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BMA opposes NHSE plans for trainees to spend three years in general practice

BMA opposes NHSE plans for trainees to spend three years in general practice

The BMA is opposing NHS England’s plans for GPs in training to spend all three years in general practice posts.

According to the union’s registrar committee, GPs in training should instead spend one year in secondary care or community settings, alongside two years in primary care.

Speaking at the UK LMCs conference last week, committee chair Dr Malinga Ratwatte said they have ‘formalised a two-plus-one position’ across all four nations. 

A survey of GPs in training revealed the ‘value of outpatient-based secondary and community care’ as part of the programme, especially for international medical graduates (IMGs), Dr Ratwatte told the conference.

NHS England’s long-term workforce plan, published last year, set out an ambition to expand GP training places by 50% to 6,000 by 2031, with £2.4bn of backing from the Government. 

The plan also committed to increasing ‘training and supervision capacity in primary care so GPs in training can spend the full three years of their training in primary care settings’.

GP trainers have raised concerns about the lack of physical space and time to implement NHS England’s plans, and a Pulse analysis revealed that the plan would require a doubling of general practice training capacity in the next four years. 

Currently, most GP specialty training programmes include 18 to 24 months spent in general practice, with the remaining time spent in hospital or other training posts. 

Last week, Dr Ratwatte told LMC leaders: ‘We know that the NHS England long-term workforce plan sets out to establish a three-year training programme for GP registrars in a general practice setting. 

‘However, after surveying our members across the four nations, it has become clear to us that the value of outpatient-based secondary and community care experience – particularly for doctors joining the UK for the first time – that ability to develop an understanding how other parts of the NHS works, is incredibly important to GP registrars.’

He continued: ‘Therefore, as a committee we have formalised a “two plus one” position across the four nations, advocating that GP training should consist of two years in a general practice setting and one year in predominantly outpatient-based secondary care or community specialist settings.’

NHS England said its ambition for all three years of GP training to be spent in primary care is based on engagement with trainees and trainers.

A spokesperson said: ‘The NHS Long Term Workforce Plan committed to increasing training capacity to support all three years of GP specialty training being based in primary care settings by 2031 following extensive engagement with stakeholders, including trainees, patients and educators.

‘The training programme will allow for the possibility of placements taking place in appropriate settings that fulfil the educational needs of the trainee to prepare them for their future careers as GPs.’

Last month, Pulse revealed that a record number of doctors applied for initial allocation GP specialty training places this year but the vast majority face rejection.

The GMC has recently called for a ‘significant increase’ in medical trainers and supervisors, and the regulator’s survey last year showed that GP trainers are more at risk of burnout than the average for all specialties.



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David Church 28 May, 2024 12:44 pm

We would still need a large increase in GP Trainee supervision capacity – which PAs can’t do.
The programmes should have been revised when PRHO changed from 1 year Med/Surg only to 2 years of F1/F2;
But still needs to provide for IMGs coming from different backgrounds (and not all IMGs are identical, either), and I don’t think anyone has a clue about F3 and F4 doctors, which should probably not exist unless they are part-time trainees. Assuming SHOs are still SHOs, and not mandatory Registrar grades (since Hospital Registrar system has also changed in meantime).

Yes Man 28 May, 2024 1:00 pm

Leave GP training as is and add proper structure/support for first five.

So the bird flew away 28 May, 2024 1:05 pm

GP trainees don’t need to spend 3 years in general practice posts – when PAs can do the job in 2…

Mark Howson 28 May, 2024 1:40 pm

It is crucial GP registrars spend at least 18 months in secondary care. To be a generalist you need exposure to a wide range of speciality. I would go as far as suggesting 5 years GP training with 2.5 years in secondary care. There is of course no comparison with PAs

John Graham Munro 28 May, 2024 1:59 pm

Never had ”training” in my day——and we don’t need it now.

Carreg Goch 28 May, 2024 3:30 pm

Any proposal from NHSE to limit the exposure of GPs to secondary care specialties during training should be viewed with scepticism. Reducing the breadth and depth of experience gained in training posts will diminish the status of GPs. As a long term goal GP training should be on a par with Consultant training. In contrast the NHSE proposal looks likely to move GPs closer to PAs in the minds of the public and politicians.

Marilyn Monroe 28 May, 2024 4:15 pm

You need to spend time working in hospitals to be a useful GP. There is NO WAY I could do what I do if I’d spent my entire training in General Practice alone. NHSE should have limited to no role in organising medical training. There is a glaring conflict of interest here. Sure this might help NHS primary care staffing but its an absolute disaster for the utility of General Practice Dr training. I’m genuinely shocked by this proposal ..its the first I’ve heard of it. Where have I been? My god how stupid. Where are the RCGP???! We are literally binning GPs because of centralised administrative ignorance/incompetence/whatever you’d like to call it. Thank god I got to be a GP when I did. Basically we’re on our way out aren’t we? Soon it’ll be ..there used to be this thing called a GP. They were like all round generalist Drs who trained in hospitals then moved out into the community to practice in there. They were fab..we should really bring them back. Why did we scrap them? Its such a shame. Health care is shit now

Marilyn Monroe 28 May, 2024 5:46 pm

..and sorry but why does it make sense to re-design the countries GP training set up around needs of international medical graduates? No disrespect to IMGs but the reason we rely so heavily on them is because of inadequacies in UK training. We need to fix that not just shrug our shoulders, take this as normal and bake it into the structure of our training system. The lack of ambition is breath taking. Losers setting up a system that accepts failure (to train sufficient Drs) and turns it back on the needs of its home grown supply. This could happen nowhere but the UK. Just 150% lame

Dave Haddock 28 May, 2024 6:05 pm

Currently full time GP trainee does 2 days per week in Practice. And see perhaps ten patients.
Perhaps fix that first?

Peter Jones 1 June, 2024 10:41 am

Trainee GPs need 2 years in secondary care rotating through specialities – essential experience.