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CPD for Non-Principals
15th December 1999
Report for GP AGMETS
Dr Rebecca Viney (Chair, Non-Principal Subcommittee GPC)
Dr Bitty Muller (Educational Adviser for Non-Principals in West Midlands Region)
Dr Richard Fieldhouse (Chairman, NASGP)
The key areas that need to be addressed for GP Non-Principals to have
equality of opportunity in Continuing Professional Development have been well
rehearsed (1,2).
These are:
- An accurate register of all Non-Principal GPs
- Equality of access and provision to continuing medical education
- Similar levels of funding for CPD/ CME to that of GP Principals
- Assistance in preparing personal professional development plans
- A GP tutor or associate adviser in every region with a specific
responsibility for GP Non-Principals or for existing tutors to extend their
remit to all GPs.
- Return to General Practice courses for career break doctors
Barriers to doctors who work as Non-Principals achieving these stated aims
include:
- No register of doctors working in general practice as Non-Principals
- Consequent lack of information and access to regular mailings (NB. the
British National Formulary)
- Marginalisation within the GP workforce.
- Professional isolation (particularly for career break doctors, limited
session employed Non-Principals and self employed Non-Principals)
- No allocated funding for CME/ CPD activities
- No record of prescribing data for GP Non-Principals
- The lower confidence levels of female GP Non-Principals, despite higher
professional qualifications (2,3)
It is tempting to suggest that doctors who work as retainers, assistants,
deputies, associates and locums should not be treated as a "special
needs" group, and be included in the CPD arrangements for all general
practitioners. By and large, this could be the case if the above issues were
addressed.
Further recommendations.
Non-Principal GPs represent on the whole, a highly qualified group of
doctors. They have over 20 million patient encounters per year as NHS GPs.
Research has shown them to be a heterogeneous group of doctors, but with 30-40
year old women doctors with children being disproportionately represented.
Percentages of female non-principals vary around the country from 64% (McGavock,
Ireland), 70% (Oxenbury, South Thames West), 73% (Fox, Mersey) and 87% (French,
Scotland)(5,3,6,7).
This research shows this group of doctors to feel vulnerable, de-skilled, under
confident, low in self-esteem and isolated. Studies have shown that
participants' concerns about returning to general practice were significantly
reduced by re-entry courses (8).
A learner centred approach and atmosphere of mutual support were helpful in
boosting confidence and aiding return to professional practice.
PCGs and emerging PCTs will be required to manage CPD in their localities,
and this process should be inclusive of all doctors who work in general
practice, both Principals and Non-Principals. It should offer ALL doctors the
full range of educational opportunities, and support to access financial grants
for courses identified as part of a Personal Development Plan (PDP). It seems
that ALL doctors who work within the NHS (and this will include GP
Non-Principals) will have an annual appraisal, which will assist them in
formulating their Personal Development Plan. Doctors will need to feel confident
that the person who is appraising them has had appropriate training in
appraisal.
Retainer Scheme Doctors and Assistants.
Assistance with completing a PDP and annual appraisal systems should be put
in place for all employed Non-Principals within a PCG/T. They should also be
included in the educational programme developed by the PCG/T.
Deputising Doctors.
Deputising doctors are sometimes principals who should all have had
appraisals and formulated PDPs as part of their PCG's managed CPD system. For
those who are not principals, and are working exclusively in a deputising
service, CPD arrangements, PDPs and appraisals should form part of their
employment contract.
Self-employed Locums.
Locums who work between several PCG/Ts and are self-employed may fall outside
the remit of a single PCG/T CPD management policy. Nevertheless Trusts and
employing GP principals will want to be assured that the person they are
entrusting their patient care to is fully accredited and up to date. Locums will
have to demonstrate that they are keeping a personal learning plan, e.g. the
NASGP log book or equivalent. The National Association of Non-Principals proposes
piloting "virtual practices" within a PCG/T for this group of doctors.
These virtual practices would in effect be a group of Non-Principals with a
"practice manager" based at the PCG/T. Locums will hold a contract
with the PCG/T. The contract would be in 2 parts: the first would be for service
provision (i.e. the locum must work for practices within that PCG/T, but may
work elsewhere if not otherwise required); the second would be for CPD (each
locum must participate in audit, clinical governance etc, and be included in the
PCG/T's educational and CPD programme). Self-employed locums should have access
to an annual appraisal if this is a requirement throughout the NHS. This could
be with the GP tutor or Clinical Governance lead of the PCG/T in the locality
where their home (or "virtual practice") is, or the PCG/T in which
they do the majority of their work. They may wish to nominate an appraiser at
the practice where they have done the majority of their work throughout the
year, or nominate another colleague who is familiar with their work. Any
re-accreditation system needs to be flexible enough to encompass the differing
educational needs and medical experiences of this heterogeneous group of
doctors.
Career Break Doctors.
Any GP who has a significant break from general practice for any reason
(childbearing, travel and work abroad, illness) should have a full learning
needs assessment when considering a return to practice. Appropriate re-entry
opportunities should be made available to such doctors (return to GP courses,
shadowing, repeat registrar experience as made possible by Paragraph 38.5ii in
the Red Book). Support and funding by the NHSE of these schemes at a national
level will encourage vocationally trained GPs to return to practice. A course
organiser/ educational advisor in every region should have specific
responsibility for offering career counselling., learning needs assessment and
returners courses for this group of doctors.
Summary.
- The CPD systems set up within PCGs and PCTs should be inclusive of all
GPs, both principals and Non-Principals.
- Where the CPD systems may fall short of their potential due to contractual
circumstances of the GP, the GP must adopt additional "contractual
systems" (e.g. virtual practices) to allow that GP to participate in
CPD systems.
- GPs who have had a career break, for whatever reason, should have access
to a variety of re-entry opportunities for general practice.
References
- Muller
EJ and Viney R. Education for GP Non-Principals: a challenge for educators
and the Department of Health. Education for General Practice (1999), 10,
377-388.
- Oxley
J and Egan J (1998). The Educational Needs of GP Non-Principals. Standing
Committee on Postgraduate Medical Education (SCOPME), London.
- Oxenbury
J. Appropriate Education for GP Non-Principals. Education for General
Practice (1999), 10,345-349.
- Chambers et al
- McGavock
H, McKnight A, Wilson-Davis K, Dick s. A Survey of GP Non-Principals in
Northern Ireland,1998 - differences between men's and women's responses.
Education for General Practice (1999), 10, 372-374.
- Fox
J. A Study of Non-Principals in the Mersey deanery. Education for General
Practice (1999), 10, 359-360.
- French
F. A survey of GP Non-Principals in the Grampian Region (north-east
Scotland). Education for General Practice (1999), 10, 350-352.
- Baker
M, Williams J, Petchey R. Putting principals back in to practice: an
evaluation of a re-entry course for vocationally trained doctors. British
Journal of General Practice 1997, 47, 819-822.
Attached is a paper summarising the main themes in "The Good CPD Guide -
a practical guide to managed CPD" (Eds. Janet Grant, Ellie Chambers and
Gordon Jackson. 1999), with comments as to the appropriateness of the suggested
forms of CPD management to GP Non-Principals marked in blue.
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