All GP trainees must be slotted in for a 3-hour weekly tutorial. The way you do this is up to you.

Three hours all in one go is probably a bit too much. Two lots of 1.5-hour tutorials across the week (each followed by a shortened surgery) would educationally fare better — the trainer and trainee simply cannot concentrate for a full 3 hours at a stretch.

What you cover is up to you: clinical topics, significant events, problem cases, random cases, or something else. However, you must also reserve some of these slots for the mandatory MRCGP assessments — namely, Case Based Discussions (CBDs) and Consultation Observation Tools (COTs).

It is important for the Practice Manager to ensure that the GP trainee’s weekly timetable includes a surgery where the trainee records their consultations. This material forms the basis of COT assessments or tutorials around communication skills in the following week. The weekly video session is non-negotiable.

🎭 Video Allergy

Sometimes, GP trainees can be very apprehensive about doing video surgeries — and many don’t like the idea of doing them. It’s not surprising: for many of them it is a new experience. Don’t forget that the GP trainer is also analysing their day-to-day performance behaviour — how would you feel if you were in the same position as them?

So, to help them settle in: reassure them that their feelings are normal and widespread among new GP trainees. Explore their anxieties and fears — try and alleviate them. Emphasise the formative nature of the feedback and the supportive climate in which it will be given.

Resources: RCGP COT Consent Form  ·  Bradford VTS COT Resources  ·  Ways of Teaching the Consultation using Video

Sit and Swap is where the GP Trainer and trainee take it in turns to see patients. It is one of the best ways of helping trainees acquire communication skills. The GP trainer demonstrates and role models consultation behaviour. Then the trainee has a go at some of the skills. The trainer fine-tunes, and the GP trainee continues to have another go.

• Schedule at least once per month throughout the entire training period. The preferred frequency is 2 per month.
• Patients need to be booked at 20-minute intervals.
• Book patients into one surgery — perhaps under the trainee’s name — otherwise the patient will expect to be consulted by the GP trainer. Then let the trainer and trainee decide how they want to split seeing them.
• Sit and Swap surgeries should be provided for trainees at all stages, not just ST1s. ST3s have consultation learning needs too — no matter how good they are.

Resources: Bradford VTS: Joint Consulting Resources

ST1 & ST2 — Beginners

The ST1/ST2 trainee should not be engaging in on-call alone during the first 6 months of GP training. They have volumes to learn. Putting them in a clinic where there are high stakes in terms of clinical risk is unnecessary danger for both patients and trainees.

In fact, many practices don’t allocate any on-call duty sessions to trainees in their ST1 year because they simply have too much to contend with. This does not mean they cannot do any on-call — as long as they are directly supervised, they can.

ST3 — Final Year

ST3s need to start learning how to do on-call. After all, they will be doing it when they are qualified. The following schedule is suggested:

Home visits are a valuable part of GP training — but they need to be timetabled and managed carefully.

Duty Doctor / Triage Work

Duty doctor and triage work involve a higher degree of clinical risk and intensity than booked surgery work. They are generally more suitable for later stages of training, once the trainee has demonstrated consistent clinical competence in standard booked sessions.

• The supervising GP should be clearly identified, easily available, and expected to monitor workload closely and adapt it based on how the session is going.
• Do not introduce duty work as a badge of progress. Introduce it when capability is clear — not because the rota needs filling.
• If a trainee is moved onto duty too early, the usual signs are: becoming defensive in consultations, over-referring, skipping safety-netting, or appearing cognitively overloaded.

These days, GPs are doing more and more technology-enhanced consultations. For example:

• E-mail consultations (often called e-Consults)
• Video to video consultations (using software like AccuRx)
• Telephone consultations

ST1/ST2

All of these different methods of consulting require their own set of skills which take a while to develop. We feel it is too much for the GP trainee in the ST1/ST2 year to be learning this when they should be focusing on basic face-to-face communication skills. Of course, there is no harm in doing the odd “other type” of consultation, but these must not detract from the bread and butter of general practice which is face-to-face consultations.

Remember: skills need to be built layer upon layer — in a gradual and incremental way.

ST3

For the ST3, it is a different matter. They will have had lots of face-to-face communication skills training, so it will be time to learn skills for other ways of consulting. This is probably best done in the ST3-2 year.

• ST3-1 (first 6 months of ST3): Consider an “introduction” to these different types of session by plugging them into the timetable here and there, with the necessary training from other GPs.
• ST3-2 (second 6 months): Get them to do these more regularly with a mixture of observed and independent practice.

Resource: Bradford VTS: Telephone Consultation Skills

Trainees may sign repeat prescriptions as soon as they start general practice. Again, it is probably best they start doing this only after a period of adequately settling in — perhaps from month 2 onwards.

The GP Trainer and trainee should engage in a tutorial about repeat prescribing and what is involved in a medication review prior to this starting.

Resource: Bradford VTS: Prescribing Resources

This is not an uncommon occurrence. At some point in nearly every GP training practice, one or two GPs who are not trainers sometimes become resentful and angry towards the requirements of GP training. They often feel that they are doing the work and the GP trainer is not. Their minds start doing what minds are naturally good at doing — making unrealistic conclusions like “it must be lovely sitting back and doing a cosey tutorial over coffee.”

They end up moaning about the proportion of time the GP Trainer actually spends on seeing patients because of “all this protected training time”. But they somehow forget what the practice gets in return for 1–2 sessions of the GP trainer’s time — namely a GP trainee pair of hands that works way more than 2 sessions a week!

So, if you sense any of this, don’t ignore it. Raise the issue and discuss it at a practice meeting. Remember to be kind and compassionate — they are more likely to listen to you and tell themselves how they have oversimplified the situation. Please calm down any anger you have because you don’t want to add fuel to the fire. Discuss it when you feel okay inside.

Why Do We Do GP Training? (especially as it is not very well paid)

• Approval as a training practice is one indication of high standards of record keeping, organisation, premises and patient care
• Contact with young doctors is stimulating and keeps everyone more in touch with developments in general practice
• Educational activity is a good balance to clinical activity for both the trainer and the practice; it also helps develop your teaching skills
• Being a training practice is very valuable for GP recruitment — either directly if an ex-GPR comes to work at the practice, or indirectly because the practice is known via the VTS, or because potential recruits from outside the area are attracted by a practice’s training status
• You get a free pair of hands (sometimes questionable) and some training money in return

It’s also worthwhile trying hard to get the practice to see GP training as a practice activity rather than a trainer-only activity. Get others to do some of the pleasurable things in GP training: clinical tutorials, debriefing trainees, clinically supervising them. In this way, they too will feel the energy and dynamism that trainees bring to one’s working life. Also, try and put a training item or update onto the agenda at most practice meetings (even if just for information). And finally, try and get your Practice Manager to share the same passion as you have for GP training — if anyone can make something happen smoothly, it’s the Practice Manager!

• “How are you finding the appointment length? Is the pace about right for you?”
• “How are you using your personal study sessions? What does a typical one look like?”
• “Is there anything on the timetable that feels unsupported or difficult to manage?”
• “Have you looked at the WPBA numbers you need? Are we on track?”
• “What’s been most useful in the tutorials so far — and what would you like more of?”
• “How did your last video surgery go? Was there anything you noticed about your consultation style?”
• “Have you done any OOH sessions? What was the clinical experience like?”

• "Before I look at your notes, can you tell me in your own words what's been going on?"
• "What's brought you in today — and is there anything in particular on your mind about it?"
• "Tell me what's been happening."

Do not say "any worries or concerns?" — it telegraphs the script. Use natural language:

• "What do you think might be causing this?" (Ideas)
• "Is there anything you've been worried this could be?" (Concerns)
• "What were you hoping we might be able to do today?" (Expectations)
• "It sounds like this has been on your mind for a while — what's the part that's worrying you most?" (Follow-up)

Interpretive empathy references something specific the patient just said:

• "It sounds like you've been managing this on your own for quite a long time — that can be exhausting."
• "Hearing that it might be serious — that's a lot to take in. It's completely understandable to feel anxious."
• "You mentioned your family don't know yet — it sounds like you've been carrying this alone."
• "That must have been frightening."
• "It makes complete sense that you're concerned about this."

• "Let me explain what I think is going on and then we'll decide together what to do about it — stop me if anything isn't clear."
• "The medical term is [X] but in plain terms, what that means is..."
• "There are a few ways we could approach this — let me go through them and you can tell me what feels right for you."
• "From what you've told me and what I've found, this fits with..."

• "I want to be honest with you — I'm not certain about this, and I'd rather check the guidance before giving you a definitive answer."
• "This is a situation where I'd want to discuss with a colleague before we commit to a plan — is that okay with you?"
• "There are a few possibilities here. Let me explain what I'm thinking."

• "Based on what you've told me, here are the options: [A] or [B]. What matters most to you in making this decision?"
• "Some people in your situation prefer to try [treatment] first; others prefer to wait and see. What feels right for you?"
• "What are your thoughts on that?"
• "We've got a couple of options — let's talk through what might suit you best."

• "I want to be clear about when you should come back — specifically if [symptom] happens, or if [trigger], please call us the same day."
• "If [red flag symptom] develops — particularly if it's severe or sudden — don't wait for a routine appointment; go straight to A&E."
• "If your pain becomes severe, spreads to your arm or jaw, or you develop breathlessness, call 999 immediately." (Example of specific safety-netting)
• "I'll review your results in [timeframe]. If you haven't heard from us within [X days], please ring to check."
• "If things don't improve in the next [X] days, I'd like you to come back — don't wait longer than that."

• "Before we finish — does that plan make sense? Is there anything we haven't covered that you wanted to raise?"
• "Does that all make sense?"
• "Is there anything else you wanted to cover today?"
• "Do you feel happy with the plan we've agreed?"

Multiple trainees describe tutorials being skipped, combined, or quietly replaced with extra clinical sessions. This is a breach of the training contract. Tutorials are part of the contracted 12 educational hours per week and are distinct from the VTS session and SDL time.

Being asked to do duty doctor in addition to a full morning surgery is a breach of the timetable. Duty doctor work, unscheduled care, and home visits are all part of the contracted 28 clinical hours — they are not extras layered on top of a full day's booked appointments.

Trainees, particularly IMGs, often accept this without question because they are reluctant to appear difficult. The correct response is to raise it at the next tutorial: "I noticed I was asked to do duty doctor after a full surgery — I wanted to check how that fits within my timetable."

A trainee doing home visits every day without these being reflected in the timetable is being asked to work beyond their contracted hours. Home visits (including travel time and post-visit documentation) count as clinical time. The number of visits should be agreed in advance and included in the work schedule.

Many practices conflate post-surgery debrief with admin time. They are distinct — and both are owed:

A practice that gives you one 30-minute slot after surgery and calls it "debrief and admin" is not meeting both obligations. Both are owed. Both count as contracted time.

The 12 educational hours per week are split into three distinct session types, each with a different function. Practices sometimes blur all three into "educational time" and give trainees one tutorial instead of three separate sessions.

The 2025 RCGP curriculum explicitly lists remote and digital consulting as a core capability. This is not a bonus — it is a requirement for CCT.

Trainees often leave mandatory WPBA entries too late, or confuse what is required at ST2 versus ST3. SDL time is the protected space for portfolio work — but trainees must actively track what is needed, not wait for the ARCP to flag a gap.

Do not start seeing patients without a written work schedule. This is not pedantic — it is your contractual right and your protection.

• Agree a written work schedule with your Educational Supervisor. Get it signed or confirmed by email.
• Confirm: tutorial day/time, SDL session, VTS day, appointment start lengths, debrief arrangements.
• Agree how OOH hours will be deducted and documented (ideally same week; TOIL logged).
• Check the timetable adds up to 40 hours — including paid breaks.
• Confirm which day VTS and SDL are scheduled (ideally the same day).
• Confirm your named clinical supervisor for each day, and who covers if they are absent.
• Ask for a written summary of the OOH induction process before booking any OOH sessions.

Educational sessions erode gradually over a post if not actively defended. Each week:

• Tutorial: Block in the diary as "protected — not for appointments." Notify the practice manager at induction and confirm in writing.
• SDL: Use for portfolio (WPBA entries, reflections), AKT/SCA revision, curriculum gap-filling, and QI. Not unpaid admin overflow.
• VTS: Mandatory; study leave applies. Any session missed should be recorded and the time formally reclaimed.

This is an example of a compliant full-time clinical day (2 sessions = 8 hours). Debrief time is part of the session, not additional.

Total: approximately 8 hours (2 sessions). Pattern varies by practice; the proportions should remain consistent.

Do not allow yourself to be moved to shorter appointments before you are ready. Any reduction in appointment length should be:

• Reviewed jointly with your trainer at 4-week, 8-week, and 12-week checkpoints.
• Mutually agreed — not unilaterally imposed by the practice.
• Documented in your learning log as an agreed progression milestone.

• Do not book OOH until you have completed a formal OOH induction from the OOH provider.
• Plan OOH sessions around your work schedule — send the details to the practice manager in advance so clinical time can be deducted in the same week.
• Keep a personal log of OOH hours worked and TOIL claimed against each shift.
• Remember the limits: no more than 3 OOH weekends per 6-month post; no shift longer than 13 continuous hours; minimum 11 hours rest between any shift and the next day's start.
• ST1 trainees: Generally avoid OOH altogether in the first GP post. If you are being expected to do OOH as an ST1, discuss with your Educational Supervisor before booking.

At the start of each GP post, map out your study leave clearly:

• ST3 (full year): 30 days study leave. Approximately 15 days deducted for VTS attendance, leaving ~15 days for courses, AKT preparation, and other educational events.
• ST1/ST2 (6-month post): approximately 15 days total; ~8 days deducted for VTS, leaving ~7 days.
• VTS dates should be mapped at the start of the post and formally deducted from the allowance.
• Any application for study leave (courses, AKT sittings, conferences) must be approved in advance — it cannot be claimed retrospectively.
• Travel expenses for study leave activities may be claimable — check your deanery's policy at induction.

Create a simple monthly self-check to catch problems before they become ARCP risks. If any answer is "no" for two consecutive weeks, raise it at the next tutorial — not at the end-of-year ARCP.

• ❓
  Are my tutorials happening and being logged on the ePortfolio?
• ❓
  Is my SDL being used productively (not just overflow clinical admin)?
• ❓
  Is my portfolio up to date? (Target: minimum monthly reflective entries)
• ❓
  Am I on track for OOH hours? (Target: approximately 36 hours per 6-month post, pro-rata)
• ❓
  Have I renewed mandatory training? (Safeguarding, BLS — check annual renewal dates)
• ❓
  Am I recording a consultation at least once per week for SCA preparation?
• ❓
  Does my timetable still add up to 40 hours or less, with breaks accounted for?