GP trainees 'exploited' to prop up overstretched out-of-hours services

Under-pressure GP out-of-hours services are using trainees 'solely for service provision' and failing to prioritise their education - with inadequate support leaving young doctors and patients at risk, a GMC report has warned.

GP trainee: out-of-hours training criticised (Photo: iStock)
GP trainee: out-of-hours training criticised (Photo: iStock)

The report found that the out-of-hours service nationally was 'struggling'. It warned that services were 'delivered but not well managed because of a lack of resources, with accountability and governance not clear'.

Out-of-hours training was a key part of GP training because it 'was valuable for meeting competences and readying doctors in training for the workforce', the GMC report warned - but 'service pressures in several programmes we visited meant that educations was not being prioritised'.

BMA GP trainee subcommittee chair Dr Tom Micklewright said: ‘At a time when general practice is suffering from a recruitment and retention crisis, more must be done to ensure that trainees – and the future of the GP workforce – are not put off by inadequate and unsafe working environments.'

GP education

The GMC report was based on visits to five locations across England, Northern Ireland, Scotland and Wales from 2016 to 2017. A team examined data from individual GP surgeries to explore how education and training is delivered in the UK.

Addressing out-of-hours training supervision arrangements and feedback, the report describes how in certain areas doctors in training would ‘arrive on site and be allocated to a room and a patient list with little practical induction prior to the beginning of their first shift’.

The researchers remarked that ‘processes were not formalised and in some instances the people we met did not know who had responsibility for safeguarding doctors in training and patient safety in an out-of-hours setting’.

It was also noted that the delay or absence of reviews for GPs in training ‘could potentially risk patient safety’.

Lack of resources

Dr Micklewright added: ‘This report reflects our significant concerns for patient and trainee safety in struggling, under-resourced GP out-of-hours settings.

‘The GMC has highlighted that current levels of supervision remain inadequate at times and that delayed feedback to trainees poses a risk to patient safety. What’s more, they have said that in some units, trainees are being exploited to prop up a struggling service, instead of meeting their training needs.

This follows a recent survey from the BMA which found that one in eight trainees have concerns for patient safety during their out-of-hours shifts and one in three have been deterred from future out-of-hours work as a result of their training experiences.

Dr Micklewright added: ‘In light of this report, we urge the UK GP deans to urgently address levels of supervision in GP out-of-hours and to abandon the practice of remote supervision which is placing trainees and their patients at risk.’

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