The epidemiology of teaching and training General Practices in England

Rees, Eliot L; McKinley, Robert K

doi:10.1080/14739879.2016.1208542

Cited by 16 publications

(9 citation statements)

References 20 publications

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“…Previous studies have reported higher QOF performance in GP training practices (1). QOF performance was previously reported as higher in both clinical and managerial domains (1) although we did not analyse different domains because QOF targets have evolved with much less recent focus on managerial targets.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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GP Training practices in England: a description of their unique features based on national data

Weston

Ahluwalia

Bassett³

et al. 2017

Education for Primary Care

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Postgraduate general practitioner (GP) training structures have been reorganised with the formation of Health Education England (HEE). We aimed to broaden the findings of previous studies and identify key features of GP training practices. In particular, we wanted to extend previous findings regarding QOF achievement and patient experience derived from the General Practice Patient Survey (GPPS), with recent data on the use of urgent cancer referral pathways ('Two Week Wait', or '2WW,' referrals) and secondary care utilisation by GP training Practices. We compared training and non-training practices, adjusting for differences in practice size and demographic features. Compared with non-training practices, we found reported patient satisfaction with 'access' was 2.0% higher (p < 0.001), 'communication' 0.75% higher (p < 0.001), 'overall experience' 2.8% higher (p < 0.001), 'continuity of care' 2.2% lower (p < 0.001). Mean QOF scores were 11 points higher in training practices (p < 0.001). There were few differences between the two types of practice in terms of Emergency hospital admissions, Ambulatory Care Sensitive (ACSC) admissions, Accident and Emergency attendances and Out-Patient attendances. Training practices used the 2WW referral pathway more frequently than non-training practices resulting in a 1.1% higher 'cancer detection rate' (p = 0.007).

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Section: Comparison With Existing Literaturementioning

confidence: 99%

“…These educational responsibilities are known to play a role in shaping the provision of care by training practices. For instance, a focus on consultation skills in workplace-based training is associated with higher reported patient satisfaction with the GP and higher overall patient experience ratings (1,2).…”

Section: Introductionmentioning

confidence: 99%

GP Training practices in England: a description of their unique features based on national data

Weston

Ahluwalia

Bassett³

et al. 2017

Education for Primary Care

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“…In keeping with the inverse care law, there is an 'inverse training law', whereby there are more GP training practices in more affluent areas compared to more deprived areas [18,19]. This is partly a consequence of the increased pressures and lack of time associated with the inverse care law, and partly explained by the higher proportion of smaller, often single-handed, practices in deprived areas, which makes it more difficult to accommodate training requirements [20].…”

Section: Inverse Training Lawmentioning

confidence: 99%

Medical education in (and for) areas of socio-economic deprivation in the UK

Blane

2018

Education for Primary Care

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Our system of medical education is still designed to produce community clinicians only as a by-product, an afterthought following a core curriculum designed by and for specialists. Its central aim remains the production of specialist excellence, unsullied by prior contact with the society it serves. It is training the wrong people, at the wrong time, in the wrong skills, and in the wrong place. The core curriculum for all doctors should be primary care: this should be taught where it is actually carried out, within communities; and the primary generalists produced in this way require not a year or two of rehabilitation in specialised vocational training, but a lifetime of in-service postgraduate study [1]. Much has changed in the 33 years since Julian Tudor Hart wrote this about medical education in the United Kingdom (UK) but are we still training the 'wrong people, at the wrong time, in the wrong skills, and in the wrong place'? In 2010, the Independent Commission on the Education of Health Professionals for the twenty-first century concluded that, globally, 'the content, organisation, and delivery of health professionals' education have failed to serve the needs and interests of patients and populations' [2]. In a linked Lancet editorial, Richard Horton described critical failures in health professional education systems worldwide including a 'chronic lack of primary care workers, rural-urban disparities, too little attention to disease prevention, isolation from the social sector, and insufficient concern with the social determinants of health and citizens' engagement in health' [3]. This sounds all too familiar and is the wider global and multi-professional context within which general practitioner (GP) teaching and training in the UK fits. This article will focus on the particular challenges of GP teaching (undergraduate) and training (postgraduate) in (and for) areas of severe socioeconomic deprivation (sometimes referred to as 'Deep End' general practice [4]). It is now widely accepted that most medical schools do not provide students with adequate general practice teaching time [5]. This is one of several drivers of the current workforce 'crisis' in UK general practice [6,7]. The Department of Health in England's target is for half of all medical students to become GPs [8]. Surveys suggest that general practice is the first career choice for less than a quarter of UK medical graduates [9,10].

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“…In the UK, GPST usually involves a 3-year training programme with 18 months of this programme spent in an approved GPST practice supervised by a named GP educational supervisor. In Scotland, there are significantly more GPST training practices in affluent areas than deprived; 1,2 in England, training practices are under-represented in ethnically diverse inner-city areas; 3,4 and in France, training practices have fewer low-income patients than the national average. Size is a significant predictor of training status: 1 in Scotland, practices in deprived areas tend to be smaller.…”

Section: Introductionmentioning

confidence: 99%

GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study

McCallum

Macdonald²,

McKay

2019

BJGP Open

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BackgroundGP training practices are less likely to be situated in areas of deprivation; little is known about GP views of postgraduate training in such areas.AimTo explore the views of GPs working in deprived areas about GP speciality training (GPST).Design & settingQualitative in-depth interviews with GPs working in practices in deprived areas in Scotland.MethodTen in-depth interviews were conducted with GPs in training and non-training practices, to explore views on training. Interviews were audiotaped and transcribed verbatim, and inductive thematic analysis was undertaken.ResultsThe importance of producing ‘well-rounded’ GPs who are able to work in a variety of environments was highlighted. Trainees need exposure to the specific challenges of deprived contexts (such as early multimorbidity, child protection, and addiction) and the benefit of this for trainees was thought to be invaluable. GPs identified many perceived barriers and benefits to training, some generic but some — such as inspiring the next generation (benefit) or overwhelming workload (barrier) — may be more relevant in areas of high deprivation. Overwhelming workload was the main reason for not becoming a training practice, though some would consider it if supported to develop a training culture. All the GPs, including non-trainers, were involved in optional activities which were felt to be important for resilience.ConclusionGPs in areas of deprivation highlighted specific skills that could be gained by undertaking at least a part placement in deprived areas, with different skills likely to be gained from affluent areas. National education bodies should consider GP training rotations ensure a variety of training environments.

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The epidemiology of teaching and training General Practices in England

Abstract: (max 250 words)Background: There is no national picture of teaching and training practices

Cited by 16 publications

References 20 publications

GP Training practices in England: a description of their unique features based on national data

GP Training practices in England: a description of their unique features based on national data

Medical education in (and for) areas of socio-economic deprivation in the UK

GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study

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