Young GPs need more support

Recent reports have turned the spotlight on GP training, suggesting slipping standards and gaps in newly qualified GPs' competencies.

Dr Taylor: new GPs used to be nurtured by partners (Photograph: Pete Hill)

A GMC survey published last week found that on average GP trainers felt 10 per cent of their trainees were not displaying the expected competencies for their level of training (GP, 15 October).

One in 10 trainers said some trainees were being signed off without reaching required standards. Half of GP trainers agreed today's trainees were less confident and less able to work independently than when they were trainees themselves.

The report followed Sir Ian Kennedy's review into children's services earlier this year. Sir Ian said the current level of GP paediatric training 'is poor and getting worse', prompting headlines claiming GPs did not know how to hold babies.

No cause for concern
GP groups and the GMC have been quick to defend the standard of training overall.

GMC chairman Niall Dickson says that while the council is concerned about instances of trainee doctors being signed off without reaching the required competencies, generally there should not be cause for concern.

'Overall I think the quality of GP training is better than in other sectors and specialities and is more advanced,' he says. But he added that the GMC will now talk with deaneries to 'get behind some of the perceptions in the GMC survey'.

RCGP chairman Professor Steve Field says that while standards remain high, young GPs need more support and training opportunities. 'The feedback is that while trainees are technically competent, they need more confidence and exposure to patients,' he says.

At the RCGP conference this month, Professor Field warned that because young GPs are not gaining the experience previous generations enjoyed, standards of care may suffer.

With GPs set to take over responsibility for commissioning, with pay linked to the outcomes they achieve, this could become an expensive problem.

Professor Field says he is 'worried' that only 30 to 40 per cent of GP trainees are able do a placement in paediatrics.

Guaranteed placements
He is calling for all GP trainees to be guaranteed paediatric placements - something currently only happening in the Mersey region.

Video: RCGP chairman challenges health secretary on GP paediatrics training

'We believe it's important that GPs see acutely ill children in hospital and community settings so they can understand how disease happens in children,' he says.

'Without having that exposure, it is very difficult for trainees who then go into practice.'

Professor Field added that out-of-hours training for GPs is 'not as good as years ago', and that because of time constraints, GP trainees probably do not get 'as much exposure to long-term conditions'.

The RCGP has long called for GP training to be extended from three to five years.

But in the last year it has also broadened its focus to create its First5 project, which aims to support new GPs from the point of completing training to their first point of revalidation.

Need for support
Dr Clare Taylor, clinical lead for the project, says newly qualified GPs face 'jumping off the cliff' when they finish training and need support in their first years of independent practice.

Watch Dr Taylor talk about the First5 scheme here

'GP trainees are used to having the support of trainers in the next room as well as support from peers,' she says. 'But when they finish they are on their own as independent practitioners in their own consulting room.'

Dr Taylor says a lack of confidence among new GPs is not a modern phenomenon, as there has always been a need for post-training support. But she says the changing nature of general practice has had some impact.

'The landscape of general practice has changed recently,' she says. 'New GPs used to come out of training and walk into junior partnerships where they were nurtured by partners.

'Now the nature of general practice means new GPs go into salaried posts, where their need for support through First5 may be greater.'

Dr Taylor says while increasing the length of GP training would address some of the issues, it would not negate the need for the First5 project. She said focus should be maintained on supporting these groups.

She adds: 'There are a huge number of enthusiastic young GPs who want to make a difference. We need to give them the ability and confidence to do that.'

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