General Practice placements in ST1 and 2 are different to placements in ST3. Your working week will consist of 7 clinical and up to 3 educational sessions per week. These will consist of a mix of tutorials, VTS teaching sessions and other educational activities. These MUST be agreed in advance with your clinical supervisor, be part of your Personal Development Plan, have a clear purpose (discussed with your clinical supervisor) and should be reflected on in your Learning Log. The activity might include attendance at particular clinics/outpatients or visiting another service. If no educational activity is arranged ST1/2s are required to do surgeries. If an educational activity is happening at the surgery ST1/2s would be expected to do a share of paperwork/visits.
The following guidance may help you and your trainer decide what activities are and are not suitable for these sessions.
Duties and activities suited to clinical sessions
- Supervised or supported consultations within the practice, with a minimum appointment length of 10 minutes for ST3s and most commonly of 20 minutes for ST1/2s for face to face consultations. There should be adequate time provided for at the end of any consulting period to allow a trainee to debrief with the supervising GP.
- Supervised or supported home visits, nursing home visits, community hospital duties including time for debriefing, and travelling.
- Administrative work that directly and indirectly supports clinical care, which includes: reviewing investigations and results, writing referral letters, acting upon clinical letters, preparing reports, general administration.
- Time spent with other members of the practice and healthcare team for the purposes of care and learning e.g. practice nurses, community nurses, nurses with a role in chronic disease management, receptionists, triage nurses, GPwSIs.
- Time spent with other healthcare professionals who are encountered in primary care e.g. ambulance crews, school nurses, midwives, occupational therapists, physiotherapists, counsellors, to gain a necessary understanding of working relationships within primary care.
- Time spent with dispensing and pharmacy professionals gaining experience in these areas, especially where a trainee might have duties that require training to be able to assist with dispensing duties, for example.
Clinical activities that may be considered educational
- Time spent in activities relating to work-placed based assessment.
- Time spent analysing video recordings of consultations, for educational development purposes outside of WPBA
- Time spent in specialist clinics; especially where these are arranged to gain exposure to patient groups and illnesses not covered elsewhere in a trainee’s programme, e.g. family planning clinics, joint injection clinics.
- Participation in clinics run by other GPs – such as minor surgery lists, especially where direct supervision is required in the process to get formal verification of procedural competences.
Non-clinical activities suited to educational sessions
- Locally organised educational events, e.g. specialty-specific educational programme run by the deanery or trust, including “half-day release” or “day-release” sessions.
- Structured and planned educational activities, such as tutorials delivered in the GP practice.
- Primary care team meetings.
- Educational supervisor meetings and other educational reviews.
- Audit and research in general practice.
- Independent study or revision.
- Case Based Discussions (CBDs) selected from outside the debrief time.
- Commissioning services.
- Time spent with other professionals who deliver services that are not considered part of general medical services, such as alternative and complementary therapists.
- Time spent with other professionals who have expertise in other matters that relate to aspect of healthcare and death administration, social workers and undertakers. Getting to know local healthcare professionals and helping the practice maintain links with the local community.
It follows then that the supervisor protected time of four hours per week should be divided to cover
- The Supervised Learning Events
- Tutorials
- Meetings with the trainee to review progress
- Time spent advising on research and audit
- Advising on action plans for further learning
- Time spent relating to the eportfolio as well as writing Clinical Supervisor Reports
- Preparation time for the above
It does not cover
- Debriefing time after consultations
- The educational activity is not meant to be for private study or eportfolio entries.
- ST1/2s should attend ST1/2 teaching arranged at the RBH and also have a tutorial per week whilst in primary care. The tutorial might be negotiated if the clinical supervisor is away.
- In weeks when there is a Bank Holiday Monday all trainees should usually do surgeries instead of educational activities except for a tutorial which should usually still take place.
- We hope that the time in practice as an ST1/2 helps you focus on your primary care learning needs and put into “practice” in primary care what you have learned in secondary care.
- For every month spent in a GP surgery you are also expected to do one Out Of Hours session (OOH), supervised by a GP Trainer (not necessarily your own trainer) or a GP trained in supervising GPStRs working OOHs.