overlooked. It adds weight to the College’s long-standing calls to extend GP training to four or five years (in line with the Health and Social Care Select Committee recommendations) to reflect what is required to practise independently in the UK. It’s also why the College would like to see an expansion of early career fellowships to support newly qualified GPs with elements of practice that may not be comprehensively covered in current training.
‘Ultimately, the sustainability of general practice will require more GPs, with more training, spending more time with patients. We have more GPs in training than ever before, and hopefully this trend will continue, but this needs to be matched with more investment in training capacity and infrastructure for practices. We also need to concentrate more on retaining our GPs, who are currently leaving the profession faster than they are entering it due to ever increasing workloads.’