Becoming a training practice can be a helpful income stream for your practice and can bring other benefits too
Becoming a training practice actually sounds more daunting than it is. The best training practices provide high quality clinical care, excellent educational opportunities, a supportive environment and an enjoyable place to work. The main aim is to train and support new GPs into the workforce; the by-product of this is that the trainers, the team and the practice benefit too.
There are various types of trainees; foundation year trainees who are rotating round different specialities and speciality trainees who are training to be GPs.
Training consists of 18 months in hospital and 18 months in general practice, with most trainees doing their first general practice placement in their second year, having rotated round specialities that are useful in general practice, such as paediatrics and obstetrics and gynaecology.
Speciality trainees (ST) are allocated an educational supervisor, who will usually be their GP trainer in their final year. The third year of speciality training (ST3 year) is where the trainee will work in a practice in order to achieve the new Membership of the Royal College of General Practice (nMRCGP). They are mentored and tutored at this stage to increase their clinical knowledge, develop consulting skills and understand how GP practices work. During this time they will keep an e-portfolio of their achievements and undertake the applied knowledge test (AKT) and clinical skills assessment (CSA).
First things first...
It’s important to assess and find out if the whole team is committed to the idea of becoming a training practice. To give the best experience to new GPs it is important that everyone who plays a part in patient care and providing the back room functions is prepared to share their knowledge and experience.
To become a training practice you will need trainers
The practicalities of becoming a trainer and training practice can be found on local deanery websites, but there are some basic elements for the associate trainer and trainer themselves, such as membership of the Royal College of General Practitioners (RCGP), foundation teaching or training courses and being a GP for a certain period of time. In our deanery area initial applications are by way of a self-assessment, followed by a deanery assessment and visit to the practice.
Re-approval periods and visits vary depending on self-assessments and reports. Practice managers and other healthcare professionals can also apply to be associate trainers.
The self-assessment covers eight domains including equality and diversity, appointment and selection processes, access to resources – nothing frightening in there – its day to day life for a practice manager and it’s vital that you are involved in this application/review process too.
Then you’ll need some organisational things
Do you have enough rooms of a suitable standard to accommodate a trainee - or even more than one if you’re feeling ambitious?
Medical records need to be summarised to the deanery standards, but since this became an element of the quality outcomes framework (QOF) it’s much more likely to have been achieved already.
Access to information is vital. Libraries used to be much more of a requirement than they are now. A video camera is required and a way of viewing the videos in the practice must be sorted too.
It is important that the trainee builds a good relationship with the practice that they will spend their final year with. They can do this by arranging visits to the practice to meet their educational supervisor, and I would encourage meeting the practice manager at an early stage too.
What are the benefits?
As mentioned earlier there are definite by-products and benefits of becoming a training practice. The very fact that a practice has to be organised and achieving certain standards to undertake this role means that the practice will often have an advantage over others when recruiting for future GPs and partners. Striving to maintain high clinical and other standards is paramount and can keep trainers and other members of the team on their toes. The skills of the trainers as educators and facilitators are useful for other aspects of improving the team.
There is financial support in the way of the GP registrar’s salary and a training grant. Once the GP registrar is in the final stages of their training in the practice, they are invaluable as they are ‘another pair of hands’ – although it’s true to say our practice always counts the GP registrar as ‘supernumerary’ in that the surgery must be able to function with staffing levels excluding this doctor.
So what does it mean for the practice manager?
The first thing to do is to make sure that you receive any communications regarding training from any organisation such as the deanery, course organiser and trainers. It’s important that you know of any changes in legislation, appointees, processes etc. Remember that the GP trainee should be treated as any other staff member in terms of employment, as you do actually employ them and hold their contract. All your policies and procedures relating to employment affect them equally.
You should ensure the rotas reflect the protected teaching times for both the trainee and trainer. In our practice our registrars have tutorials each week, followed by joint surgeries as well as attending the half-day release at the local hospital. Make sure they are invited to any appropriate meetings, and I usually make sure they attend any clinical commissioning group (CCG) meetings locally and get involved as much as possible. We ensure there is a trainer available to the registrar every day, or if not, a nominated person the registrar can liaise with. We also have round ups at the end of the surgeries so that the trainee can go over cases and discuss learning needs/problems.
Obviously, life in a training practice is not always a bed of roses. Ensuring protected time for the trainer and the registrar must be high on everyone’s agenda.
When it’s busy, busy, busy, the fact that the trainer and registrar have a protected tutorial and joint surgery can sometimes feel a little unfair to those manning the pumps, but with good planning and willingness of all involved to make it work, it usually does. The majority of patients are more than happy to help trainees and more often than not these new GPs build up quite a patient list as they work in the practice.
We have found it useful to have more than one trainer and this way the work is spread and the registrar gets exposure to different experiences. As a manager I find it extremely useful to be involved more at the beginning, arranging the induction programme with the incoming registrar and then ensuring that they have regular sessions with me spread through their time. Subjects I would cover with them are finance, employment, communications, quality and outcomes framework, partnership structure etc.
I see my role as getting them ready for their next practice in whatever capacity they go into and more often than not they will involve me in their thinking about interviews and practices they might want to be moving on to. We have been lucky as many of our registrars have gone on to either work at our surgery or in local practices - so one final benefit from all that hard work is that we get to see their skills in action every day.
Managing Partner at Spinney Surgery in St Ives in Cornwall