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Practice Managers

Practice Managers play an incredibly important role in GP training...

Over the years, we’ve noticed some GP practices seem to bet better than others when it comes to GP training being flexible, dynamic and generally running smoothly.  It usually boils down to 3 things:

  1. The good GP training practice has a GP Trainer who is passionate and committed to delivering good training. 
  2. The good GP training practice has a  good practice ethos towards training. In other words,  where all the the members of the practice (not just the doctors) are keen for GP training.  Practices where its members see GP training as a whole practice activity and not solely a GP Trainer activity.
  3. The good GP training practice has a Practice Manager who fully engaged, understands and is committed to delivering good GP training.  The perfect Practice Manager is one who is as enthusiastic about GP training as the GP Trainer wanting to do it.

So, if you are a Practice Manager, it is important that you

  • Understand the implications of GP training
  • Remember the positive things it brings to your practice
  • See it as a practice activity (not one that is solely the responsibility of the GP Trainer)
  • See it as a core activity (rather than something that is tagged on)
  • Provide protected time to do the training (rather than squeezing it in between surgeries etc).
  • Get involvedin GP training.  Be part of it, just as the rest of your team will be.   The more you ‘fall in love with it’, the more you will love doing it and the more satisfaction and reward it will give you.  And this means linking up with other PMs in your region who are also GP Training.  Get on a WhatsApp group, or develop a forum, where you can share ideas, lessen the work load and effortlessly learn from each other.

How does one become a qualified GP from Medical Student?

  • Medical students take 5 years to do their medical degree.   During their medical school years, they have to read, understand and acquire medical knowledge and skills from books, lectures and tutorials.  They then get to practise those knowledge and skills through various placements in hospitals, GP surgeries and other community health organisations.  In doing this, it is hoped they also acquire the right attitudes for doing the work.  
  • Once they have completed medical school, they are then allowed to be called qualified doctors because they now have a degree – which is called MB ChB or MB BS.    MB is short for Batchelor of Medicine.   Both ChB and BS is short for Batchelor of Surgery (the latin for surgery is Chirurgia, which is an obsolete term these days).
  • However, to be able to practice as an independent doctor, they need to complete 2 years of something called Foundation Year training (FY1 and FY2).   During these 2 years, these new doctors get the opportunity to apply and translate a lot of what they have learn’t to the real world by working directly with patients and qualified seniors – in both the fields of medicine and surgery.
  • After their 2 years of Foundation Year training, they can then decide to specialise – either in hospital medicine, hospital surgery or General Practice medicine. 
  • Whatever they decide to specialise in, they must first do a Specialty Training Programme for that specialty.   So, if a doctor wants to become a surgeon, they have to do 5 years of further training – rotating around various surgical specialised jobs.  If they want to do medicine – again, it’s 5 years of rotating around various medical jobs covering a variety of specialised fields.   And at the time of writing, if they want to be a GP, they have to do 3 years of specialty training – which usually involves 18 months around various hospital departments (like obstetrics & gynaecology, paediatrics, general adult medicine, psychiatry) and 18 months in a couple of different GP posts.
  • During their Specialty Training, whether they are training to be a surgeon, a hospital physician or a GP, trainees will have to do further medical exams – but this time, focused on the specialty they have chosen.  These exams are expensive and are difficult (and that’s why they get so stressed about them).
  • Only after they have completed the specialty training and successfully completed all exams, they will then get a certificate from their specialty’s royal college to say that they are now qualified in that specialised field, which also grants them permission to practise independently in that field.   For general practice, that college is called “The Royal College of General Practitioners” or RCGP for short.    That certificate for specialised practice is to be regarded as another qualification.  In the case of General Practice, it is called the MRCGP.  So, qualified GPs in the UK usually have the qualification MB ChB, MRCGP.    For a general physician it will be: MB ChB, MRCP, for a psychiatrist it will be MB ChB, MRCPsych and for a paediatrician it will be MB ChB< MRCPaeds.  I hope you get the idea.

How do GP Training Schemes work?

  • So let’s recap a little.     After completing 5 years of medical school, new doctors then have to do two years of Foundation Year training in hospital.   After that, they are free to choose which area they want to specialise in.
  • If that area is General Practice, then they have to do another 3 years of structured training and some specialised exams before the 3 years is up in order to qualify as a GP.
  • That structured 3 years of training is organised by local GP training schemes – Bradford has one, Leeds has one, Harrogate has one as does York.          
  • So, you might be wondering how a doctor who has completed their 2 year Foundation Training gets onto a GP Training Scheme.  The whole of the UK is split into several big regions, like Yorkshire & the Humber, Greater London and so on.    Each region has a GP school.   These GP schools look after several GP Training Schemes.  For instance, the Yorkshire & Humber Deanery has 16 GP Training Schemes – representing the major cities or towns, like Leeds, Bradford, Wakefield, Huddersfield, York, Sheffield, Barnsley, Doncaster, Hull and so on.  London has Bexley, Epsom and Hillingdon – just to name a few.
  • So, one a doctor who has completed FY trainee decides to go down the GP training path, they must apply to a GP school to see if they will take them on.   These GP schools have recruitment rounds twice a year which involves several things like more exams (a multiple choice paper), a Situational Judgement Test (SJT) and a patient-simulation test.  If they do well, then they are usually accepted by the GP school for that region.    The GP school will then decide which local area to put the GP trainee – i.e. they are then assigned to a local GP training scheme (sometimes called a programme).
  • The local GP training scheme will then work out a rotation for each of their trainees.    
  • The trainees will do their rotations.  During their placements they will demonstrate and provide evidence of their learning in something called an ePortfolio – which is like an online notebook and diary.   They will also do some expensive exams which are hard to get through.  And they meet their supervisors several times a year to see how they are doing, do some mini assessments, and make sure they are on track
  • Once they have completed their rotations, provided enough evidence of good experience and learning in their ePortfolio AND have been successful at all their exams, they are then given a Certificate of Completion of Training which is then followed by an MRCGP certificate.
  • The MRCGP certificate grants them to practice independently.
  • Each GP scheme has several experienced senior GP educators (called Training Programme Directors, TPD for short) and an administrator.   Different TPDs have different roles and responsibilities.   Together, they look after these trainees.  Each scheme will have somewhere between 40-100 trainees.  That’s a lot of trainees to manage!  And as you can now tell, each GP trainee has a lot to do in those 3 years.  Each scheme will usually have its own website furnishing more details and things about them.

Top Tips for PMs

  • Familiarise yourself with the resources available in the “Downloads” section above
  • Understand what your new GP trainer has to do.  Click the New Trainer & New Training Practice page on the right. 
  • Understand the rules around The GP Trainee’s Timetable (again, see right).
  • Use the Trainer & Practice Manager Toolkit (see right)
      • to help plan induction for new GP trainees 
      • to plan everything else post-induction
  • Form a WhatsApp or similar forum with other GP training PMs in your area.   Share ideas, knowledge and resources.   Add fun and dynamism to GP training.  You are an essential part of making GP training work.  

Areas of difficulty

First, define the extent of the problem.  Suggest to the scheme administrator a ‘late arrivals register’ separate from the normal attendance register, so that trainees can record what time they arrive and the reason for late arrival.   Also do a ‘late arrivals’ register at the surgery.  Compare the two.  Is the trainee just late for HDR or always late for everything.    If for everything, even practice surgeries, suggest informing the GP Trainer to explore.   If only at HDR but not at the practice, an open and neutral discussion of what is making them late for HDR.  What can be done to rectify this? Remember, the trainee might be trying their best to get to HDR on time, but is struggling because of organisational things at your practice.   (e.g. limiting home visits to a maximum of 1 or 2 for trainees when they have to go to HDR).

  • A Practice Manager can do loads in this situation.  For instance, what if it turns out to be something about their conditions of work? 
  • So, the first step is always to explore, explore and explore.  And when we mean explore, we mean on neutral territory without the negative emotions you may be feeling about the trainee.   Our desire is to understand and the trainee will only be open and honest if we show them that we want to understand and help rather than criticise and tell off like a headmaster/mistress.  
  • You may want to do this yourself or bring it up with the GP trainer and see if they want to explore it. 
  • There are loads of reasons why our staff get resentful.  Perhaps they don’t feel respected.  Perhaps they have lost a loved one or something is kicking off at home.  Perhaps they are depressed or anxious.    Perhaps they have financial difficulty and have not been sleeping hence the irritability and resentfulness.  Perhaps they are struggling with being a new parent or have several children that are proving difficult to maange.   There are lots of reasons, and the only way to find out is to explore.    Once explored,  there might be things which could be done (e g family-friendly working hours).
  • However, the trainee may also be resentful that their fellow trainee is having it “easy” at the practice down the road.  In this sitaution, it is important for trainees to understand that there will inevitably be variability between the exact working conditions in different practices, which are autonomous organisations.   That is the real world and will be no different when they qualify and apply for a job.  No two jobs are the same. 

Legally, Health and Safety procedures suggest that the patient could be asked to stop smoking, and open all the windows, for 4 hours before the doctor’s visit.   Clearly, this would need good organisational skills in order to avoid unnecessary delay in the visit.   Or the patient could be asked to move to a room where they don’t smoke, perhaps the kitchen or hallway.      Please remember, any health professional has the right to prioritising their own safety.  For example, I don’t have asthma, but I would still insist the patient open all windows and aerate the place.    Why should my lungs inhale their fumes?  Why should my clothes stink of smoke?   Why should I have to put up with the smell of smoke all over me during the rest of my working day?

  • First of all, if the trainee is ringing so late, has anyone actually talked to them about the process of informing the practice about ringing in sick?  Perhaps they ring last minute because they want to give themselves some time to see if they can manage coming in.  In other words they want to do the right thing.  But at the last minute they realise they can’t.  Of course, if they knew that logistically it would be much better for the practice to know as early as possible and they can see why, then perhaps that is all that is needed for them not to ring in so late.
  • As for the repeated absences, this should be raised with the GP trainer.   Jointly plan a way forwards – which might, in the first instance, be down to the Practice Manager to handle or the GP trainer might take it upon themselves.
  • Whoever takes on the role of the first contact to talk about repeated absences, please, please, please remember, the aim is to explore the difficulty.  Do not go in with negative emotions and guns blazing.   We want to understand what is going on here.  It is dangerous to start with the thinking “this trainee is a bit lazy and doesn’t pull their weight”; a very dangerous approach.    We need to first explore and understand.    State matters of fact because they cant be argued with.  “I see last month you were away 4 times”.    And then show that you are here to try things better rather than to criticise and tell off.  “We know as an experienced training practice that often this is a result of something happening with yourself,  back at home, or here at work.  I was WONDERING if this is the case and whether we could talk to see how to make things better for you….”
  • Remember, need to keep your emotions in check.  They might be going through a divorce.   Or they might be in financial difficulty and moonlighting and hence the need to be off work at the last minute.  Perhaps they are depressed or have a medical condition like Rheumatoid Arthritis that keeps flaring up.   The possibilities are endless.  One thing is for sure…..  the lazy GP trainee who just can’t be arsed is an uncommon occurence.  
  • Remember, the PM should implement the normal practice sickness policy (e g a back-to-work conversation after every episode of sick leave; a formal interview if there are 3 episodes in 6 months; could refer to Occupational Health).
  • Don’t forget a referral to their own GP if health issues identified.   Don’t forget that you may need to do a referral to Occupational Health too.   The GP Trainer SHOULD NEVER assume the role of becoming the trainee’s temporary personal GP.
  • Trainer should discuss the educational implications and possible need for additional training period at the end of the scheme if more than 2 weeks in any one ST year.
  • The Trainer should also discuss the issue with the Training Programme Directors.    The GP trainee should know that they are doing this. 
  • The GP training scheme should have in place a continuing sickness and holiday record for each trainee, with continuity from post to post.  Check to see and inform the administrator of each sickness period for your trainee.  This is the role of the PM.
  • A good Practice Manager is enthusiastic about GP training as much as their GP Trainer(s).     If the GP trainer feels low about the place of GP training in the eyes of the practice compared to other activities, ask yourself….  is this an organisational ethos that you have perpetuated through actions of your own.  For instance, if other GP trainers or even other members of staff are constantly complaining about something to do with GP training, have you ignored it and let it go by.   Have tensions risen as a result of this.   Or perhaps you have given too much focus on the money-generating activities at the expense of GP training – which then never gets discussed or reviewed.
  • So, if this situation arises, we would suggested
  • Having an open and honest discussion with the GP trainer on neutral territory.   Just listen, do not defend.   The aim is to understand, not to retaliate or defend.
  • Ask yourself about your role in all of this as Practice Manager.
  • Discuss with the GP trainer how to make things better.   How do we proceed from this point forwards?
  • Arrange a meeting with the practice or doctors, or a relevant group (e.g. admin staff) and structure a session to discuss views.  Educate about the pros and cons of GP training.  Promote shared understanding.  Then try to come up with a shared plan that promotes the ethos with which you wanted to engage with GP training in the first place.  
  • (see document under Downloads section on the pros and cons of training)

 

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

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