Dr Zoe Rog considers how better support for GP trainees now will benefit the future of the profession
Pulse recently reported that 7 in 10 GP trainees are already suffering with burnout. As a profession we need to do our utmost to propel GP trainees into a position to lead primary care into the future, and ideally to a better place than we find ourselves currently. This is clearly not happening, and changing this needs to be a priority for the RCGP and NHSE.
As a GP trainee in the late 1990s, I thoroughly enjoyed my training experience. Summative assessment and the MRCGP exam of the day ensured that my competence was tested. But, there remained plenty of time in tutorials to discuss whatever I chose, and to explore anything and everything that interested me about my chosen career.
When I became a trainer myself, I was elated at the thought of spending tutorials discussing the fascination of GP life. Imagine my dismay when I discovered the monotonous and impenetrable monster that is the e-portfolio. Just as the appraisal process steals our valuable time and saps our energy, writing endless reflective log entries is time consuming for trainees and not necessarily proof of their skills as a GP. It also takes considerable time for trainers to review and comment on these; and by the time all the details of the Workplace Based Assessment have been attended to, there is little time to deviate from the mandatory to discuss the more joyous aspects of the job.
The Annual Review of Competency Progression (ARCP) process is particularly onerous. Reviews are scheduled twice a year, inconveniently falling during the summer holidays and immediately before Christmas. Preparation is time-consuming for trainers and trainees alike. It is also a costly process for the Royal College.
There are multiple possible outcomes from an ARCP, but an ‘Outcome 5’ is the most perplexing. This outcome is due to incomplete information in the e-portfolio. It can often be something as minor as the wrong version of a form completed, or omitting a single type of log entry. I still have significant doubts about the fact that a trainee can be deemed to be making unsatisfactory progress as a GP one week, but after a few days of stressful e-portfolio editing – and potentially without seeing a single patient during that time – can then suddenly be deemed to be progressing entirely satisfactorily.
Confusingly, the consultation skills exam has been reiterated twice in recent years. Admittedly the RCA exam originally replaced the CSA exam in response to the Covid-19 pandemic, but no sooner had everyone got to grips with it, the SCA exam then replaced the RCA. This is unsettling and more difficult as there are fewer resources in existence to use in preparation for the newer exam, and as trainers we have less experience of this exam to pass on. The cost is high too with the price of an AKT exam sitting being £470 and £1180 for the SCA. Since some trainees require more than one sitting this can be expensive, and the psychological impact of paying for a further sitting whilst coming to terms with a recent failure can be extremely tough.
To add insult to injury, the funding for the New to Practice Fellowship ended last month. This was an excellent way for trainees to be supported in their transition from training to the daunting demands of a salaried GP job, with a funded and relevant CPD session every week, and access to a GP mentor outside the practice in which they worked.
It is a pleasure to be a GP trainer and to watch bright and talented young doctors develop into excellent GPs. However I would like to see them complete their training far less battered and bruised by the process, especially knowing the challenges that lie ahead of them. The e-portfolio could be significantly slimmed down with a good dose of common sense. The ARCP process could be less complicated and costly – and the funds saved could provide a subsidy for exam costs. Further exam format changes need to be avoided. Most of all, NHSE should invest in supporting our trainees into their roles as the GPs of what could be a brighter future for the profession.
After all, if the e-portfolio saps my will entirely, I will need a good GP to look after me when I retire.
Dr Zoe Rog is a GP in Runcorn, Cheshire
We are all going to lucky to see a doctor when we retire……there will be so few that all the consultation will likely by done by noctors and you only get see one when you have been back 10 times with no progress in your clinical symptoms. Sad
G.P. trainers are superfluous
I think you’ve missed the mark a little bit here. The e Portfolio isn’t the most annoying part of training to be a GP. Its the one and a half years spent in hospitals doing discharge summaries that provide no training towards our end career. We should be spending that time in specialist outpatient clinics or on take for the specialty.
Sam Wilson, essentially what you are saying is that training in secondary “care” is very poor. Yes, we know that and don’t expect anything else from them. The mark is on RCGP making real learning inside GP practices difficult and less relevant to the real GP life
From the perspective of a GP trainer, the issues raised by Dr. Rog resonate deeply. The high burnout rates among GP trainees are indeed alarming and suggest that current training protocols are not optimally supportive. Reflecting on the changes since my own training days, the shift towards a more bureaucratic and less flexible training system—especially the cumbersome e-portfolio and the stringent ARCP process—seems to detract significantly from the core learning experience.
The increasing administrative burdens not only hinder the trainees’ educational engagement but also place substantial pressure on trainers who must navigate these requirements while trying to provide meaningful mentorship. This detracts from the more enjoyable and fundamentally important aspects of GP training, such as the exploration of clinical interests and development of practical skills. It’s crucial that training programs focus on fostering the intellectual curiosity and resilience of future GPs rather than merely testing their ability to comply with procedural demands. Streamlining the e-portfolio, simplifying the ARCP, and ensuring stability in examination formats are essential steps to achieve this. Additionally, restoring supportive measures like the New to Practice Fellowship could significantly ease the transition for new GPs, helping maintain their enthusiasm and well-being in their crucial early years of practice.