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How to become a GP training practice

Dr Rodger Charlton provides an overview of what the requirements are for training GP registrars.

Dr Charlton says the main requirement for becoming a GP educational supervisor is enthusiasm
Dr Charlton says the main requirement for becoming a GP educational supervisor is enthusiasm

General practice has changed and so has GP training - and we can expect both to keep changing. But training is a great way to channel your enthusiasm as a GP and develop a new interest.

In 2007 the new MRCGP (nMRCGP) was introduced, replacing summative assessment, and we have moved further into the electronic era with an ePortfolio and many different formats of e-learning.

However, GPs still require training, but given the increasing complexity of their job, being a trainer is more demanding and requires keeping up to date with the changing technology.

GP trainers are now called 'educational supervisors'. They supervise a trainee, now called a 'GP specialty registrar', over their three years of vocational training and not just when they enter the practice for the final specialty trainee year.

Requirements
The first and foremost requisite is enthusiasm for general practice and teaching it. That might sound obvious, but a major difficulty can be getting your practice colleagues to be of a like mind. GP training has to be a practice team activity and ethos, not a solo activity.

To become an educational supervisor, most postgraduate education deaneries state that MRCGP is essential together with a minimum of three years' experience as a GP.

Assuming you meet these criteria, contact the area director for your local vocational training scheme (VTS). They will organise a visit to your practice and, prior to this, will ask you to complete some paperwork, hopefully in an electronic format.

What if you do not have MRCGP? Currently, you can get it by Interim Membership by Assessment of Performance. It is hard work, but it will stand you in good stead for revalidation. Visit www.rcgp.org.uk for more details.

Facilities for registrars
You will need a spare consulting room or one needs to be available for when the registrar is scheduled to be at the practice. In the room the registrar will need medical equipment to borrow and also an equipped doctor's bag to take on home visits.

The room also needs equipment to film consultations and record them on DVD and to play them back for teaching, as part of one of the items of the nMRCGP workplace-based assessments (WPBA) called the consultation observation tool.

It is difficult to know how essential a practice library is now, because most information and journals can be accessed via the internet. However, it would seem reasonable to have a few seminal textbooks (for example, The Doctor, His Patient, and the Illness by Michael Balint or The Inner Consultation by Roger Neighbour to name a couple) from a massive potential list.

Similarly, copies of the British Journal of General Practice and RCGP News should be available.

Protected time
Training takes time and the trainer needs protected time for reviewing cases the registrar has seen, undertaking the many tasks of WPBA and conducting tutorials. Although a registrar is supernumerary, they do see patients and so the service load of the practice will be reduced. In turn, the freed-up time should be used for teaching, whether that is by the designated trainer, one of the practice's other doctors or the practice nurse.

While a registrar is seeing patients, the supervising GP should have some gaps in their appointments to ensure they are available to advise.

Training the trainer
To become an educational supervisor, it is necessary to attend an approved GP trainers' course and then to attend local trainers' workshops, which in many regions are quarterly.

No higher qualification is required, although it may be helpful to work towards a local university certificate in medical education. Many deaneries are introducing cluster-based learning and this can involve trainers facilitating a tutorial for a 'cluster' of registrars and not just their own registar.

Practice organisation
Each postgraduate deanery will have its own criteria based on those of the Postgraduate Medical Education and Training Board, which was merged with the GMC on 1 April 2010. The GMC is responsible for approval of all general practice training posts.

Find your deanery's website at www.copmed.org.uk/contacts.

Key requirements for training practices from the West Midlands deanery's criteria include satisfactory surgery premises; a partnership agreement and a registrar contract; minutes of practice team meetings; a clinical audit programme; a patient satisfaction survey; a practice development plan; and an educational programme.

10 Quality standards
West Midlands deanery's quality standards for training posts:
  • An approved GP trainer.
  • Provision of protected teaching time.
  • An educational supervisor.
  • Adequate feedback, appraisal and assessment.
  • An induction programme.
  • Availability of clinical guidelines.
  • Adequate cover.
  • Exposure to an appropriate level of clinical activity.
  • Appropriate tasks relating to the registrar's educational objectives.
  • Study leave of 30 days a year.

 

Training practice criteria
West Midlands deanery requirements:
  • Satisfactory surgery premises.
  • Partnership agreement and registrar contract.
  • Minutes of practice team meetings.
  • Clinical audit programme.
  • Patient satisfaction survey.
  • Practice development plan and educational programme.
  • A GP trainer must be able to:
  • Demonstrate the quality of practice care.
  • Provide adequate cover for the registrar personally or by a named doctor at all times.
  • Demonstrate consulting skills with filmed consultations and be able to analyse a consultation and teach consultation skills.
  • Draw up an educational registrar contract that meets the Ten Quality Standards for training posts - see above.

 

  • Dr Rodger Charlton is a GP trainer and training programme director of East Birmingham & Solihull VTS and associate clinical professor in medical education at Warwick Medical School

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