Improving the quality of training

Purpose and context

As we continue to expand GP training capacity, it is vital to assure the quality of training and to ensure that the quality of clinical care is safe for patients and GP DiTs. There is an opportunity to use training standards and placements to enhance care quality and further address health inequity.

General practice has a proud history of using training levers to improve the quality of care. The pioneers of Vocational Training, as it was then known, applied care and educational quality standards and quality assurance processes. In addition to the high-quality standards of the Joint Committee for Postgraduate Training in General Practice, training practice standards also led to significant improvement in care quality, including robust record keeping, age-sex registers and disease registers.

We heard...

Doctors in training told us that having high-quality placements is important to them. They feel the majority of secondary care placements are not well aligned to the needs of their curriculum, and are often purely about service delivery without more than a nod to their training or becoming better GPs.

Educators fed back that they value the accreditation of the quality-management process but that they see variation between regions with different standards applied, and overlap with Care Quality Commission (CQC) inspection.

Focus groups have highlighted the need for emphasis on wellbeing and empowerment for future careers throughout training, to enhance the quality and impact of learning. Surveys have shown an increasing risk of burnout, including in the first five years post-training (PRUComm, 2022). A focus on prevention during training may enhance the impact and retention rates of our valuable workforce.

The need for future GPs to develop experience in leading and designing quality improvements was also emphasised, along with the need to develop a strong connection with ‘place’. The place-based pilots highlighted ways to connect GP DiTs to the needs of the local population, and embed them in the clinical leadership and permanent workforce within a place.  For example, the place-based pilot in North East London recruited six trainees from diverse backgrounds, all of whom had done their initial medical training outside the UK and who may not otherwise have had a chance to train as GPs. The pilot provided them with opportunities to do more of their training in local communities, testing different selection and support processes as well as new ways to help trainees develop competencies in primary care. Trainees reflected warmly on the opportunity to train outside of hospital settings.

Priorities and action

We will continue to explore options to further reform our placement and delivery model as capacity and funding permit. While there has been much discussion about basing all three years of GPST in general practice, with personalised and targeted placements according to curricula and personal need, there is no current capacity or funding to do so. The unintended consequences and impacts of such a change on the wider system would need to be carefully considered.

We are working to standardise quality management processes in line with the refreshed HEE Quality and Intensive Support frameworks, to share and embed good practice and to reduce bureaucracy. Any practice that is rated as good or outstanding by the CQC will be regarded as an acceptable clinical learning environment, and quality assurance will focus on the educators and the educational environment.

General practice is a team service and education model. Practices are now working together in PCNs. The Nursing and Midwifery Council (NMC), Health Care Professions Council (HCPC), and the GMC have agreed that we can quality manage training at PCN level. We have commissioned primary and community care training hubs serving every integrated care board (ICB) area. As these mature, we will move to training hubs overseeing PCN-level quality control and use this to expand and diversify our placements, while maintaining and improving quality for all general practice learners.

We also seek to increase the use of innovative placements, including longitudinal placements and those across community, voluntary and digital services.