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Q&A: Four-year GP training

What is the thinking behind four-year training?

The RCGP says that the length of GP specialty training in the UK is shorter than in other EU countries, and shorter than specialist training. The ‘dual challenges’ of an ageing population with complex conditions, and the plans to move treatment out of hospitals and into community will ‘demand much more of your average GP in terms of clinical, managerial and leadership skills’, the college says.


What will it involve?

As part of the four-year programme, GP trainees would:

·         Spend at least 24 months in primary care based placements;

·         Gain experience of general practice early in the training programme;

·         Receive specialist-led training in child health and mental health problems.

There would also be tailored programmes and more innovative and integrated training placements based in a range of locally relevant settings.


What is the timetable?

In its April 2013 position paper, the RCGP said it was working towards the first intake of trainees beginning the four-year training programme in August 2015.


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Who has signed up to this?

In September 2012, Medical Education England – now subsumed under Health Education England – approved the educational arguments to extend GP training. The Medical Education UK Scrutiny Group – led by the DH and including representation from the chief medical officers of all the four nations – met in November 2013 and confirmed they would support the principle of four-year training. Importantly, the Shape of Training review, commissioned by the GMC and the medical royal colleges, recommended that specialty training should last no less than four years, significantly boosting the RCGP’s case.


What is the latest?

In a council paper for its meeting on Friday, the RCGP said ‘any decision-making on extended GP training has… halted as the RCGP awaits a decision from all four nations regarding Shape of Training’. The DH told Pulse that it was not going to publish its response until next year.


What does this mean for the RCGP’s timetable?

No-one has ruled out the possibility of it beginning in August 2015, but in reality, it would be impossible. There is no indication when the first tranche of four-year trainees will begin – if at all.


What is the hold-up?

There is a political aspect to this. One education leader said that the Scottish administration won’t make any decisions until the referendum on independence later in the year, and the DH will not make a decision until the next general election in May 2015. However, the main reason remains funding.


What is the issue over funding?

An extra year of training will be a significant expense to the treasuries of all four nations. There was a suggestion from the Committee of General Practice Education Directors that practices should pay for the service element provided by trainees in their fourth year of training, which provoked an angry reaction from GPs. There have been no indications yet regarding the four governments’ thinking over funding and this is not expected until the response to the Shape of Training review next year.