The RCGP has long believed that all doctors in training should spend time in general practice.
Since the introduction of the Foundation Programmes in Modernising Medical Careers1 there have been some local pilots, but wider introduction has been difficult because of lack of funding. The Minister of Health has now announced new funding for Foundation Year 2 (F2) posts in England, of £70 million. This will fund, from August 2005, 55% of all Foundation Year 1 (F1) doctors (pre-registration house officers), who from 2005/2006, will spend 4 months in general practice during their F2 year, rising to 80% in 2006/2007. The funding is calculated to fund a trainer's grant and the salary of these doctors. The split of funding between deaneries/strategic heath authorities has not been announced and it is not currently clear how the funding will flow to support posts that cross financial-year boundaries. In the Mersey Deanery we expect to receive around 5% of the funds, working out at between £30k and £35k per post.
F2 doctors will not have to be supervised by vocational training scheme trainers or to be in training practices but directors will have to satisfy themselves that host practices will provide a placement of appropriate quality. Priorities will be trainers, and their partners, non-trainers with other educational experience and other GPs. The curriculum for F2 and the assessments are agreed and published. Issues to be dealt with include the allocation, phasing and adequacy of the funding, the infrastructure requirements within the deaneries and the negotiation of possible reductions in current F2 posts in hospitals to accommodate the new GP posts.
In 2003 in the West Midlands Deanery, 35 4-month general practice F2 slots were funded. In August 2004 we extended this pilot giving 240 4-month placements and enabling virtually all doctors involved in the F2 pilots to have 4 months in general practice.
Lessons learnt? There need to be high level champions in the deanery to make things happen. All committees and PCOs need GP input and the administrative process must be joined up. Deanery links with GPs on the ground are essential.
In the West Midlands we have established five foundation schools based on geographical areas. A local GP educator has been identified as the lead for foundation programmes and works very closely with the hospital clinical tutors. The lead educators meet regularly and share good practice; they are involved in the training of clinical supervisors (with the local trainers workshops) especially in assessment methods such as mini-CEX and 360 degree assessments. Administratively, F2 doctors in general practice are treated as if they were GP registrars. They have the same contract and same funding arrangements. The trainer receives the trainers' grant and PCOs are notified and advised on how these doctors should be placed on the Performers List. The F2 doctors are able to sign prescriptions even if they only have GMC Limited Registration. Defence cover is arranged and refunded as with GP registrars. Our F2 doctors have a planned induction, a downloadable logbook, weekly practice tutorials and release for foundation programme teaching. Doctors undergoing their foundation programmes and their supervisors have described their experiences very positively2-4 and full evaluation of the programme is in progress.
West Midlands has shown that F2 doctors can be successfully placed in general practice, the F2 doctors value the experience, and trainers and their practices have been enthusiastic in supporting this opportunity to expose all doctors to an early placement in general practice. Up to 60% of F2 doctors in the West Midlands are now considering general practice as a career.