The implications of the GP contract for 2020/21 are potentially huge for current and future GP trainees. There are four key areas of the contract that will have a direct impact on trainees and newly-qualified GPs.
Trainees will spend more time in general practice
I have written previously about the toll working in hospital for 18 months can have on ST1s and ST2s, so to hear that from 2022 the proportion of time spent in general practice during training will rise from 18 months to 24 months is music to my ears.
This is something which I personally think will be a brilliant improvement to the training model. Twelve months will still be spent in hospital rotations, but now over half of training will be based in general practice – a specialty that is complex, and which therefore needs time to hone the skills and knowledge required. Although we’re only talking about an extra six months in general practice for trainees, I believe it’s six months in the right direction.
More £20k ‘golden hellos’ in under-doctored areas
We’ve all heard of the targeted enhanced recruitment scheme (TERS), and as trainees if we didn’t think about applying to an area offering a ‘golden hello’, then we probably know someone who did.
Last year’s scheme had a fill rate of nearly 100% and was oversubscribed in certain parts of the country. It’s not surprising then that the number of TERS places will rise, however the size of the increase is quite extraordinary - rising from the 2019 figure of 276 places, to at least 500 by 2021, and at least 800 by 2022.
The statistics suggest that it is clearly a popular arrangement so far (although I’d be interested to ask my peers on the scheme whether they all plan on staying in their respective locations in future) so this seems like a sensible move from HEE. But are those numbers a bit excessive? Will the definition of ‘under-doctored’ area need to be adjusted to make room for this change? Will ‘less desirable’ areas actually be rather desirable areas for young trainees to live in? We will have to wait and see.
A new fellowship programme
According to the contract, from 2021: 'all new entrants to GP trainee training will automatically be enrolled in the [two-year primary care fellowship] programme as part of signing up to the training programme and then be expected to enter the fellowship programme on qualification’.
The fellowship will include funded mentorship, funded CPD opportunities (one session per week), and rotational placements within or across PCNs to support new GPs’ integration into the local working area.
The intention is for ‘as close to’ 100% of newly qualified trainees to enter the fellowship programme, which implies it will be compulsory, or obligatory.
For me, I think extra support will always be welcomed by those starting their careers, however introducing another mandatory component in a world of workplace-based assessments and exams, followed by administration and appraisals - do we need more things we have to do?
Without more details on the requirements of this fellowship and how it will work, it’s difficult to be clear on how welcome this initiative will be.
£20k ‘golden hellos’ for new GP partners
The ‘new to partnership payment’ that also forms part of the new contract deal does what it says on the tin – provides a financial incentive to GPs who have never before been partners to step up to a partnership.
Along with the £20k payment (which part-time GPs will receive on a pro-rata basis), they will also receive a £3k business training allowance. Similar to TERS, there is the provision that the GP must complete a minimum number of years as a partner for the payment to be permanent (the update suggests five years as an example).
It’s also worth noting that the scheme’s initial phase is likely to run for two or three years – so for those of us who are still ST1s and not necessarily working full time, it is not a guarantee that this offer will still be on the table by the time training is completed.
Will this encourage younger GPs to become partners? Maybe. Certainly, from my own experience, more trainees are unafraid these days to say that they intend to be salaried GPs and that partnership isn’t for them – a view that may have been frowned upon in years gone by. However, equally I know of several colleagues and friends who have stepped into partnership fresh from ST3.
A ‘golden hello’ is definitely an attractive idea, and one which makes my own ears prick up – but I wonder, is it necessary? Those trainees who want to become partners are likely to do so anyway, and will a one-off payment be enough to convince those who find aspects of the partnership model not for them? I’m not so sure.
As a GP trainee, the changes to the GP contract are exciting, surprising and questionable in equal measure. It’s an interesting time to be a GP trainee (as always!) and these are big moves that will have a definite and marked effect on our training experience and possibly the first few years of our careers as fully-fledged GPs. Let’s hope they are all changes for the better.
- Dr Brown is an ST1 GP trainee in Gloucestershire