Full and part time training for GP Registrars from August 2005

The Committee of General Practice Education Directors (COGPED) has reached a national agreement (March 2005) as to what constitutes `full time' in general practice for a GP registrar. Registrars have until now been expected to commit themselves to the same work level as their trainers. This policy is no longer sustainable with increasing numbers of trainers working part time and sharing training responsibility. Only by defining full time can inequities be addressed effectively.

The registrar salary includes a substantial additional component for out-of-hours work. Outof-hours experience is a mandatory element of training and should be obtained in addition to the practice commitment outlined below, bearing in mind the constraints of the European Working Time Directive (see footnote).

In response to the COGPED agreement Trent Deanery has produced the following guidance which is intended to form the basis for negotiation between trainers and registrars when drawing up and agreeing the trainer-registrar contract

FULL TIME TRAINING FOR GP REGISTRARS
A full working week for the GP registrar comprises 10 sessions.

One session equates to 4 hours. Although a session should be 4 hours it is recognised that some sessions may be longer while others shorter, but the overall full-time working week should be 40 hours plus OOHs (within the constraints of the European Working Time Directive). GPRs and trainers should therefore look at the total workload/hours rather than the hours of an individual session.

Registrars are expected to undertake the following session within the working week:

• • 8 clinical sessions in the practice - 1 session can be replaced by a flexible planned educational session*

• • 1 session to attend the vocational training half day release.

• • 1 tutorial session

*Examples of use to which the flexible planned educational session might be put include attendance at an out patient clinic or community facility, private preparation for the MRCGP, work on an audit, participation in a self-directed learning group or working with another member of the primary care team.

NB when the vocational training scheme is not operating (e.g. out of term time) the vocational training session must be replaced by an additional clinical or flexible session depending on local negotiation.

PART TIME TRAINING FOR GP REGISTRARS

In accordance with a recent European Directive on part-time training, domestic law in the UK is due to change. Although formal guidance is not yet available from the Joint Committee on Postgraduate Training for General Practice, the Deanery has been advised both by the committee and the Department of Health that legislation will shortly be introduced reducing the minimum requirement for part-time training to 50%. This legislation will be back-dated to 1.1.03.

Therefore from 1.1.03:

1. GP training in the UK can be undertaken part time/flexibly. A mixture of full and part time posts is also acceptable. There are, however, specific requirements to be met to comply with the regulations currently in force.

2. Part-time employment must include at least two periods of whole-time employment, each lasting not less than one week, one in relation to the prescribed hospital experience and one in relation to the prescribed period of training in an approved NHS general practice.

3. Part-time training must equate to a minimum of 50% of the time occupied by the duties of persons employed whole-time in similar employment and as such will count towards the GP training programme.

4. It is also expected that additional duty hours and on call commitment should be at a level of 50% of those carried out by those in equivalent whole-time employment, or pro rata.

5. The consequence of the above will be that the general practice component of training, instead of taking 12 months whole-time, will be accomplished in 24 months, part-time or pro rata.

6. The Deanery expects that a part-time GP registrar or SHO will normally attend a minimum of 50% of VTS half-day release sessions.

ORGANISING A PART-TIME GP REGISTRAR TIMETABLE

Guidance effective for GP registrars commencing in post August 2005

GP registrars (GPR) must work at least 50% of full-time and work at least one week full-time during their general practice placement. The timetable should be based on what a full-time GPR works in the same practice.

The Joint Committee on Postgraduate Training for General Practice require the part-time GPR to work the same percentage of clinical sessions, educational sessions and out of hours (OOHs). The GPR cannot reduce the number of clinical sessions but continue with a 100% of educational activities. At the end of their GPR part-time training period they should have completed the same amount of training as a full-time GPR.

For the purposes of this guidance one session equates to 4 hours and a full-time working week comprises 10 sessions (see Deanery guidance on full time working), which equates to 40 hours per week plus OOHs.

Full-time GPRs are expected to undertake:

• 8 clinical sessions in the practice - 1 session can be replaced by a flexible planned educational session*

• 1 session to attend the vocational training half day release.

• 1 tutorial session

The timetable will vary according to local arrangements e.g. a full-day VTS session, but it is important GPRs get sufficient clinical experience

VTS course organisers like GPRs to attend every week to avoid disruption. A part-time GPR could choose to attend every week for a year and then do other activities for the remainder of their training. If they want to continue going to the VTS it should be at the expense of other educational activities e.g. the flexible session. For example a GPR working 50% might choose to go to the VTS during term time and have their flexible session during the academic holidays. Some degree of flexibility around educational activities is acceptable providing it is at the appropriate percentage and supports the GPR's learning needs.

GP Dean or Deputy must approve timetables and a finishing date will be calculated by the Deanery.

Footnote: key points of European Working Time Directive

Reference: Guidance on Working Patterns for Junior Doctors (2002). DoH (PDF available).

NB this is important when looking at the working week that includes OOH training sessions.

DATE DEADLINE

August 2004. Interim 58-hour week. August 2007. Interim 56-hour week August 2009. 48-hour week.

In addition to the overall hours limit, the EWTD requires the following rest and break entitlements:

• 11 Hours Continuous Rest in every 24-hour period

• Minimum 20 minute break when working time exceeds 6 hours

• Minimum 24 hour rest in every 7 days OR Minimum 48-hour rest in every 14 days

• Minimum 4 weeks annual leave