GP Trainees eventually need to get onto 10 minute appointments after 12 months in general practice. Remember: in the hospital setting they had 1 hour or more to get a history and examine a patient but now we're asking them to cut this down to 10 minutes: clearly it is going to take time.

GP1: This means that GP trainees who have never been in a GP post before should really start off at 30 min appointments and end with 15 minute after their first 6 months in a GP post.Please be sure to start off at 30 minute intervals and titrate at a rate they are comfortable with.

GP2: For a GP trainee who has done a previous GP post, consider starting them on 20 minutes with the ultimate aim of getting them down to 10 minutes before their 6 months with you is up.

For this to work smoothly, please discuss any changes with both the trainee and trainer and be flexible where necessary.

A suggested plan is offered here:

In a GP post, all trainees MUST engage in doing two forms of assessments:

1. Case Based Discussions (CBDs)

2. Consultation Observation Tool (COTs)

Practice Managers - don't worry about what these actually mean. What you need to know is that there is a MINIMUM number that they have to do in general practice; if they don't = they FAIL! To make sure this happens in an effortless way, I would strongly recommend that you timetable in two lots of weekly 1.5 hour sessions where the trainer and trainee have protected time for doing this. For instance in my practice, I do COTs every Monday 0900-1030 and then do shortened surgery; On Fridays, we do CBDs from 0900-1030 (and again, a shortened surgery).

Trainers - to be honest, I don't necessarily do a COT EVERY Monday nor do I do a CBD EVERY Friday. But around 60-70% of the time this is what we do. Don't forget that with annual and other leave, you dont end up doing a tutorial every Monday/Friday of a 6 month period. In addition, there are other valuable tools that I would strongly encourage trainers to use during this time too (even if not prescribed by MRCGP): examples include random cases, problem cases, assessing videos by other consultation analysis methods etc.

Trainers & Practice Managers - I know some non-trainer doctors in some practices moan about the amount of time the trainer is actually seeing patients (because of all this protected training time). But even with a first timer trainee, if you combined the efforts of both trainer and trainee, they're probably seeing many more patients than if the trainer had no trainee (or neutral at the very least). This needs to be explained to the rest of the team. In addition, we have another pair of hands to do the home visits. We have another pair of hands to help out when things are busy on a particular day. So you may need to do a reality check; they seem to forget this. If there are practice members who keep going on about this, I would also re-evaluate your practice's ethos towards training: are you all geared up to wanting to do this? Can the practice remember what the advantages of training are and why you got involved with it in the first place? You may wish to revisit this during a practice meeting or a time out event; remember not to be too patriotic - we're trying to engage them not rub their backs up a wall. Some advantages (off the top of my head) are:

1. another pair of hands - for appointments and visits

2. creates a renewed learning enthusiasm amongst other docs

3. some money (although not much)

4. helps with recruitment: training practices stand out better than the rest

5. quality of patient care often improves as old policies and protocols are reviewed

Quick Tip for Trainers:

To promote a collaborative practice wide approach to GP training, consider the following

a) always keep your practice manager informed and on board. Get on with them because they can make things happen!

b) try to put a training item onto the agenda at nearly every practice meeting (even if it is just for information giving). In this way your partners will be kept up to date, been part of any ensuing discussions, feel they have been kept in the picture and generally feel part of the GP training process.

I mentioned COT (Consultation Observation Tool) above. Basically, this is an assessment of the trainee's consulting abilities based on what is reviewed from a video (or live during an observed surgery). This means that trainees must start videoing some of their surgeries (not all) for this to happen.

Practice Managers - I would therefore suggest you discuss this with the trainee and set one or two surgeries a week which have to be videoed. These should definately start by month 2. Mark these surgeries as video surgeries and remember to ensure that they are always booked at 20 minute intervals (unless the trainee is currently consulting longer at 30 mins).

Practice Managers - remember to ensure that staff are aware of the need to get patient consent for every patient that atends a videod surgery. These consent forms have to be kept by the trainee until they finish training (explain this and hand over this responsibility to them)

• Click here for a patient consent form
• • A special note on video allergy

Trainers & Practice Managers - sometimes, trainees can be very apprehensive about doing video surgeries and many don't like the idea of doing them. It's important for you to show understanding in this regard: for most being video'd would be a new experience. How would you feel if we asked for videos of your day to day activities so we can watch them? If the trainee shows any evidence of this, please show empathy and understanding by acknowledging their concerns and asking them to discuss this with the trainer (and consider dropping the trainer an email/verbal note too). It might be worth the first video session being that of the trainer and an analysis of his/her consulting skills (remember, try not to record a perfect consultation: you're trying to engage the trainee and show them that you have learning needs too). We need to get them to open up in a safe environment.

Trainers & Practice Managers - I love sit and swap surgeries because they provide a great educational and development opportunity that can result in rapid progress and acquisition of skills. Sit and Swap surgeries are where the trainer and trainee do a joint surgery; patients are booked in at 20 miinute intervals: half are booked with the trainee and half with the trainer (or alternatively, to make it easier: just book them in at 20 min intervals and let the trainee and trainer decide how they want to split seeing them). The idea is that the trainer can directly observe the trainee in action and help fine tune their skills. In addition, by seeing some patients the trainer can model desired behaviour.

Trainers & Practice Managers - it has often been traditional for most training practices to book in sit and swap surgeries at the beginning (ie during the induction period) but for some reason, they just fizzle out after that. I've never been able to understand the logic behind this. I think because sit and swap surgeries are so invaluable, they should happen throughout the whole training period based in a GP post. So, I would suggest booking in ONE sit and swap surgery EVERY MONTH. This will help with the acquisition of skills based on a continuous learning process. The trainer can also use the direct observation as another opportunity for doing COTs!

• Joint consulting recording sheet
• Here are some tips on joint consulting

During the initial time spent with the trainer, trainees will identify other sessions they may want to participate to gain further medical experience. Examples include: the local drug service, in house psychiatry, cervical smear sessions, asthma clinics etc

Clearly, the number and types of clinics they wish to attend needs to be in keeping with whether it will provide useful experience for the day to day job of being a GP. So for instance, a trainee who wants more experience of the asthma clinic run by the nurses might want to go to 2-3 sessions inorder to get a good flavour. Attending more is unlikely to give added benefit and attending less may not give enough.

Practice Managers - Of course, everything has to be in balance: there is no point in doing a GP post if the trainee spends 3/4 of their time attending clinics and 1/4 of their time seeing patients in the surgery. If you have any concerns about this balance, please talk to the trainer. Otherwise, please try and cater for trainee requests for sessions elsewhere.

Trainers & Practice Managers - Consulting on the telephone is a skill in its own right. When a trainee is starting off, they have lots they have to get to grips with. Some will have come from hospital posts where they need time to adjust because general practice is so different. Telephone consultations form part of the normal routine surgery for some GP practices BUT I strongly suggest that the trainee is not given telephone consultations until after they have had time to adjust; usually at the 3 month stage.

Practice Managers - remember, when you put them down for telephone consultations: tell both the trainer and the trainee. The reasons for this are two fold:

1. it is good practice: remember I said there is nothing worse than unexpected change

2. it will signpost the trainer to consider a tutorial on 'handling telephone consultations'.

• click here for resources on telephone consultations

Practice Managers - Again, putting on-call on the new trainee within the first 2 months whilst they are still settling in is a no no. Please only start considering it at month 3. Again, discuss it with the trainee and trainer first just to make sure they're okay with it and ready to move forwards. Some trainees take longer. That's what makes GP training so exciting: that you have to pitch and pace the learning at the right level for individual learners.

Practice Managers - Trainees may sign repeat prescriptions as soon as they start in general practice. BUT: I would recommend they start doing this only from month 2 onwards. Again, notify the trainee and the trainer when you plan to do this so that the trainer can give a tutorial on 'repeat prescribing'.

• click here for resources on prescribing

During months 3-4 just check to ensure

a) you are titrating their surgery time per patient

b) they have started to do on call

c) they have started to take telephone consultations

d) they have started to sign prescriptions

e) check with the trainer all is going okay