STAYING UP TO DATE is difficult for all doctors, but particularly for those that aren’t in full time practice or who move about a lot. Nevertheless there is a professional expectation that all doctors will stay up-to-date. Indeed the GMC specify this in their Duties of a Doctor guidance booklets. Principals receive a Postgraduate Education Allowance (PGEA, £2360 per annum 1997/8) if they collect 30 hours worth of Postgraduate Education Allowance points. Associates have the same entitlement. Retainer scheme doctors receive an annual retainer, but the amount is so small it cannot contribute much to education. Some assistants get an allowance towards education, or it will be included as part of their job but most do not. Generally locums, assistants and deputies do not get any support for postgraduate education. It is hoped that this will soon change. Sir Kenneth Calman, the Chief Medical Officer’s review of postgraduate education was due to be published in early 1998. It is rumoured that practice based education contracts will be established - how this will benefit locums is not known.

Section 63 (of the Health Service and Public Health Act 1968)
Funds were allocated for use of Regional Advisers (RAs) in General Practice (now Directors of Postgraduate General Practice Education, DPGPE) for arranging and paying for GP training. Each RA's budget depended on the number of GP Registrars (trainees), Assistants, Restricted Principals, Retainer Scheme Doctors, Trainers, GP Tutors and Course Organisers in their region. From April 1996 a more sophisticated funding system based on educational purchasing was introduced called MADEL, a national Medical and Dental Levy, a charge made on purchasers (health authorities and fundholders). Postgraduate Deans were made budget holders for the delivery of Postgraduate Medical and Dental Education in each deanery. The section 63 training money was included in their budgets although managing the budget remained the responsibility of the Directors of Postgraduate GP Education.

Locums are not entitled to claim anything under existing arrangements although Directors have the discretion to fund specific educational projects subject to the availability of the funds. Activities that have been approved and funded under Section 63 cannot be accredited for PGEA because PGEA is meant to enable GPs themselves to pay for educational activities they undertake. Participants are not expected to pay twice and cannot therefore collect PGEA points for Section 63 approved activities.

The ease of staying up-to-date can be influenced by the flow of information into your home. If at present, you get very little medical mail, see the chapter on medical mailings on how to get more. If you are flooded, the difficulty is knowing what to read and what to throw away. Favourites are GP, Pulse, Doctor, the British Medical Journal, MeReC Bulletin, Drugs and Therapeutics Bulletin and Update. Even these can be inundating (and there are many more) and the temptation to file (in the bin) and never read is often too great.

Staying up-to-date requires one to constantly question one's practice, to recognise deficiencies and to address them. Self-directed learning is the modern way to learn. It is a deliberate step away from attending lectures that others want to put on for you and that are frequently irrelevant to general practice. Local GP tutors should be able to give advice on self directed learning - some will accredit individual learning plans. Once you’ve identified your weak areas, the GP press can be helpful in starting to address them. One method of identifying weak areas is known as PUNS & DENS (Patients’ Unmet Needs and Doctors Educational Needs). It’s easy to use and patient- directed but doctor-centred. See the next chapter for details. Non-principals should get into a routine of spending time on CME. In many areas, GP tutors offer to help non-principals with personal education plans which have PGEA approval. Although at present most non-principals will gain little from collecting PGEA points, if they become a principal with full points, they will start to receive the full PGEA. Currently in a few areas, locums are reimbursed for the time and cost of attending CME events.

Standing Committee on Postgraduate Medical Education Report (SCOPME)
A report was published in January 1998 by SCOPME entitled “The educational needs of GP non-principals” (ISBN 1873436 300). An executive summary from the SCOPME website is reprinted below. SCOPME has investigated the educational needs of GP non-principals (assistants, locums and retainer scheme doctors) through two studies involving over 140 doctors. It estimates that there may be more than 4,000 doctors in this category.

It has found that they are an educationally disadvantaged and vulnerable group. SCOPME has consulted with the directors of postgraduate general practice education (DPGPE) about the feasibility of implementing its recommendations.

Summary of Recommendations

1. The mechanism for regional/deanery registers of GP non-principals should be examined by all concerned.
2. Induction to a practice needs to take place for all GP non-principals. Examples of good practice should be collected and disseminated.
3. On educational grounds a contract and/or a written statement about employment terms should be given to eligible non-principals and should specify time available for education within contracted hours.
4. Professional career counselling should be available and all should be encouraged to avail of it. A nominated person, with appropriate skills, on the DPGPE's staff, should be given responsibility for this.
5. GP non-principals should be included in mentoring schemes in general practice.
6. The educational needs identified by this study should be brought to the attention of those responsible for planning educational activities for GPs, including practice-based education.
7. GP non-principals should be included in initiatives to help GPs to draw up personal educational and development plans.
8. Special account should be taken of the needs of locums in managing chronic disorders and those who spend little time in medical work.
9. GP non-principals should be routinely notified of local educational activities in the same way as principals and have easy access to postgraduate centres and associated libraries.
10. All GP non-principals should be provided with written information about their eligibility for educational funding. The information needs to include contact names at the agencies concerned.
11. Mechanisms need to be devised so that GP non-principals have appropriate access to financial support to meet their educational needs.
12. GP non-principals should be given proper time for education (study leave). This needs to be specified in contracts of employment in the case of assistants and long-term locums. GP non-principals should be included on mailing lists for important publications.

Those best placed to implement each recommendation are identified in the report.

The full report will be published by SCOPME in early 1998. For a copy email your postal address to j.oxley@scopme.org.uk.

Educating GP Non-Principals - A national workshop
In June 1997 a workshop was held in Birmingham with many of those concerned with educating GP non-principals in the UK, including representatives of the NASGP. It was an opportunity to share experiences and swap ideas. Sixteen presentations were given detailing research into this area and examples of many successful local initiatives, At the end of the workshop delegates agreed key points from the day’s presentations and discussions. These were:

1. There should be equal opportunities for postgraduate education and training for GP principals and non-principals, including access to, and funding of, education;
2. There should be opportunities for career variation for GP principals and non-principals;
3. A database of non-principals is essential;
4. Inequalities with entitlement to superannuation and other rights of employment should be resolved;
5. The momentum for the improvement of educational provision for non-principals must be maintained.

The full report of all the presentations and discussions has been published as a supplement to Education for General Practice Volume 9 Number 1 February 1998 (ISSN 136-8523), available from good medical libraries.

The publication of the SCOPME report, and of the Birmingham workshop proceedings in the journal read by GP educationalists helps to maintain the momentum mentioned in point 5 above but non-principal groups and individuals have a responsibility to maintain the profile of this issue at local and national level. Equality of access and funding needs to be fought for! At the time the handbook went to press in March 1998 the CMO’s review of postgraduate education was still to be published - the delay of this is disappointing. The NASGP will, with its members support, endeavour to ensure the pressure is maintained and that non-principals’ education is not forgotten.

Somerset Locum Education Grants
In January 1997 Somerset Authority launched a pioneering scheme as a way of attracting locums into the county. The Health Authority's Director of Primary Care Support and Development, Mr John Haines, recognised the need for locums to keep up-to-date but at the same time, he recognised the inequity of locums having to pay for education and training out of their own pocket. The Somerset Locum Education Grant is simple and straightforward. It was developed in close collaboration with Dr Greg Carter, Chairman of the West Somerset non-principal group. Briefly the scheme is as follows:

• locums must register with the scheme;
• locums can submit grant applications quarterly, half yearly or annually;
• payments are made if the number of sessions worked that quarter reaches the pre-determined level;
• locums keep time sheets as proof of employment. The authority randomly audits these with practices;
• out of hours work can account for a maximum 25% of total sessions;
• locums undertaking four sessions on average each week will be eligible for up to £1200 annually;
• locums undertaking eight sessions on average each week will be eligible for up to £1800 annually;
• PGEA certificates are the only accepted proof of time spent in education.

West Midlands
The region appointed Dr Bitty Muller as Education Facilitator for GP Non-Principals in 1996. Dr Muller has helped local non-principal groups set up and has helped with identifying and meeting their educational needs. She has produced the region’s guide to the Doctor’s Retainer Scheme and has raised the standards for the benefit of all participating. Dr Muller and Professor Ruth Chambers arranged a national workshop called ‘Educating Non-Principals’ which brought together many of those involved in non-principal education and innovation across the country. The conclusions of this group were used by SCOPME (Standing Committee on Postgraduate Medical Education) to report to the Secretary of State.

In September 1997 Dr Muller and Professor Chambers launched an innovative returner scheme to enable 12 non-principals from eight health authority areas receive reimbursement of all educational expenses (including childcare) whilst attending a year long series of half day workshops that will cover personal reviews, portfolio learning and skills training. Such work should enable these doctors to increase their working commitment to general practice.

For further information contact Dr Bitty Muller. Telephone 01543 414311. Fax 01543 256364.

South Staffordshire
The health authority in South Staffordshire is piloting a similar scheme to the Somerset model. Non-principals who work an average of 4-10 sessions per week in South Staffordshire practices will be eligible for thirty hours of paid annual study leave of up to £1500. Doctors working an average 1-3 sessions will be eligible for up to twenty hours of study leave of up to £1000.

North Thames (East) Department of Postgraduate General Practice Education
In North Thames Dr Rebecca Viney was appointed as Non-Principal GP Tutor in 1996. She has set up a non-principal database in the area and helped local non-principal groups to set up. She is working closely with local health authorities to secure a supply of BNFs and money for postgraduate education. In June 1997 she produced a comprehensive information pack for local non-principals containing details on the local postgraduate education structure and a Who’s Who, a list of local postgraduate centres and their usual GP meeting times, information on Section 63 money, on local non- principal groups, on local co-ops and ways to get work, on superannuation, on accountants and on the local arrangements for the Doctors Retainer Scheme. A number of free (PGEA approved) study days have been held, (where necessary with crèche facilities) and a self-directed learning group has started.

For further information contact: Dr R. Viney on fax 0171 278 0772 or telephone 0171 692 3257 or post c/o GP Dept (North Thames East), Thames Postgraduate Medical and Dental Education, 33 Millman Street, London WC1N 3EJ.

CME Plus Website
This website contains all the addresses of postgraduate medical centres around the country and the GP tutors in post. For many centres a list of forthcoming events is given enabling individuals to look at local centres and select appropriate courses. You can even search for particular courses, e.g. on minor surgery, for extended courses, for journal articles, search an educational resources database and find lists of Postgraduate Centres in the UK, Vocational Training Schemes in the UK and links to other medical & educational resources on the Internet. It is possible to get details of your own meetings on the site and there are details on how to do this.

If you don’t have access to the Internet the local postgraduate centre should put you on their mailing list for free and enable you to get in touch with the local GP tutor. Some areas offer free or discounted attendance at GP meetings whilst others shamefully charge the same as principals. Local groups should challenge the postgraduate centres, the health authorities and the local Directors of Postgraduate GP Education to ensure non-principals needs are met.

London Implementation Zone Educational Initiatives (LIZEI)
LIZ, the London Implementation Zone and its accompanying Educational Initiatives were developed as a result of the Tomlinson review of health care provision in the capital ^{Note 1}. The aim was to develop primary care in London by providing educational incentives to encourage, recruit, refresh and retain LIZ GPs with educational initiatives.

LIZEI started in 1995 and will officially finish in March 1998 when the money runs out. Over 2000 GP principals, registrars, and newly qualified GPs have benefited from this unique injection of £30 million into general practice. Non-principals have benefited too, covering for principals on an as-required basis and in a few formal posts. It is hoped that some of the schemes tried under LIZEI will continue after March 1998 either as pilot schemes under the NHS (Primary Care) Act 1997 or in other ways.

London Academic Training Scheme Posts (LATS)
These posts resulted from a collaboration between university departments of General Practice and health authorities hoping to attract vocationally trained GPs to London to study teaching and research and to do clinical sessions in local practices. The clinical sessions enabled hard pressed GPs to have some help and free time for their own personal development. Inner city practices are a stark contrast from many established suburban training practices so the LATS post provided experience without commitment. The posts have been a huge success, in effect lengthening the period of vocational training and preparation for practice. Many of the doctors who have participated have stayed in London as principals and others have gone on to do more academic work. By April 1997 31 doctors had participated in the LATS posts.

Academic Assistants - see chapter on Assistants

The KCW GP Postgraduate Education and Support Scheme
In Kensington, Chelsea and Westminster, LIZ money has funded a scheme for recent graduates, new principals and doctors returning to general practice. The scheme is run by a course organiser for post-VTS non-principals. To date the scheme has established a database of non-principals, arranged away day conferences, produced a monthly newsletter, provided individual career counselling, set up a Balint group and arranged courses in computer skills. The contact for the scheme: telephone/fax 0171 594 3371.

LIZ Office 40 Eastbourne Terrace, London W2 3QR. Telephone 0171 725 5352.

After June 1998 copies of the LIZEI annual reports will be available from the Directorate of Education and Training, North Thames NHS Executive, 40 Eastbourne Terrace, London W2 3QR. There are further contact names and addresses in the reports. There are a number of other groups, for example, an educational support group for non-principals in Croydon and it is likely that these will continue after March 1998. Contact the addresses above for further information.

Note 1
Tomlinson B, report of the inquiry into London’s health service, medical education and research. HMSO 1992.