Becoming a general practitioner trainerBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7207.2 (Published 14 August 1999) Cite this as: BMJ 1999;319:S2-7207
Many general practitioners, once they have been in post for a few years, start to look for new challenges. Some may consider becoming a general practitioner trainer. Harry Brown looks at the attractions and pitfalls
Vocational training in Britain has been an undoubted success, and the unsung heroes are the general practitioner trainers and their staff, who have made a dramatic and effective impact on the training of general practitioner registrars (formerly called trainees). A trainer is a complex amalgam of friend and mentor to the general practitioner registrar while also supervising, monitoring, and assessing him or her. In addition, a registrar is a vulnerable individual who requires teaching and is dependent on the trainer for a “good” reference as well as a positive trainer's report. The trainer also acts as a focus for the practice when it comes to dealing with issues about a general practitioner registrar, which could range from complaints to compliments. In addition, the trainer and the practice are the employer of the general practitioner registrar. This places considerable responsibility on both the practice and the trainer.
A trainer is more than a clinician and supervisor and is also an educationalist, a parent figure, and an assessor. The relationship between the general practitioner registrar and trainer is complex and multifaceted, but in practice it works very well.
A trainer's role does not just cover managing a general practitioner registrar's education; it involves the whole concept of training, including sorting out contractual problems and making sure that the registrar integrates well with patients and the practice team. In order to be a training practice, the practice must have attained a sufficient level of quality. Maintaining medical records to specific standards, keeping an up to date and well ordered practice library, and ensuring adequate and protected tutorial time are just some of the many quality standards that a training practice has to reach. Training practices and the designated trainer(s) are subject to regular and rigor ous external inspections.
Having a general practitioner registrar also means sustaining a large volume of documentation. This includes items like the registrar's contract, an introductory package, and a manual to help the registrar cope with everyday work. The trainer must also maintain documentation on the progress of the registrar throughout his or her training. This is crucial in making the decision about the registrar's ability to become a fully fledged general practitioner. The trainer and the practice will help the registrar to pass summative and formative assessment and also help to prepare for exams such as the MRCGP. Often, the trainer and other members of the practice team will keep in contact with registrars well after they leave the practice, providing an avenue of support in their early career.
Trainers should set aside time to attend workshops, which consist of a group of trainers in the same geographical area. In addition, they should also participate in the registrar's half-day release and occasionally will have to participate in residential courses.
Even though the trainer has specific responsibility for the general practitioner registrar, the practice is also intimately involved. Sometimes there is more than one designated training partner, and the whole practice team is involved in teaching and in maintaining the standards necessary to be a training practice. This means that if your enthusiasm for becoming a trainer is mainly limited to yourself then it is an uphill battle in becoming a trainer and a training practice. Training is very much a practice responsibility.
The CMEPlus website (www.cmeplus.co.uk/) is a good source of information about general practitioner training in Britain. In particular, documents relating to trainer approval and reapproval in my own deanery of Yorkshire can be downloaded. The deanery covers 1952 general practitioners, of whom 179 are trainers, located in 129 training practices.
So why do it?
General practitioners and their practices give various reasons for getting involved in training, but no single one seems to predominate1:
A desire to improve standards of general practice, not only within themselves but in future general practitioners
The enjoyment of having another (and often recently qualified) doctor within the practice, questioning established routines and principles
A change in the day to day routine
The kudos associated with being a trainer and a training practice
The addition of an extra doctor whose cost is fully reimbursed by the health authority
Financial benefit of trainer's grant and other fees
Forging new and lasting friendships with general practitioner registrars
An incoming partner may be expected to take on the trainer role to replace an existing trainer.
Pay and conditions
A trainer's annual grant is currently £5645, and the general practitioner registrar's salary is, of course, fully reimbursed by the NHS. The registrar's pay scale is determined by previous experience, and other claims, such as car allowances and reimbursement for the registrar's medical defence union fees, may be possible. This may sound generous, and having the salary of the general practitioner registrar fully reimbursed is an attraction for practices, but, from the trainer's point of view, training is hard work. The financial benefits probably do not reflect the workload.
Recently, some additional money came in to training. Last year, the government announced an additional pay award of £60m to the general practitioner pay pool. The distribution of the extra money has recently been published,2 and part of this money, the sustained quality allowance, will go towards practices that satisfy standards of quality. Training practices will automatically qualify for this award, which currently amounts to £690 a year per general practitioner partner.
The general practitioner registrar is not the only person requiring support; the trainer, too, needs to be part of a support network. In part, this is facilitated by the trainer's workshop, which meets regularly, and attendance is essential for reapproval of a trainer. It acts as a central anchor for sharing problems, passing on news and updates, peer support, and learning. It is also extremely useful for prospective trainers, who can use it to “plug into” the system and find out what it really means to be a general practitioner trainer. Course organisers are an essential link for general practitioner trainers to the training network, and for helping to solve any problems that a trainer or registrar may have.
Becoming a trainer
Becoming a trainer is no easy task, particularly if the practice is not already a training practice. However, it is often the case that a new partner to a training practice is groomed to become a trainer. This is either to ensure a smooth transition for the retirement of the regular trainer or to be an additional training partner. A prospective trainer will probably have been a principal for a few years and should have obtained the MRCGP.
Start by obtaining the regional criteria for your area, which should be available from the office of the local director of postgraduate general practice education (addresses available on the CMEPlus website). There are also national guidelines available from the joint committee on postgraduate training for general practice (JCPTGP), which is the national regulating body for general practitioner training. It produces a minimum basic list of regulations relating to becoming a trainer. The local deanery often adds to these standards.
The regulations and criteria may initially seem daunting and extensive, but they are attainable over time. It is essential to involve the whole practice, including the non-medical staff, in the accreditation process. There will be a specific course for prospective trainers and it is usually residential and compulsory. In addition prospective trainers will find it useful to attend the trainers' workshops held in the local area. Some trainers' workshops operate a mentoring scheme, in which established trainers help aspiring trainers through the accreditation process.
The selection procedure straddles many aspects and may vary from one deanery to another. It usually involves an interview with the prospective trainer, an application form, and a team visit to the practice, which is effectively an inspection. If you achieve the standard, assessment continues in the form of reapproval for all trainers. This can occur at variable intervals, depending on whether deficiencies are found. Trainers who continue to achieve the standard expected often undergo reapproval every three years.
Is it worth it?
There are many pros and cons to becoming a general practitioner trainer, and the whole situation must be carefully assessed not only by the prospective trainer but by the whole practice. Although there are financial attractions, much hard work has to be done. Many additional hours have to be spent with the general practitioner registrar in tutorials and training and in dealing with the administrative load that goes with being a trainer and a training practice. This can lead to friction within a partnership between those in favour of and those against the idea of being a training practice. The final decision often depends on the philosophy and the enthusiasm of the practice team as well as the trainer. However, despite the trials and tribulations of being a trainer, the vast majority seem to enjoy it.