Review of GP training practices - Survey of Current GP Trainers and trainees: Report
November 2006
Summary
- This report represents the results of a national review of UK GP training practices, with the aim of obtaining accurate information on the work involved in being a GP trainer, the impact on other GPs in the practice, as well as the level of service provided by a trainee.
- More than half of respondents were currently working in GP principal/provider posts and a quarter in GP registrar posts. Two in five respondents were currently working as trainers.
- A third of respondents reported working as trainee doctors in the GP practice. A fifth were foundation year 2 trainees and the remainder were working in the GP registrar grade, largely in the early stages of training.
- Results indicate that whilst all trainee doctors appear to spend an equal number of half-day sessions in the practice, GP registrars were more likely to undertake unsupervised face-to-face consultations with patients, whilst foundation year 2 trainees appear to spend more time interacting and consulting with the GP trainer and members of the practice team.
- Whilst both foundation year 2 trainees and GP registrars were undertaking unsupervised patient consultations, considerable time was also spent discussing the clinical management of patients with the trainer and obtaining second opinions from the practice team.
- The average time spent per week on educational and clinical administration by foundation year 2 trainees was around 19 hours, compared with the 25 hours spent on these activities by GP registrars.
- GP registrars in the first six months of training undertook fewer unsupervised face-to-face patient consultations and longer average consultations compared with those in the later stages of training. Furthermore, the average time spent per day on education and clinical administration activities by GPRs in the first six months of training was 27 hours and 39 minutes per week, but declines to 14 hours and 24 minutes for GPRs in the later stages of training.
- Two in five respondents identified themselves as currently working as GP trainers. The majority of trainers personally supervised 1 trainee and a further 10 percent personally supervised 2 trainees, largely GP registrars in the early stages of their training.
- The most common protected time arrangement provided by the practice to cover the GP’s role as a trainer was partner cover, followed by reduced number of surgeries. The vast majority of GP trainers reported that they undertook some of their trainer work in their own time and on average this amounted to 2.6 hours per week.
- GP trainers spent at least 17 and a half hours per week on education and clinical administration and this increases by at least two and a half hours per week if the trainer is supervising more than one trainee.
- One in five respondents were GPs within the practice, who were neither trainers or trainees, although three quarters of these respondents had some degree of interaction with trainees within the practice.
- The presence of a trainee appears to impact substantially on the whole practice, requiring both trainers and non-trainers to accommodate their training needs within their weekly activities.
- GP trainers were more likely to undertake patient consultations with a trainee present and these consultations were comparatively longer. Trainers also spent considerable time each week discussing the clinical management of patients with the trainee.
- Trainers spent more time on average per week on clinical administration and education compared with their non-trainer colleagues. A significant component of this weekly workload was tutorial preparation and delivery and meeting with trainees. Supervision of more than one trainee appears to almost double this aspect of the trainer’s workload, not reduce it.
- Although trainees they were undertaking unsupervised patient consultations, this required supervision and extensive discussion with trainers and involved other members of the practice team, hence impacting widely across the practice.
To assist the BMA’s General Practitioners Committee (GPC) in preparing evidence to the Doctors’ and Dentists’ Review Body on the service commitment of GP trainers and the impact of trainees on the practice, a review of UK GP training practices was undertaken. The aim of this research was to obtain accurate information on the work involved in being a GP trainer, the impact on other GPs in the practice, as well as the level of service provided by a trainee. Questionnaires were sent to a sample of GP training practices across the UK. Within each practice, we requested that the questionnaire be completed by the GP trainer(s), trainee(s) - including GP registrars and foundation year doctors - and GP colleagues (non-trainers or trainees).
The Department of Health (DoH) and the Committee of General Practice Education Directors (COGPED) recently undertook a similar review in July. The BMA’s GPC are concerned that they conducted this at a time when many trainees were nearing the end of their training and so its results may not reflect the true experiences of trainers and trainees throughout the year. In order to ensure a more balanced review, the current study was carried out during early September 2006.
Respondents were asked a series of questions about their own position within the practice and general working arrangements. Additionally, all respondents were asked to complete a daily diary exercise for a period of 5 consecutive working days reflecting a typical working week. The diary relates to service activities within general practice only, plus any educational activities that are integral to the training and continuing professional development of the respondents (appendix B). A total of 295 completed surveys were received. This report presents the key findings of this survey.
Results
Respondent characteristics
Table 1 shows that more than half of respondents (60%) were currently working in GP principal/provider posts and a quarter in GP registrar posts. Two-thirds (78%) of respondents reported working on a full-time basis. Two in five (44%) respondents were currently working as trainers. More than half of respondents were male (male-56% female-44%) and the average age of respondents was 41 years (range 24-65 yrs).
Around half of respondents reported working in a mainly urban GP practice (48%), a third (36%) in a mixed (urban and rural) practice and the remainder in a rural (17%) GP practice. Whilst respondents were drawn from across the United Kingdom, 80 per cent currently worked in England and 14 per cent in Scotland (table 2). A full list of responses according to Deanery is included in Appendix A.
The average number of half-day sessions (up to 4 hours) worked by respondents in general practice during a typical week was 7.7, but ranged from 1 to 13. The number of half-day sessions worked also varied somewhat according to the respondents’ role in the practice. The average number of half-day sessions reported by trainees was 7.5 (range 1-11), whilst trainers reported an average of 8.1 half-day sessions (range 3-13) during a typical week in general practice.
Frequency |
Percent |
|
F1 trainee |
- |
- |
F2 trainee |
18 |
6.2 |
GP registrar |
76 |
26.2 |
Salaried GP |
14 |
4.8 |
GP principal/provider |
175 |
60.3 |
Locum GP |
1 |
0.3 |
Other |
6 |
2.1 |
Total |
290 |
100.0 |
No reply |
5 |
- |
Table 2 - Current location of respondents
Frequency |
Percent |
|
England |
219 |
79.1 |
Scotland |
38 |
13.7 |
Wales |
12 |
4.3 |
Northern Ireland |
8 |
2.9 |
Total |
277 |
100.0 |
No reply |
18 |
Trainee doctors
A third (32%) of respondents reported working as trainee doctors in the GP practice. Table 3 shows that a fifth were foundation year 2 (F2) trainees and the remainder were working in the GP registrar grade (GPR), largely in the early stages of training (less than 12 months). Of those trainees who reported being between 13-18 months of a GP registrar post, this was largely due to doing an innovative GP training post or training part-time. One in ten trainees (10%) reported being based also in a hospital (5 F2 trainees and 4 GPRs). In most cases, this was part of an innovative training post and the average time spent in the hospital was 18 hours per week.
| Frequency | Percent | |
| F1 trainee | - | - |
| F2 trainee | 18 | 20.5 |
| 0-6 months GP registrar | 44 | 0.0 |
| 7-12 months GP registrar | 11 | 12.5 |
| 13-18 months GP registrar | 8 | 9.1 |
| Other | 7 | 8.0 |
| Total | 88 | 100.0 |
| No reply/td> | 6 | - |
All trainee doctors were asked to complete a daily diary exercise relating to their service activities within the general practice. Table 4 provides the details of this exercise with regard to a range of activities and indicates that whilst both groups of trainee doctors appear to spend an equal number of half-day sessions in the practice, GP registrars were more likely to undertake unsupervised face-to-face consultations with patients, whilst F2 trainees appear to spend more time interacting and consulting with the GP trainer and members of the practice team. This is likely to be a reflection of the more advanced stage of training of GPRs. In addition to those listed in the diary, both groups reported other service commitment activities such as on-call work, general practice paperwork, repeat prescriptions and checking test results. Whilst both F2 trainees and GP registrars were undertaking unsupervised patient consultations, considerable time was also spent discussing the clinical management of patients with the trainer and obtaining second opinions from the practice team.
|
|
Average per day |
|
Average per week |
Activity |
F2 |
GP |
F2 |
GP |
Number of half-day sessions (up to 4 hours) worked per day |
1.4 |
1.5 |
7 |
7.5 |
Number of face-to-face consultations you had with patients-unsupervised |
8.2 |
10.8 |
41 |
54 |
Number of face-to-face consultations you had with patients-with another GP trainer |
0.6 |
0.2 |
3 |
1 |
Length of average consultation |
19.4 |
16.6 |
- |
- |
Number of times you discussed clinical management of a patient with a trainer |
3.4 |
1.8 |
17 |
9 |
Number of telephone calls (initiated or received) |
0.8 |
2.3 |
4 |
11.5 |
Number of home visits you made alone |
0.3 |
0.9 |
1.5 |
4.5 |
Number of home visits you made with another GP/trainer |
0.2 |
0.1 |
1.0 |
0.5 |
Number of immediate second opinions obtained from practice team |
1.0 |
0.6 |
5.0 |
3.0 |
Number of patient referrals you made within practice team - excluding immediate second opinions |
0.3 |
1.0 |
1.5 |
5.0 |
Number of patient referrals you made outside practice team |
0.7 |
0.5 |
3.5 |
2.5 |
Total number of doctors in category |
18 |
76 |
- |
- |
Table 5 shows the average time spent by F2 trainees and GPRs on educational and clinical administration per day in an average week. The average time spent per day on these activities by F2
trainees was around 4 hours (19 hours per week), compared with the 5 hours (24 and a half hours per week) spent on these activities by GPRs. Both groups of trainees reported spending the greatest
amount of time per week on personal learning, tutorials, reading, looking up information on the internet and discussion of clinical management with their trainer following patient consultations/surgery. GP
registrars also reported spending considerable time per week on VTS workshops and preparation for summative assessment. In addition to those listed in the diary, both groups reported other clinical
administration duties such as reviewing notes and results, signing prescriptions and reading letters. Additional education and practice related professional activities included practice teaching sessions,
completion of eportfolio, preparation for DRCOG, audit, out-of-hours training and BMJ learning modules.
|
|
Average per day |
|
Average per week |
Activity |
F2 |
GP |
F2 |
GP |
Discussion of clinical management |
22.8 |
23.4 |
1 hr 54 |
1 hr 57 |
|
|
|
|
Clinical administration |
writing letters |
16.8 |
10.2 |
1 hr 24 |
51 |
practice meetings |
5.0 |
13.7 |
25 |
1 hr 9 |
practice and patient related emails |
7.2 |
6.4 |
36 |
32 |
telephone calls |
6.3 |
14.0 |
32 |
1 hr 10 |
|
|
|
|
Education |
time learning, ie personal learning |
62.7 |
48.5 |
5 hrs 13 |
4 hrs 2 |
VTS workshops |
- |
57.3 |
- |
4 hrs 47 |
reading |
28.6 |
31.5 |
2 hrs 23 |
2 hrs 38 |
reflection |
19.0 |
14.8 |
1 hr 35 |
1 hr 14 |
shadowing |
7.0 |
1.2 |
35 |
6 |
tutorials |
24.3 |
28.9 |
2 hrs 2 |
2 hrs 25 |
preparation for summative assessment |
1.0 |
22.7 |
5 |
1 hr 54 |
looking up information on the internet |
25.7 |
19.6 |
2 hrs 9 |
1 hr 38 |
Average time spent per week |
3 hrs |
4 hrs |
18 hrs |
24 hrs |
Half of respondent trainees were GP registrars (GPRs) in the early stages of their training (table 3). Table 6 shows that GPRs in the first six months of training undertook fewer unsupervised face-to-face patient consultations and longer average consultations compared with GPRs in the later stages of training. Furthermore, the average number of times GPRs in the early stages of training discussed clinical management of a patient with a trainer was considerably greater than those GPRs in the later stages of training.
|
|
|
Stage of training |
|
Activity |
0 - 6 |
7 - 12 |
13 - 18 |
All |
Number of half-day sessions |
7.5 |
7.5 |
7.5 |
7.5 |
Number of face-to-face consultations |
50 |
66.5 |
69.5 |
54 |
Number of face-to-face consultations you |
1.5 |
0.7 |
0.5 |
1 |
Length of average consultation |
17.7 |
15.2 |
13.6 |
16.6 |
Number of times you discussed clinical management of a patient with a trainer |
10.8 |
4.0 |
2.5 |
9 |
Number of telephone calls |
10.3 |
8.0 |
16.0 |
11.5 |
Number of home visits you made alone |
4.5 |
6.0 |
3.0 |
4.5 |
Number of home visits you made |
0.5 |
- |
- |
0.5 |
Number of immediate second opinions obtained from practice team |
3.0 |
3.0 |
0.5 |
3.0 |
Number of patient referrals you made |
3 |
6.5 |
4.5 |
5.0 |
Number of patient referrals you |
4.5 |
2.0 |
1.8 |
2.5 |
Total number of doctors in category |
44 |
11 |
8 |
76 |
Table 7 shows the average time spent by GPRs at various stages of training on educational and clinical administration in a week. Time spent on clinical management with a trainer following patient consultation/surgery was greatest among GPRs in the first six months of training. The average time spent per day on education and clinical administration activities by GPRs in the first six months of training was 27 hours and 39 minutes per week), but declined to 14 hours and 24 minutes for GPRs in the later (13-19months) stages of training.
|
|
|
Stage of training |
|
Activity |
0 - 6 |
7 - 12 |
13 - 18 |
|
Discussion of clinical management |
2 hrs 15 |
1 hr 24 |
1 hr 15 |
1hr 57 |
|
|
|
|
Clinical administration |
writing letters |
52 |
36.5 |
12.5 |
51 |
practice meetings |
1 hr 18 |
50 |
- |
1 hr 9 |
practice and patient related emails |
26 |
27 |
47 |
32 |
telephone calls |
1 hr 9 |
43.5 |
1 hr 20 |
1 hr 10 |
|
|
|
|
Education |
time learning, ie personal learning |
4 hrs 46 |
4 hrs 44 |
3 hrs |
4 hrs 2 |
VTS workshops |
6 hrs 24 |
3 hrs |
- |
4 hrs 47 |
reading |
3 hrs 12 |
1 hr 37 |
1 hr 30 |
2 hrs 38 |
reflection |
1 hr 19 |
1 hr 45 |
- |
1 hr 14 |
shadowing |
9 |
- |
- |
6 |
tutorials |
2 hrs 3 |
2 hrs 45 |
3 hrs |
2 hrs 25 |
preparation for summative assessment |
2 hrs |
3 hrs 15 |
1 hr 40 |
1 hr 54 |
looking up information on the internet |
1 hr 46 |
1 hr 18 |
1 hr 39 |
1 hr 38 |
Average time spent per week |
27 hrs |
21 hrs |
14 hrs |
24 hrs |
GP Trainers
Two in five (126) respondents identified themselves as currently working as GP trainers. Most of these respondents were GP principal/providers (96%) and three quarters (75%) were working on a full-time basis. A third (33%) of respondent trainers were female (male-68%). Almost half of respondent trainers worked in a practice that had a single trainee and a further third had two trainees (figure 1). The majority of trainers (84%) personally supervised 1 trainee and a further 10 percent personally supervised 2 trainees. Table 8 shows that the majority of GP trainers were personally supervising a GP registrar, largely in the early stages (less than 12 months) of their training.
| Trainee 1 | Trainee 2 | |||
| F2 | GPR | F2 | GPR | |
| 0-6 months | 100.0 | 55.4 | 100.0 | 15.4 |
| 7-12 months | - | 21.8 | - | 23.1 |
| 13-18 months | - | 9.9 | - | 15.4 |
| 18+ months | - | 4.0 | - | - |
| Average no. sessions per week | 7.7 | 7.7 | 7.6 | 6.4 |
| Total number | 14 | 96 | 13 | 15 |
The most common protected time arrangement provided by the practice to cover the GP’s role as a trainer was partner cover, followed by reduced number of surgeries (table 9). Other arrangements included reduced number of patients per session, blocking out of a weekly session, and reduced length of surgeries. The vast majority (92%) of GP trainers reported that they undertook some of their trainer work in their own time and on average this amounted to 2.6 hours per week (range 1-39 hours).
| Frequency | Percent of total respondents (n=126) |
|
| Partner cover | 91 | 72.2 |
| Reduced number of surgeries | 74 | 58.7 |
| Cancellation of surgeries | 16 | 12.7 |
| Cover from other member of team | 10 | 7.9 |
| Reduced home visits | 12 | 9.5 |
| Locum cover | 6 | 4.8 |
| No home visits | 1 | 0.8 |
| Other | 27 | 21.4 |
* multiple response question
All GP trainers were asked to complete a daily diary exercise relating to their service activities within the general practice. Table 10 provides the details of this exercise with regard to a range of activities within general practice. Table 11 provides the details of the average time spent per day and over a week on education and clinical administration and shows that on average, GP trainers spent at least 17 and a half hours per week on education and clinical administration and this increases by at least two and a half hours per week if the trainer is supervising more than one trainee.
| Activity | Average per day |
Average per week |
| Number of half-day sessions (up to 4 hours) worked per day | 1.7 | 8.5 |
| Number of face-to-face consultations you had with patients without a trainee present |
19.6 | 98 |
| Length of average consultation without a trainee present | 10.3 | - |
| Number of face-to-face consultations you had with patients-with a trainee |
1.9 | 9.5 |
| Length of average consultation with a trainee present | 7.9 | - |
| Number of consultations interrupted by a trainee | 1.6 | 8 |
| Number of times you discussed clinical management of a patient with a trainee 1 |
1.2 | 6 |
| Number of cancelled consultations as a result of a trainee | 3.4 | 17 |
| Number of times you discussed clinical management of a patient with a trainee 2 (if applicable) |
1.8 | 9 |
| Number of telephone calls (initiated or received) | 6.3 | 31.5 |
| Number of home visits you made alone | 1.3 | 6.5 |
| Number of home visits you made with a trainee 1 | 0.2 | 1.0 |
| Number of home visits you made with a trainee 2 (if applicable) |
0.1 | 0.5 |
| Number of immediate second opinions obtained from practice team |
0.8 | 4.0 |
| Number of patient referrals you made within practice team - excluding immediate second opinions |
0.9 | 4.5 |
| Number of patient referrals you made outside practice team | 2.1 | 10.5 |
Table 11 - Average time spent on education and clinical administration: GP trainers (minutes)
| Activity | Average per day |
Average per week |
| Discussion of clinical management with a trainer following patient consultation/surgery |
19.1 | 1 hr 36 |
| Clinical administration |
||
| writing letters | 21.5 | 1 hr 48 |
| practice meetings |
27.2 | 2 hrs 16 |
| practice and patient related emails | 18.9 | 1 hr 35 |
| telephone calls | 21.7 | 1 hr 49 |
| Education |
||
| time learning, ie personal learning | 19.6 | 1 hr 38 |
| reading |
13.1 | 1 hr 5 |
| reflection | 8.1 | 41 |
| looking up information on the internet | 7.6 | 38 |
| tutorial preparation-trainee 1 | 8.4 | 42 |
| tutorial preparation-trainee 2 (if applicable) |
2.6 | 13 |
| tutorial delivery-trainee 1 |
17.8 | 1 hr 29 |
| tutorial delivery-trainee 2 (if applicable) |
13.0 | 1 hr 5 |
| meeting with trainees-trainee 1 | 15.9 | 1 hr 20 |
| meeting with trainees-trainee 2 (if applicable) | 12.3 | 1 hr 2 |
| Average time spent per week-trainee 1 | 3 hrs 32 mins | 17 hrs 40 mins |
| Additional average time spent per week-trainee 2 (if applicable) |
30 mins | 2 hrs 30 mins |
GP (non-trainers or trainees)
A fifth (64) of respondents completed the diary exercise for GPs within the practice, who were neither trainers or trainees. The majority of these respondents were GP principal/providers (80%) or salaried GPs (17%). More than half (58%) of these respondents had some degree of interaction with trainees within the practice and a further 29% reported considerable interaction with the practice’s trainees. Only 14% had minimal interaction with trainees within the practice. All non-trainer or trainee GPs were asked to complete a daily diary exercise relating to their service activities within the general practice. Table 12 provides the details of this exercise with regard to a range of activities within general practice. Table 13 provides the details of the average time spent per day and over a week on education and clinical administration and shows that on average, GP (non-trainers or trainees) spent around 11 hours per week on education and clinical administration.
| Activity | Average per day |
Average per week |
| Number of half-day sessions (up to 4 hours) worked per day |
1.9 | 9.5 |
| Number of face-to-face consultations you had with patients without a trainee present | 24.0 | 120 |
| Length of average consultation without a trainee present | 10.3 | - |
| Number of face-to-face consultations you had with patients - with a trainee | 0.5 | 2.5 |
| Length of average consultation with a trainee present | 2.4 | - |
| Number of consultations interrupted by a trainee | 0.8 | 4 |
| Number of cancelled consultations as a result of a trainee |
0.04 | 0.2 |
| Number of telephone calls (initiated or received) | 6.8 | 34 |
| Number of home visits you made alone |
1.5 | 7.5 |
| Number of home visits you made with a trainee | 0.1 | 0.5 |
| Number of imediate second opinions obtained from practice team |
0.6 | 3.0 |
| Number of patient referrals you made within practice team - excluding immediate second opinions |
0.4 | 2.0 |
| Number of patient referrals you made outside practice team |
2.0 | 10.0 |
Table 13 - Average time spent on education and clinical administration: GP (non-trainer or trainee) (minutes)
Activity |
Average per day |
Average per week |
|
|
Clinical administration |
writing letters |
21.4 |
1 hr 47 |
practice meetings |
21.1 |
1 hr 46 |
practice and patient related emails |
16.6 |
1 hr 23 |
telephone calls |
22.3 |
1 hr 52 |
|
|
Education |
time learning, ie personal learning |
25.4 |
2 hrs 7 |
reading |
11.1 |
56 |
reflection |
9.6 |
48 |
looking up information on the internet |
5.9 |
30 |
Average time spent per week |
2 hours 13 mins |
11 hrs 9 mins |
Impact of trainees on the practice
The results of the individual diary exercises for GP trainers and their non-trainer colleagues can be compared to gain a picture of the impact of trainees on the practice as a whole. Table 14 compares the average weekly activities of GP trainers and non-trainers and shows that on average, non-trainers saw comparatively more patients per week. GP trainers were more likely to undertake patient consultations with a trainee present and these consultations were comparatively longer. Trainers also spent considerable time each week discussing the clinical management of patients with the trainee. Furthermore, GP trainers were more likely to have consultations interrupted by or cancelled as a result of a trainee. Despite these differences, the presence of a trainee appears to impact substantially on the whole practice, requiring both trainers and non-trainers to accommodate their training needs within their weekly activities.
Activity |
Trainers |
Non-trainers |
Number of half-day sessions (up to 4 hours) worked per day |
8.5 |
9.5 |
Number of face-to-face consultations you had with patients |
98 |
120 |
Length of average consultation without a trainee present |
10.3 |
10.3 |
Number of face-to-face consultations you had with patients - |
9.5 |
2.5 |
Length of average consultation with a trainee present |
7.9 |
2.4 |
Number of consultations interrupted by a trainee |
8 |
4 |
Number of cancelled consultations as a result of a trainee |
6 |
0.2 |
Number of times you discussed clinical management of a patient |
17 |
n.a. |
Number of times you discussed clinical management of a patient |
9 |
n.a. |
Number of telephone calls (initiated or received) |
31.5 |
34 |
Number of home visits you made alone |
6.5 |
7.5 |
Number of home visits you made with a trainee 1 |
1.0 |
0.5 |
Number of home visits you made with a trainee 2 |
0.5 |
n.a. |
Number of immediate second opinions obtained from practice team |
4.0 |
3.0 |
Number of patient referrals you made within practice team - |
4.5 |
2.0 |
Number of patient referrals you made outside practice team |
10.5 |
10.0 |
Trainers spent more time on average per week on clinical administration and education compared with their non-trainer colleagues (table 15). A significant component of this weekly workload was tutorial preparation and delivery and meeting with trainees. Supervision of more than one trainee appears to almost double this aspect of the trainer’s workload, not reduce it. Non-trainers appear to spend more time per week on personal learning and reflection.
Activity |
Trainers |
Non-trainers |
Discussion of clinical management with a trainer following patient consultation/surgery |
1 hr 36 mins |
n.a. |
Clinical administration |
|
|
writing letters |
1 hr 48 mins |
1 hr 47 mins |
practice meetings |
2 hrs 16 mins |
1 hr 46 mins |
practice and patient related emails |
1 hr 35 mins |
1 hr 23 mins |
telephone calls |
1 hr 49 mins |
1 hr 52 mins |
Education |
|
|
time learning, ie personal learning |
1 hr 38 mins |
2 hrs 7 mins |
reading |
1 hr 5 mins |
56 mins |
reflection |
41 mins |
48 mins |
looking up information on the internet |
38 mins |
30 mins |
tutorial preparation-trainee 1 |
42 mins |
n.a. |
tutorial preparation-trainee 2 (if applicable) |
13 mins |
n.a. |
tutorial delivery-trainee 1 |
1 hr 29 mins |
n.a. |
tutorial delivery-trainee 2 (if applicable) |
1 hr 5 mins |
n.a. |
meeting with trainees-trainee 1 |
1 hr 20 mins |
n.a. |
meeting with trainees-trainee 2 (if applicable) |
1 hr 2 mins |
n.a. |
Average time spent per week-trainee 1 |
17 hrs 40 mins |
11 hrs 9 mins |
Additional average time spent per week-trainee 2 |
2 hrs 30 mins |
|
In terms of the additional clinical manpower provided by trainees, although trainees were undertaking unsupervised patient consultations, this required supervision and extensive discussion with trainers and involved other members of the practice team, hence impacting widely across the practice. The survey results reported here show that GP registrars during the early stages of their training undertake only a proportion of the direct service to patients, compared to the qualified GPs within the training practice. Nevertheless, the survey was not able to look fully at the workload implications for a training practice in supervising the training and work of a remedial GP registrar. In addition, the survey did not consider the repeat visit rate of patients nor the type of patients seen by a GP registrar or F2 trainee. These are areas which are likely to produce higher workloads for training practices. Furthermore, the survey did not gather information on whether those patients seen by GP registrars and F2 doctors unsupervised were follow-up consultations.
Finally, the impact of trainees on a GP practice is felt long before they actually begin their formal training. Although this aspect was not addressed specifically in this study, one respondent provided a case study of the impact on her workload of becoming an accredited training practice- none of which is remunerated:
‘We were only granted training status last month! - so as yet have no training doctors in our practice. We have just been assigned a GPST2 and are very pleased by this. But I, and my partners, are very aware than in the first 6 months following training accreditation, I will have:
- attended a road show (one session)
- attended local trainers group (one session)
- arranged four days for GPST in the practice (one day induction) and 3 full days
- completed an initial appraisal with the incoming trainee
- regularly retrieved her e–portfolio.
Table A1 - Deanery location of respondents
Deanery |
Frequency |
England |
219 |
Severn & Wessex |
43 |
Kent, Surrey & Sussex |
28 |
West Midlands |
25 |
Leicester, Northampton & Rutland |
23 |
Yorkshire |
23 |
Northern |
19 |
Trent |
13 |
Mersey |
11 |
Eastern |
10 |
South West Peninsula |
9 |
London |
6 |
North West |
5 |
South Yorkshire & South Humber |
4 |
Scotland |
38 |
South East Scotland |
27 |
East Scotland |
7 |
North Scotland |
2 |
West Scotland |
2 |
Wales |
12 |
Northern Ireland |
8 |
Total |
277 |
No reply |
19 |
Appendix B - Questionnaire - Review of GP training practices - A survey of GPs and trainees - September 2006
Part 1 : About you and your practice
1. What is the name of your GP practice?
2. What is the name of your Deanery?
3. Is your GP practice mainly:
Urban
Mixed (urban and rural)
Rural
4. Which of the following best describes your current position?
F1 trainee
F2 trainee
GP registrar
Salaried GP
GP principal/provider
Locum GP
Other (please specify)
5. Are you currently working full-time or part-time?
Full-time
Part-time
6. Are you currently working as a trainer?
Yes
No
7. What is your gender?
Male
Female
8. Year born
9. How many half-day sessions (up to 4 hours) do you work in general practice in a typical week?
The next section of questions (part 2) are for trainee doctors only. If you are a trainer, please progress to part 3 of the questionnaire. If you are a salaried GP or other GP colleague, please progress to part 4 of the questionnaire.
Part 2 : Trainee doctors
10. At what stage of training in general practice and month of training are you in now? (please tick box and write in month)
Foundation Year 1 (please go to Q12)
Foundation Year 2 (please go to Q12)
0-6 months GPR (please go to Q12)
7-12 months GPR (please go to Q12)
13-18 months GPR (please go to Q11)
Other (please specify below) (please go to Q12)
11. If you are between 13-18 months of a GPR training post, is this because you are/have: (please tick as many as apply)
Training part-time
Doing an innovative GP training post
Failed summative assessment
Needed more time to get your Certificate of Completion of Training (CCT) as a GP as indicated by a formative assessment
Doing voluntary extension of your GP training pre-Certificate of Completion of Training (CCT) to gain specific skills
Doing an additional GP post because you have not worked for a sufficient time in an approved hospital training post
12. What previous training posts in general practice have you completed and for how long did you do each post? (please tick box and write in number of months you have completed )
Foundation Year 1
Foundation Year 2
0-6 months GPR
7-12 months GPR
13-18 months GPR
Other (please specify)
13. Are you also based in a hospital? e.g. in an innovative training post
Yes
No
If yes, please describe in what capacity and how much time is spent on each.
Innovative training post
Out-of-hours
Other (please specify)
The next section of questions (part 3) are for GP trainers only. If you are not a trainer, please progress to part 4 of the questionnaire.
Part 3 : Trainers
14. How many trainees does your currently practice have?
15. How many trainees do you personally supervise?
16. If you did not have a trainee(s), how many patients would usually be booked per hour for you in a typical week?
17. If you did not have a trainee(s), how many hours would patients be booked in for you in a typical week?
18. What protected time arrangements does your practice provide for you in your role as a GP trainer? (Please tick all that apply)
Partner cover
Locum cover
Cover from other member of team (please specify)
Reduced number of surgeries
Cancellation of surgeries
Undertake some of the work in my own time
Reduced home visits
No home visits
Other (please specify)
19. Do you undertake some of this work in your own time?
Yes
No
If yes, how much on average per week? (hours)
Please go to the next section (part 4). The next section is for ALL respondents to complete.
Part 4 : Daily Diary
Guidelines for completing the Daily Diary
- The diary relates to service activities within your general practice only, plus any educational activities that are integral to your training, or continuing professional development.
- The diary covers the time spent on GP work and related educational activities from 7.00 a.m. to 7.00 p.m. Monday to Friday and excludes clinical out of hours time/work.
- Please complete the diary for your typical working week e.g. Monday to Friday, or Wednesday to Tuesday. Please start the dairy on any day of the week between 4 to 11 September 2006 and continue completing the diary for a period of 5 consecutive days. The diary should be completed by 15 September 2006.
- You may find it helpful to keep a record of your activities throughout the day.
- Please do not include time spent on activities such as holidays, sabbaticals and non-NHS work.
- Clinical administration. Please include time spent on dictating / writing letters, practice meetings, practice and patient related emails/telephone calls etc. However, please do not include time spent looking up information on the internet.
- Education – please include time spent on your personal learning, e.g. attending VTS workshops, reading, searching the internet, reflection, shadowing, tutorials etc.
- Other practice related professional activities - this includes time spent on professional activities e.g. insurance forms, cremation forms etc.
- There are three diary sheets attached which vary slightly according to whether you are a trainee, GP trainer or other GP, (ie salaried, principal/provider, locum). Please ensure that you complete the relevant diary sheet for your current position.
Tania Fisher on 0207 383 6248 or tfisher@bma.org.uk
Weekly diary: Trainee
Date diary started :
Activities within general practice
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Number of half-day sessions (up to 4 hours) worked per day |
|
|
|
|
|
Number of face-to-face consultations you had with patients-unsupervised |
|
|
|
|
|
Number of face-to-face consultations you had with patients-with another GP trainer |
|
|
|
|
|
Length of average consultation |
|
|
|
|
|
Number of times you discussed clinical management of a patient with a trainer |
|
|
|
|
|
Number of telephone calls (initiated or received) |
|
|
|
|
|
Number of home visits you made alone |
|
|
|
|
|
Number of home visits you made with another GP/trainer |
|
|
|
|
|
Number of immediate second opinions obtained from practice team |
|
|
|
|
|
Number of patient referrals you made within |
|
|
|
|
|
Number of patient referrals you made outside practice team |
|
|
|
|
|
Other service commitment activities (please specify) |
|
|
|
|
|
Time spent on education and clinical administration (Please add up the minutes that you have spent on the following activities).
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Discussion of clinical management with a |
|
|
|
|
|
|
|
|
|
|
Clinical administration: |
writing letters |
|
|
|
|
|
practice meetings |
|
|
|
|
|
practice and patient related emails |
|
|
|
|
|
telephone calls |
|
|
|
|
|
other (please specify below) |
|
|
|
|
|
|
|
|
|
|
Education: |
time learning, ie personal learning |
|
|
|
|
|
VTS workshops |
|
|
|
|
|
reading |
|
|
|
|
|
reflection |
|
|
|
|
|
shadowing |
|
|
|
|
|
tutorials |
|
|
|
|
|
preparation for summative assessment |
|
|
|
|
|
looking up information on the internet |
|
|
|
|
|
other (please specify below) |
|
|
|
|
|
Other practice related professional |
|
|
|
|
|
Weekly diary: Trainer
Date diary started :
If you are personally supervising more than 1 trainee, some of the components of the diary below require a separate response for each trainee. These questions are marked with an *. Please complete the information below for each of your current trainees and use the corresponding number as indicated below to identify which trainee you are referring to, eg 1 or 2.
For each trainee, please indicate the type of trainee, what level they are at and how many sessions they are in the practice per week:
Type of trainee (e.g. F1, F2, GPR)
Stage (0-6, 7-12, 13-18 months)
No. of sessions
Activities within general practice
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Number of half-day sessions (up to 4 hours) worked per day |
|
|
|
|
|
Number of face-to-face consultations you had |
|
|
|
|
|
Length of average consultation without a trainee present |
|
|
|
|
|
Number of face-to-face consultations you had with patients-with a trainee |
|
|
|
|
|
Length of average consultation with a trainee present |
|
|
|
|
|
Number of consultations interrupted by a trainee |
|
|
|
|
|
Number of cancelled consultations as a result of a trainee |
|
|
|
|
|
*Number of times you discussed clinical |
|
|
|
|
|
Number of telephone calls (initiated orreceived) |
|
|
|
|
|
Number of home visits you made alone |
|
|
|
|
|
Number of home visits you made with a trainee: |
|
|
|
|
|
Number of immediate second opinions obtained from practice team |
|
|
|
|
|
Number of patient referrals you made within |
|
|
|
|
|
Number of patient referrals you made outside |
|
|
|
|
|
Other service commitment activities (please specify) |
|
|
|
|
|
Time spent on education and clinical administration (Please add up the minutes that you have spent on the following activities).
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Discussion of clinical management with a |
|
|