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Pay for the privilege of training GPs? Practices will vote with their feet



I’ve done the maths. GP trainers up and down the country have done the maths – and most are coming to the same conclusion: we’d give up training.

The cause of such alarm? The latest business plan from Health Education England, reported in Pulse, detailing proposals for a triple whammy to be levied on training practices to ‘remove their unfair advantage’. The Department of Health wants training practices to foot the bill for half the GP trainee’s salary, lose the current trainer’s grant (worth £7,600 per year and intended to meet the costs of training) and pay a ‘placement rate’ for the privilege of having a trainee.

It doesn’t take long to work out that the numbers don’t stack up. Over the course of a training year, a really good full-time trainee would average around 250 appointments per month, but this has to be set against the time the trainer has to invest in their training. Appointments need to be taken out for tutorials, joint surgeries, blocks put into the trainer’s surgery in order to provide proper supervision – all in all this adds up to around 100 appointments lost per month, leaving a net gain to the practice of 150. GP trainees start at £50K – who is going to pay £25K per year, plus an undetermined placement fee for 150 appointments a month? A salaried GP would be a far more reliable and cost effective alternative.

And this is for a good trainee. Where a trainee is struggling, failing exams, unable to speed up their consulting, lacking confidence and constantly needing support…the equation starts to look even less favourable. Training practices have no say over the quality of trainee they receive, they do not advertise for a trainee or have any opportunity to interview them – they take whomsoever they are given. Which employer would accept paying £25K a year salary for an employee without having the right to interview?

What the policy wonks at the Department of Health frequently don’t seem to realise is that general practice is made up of small businesses that will make their own decisions. If they say: ‘Do this or lose all your trainees’, a training practice can just answer: ‘OK then, we’ll lose all our trainees’. Trainers don’t just do it for the money, but neither can training operate on purely altruistic principles – it has to benefit the practice or it just doesn’t make sense.

If there is a mass resignation from GP trainers, what happens then? We have 16 GP training rotations on our patch, so not only would this have a huge impact on those trainees who wish to enter general practice, but there are departments in our local Trust that would come to a standstill. GP trainees make up almost all the junior doctors in paediatrics, and most of those in several medical specialties as well as psychiatry and obstetrics and gynaecology. If half of GP trainers across the country stopped training, what then?

The resignations may not stop at GP trainers. I work as a programme director for our local training scheme. I love the job, but I have enough trouble as it is trying to find places for GP trainees. This would make it nigh-on impossible and I am quite sure it would tip me over the edge; I would leave anything to do with training. My patients would be delighted to find I was available for them once more on a Thursday.

The irony is that this is coming from a Conservative Government, yet they seek to ‘remove any advantage there may be to a practice that takes trainees.’ I thought the very essence of conservatism was to reward those who work hard and try to improve their situation? Apparently, however, the two years of training in order to become a trainer, the hours of work involved in obtaining a post-graduate Certificate in Medical Education now required by most deaneries, the annual peer review and dreaded workload involved in the five-yearly renewal of the licence to train – all this investment of time and effort, should not give any advantage to a training practice. I wonder if they would say the same to Virgin Care about making any profit?

The idea is barmy and the implications for the future of general practice would be enormous. It’s too barmy to really happen isn’t it? Isn’t it??

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68