GP trainees could be offered five-year posts based wholly in primary care

Doctors could be offered a five-year GP training programme based entirely in primary care under a scheme being drawn up by a senior GP in conjunction with Health Education England (HEE).

Sir Sam Everington: GP training overhaul (Photo: Pete Hill)
Sir Sam Everington: GP training overhaul (Photo: Pete Hill)

Plans for the revolutionary training scheme are being drawn up by former BMA chair and London GP Sir Sam Everington, who is discussing the concept with HEE.

Speaking to GPonline, Sir Sam said: ‘Just imagine if we had trainees for five years [in general practice]… Not only would we give amazing training, I think, but we’d also have a lot more opportunities to train them in leadership, partnership, and all the extra things that sometimes training doesn’t give you much time for.’

He also suggested that a five-year practice-based training scheme would allow trainees to have more control over where they work, and promote continuity.

GP trainees

‘My sense from talking to a lot of trainee doctors was just immense frustration with the system at present that can put them anywhere in the country,' he said. 'It puts the training ahead of people’s private lives, family life, children, where they have their roots - doctors describe a scenario of often moving every few months.

‘We also get feedback along the lines that they don’t get any continuity of mentorship from their teachers in the hospital. So what we want to do is offer to doctors who want it the opportunity to live and work in one area - to choose which practice they want to go and work in and for the practice to choose them. You’d get a much stronger buy in for both sides.’

Sir Sam told a King’s Fund conference in London last week that it was ‘absolutely crucial’ for GP training to undergo a ‘paradigm shift’ to stand the test of time. He said it was 'shocking that only 11% of medical training currently takes place in a primary care setting, and told the conference: ‘I have a project going with HEE where we’re going to offer doctors newly qualified the opportunity to spend five years in general practice.’

He argued that current medical school training ‘is not fit for purpose now… let alone fit for the future’. He added: ‘I still see medical schools training the way I was trained 30 years ago.'

GP environment

Currently, GP trainees spend just 18 months of their three-year postgraduate training in a general practice setting. ‘If I suggested to an orthopaedic surgeon they spent three and a half years in general practice and one and a half years in hospitals you can imagine the uproar that would cause,’ Sir Sam told GPonline, adding that GPs must ‘have the confidence to acknowledge that we provide superb training in general practice’.

‘You know, if a trainee sits in on a morning surgery they might see something like 20 patients and in educational terms that is incredible.’

An HEE spokesperson said: ‘Health Education England is always looking for innovative ideas to improve local recruitment to general practice. As we outlined in our draft workforce strategy, it is our intention to to investigate options around GP training in the future.’

Sir Sam, who also chairs NHS Tower Hamlets CCG, said it would be ‘absolutely crucial’ to train GPs alongside pharmacists, physician associates, nurses and other healthcare professionals in future.

Team working

'The most successful outcomes will come when you work within a team, and the logic therefore is you train as a team. In other words the idea that you just train doctors with other doctors or medical students with other medical students needs to change,' he said.

'Increasingly in Tower Hamlets we have protected learning time for half a day a month to kind of close and then learn together. And some of that would be just with your own peer group but increasingly it’s mixed.

'For us it has absolutely been beneficial. There’s two big gains - the first being you learn a lot from other people and what they know and so much of learning is done like that. The old style of learning - sitting in a lecture theatre and writing everything down - just isn’t sufficient.

'Secondly, there’s very clear evidence that actually it’s not just about whether you’re a good doctor or not - if you’re part of a good team, that will make you a better doctor and less likely to make mistakes.'

Although there is no timeline yet for the plans, Sir Sam says he is keen to get the ball rolling ‘as soon as possible’ on the project, which is intended as an alternative rather than a replacement for the current training model.

Earlier this month it was announced that a record number of GP trainees were recruited in 2018.

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