BMA raises concern about GP trainees spending less time with patients

The BMA has raised serious concerns about the ‘dilution’ of GP training quality via new methods where more learning takes place online. 

At the UK LMCs conference last week, the GP registrars committee warned of the rollout of a new training approach where a ‘significant portion of what was direct patient contact time is now spent behind a computer’ doing e-learning modules. 

This learning method – named ‘blended learning’ – is being piloted and the committee co-chairs Dr Victoria McKay and Dr Cheska Ball told Pulse they are concerned about an ‘impending rollout soon’, possibly as soon as August. 

NHS England confirmed that blended learning is ‘being piloted’ in GP training programmes, and that an ‘evaluation of the pilot will inform any further roll-out’ – but did not address claims that a wider rollout would take place this year.

The RCGP told Pulse it is ‘following the progress of this pilot closely’ and reaffirmed its ‘longstanding position’ that no more than six months of GP specialty training should be spent away from patients.

In a speech at the LMCs conference, Dr McKay said the GP training experience is ‘currently under threat of the equivalent of homeopathic dilution for training expert generalists’ via blended learning. 

She said this method of training is ‘being rolled out at pace’ and ‘solely to achieve the government directive of a rapid increase in GP registrar numbers’.

NHS England’s long-term workforce plan – which will be updated this year – aimed to increase GP training places by 50% to 6,000 by 2031, and to 4,500 by 2025. 

Dr McKay continued: ‘[GP registrars committee] will push back with everything we have, to prevent the substitution of high-quality clinical patient contact with e-learning. 

‘We will not allow this rapid increase in training posts to justify a dilution of the quality of general practice training, especially when we know there are not enough post-CCT GP jobs.’

She emphasised to LMC leaders that general practice ‘is not learnt behind a computer’, and that if blended learning is rolled out further, the profession ‘will lose the “expert” from “expert generalists”’.

‘Regular blood pressure monitoring, close titration of anti-hypertensive medications and when to repeat U&Es could be taught via an e-learning module, but only an experienced GP could use their skills and knowledge to detect that the patient is unable to open his tablets since his stroke, and bring the blood pressure within normal range by advocating for him to have a blister pack,’ the GP registrars committee co-chair told the LMCs conference.

In an interview with Pulse, Dr McKay said GP training with increased e-learning is being proposed ‘as a solution’ to the lack of physical space within practices.

She added: ‘It’s being piloted. We are very concerned about an impending rollout soon, potentially by August. 

‘But if we think it’s got a huge training, quality, safety implication, imagine if you’re a patient learning that your GP, that you’ve waited all this time to go and see, spent a big proportion of their training time sitting behind a computer. If you’re a patient, I would think you would find that quite scary.’

NHS England told Pulse that blended learning is particularly beneficial for international medical graduates (IMGs) who report that it supports their understanding of UK general practice and enhances their confidence. 

The new training method is also helpful for those with a need for more flexibility, such as those with caring responsibilities and health problems, according to NHS England. 

A spokesperson said: ‘Blended learning is one of several modern educational approaches being piloted to use technology to supplement and improve traditional training methods for GPs, rather than replace them – and to provide more flexibility to doctors in training.

‘An evaluation of the pilot will inform any further roll-out, but gold standard training to become a GP will continue to require majority face-to-face teaching and patient contact in a high-quality training practice.’

But previously, NHS England has said that it aims to use these placements with increased e-learning as a ‘capacity building initiative’ in order to meet future training targets.

And several deaneries across England told Pulse this year that they were using blended learning to address GP training capacity issues.

RCGP chair Professor Kamila Hawthorne said: ‘We understand the need to explore innovative options for delivering GP training, particularly in the light of chronic workforce shortages and the limited training places available, and we’re following the progress of this pilot closely.

‘It is the College’s longstanding position that no more than six months of GP specialty training should be spent in non-patient facing posts – and this ‘blended learning’ pilot fits within this.’

She said it is ‘vital’ that NHS England’s pilot schemes for GP training are ‘rigorously evaluated’ with feedback from both registrars and trainers before any ‘wider roll out’.

‘Given the College’s role in maintaining standards and quality of GP training, we will continue to engage with NHS England on this,’ Professor Hawthorne added.

The RCGP defines a ‘blended learning post’ as an ‘innovate training placement that integrates clinical work in general practice with a structured and modular programme of curriculum-linked education and self-determined learning via electronic and online media’.

Blended learning has been rolled out more widely for undergraduate health courses such as adult nursing and anaesthesia associates, where it is described as ‘predominantly online, remote-access study’ for people who are ‘currently unable to learn in traditional ways’.