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GP education leaders draw up plans for trainees to plug service gaps

Exclusive: Plans to extend GP training by a year could see fourth-year registrars drafted in to plug service gaps and fill gaps in out-of-hours rotas, Pulse can reveal.

GP education leaders have begun 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.

The controversial plan follows Pulse's revelation in January that up to a quarter of GP out-of-hours shifts have been left unfilled in some parts of the country, and comes as the RCGP set out its full case for extending training to four years, which it said would give trainees ‘a 33-50% increase in out-of-hours experience'.

The DH is currently developing ‘placement tariffs' for healthcare trainees to stamp out ‘inequities' in funding, with tariffs for undergraduate placements in hospital due to be introduced next April. And the RCGP, GPC, the BMA's junior doctors committee and deaneries are understood to be in talks over a primary care tariff, which the DH said would be subject to an ‘appropriate pace of transition'.

Under proposals tabled by the Committee of GP Education Directors (COGPED), training practices would be able to recoup money from out-of-hours services, secondary care, hospices or other providers who take on fourth-year trainees.

Dr Barry Lewis, chair of COGPED and a GP in Rochdale, said: ‘Where a GP registrar is delivering a service, there would be a look at introducing a "recharge mechanism". This should be acknowledged by the out-of-hours provider, as it helps their delivery of shifts. They would still be providing placements so costs would be mitigated by the tariff.'

Dr Lewis insisted any fourth-year training placements would have to be GMC-approved with ‘appropriate supervision', and that any changes were likely to be ‘five or six years in the future': ‘No tariff has been worked out – it's simply a proposal to mitigate some of the costs of extending GP training.'

But the GPC said it ‘objected strongly' to using fourth-year trainees to fill shifts.

Dr John Hughes, deputy chair of the GPC education, training and workforce subcommittee, said: ‘You're talking about what are, to all intents and purposes, fully qualified GPs acting as stopgaps.'

Dr Richard van Mellaerts, a GP in Kingston-upon-Thames, said: ‘Nobody's going to complain about more training as long as it's practice-based and senior trainees aren't being used as work horses. But this sounds more like filling gaps than about training.'