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.