Introduction

F2 Doctors

F2 Doctors and General Practice

Educational and Clinical Supervisors

F2 Doctors in General Practice:How to Organise Training

Working Week section

The Foundation Training e-portfolio

The Curriculum and Competencies – SLEs and Assessments

F2 Doctors and Employment:The Practicalities

Guidelines for Home Visiting in the GP F2 Attachment

Leave Entitlement for F2 Doctors

Trainee Support

 

Appendix 1: Annual Leave & Sickness Absence Record for F2 doctors in GP attachment 

Appendix 2: Honorary Contract

Appendix 3: Key Themes for F2s to learn in primary care

Appendix 4: A few learning areas suitable for tutorials

Appendix 5: Foundation Programme Contacts in the Severn Deanery

Appendix 6: Job Description

 

Introduction 

This Guide to Foundation Programme Supervision in General Practice is intended to be exactly that. Every practice is different and will offer different learning opportunities for their Foundation Doctor. This guide is not intended to be either definitive or prescriptive but a framework that you can build on and adapt to suit your circumstances.

The Programme is designed to train foundation doctors over a broad range of clinical scenarios and professional skills.

It emphasises the following:

  • The programme is trainee led 
  • Experience of the primary-secondary interface is important
  • There is a programme of assessment which the trainee organises
  • The trainee engages in Continuing Professional Development (CPD) and becomes familiar with the process of life-long learning in their professional life
  • The programme is organised by the Foundation School, and a network of Educational and Clinical Supervisors support the trainees’ activities and under-pin the Foundation Programme philosophy
  • Supervisors and trainees are trained in the use of the assessment tools and the Foundation Programme activities

Experience in general practice has been considered a training ideal for all doctors for many years. Now, 55% of all newly registered doctors have the opportunity to experience a 4-month placement in general practice.

F2 Doctors 

What are F2 doctors?

  • Doctors with full GMC registration in their second year of postgraduate medical education and training
  • They will have completed a pre-registration F1 year, and be undertaking an F2 programme rotating through three specialties
  • They are expected to undertake a clinical workload under supervision. 
  • They are not expected to do ‘out of hours’ in general practice
  • They are trust employees for the whole of their F2 year
  • F2 doctors will attend the generic foundation teaching programme organised by the Foundation Programme Director (FTPD), who is usually based in the acute trust.

How is an F2 doctor different from a GP speciality trainee?

  • The F2 doctor is NOT learning to be a GP
  • The aim of this rotation is to give the F2 doctor a meaningful experience in general practice with exposure to the patient in the community, as well as gaining an understanding of the interface between primary and secondary care.
  • Experience in general practice will contribute towards the F2 doctor achieving the competences required for the Foundation Programme.

Who decides which doctor will go to which practice?

  • Each F2 programme usually consists of 3 rotations. There are numerous combinations. 
  • The School of Primary Care identifies practices that are able to host the F2 placements. Foundation Programme Directors (FPDs) in Trusts are given the list of GPs who have agreed to be clinical supervisors and they link them to F2 programmes with a GP component.
  • Information about the names, contact details and programmes of a practice's F2 doctors should be provided by the local Foundation Programme administrator in the acute Trust.

F2 Doctors and General Practice 

Why have F2 attachments in primary care?

All doctors need to understand how the NHS works and the interface between primary and secondary care. Key themes in the curriculum for F2 doctors that are highly appropriate to general practice include:

  • The recognition and management of acute illness
  • Prescribing
  • Communication skills
  • Teamwork
  • Triage and problem solving
  • Impact of illness of everyday lives of patients and carers
  • Long term conditions
  • Understanding the interface between primary and secondary care
  • Management skills

It provides an opportunity for F2 doctors to experience general practice as a specialty, and helps to consolidate career choices.

The aim is to provide a tailored education programme for each F2 trainee developing the generic skills and competencies appropriately acquired and assessed in the context of general practice, allowing them to be further developed and perfected in the remainder of the Foundation Programme.

Educational and Clinical Supervisors 

Who can supervise F2 doctors?

  • GPs that are approved as either GP Trainers or GP Clinical Supervisors, in practices that have been approved for training by the Severn School of Primary Care.

 The GP F2 Supervisor's Role

Foundation Programme doctors will have an Education Supervisor and a Clinical Supervisor. They may or may not be the same person!

The Role Of The F2 Educational Supervisor

The Educational Supervisor is responsible for making sure a Foundation Doctor receives appropriate training and experience throughout the F2 year, and for deciding whether placements have been completed. They should help with the Foundation Doctor’s professional and personal development. 

  • This person will supervise the F2 doctor for 1 year and is responsible for the overall development of the programme through all three placements. This person will normally be based in the Acute Trust and not a GP because it is difficult for the F2 to access the General Practice after he/she has left. Only rarely will the Educational Supervisor be a GP.
  • The Educational Supervisor has regular meetings with the trainee and should be in contact with the Clinical Supervisor when the trainee is in post
  • The Educational Supervisor liaises with the Foundation Programme Director in the Trust. The Educational Supervisor will have completed an appropriate training programme 

The Role Of The Clinical Supervisor In General Practice

The Clinical Supervisor is the doctor supervising the F2 doctor's clinical work in the practice.

The supervisor will be able to: 

  • Organise the clinical attachment and be directly involved with the trainee in organising their assessments.
  • Supervise the clinical work of the F2 or arrange for this to be covered by a colleague.
  • Ensure that there is always appropriate cover available to the F2 doctor.
  • Enable the practice to facilitate the learning necessary to fulfil the objectives of the Foundation Programme.
  • Liaise with the trainee’s Educational supervisor regularly and promptly if any difficulties are emerging during the placement.
  • Sign relevant employment-related paperwork on behalf of the trust while the trainee is working in the practice.
  • Demonstrate that they have a level of competence in training and education and be able to apply this to the appraisal and development of an appropriate PDP for the trainee.

At the end of the rotation

At the end of the rotation GP F2 Clinical Supervisors are asked to complete a clinical supervisors report on the e-portfolio. This is an overall assessment of the doctor’s performance during the time they have spent with in the practice and helps the Educational Supervisor to ensure the trainee has performed to the required standard. This report is essential for sign off at the end of the year.

If there have been problems in the placement it is important that the GP F2 Clinical Supervisor passes the information on to inform the GP Foundation Lead in your area. The Lead will then liaise with the appropriate Foundation Programme Director.

F2 Doctors in General Practice: How to Organise Training 

This is really an orientation process so that the Foundation Doctor can find their way around the practice, understands a bit about the practice area, meets doctors and staff, learns how to use the computer and knows how to get a cup of coffee!

This is very similar to the induction programme used for GP Registrars but will probably last about a week. It should be planned for the first week of the 4-month practice placement.

It is also very helpful for the GP F2 to have an introduction pack, which again is similar to that which might be used for a locum or GP Registrar.

An induction week might look something like the timetable below, but this is only a guideline and should be adapted to suit the GP F2 and the practice.

Before the F2 doctor starts:

  • GP Supervisor contacts the F2 trainee, and provides them with an induction pack to the practice.

How should induction in GP be structured for the F2 doctor?

  • Rotation dates are the first Wednesday of August, December and April.  The trainees will attend a Trust induction on the first day of the August rotation.  This will incorporate the necessary mandatory yearly updates.
  • The GP Practice induction process should include a discussion of roles, responsibilities and expectations, a review of the F2 doctor’s portfolio, and agreeing a learning contract including learning objectives.

In discussing expectations, you may wish to cover the following areas:

  • Educational needs of F2 doctor- identified in previous placements, by self-assessment and by supervisor observation (e.g. sitting-in on consultations)
  • Confidentiality
  • Clinical emergencies and how to manage them
  • High risk groups (eg. pregnant women, neonates, elderly etc.)
  • Computer systems and record keeping
  • Timetable
  • Tutorials and preparation
  • Project work
  • Debriefing after consultations
  • Supervision and patient saftey
  • Home visits
  • Availability of clinical and educational support
  • Learning about and from the primary healthcare team
  • Planning ahead for assessments
  • Planning ahead for annual leave and study leave

It is generally helpful to summarise what has been agreed in short written notes at the end of the discussion.  This can be undertaken in the initial review meeting on the e-portfolio.  It is also necessary for the practice to sign an honorary educational contract with the F2 doctor to fulfil clinical governance processes with the practice.

  • During induction, the GP Supervisor should observe the doctor’s basic clinical skills and knowledge to make an assessment as to whether they can start seeing patients under indirect supervision. 
  • The doctor must have a named supervisor for every surgery.  It is better if this is not always the F2 trainer, and that others from the surgery are involved.  This can be a salaried GP but not a locum.
  • The GP Supervisor and F2 doctor need to discuss how to deal with problems.  The GP Supervisor should reinforce that they are willing for the F2 to knock on their door or phone if they need help.

A Typical F2 Induction Programme for Week 1

(Modified from “Simple guide for Foundation training in GP”, London Deanery)

Day 1

Meeting

doctors/ staff

9-10

Sitting in the

waiting room

10-11

Surgery & Home

visits with

 Trainer

11-1

Working on

Reception desk

2-3

Surgery with Trainer

3-6

Day 2

Treatment Room

9-11

Chronic Disease

Nurse  clinic 11- 1

Computer training

2-3

Surgery with another doctor

3-6

 

Day 3

District Nurses

9-12

Computer training

12-1

Local Pharmacist

2-4

Surgery with another trainer

 

Day 4

Health Visitors

9-11

Admin staff

11-12

Personal study/ Needs assessments

 

 

Day 5

Teaching session – Prescribing, reviewing results, referrals, and clinical Protocols 9 - 12

Practice meeting

12-1

Computer training

2-3

Surgery with trainer

3-6

 

First 1-2 weeks

  • The F2 doctor should sit in on surgeries with the GP so they can see how others consult and the variety of problems that come to general practice. 

Week 3 and 4

  • 1 appointment every 30 minutes for 2 weeks
  • The Clinical Supervisor should have every second appointment of their surgery blocked so they review each case with the F2 doctor throughout the day.

2nd, 3rd and 4th month

  • 1 appointment every 20 minutes  (depending on the ability of the trainee)
  • The Clinical Supervisor should have every third appointment of their surgery blocked so they review each case with the F2 doctor throughout the day.

What work can F2 doctors do?

  • F2 doctors should participate and be involved to the whole range of experience and learning opportunities within general practice.
  • An appropriate level of supervision must be available at all times to support the F2 doctor.

What should an F2 doctor’s typical weekly timetable contain?

Every experience that the Foundation Doctor has will be an opportunity for learning. It is sometimes difficult to get the balance right between learning by seeing patients in a formal surgery setting and learning through other opportunities. This is a suggestion as to how the learning programme over a typical week might be planned.

  • Morning surgery: followed by discussion patients seen with Supervisor.
  • Lunchtime: administrative work.
  • Early afternoon: clinical meetings, domiciliary visits, private study time.
  • Afternoon/early evening: surgery.
  • There will be a weekly tutorial lasting at least an hour.
  • There will be attendance at the generic F2 training programme.
  • This pattern varies from practice to practice. Practices may ask GP F2s to work the same pattern that most GPs do, ie with longer working days but time off in lieu.

The "traffic-light" system for supervision

The Severn GP/F2 leads have developed a "traffic-light" system. F2s that have just started in the practice need to be supervised at "red" level. When the GP Supervisor deems them competent enough, they can progress to the "amber" level of supervision. At some stage, they may be considered competent enough to have a "green" level of supervision.

  • Red: call supervising GP in to see each patient before they leave the surgery;
  • Amber: either speak to GP or call GP in for each patient before they leave the surgery;
  • Green: OK for patients to leave the surgery without having discussed with GP, but each case must be reviewed by GP at end of the clinic.
    • Obviously if at any stage there is clinical concern, every patient should wait to be seen by the supervising GP.

GP F2s can do home visits, and the traffic-light system is just as relevant for them as for surgery consultations.

Debriefing

A debrief should take place as soon as possible after a clinical event. Patient safety is paramount.  The focus of de-briefing for the F2 should also be progress/achievement as evidenced by, for example, mini-CEX assessment.  Reference should be made to the syllabus and competences as appropriate.  They should be used to aid action plans for learning in terms of knowledge and behaviours.

This can be done in various ways:

Ask Foundation Doctors to talk through the consultation.

  • How did you make your decisions?
  • What different decisions might you have made and why?

Ask the F2 about their own views as to strengths and points for improvement:

What were you happy with?

  • I liked…
  • What would you do differently next time?
  • What about… (suggested alternatives)?

Tell the F2 their strengths and points for improvement:

  • … was good/excellent
  • Maybe you need to improve or to consider…

Encourage reflection both personally and from the patient’s perspective. Consider how this can link into the F2's personal development plan and the syllabus.

  • How was that compared to last time?
  • What was different?
  • I am interested to know how you are getting on with…
  • I am getting worried that you may be… Is that a possibility do you think?
  • What other questions does this raise for you/the team?
  • So, what have we discussed?

What about planned teaching / training for F2 doctors?

Tutorials

  • There needs to be a weekly tutorial lasting at least an hour. However, the emphasis during the attachment is learning through seeing patients and discussing the cases with the supervising doctor providing de-briefing.
  • Tutorials can be given either on a 1:1 basis or as part of a small group with other learners.
  • Any member of the practice team can be involved in giving a tutorial.
  • Preparation for the tutorial can be by the supervisor, the learner or both.

Chronic Disease Management

  • Although the emphasis is on acute care it is also important for Foundation Doctors to realise how much ‘acute illness’ is due to poorly controlled chronic disease
  • The importance of exposure to chronic disease diagnosis and management should not be overlooked

Classroom taught sessions

  • In addition to the weekly timetable organised by the practice, the Foundation Programme Directors will also arrange generic teaching sessions specifically for F2 doctors.
  • Some of these days will be whilst the F2 doctor is in their rotation in the practice.
  • GP F2 doctors need to attend these sessions along with their colleagues in the hospital rotations. These sessions cover some of the generic skills such as communication, teamwork, time management, evidence-based medicine.
The Foundation Programme Director should provide the F2 doctor with a list of dates and venues at the start of the Foundation Programme and it is the F2 doctor’s responsibility to ensure that they book the time out of practice
  • In addition, the Deanery organises regional training days that the F2s are encouraged to attend. They are required to take study leave for these.  They can take up to 12 study days per year.

The working and learning week

Every experience that your Foundation Doctor has should be an opportunity for learning. It is sometimes difficult to get the right balance between learning by seeing patients in a formal surgery setting and learning through other opportunities.

The table below is an indicator as to how the learning programme over a typical week might be planned. The next section will look in more detail at each of these learning opportunities.

While the working/learning week for a Foundation Doctor is 10 four-hour sessions, practices may ask GP F2s to work the same pattern that most GPs do, ie with longer working days but time off in lieu.

The F2 is not expected to do out of hours work during their General Practice rotation.

Surgeries

Six or seven sessions of Surgeries and Home Visits per week

  • These will usually start at 30 minute appointments for each patient and then reduce to 15- 20 minute appointments as the Foundation Doctor develops their skills, knowledge and confidence.
  • The F2 doctor must have access to another doctor (not a locum doctor) but not necessarily the trainer in the practice
  • The F2 doctor does not need to have their own consulting room and can use different rooms so long as patient and doctor safety and privacy is not compromised

2 sessions in other learning

opportunities

This could be

  • 1:1 session with the trainer or other members of the practice team. (i.e. a Tutorial)
  • Small group work with other learners in the practice
  • Small group work with F2s from other practices
  • Shadowing or observing other health professionals or service providers e.g. outpatient clinics pertinent to primary care, palliative care teams, voluntary sector workers
  • The F2 will undertake a project or audit during their time in the practice. They should have protected time to do some research, collect the data, write up the project and present their work to the practice team

 

Working Week section

While the working week for a Foundation Doctor is nominally 10 four-hour sessions to make up the 40h week. Practices may ask GP F2s to work the same pattern that most GPs do, for instance with longer working days but time off in lieu.

The F2 is not expected to do out of hours work during their General Practice rotation.

 

6-7 sessions surgeries /home visits per week

  • These will usually start at 30-minute appointments for each patient and then reduce to 15- 20-minute appointments as the Foundation Doctor develops their skills, knowledge and confidence.
  • The F2 doctor must have constant access to supervising GP (not a locum) but not necessarily the trainer in the practice
  • The F2 doctor does not need to have their own consulting room and can use different rooms so long as patient and doctor safety and privacy is not compromised

2 sessions in other learning

opportunities per week

This could be

  • 1:1 session with the trainer or other members of the practice team i.e. a tutorial
  • Small group work with other learners in the practice
  • Small group work with F2s from other practices
  • Shadowing or observing other health professionals or service providers e.g. outpatient clinics pertinent to primary care, palliative care teams, voluntary sector workers
  • The F2 will undertake a project or audit during their time in the practice. They should have protected time to do some research, collect the data, write up the project and present their work to the practice team

 

 

 

The Foundation Training e-portfolio 

The Foundation Programme requires the trainee doctor to create a portfolio that provides information about their development throughout the two-year programme.  At the end of each year, the portfolio will be reviewed by the FTPD against a national checklist prior to F1 / F2 sign off.

Why bother with Portfolios?

  • The Foundation Programme publications lay out a clear structure for portfolios
  • They introduce junior doctors to some important concepts:
    • Planning a PDP and developing achievable learning objectives
    • Engaging in an appraisal cycle
    • Developing reflective writing skills

What is the GP F2 Supervisor's role?

  • They need to have an idea of what their F2's portfolios should contain
  • They should take an active interest in the F2’s work and check their portfolios regularly.
  • See the foundation websites guide to the e-Portfolio system and requirements.

What should the portfolio that F2s assemble look like?

  • The GP supervisor needs to request "clinical supervisor" access to the e-portfolio from the Foundation Administrator in the Trust. Teaching and instruction can be arranged at a mutually convenient time with the Foundation administrator in the Trust.
We advise that supervisors check the F2's portfolio before arrival in the practice, so that they are aware of the F2's learning needs well in advance.

Personal Development Plan        

  • Summary of learning objectives gathered through the year
  • Self-assessments carried out
  • Career management information

Summary of Meetings                    

Each 4 month post should generate:    

  • Initial meeting with CS; induction meeting with CS
  • Any update to PDP; educational agreement
  • Mid-point review with CS (optional)
  • CS final placement review

Reflective Writing                           

Strongly encouraged and each doctor is expected to provide several pieces of reflective writing. They have some templates that they can work from in their portfolio. 

The Curriculum and Competencies 

The defined competences for the Foundation Programme outline in broad terms what the doctor can be expected to offer as a professional upon completion of the programme. Set out below are the broad headings. 

This, and the assessments required during the GP placement are covered in more detail on the Seven Foundation Website, and on the National Foundation Programme Website.

Aims and objectives

  • To provide a tailored educational programme for each F2 trainee developing generic skills and competencies appropriately acquired and assesses in the context of general practice allowing them to be further developed and perfected in the remainder of the Foundation programme
  • Develop key skills and core competencies
    • Communication
    • Team work
    • Triage and problem solving
    • Clinical governance and risk management
    • Critical appraisal skills
    • Management skills
  • To develop an understanding of the primary and secondary care roles, responsibilities and understand how they interact
  • To provide F2 trainees with learning and experience in general practice to inform their future career choices for specialty training
  • To provide an enriched and enjoyable educational experience

It is important to remember

  • The rotation in the practice is part of a programme.
  • The Foundation Doctor will not cover all competences during his/her time in the practice.  It is intended that the Foundation Doctor will work through the curriculum during the 2-year Programme.
  • Some competences may well be more readily met in general practice than in some other rotations e.g. Relationships with Patients and Communication Skills.
  • The GP Supervisor and the F2 doctor should work together to identify the areas most appropriately covered in the Primary Care setting and in their unique Practice.

By the end of their four month GP placement F2 trainees will be developing to be able to:

  • Consult, visit and prescribe (under supervision) with surgeries of 6-8 patients at intervals of no less than 15 minutes per patient
  • They should have developed basic competence in consultation and communication skills
  • Manage simple problem solving and triage (of their own cases)
  • Be able to manage both acute and chronic illness in the community
  • Understand the care and referral pathways for the above
  • Have an evidence based framework for the management of common problems such as ‘tired all the time, headaches, back pain, breathlessness.’
  • Be able to develop a simple clinical or management protocol
  • Be able to perform a risk assessment in the context of clinical risk or risk in the workplace
  • Complete a significant event and clinical audit
  • Understand the roles and responsibilities and interact with the wider Primary Care team
  • Perform a simple management task e.g. draw up a staff rota, draft an agenda for a team meeting

Proposed outcomes of the GP placement

  • Work effectively within the Primary Health Care team understanding the roles of each member of the team
  • Have a working knowledge of the role of the GP and to be able to work under supervision in that role
  • To have worked at the primary/ secondary care interface in primary care and be able to identify good practice in referral and discharge of patients from hospital
  • To have undertaken supervised surgeries and identified management plans for the patients.
  • To have identified personal learning needs from the working in General Practice and to have an up-dated personal development plan.
  • To have completed a piece of work on a practice related topic.
  • To have seen and treated patients with illnesses in their own homes and to understand the management issues related to this.

If any trainee is failing to achieve expected progress, or there are concerns regarding clinical ability or professionalism the GP Supervisor needs to bring this to the attention of the trainees ES as soon as they are identified. The ES will then liaise with the Foundation Programme Director of the Acute Trust to determine the next steps.

F2 Doctors and Employment: The Practicalities 

Who holds their Contract of Employment?

  • The Contract of Employment is held by the host acute trusts, which is responsible for paying salaries and other HR related issues.

Does the F2 doctor need to be on the Performers List?

  • It is not necessary for the GP F2 doctor to be on the Performers List of a CCG because they remain employees of their host NHS trust who will have carried out the necessary pre-employment checks and they are considered to be fully supervised in their GP placements.

Does the practice need to organise medical indemnity cover?

  • The F2 doctor is an employee of the Trust and will be covered by the Trust indemnity scheme. They do not require further MDU/MPS cover however they should inform them when they're moving to their GP placement.

Can an F2 doctor sign prescriptions?

  • Yes. Unlike a GP F1, a GP F2 doctor is post-registration and is able to sign prescriptions.
  • The F2 should use their supervising GP’s FP10.

Should an F2 doctor do out-of-hours shifts?

  • F2 doctors are contracted to work a 40-hour week and are not expected to work out-of-hours shifts during their general practice posts.
  • The F2 timetable must be compliant with the European Working Time Regulations.
  • Some F2 doctors have asked to experience out of hours as a means of exposure to different types of acute illness. They may also be asked to work an extended day to match the practice hours.  This can be a useful learning opportunity but a level of supervision appropriate for F2 doctors must be available at all times.=

Guidelines for Home Visiting in the GP F2 Attachment

Can the F2 do home visits?

  • Whilst undertaking GP home visits is not an absolute requirement within the F2 curriculum, there is significant benefit to be gained in terms of education and training, particularly in the management of long term patients with chronic ill health.
  • Home visits must at all times remain the responsibility of the supervising GP trainer, and undertaken at their discretion with careful patient selection and appropriate debriefing following a visit.
  • Travel costs should be kept to minimum.

Guidance on home visiting for F2 Doctors in General Practice

Home visiting by general practitioners is an important feature of British general practice. Home visits represent 10% of contacts with general practitioners although the rate of home visiting has declined over the past 30 years.

The average annual home visiting rate is 30/100 patient years, with the majority in the elderly (300/100 over 85 years).

Home visiting provides an opportunity to gain experience in many of the Foundation competencies. It provides useful patient contact in the areas of respiratory disease, circulatory disease, infections musculoskeletal disease, and pain management.

The commonest diagnostic group is disease of the respiratory system. In the elderly, disease of the cardiovascular system is also a common diagnostic area.

These patient contacts provide useful material for case based discussion, or direct observation of procedural skills. They also allow the trainee to see the environment in which the prescribed care will be delivered.

What do F2s think about home visits?

A 2013 survey of Somerset GP F2s by Stephen Harris, Consultant in Anaesthesia & Intensive Care and F2 Programme Director at Musgrove Park Hospital, revealed the following:

  • Most F2s were very glad to have done home visits.
  • There was a direct correlation between their confidence levels and how long they had been at the practice.
  • Most trainees knew how to get help if needed on the visit.
  • However, most were unsure about what to expect on a visit, especially if early on in the placement.

GP Trainers need to take these factors into account when considering home visits for their F2s, and here we give advice as to how that should be done. Three areas need to be considered:

  • the clinical competence of the F2,
  • clinical supervision, and
  • the risk to the patient and the doctor.

Clinical Competence

All foundation doctors should gain competence by making home visits during their GP attachments. At first foundation doctor will accompany the GP Trainer on home visits, and will later be allowed to visit alone.

Some F2s are less happy about doing unaccompanied visits until they have more confidence in working in the primary care environment. Because of this, F2s and their Trainers need to discuss and agree when solo visits are appropriate - for some this will be in the first week, for others not until the end of the first month of the placement.

What about clinical supervision?

A GP trainer will only allow an F2 doctor to visit alone when the trainer is satisfied with her/his clinical competence. There needs to be careful selection of appropriate visits.

All visits must be assessed by the GP Trainer as being suitable and within the competence of the Foundation doctor. The doctor needs to be briefed before the visit and needs to know what is expected of him/her. There needs to be a debrief afterwards.

At all times the F2 needs to know who to contact for urgent advice and how to get help in an emergency. So, the Trainer or nominated deputy needs to be contactable by mobile or landline.

Is there a risk to the F2?

Visiting patients in their own homes by a lone doctor exposes that doctor to the potential - but very small - risk of injury due to a violent patient or relative, or of injury whilst travelling in the community. However, most violence against GPs occurs in the surgery rather than on home visit.

A number of factors increase the risk of home visits, including type of accommodation, locality, history of alcohol, drugs or violence. The Trainer needs to take these risk factors into account in deciding whether the visit is appropriate for the F2. If in doubt, the Trainer should accompany the F2 on the visit.

Recommendations:

  • All Foundation doctors should gain experience of home visiting during their GP attachment.
  • The number of home visits undertaken will normally be 1-2 a day.
  • The GP Trainer is responsible for assessing the suitability of the visit for an F2 in terms of clinical competence and personal safety. Only visits deemed to be "low risk" and within the doctor's competence are suitable for Foundation doctors.
  • The GP Trainer is responsible for making arrangements to brief before, provide clinical supervision during, and debrief after the visit.
  • The Foundation doctor needs to ensure that s/he has motor vehicle insurance that covers him/her for business purposes.  

Are F2 doctor’s travel costs reimbursed?

  • Eligible travel claims are reimbursed by the employer (the host trust).
  • Only additional actual costs are reimbursed. That is, the F2 doctor may claim for any cost of travel from their home to the practice in excess of the cost of their normal travel to the trust.
  • They may claim for expense incurred if they have to travel between the practice and their base trust during the working day (e.g. if they have to attend meetings or educational sessions).
  • They may also claim for any additional expense of travel associated with work (e.g. visits to patients but please try to minimise the cost of this travel to help trusts stay within budget).
  • They cannot claim for travel from home to work other than that in excess of the cost of their normal travel to the Trust.

Leave Entitlement for F2 Doctors 

What about annual/sick leave?

  • The F2 doctor is entitled to 27 days annual leave in the 12 months and this should be equally divided between the three posts.
  • Sick leave should be documented and all absences recorded and forwarded to the trust at the end of the attachment
  • The Foundation Programme Director (FPD) must be informed of sick leave beyond 2 weeks by both the GP F2 doctor and the supervisor.

What study leave are F2 doctors entitled to?

  • Normally no more than a third of the study leave should be taken in each four month rotation.
Study leave beyond the Trust programme will require approval through normal Trust channels from the Programme Director and may not be funded.  The F2 doctor should also discuss the request with the GP practice and provide at least six weeks notice.

For more information on study leave please see the Foundation School Study Leave Policy

Trainee Support 

  • The vast majority of F2 doctors will complete the programme without any problems.
  • However, a few doctors may need more support than others; for example ill-health, personal issues, learning needs or attitudinal problems. 
  • GP Supervisors who that feel their F2 needs additional support or has performance problems should contact the GP lead for their patch as well as the Foundation Training Programme Director of the host Trust. They will work to ensure that the right level of support is given both to the Supervisor and the F2.
  • It is very important to keep written records of any issues as they arise and that any discussions with the F2 doctor regarding concerns are documented. These records should be shared with the F2 doctor.

 


 

Appendix 1: Suggested Annual Leave & Sickness Absence Record for F2 doctors in GP attachment 

Name of F2 Doctor

 

Name of Practice

 

Name of Education Supervisor

 

Name of Clinical Supervisor

 

Start date in Practice

 

Finish date in Practice

 

Annual leave entitlement for August – August:   27 days
Annual leave entitlement for each attachment:   9 days

Dates booked

From

 

To

 

From

 

To

 

From

 

To

 

From

 

To

 

Sick leave

Dates

From

 

To

 

From

 

To

 

Other absence

Dates

From

 

To

 

From

 

To

 

 

Please fax this form to your local FP.

Appendix 2: Honorary Contract

Honorary Contract

Honorary contract between Foundation Programme Doctors in General Practice and their Primary Care Supervisors

 

This Agreement is made on ……………………………………………………………[date]

 

between …………………………………………………………………………………………

(Primary Care Clinical Supervisor)

 

and…………………………………………………………………………………………………

(Foundation Programme Doctor in General Practice)

 

The terms and conditions of this honorary contract are as follows:

  • All medical practitioners covered by this contract will be fully registered with the General Medical Council (GMC)
  • Primary Care Educational Supervisors will be so recognised by the Severn Deanery General Practice Directorate
  • This contract will cover that part of Postgraduate Medical Training, known as the Foundation Programme, and will regulate the General Practice component of that programme. It will form part of the supplementary regulations enabling that training period.
  • This document will act as a supplementary/honorary contract between the above parties. Their principal contract will be held by a host Acute Trust within the Deanery for the duration of the Foundation Programme.

 

General

  1. The Primary Care Educational Supervisor will supervise and organise the period of training within General Practice for the purpose of teaching and advising on all matters appertaining to general medical practice for a period of four months from ……………………… [date placement commences] unless this agreement is previously terminated under the provision of clause 2.
  2. This agreement may be terminated by either party by giving one month’s notice in writing. Such notice may be given at any time.
  3. Salary will be paid by the host trust at the agreed rates as determined by the DDRB.
  4. The Primary Care Educational Supervisor and the practice will be covered by recognised medical defence body at their own expense for the period of this agreement.  The Foundation Doctor will be covered by Crown Indemnity as they remain employed by their host trust. Many trainees will also – wisely – be independent members of a defence organisation, and they should inform them of the dates that they’re working in General Practice.
  5. The Foundation Doctor will not be required to perform duties which will result in the receipt by the practice of private income.
  6. Any specific or pecuniary legacy or gift of a specific chattel shall be the personal property of the Foundation Doctor.
  7. The hours worked by the Foundation Doctor in the practice, the practice programme and regular periods of tuition and assessment will be agreed between the Primary Care Educational Supervisor and the Foundation Doctor and make provision for any educational programme organised by Severn Deanery and as advised by Severn Deanery.
  8. The hours of work shall comply with the European Working Time Directive legislation, or any subsequent Working Time legislation.
  9. The Foundation Doctor is supernumerary to the usual work of the practice.
  10. The Foundation Doctor may be required to accompany their Primary Care Educational Supervisor or another member of the practice team on out of hours work.
  11. The Foundation Doctor should not be used as a substitute for a locum in any practice.
  12. Time spent in practice by the Foundation Doctor should be no more than the average time spent on practice work by a full-time member of the practice.
  13. The Foundation Doctor shall be entitled to 27 days holiday during a 12-month period and pro rata for shorter periods, and also statutory and general national holidays or days in lieu.
  14. The Foundation Doctor is entitled to approved study leave to attend Severn Deanery classroom taught sessions and any other educational activity considered appropriate by the Primary Care Educational Supervisor
  15. If the Foundation Doctor is absent due to sickness, they must inform the practice as early as possible on the first day of the sickness. Statutory documentation shall be provided as required for any illness lasting more than 7 days. Any accident or injury arising out of the Foundation Doctor’s employment in the practice must be reported to the Practice Manager, duty doctor in the practice or their Primary Care Educational Supervisor
  16. A Foundation Doctor in General Practice who is absent on maternity leave will comply with the terms of their Principal Contract.
  17. If a Foundation Doctor is chosen or elected to represent the profession, or Foundation Programme Doctors at any recognised body or to attend an Annual Conference of Representatives of Local Medical Committees, the Foundation Doctor in General Practice will be given facilities including special paid leave to undertake such functions and to attend appropriate meetings. The Foundation Doctor must obtain the consent of their Primary Care Educational Supervisor for such absence from duty, but consent shall not be withheld unless there are exceptional circumstances.
  18. The Primary Care Educational Supervisor will provide or organise any message taking facilities that will be required for the Foundation Doctor in General Practice to fulfil their duty requirements.
  19. The Primary Care Educational Supervisor will provide cover or arrange for suitably qualified cover to advise the Foundation Doctor at all times.
  20. The Foundation Doctor shall undertake to care for, be responsible for and if necessary replace and return any equipment that may have been supplied by the Practice or Primary Care Educational Supervisor at the end of the training period.
  21. The Foundation Doctor will apply himself/herself diligently to the educational programme and service commitments and other matter as directed by the Primary Care Educational Supervisor in accordance with the advice of the Severn Deanery Foundation Programme and its Directors.
  22. The Foundation Doctor will keep an educational log and records such that they may be able to develop a Professional Learning Plan. These records will enable them to fulfil any requirements of the General Medical Council for appraisal, or professional revalidation in their career.
  23. The Foundation Doctor shall keep proper records of attendances or visits by and to any patients in handwritten or electronic format as advised by their Primary Care Educational Supervisor.
  24. The Foundation Doctor shall preserve the confidentiality of the affairs of the Primary Care Educational Supervisor, of the partners in the practice, of the patients and all matters connected with the practice. The exception shall be where information may be required by the Director of GP Education of the Deanery or their nominated officer.
  25. The Foundation Doctor will make suitable provision for transporting themselves in order to carry out the above duties satisfactorily. Appropriate expenses may be reclaimed from the host Trust.
  26. Any dispute between the Foundation Doctor and the Primary Care Educational Supervisor should be brought to the attention of the Foundation Programme Director for General Practice. If the matter cannot be resolved at this level it will then proceed through the appropriate Deanery channels.
  27. The terms of this contract will be subject to the terms of service for doctors as set out from time to time in the National Health Service (General Medical and Pharmaceutical Services) Regulations.

 

I have read, understood and agree the terms of this honorary contract

Signature…………………………………………………………… [Foundation Programme Doctor]

Name…………………………………………………………………………………

Date….………………………………………………………………………………………

In the presence of………………………………………………………………………[Witness Name]

Signature……………………………………………………………………………………

Date…………………………………………………………………………………………

 

Signature……………………………………………………………………[Primary Care Clinical Supervisor]

Name…………………………………………………………………………………

Date…………………………………………………………………………………………

In the presence of ………………………………………………………………[Witness Name]

Signature……………………………………………………………………………………

Date…………………………………………………………………………………………


 

Appendix 3: Key Themes for learning

This list highlights those skills that are most appropriate for development in Primary Care for F2s.

Good Clinical Care

History, Examination & Record-keeping Skills         

  • Psychological / social factors
  • Family issues
  • Psychiatric Illness
  • Patients with special educational needs
  • Therapeutics               
  • Evidence-based prescribing
  • Common prescribing situations and issues
  • Records           
  • Communication between primary and secondary care

Time Management, risk management and decision making

  • Time management     
  • Team working skills
  • Risk management     
  • Epidemiology of clinical presentation within primary care
  • Decision making        
  • Involving patients in decision making process

Communication Skills

  • Within consultation
  • Breaking bad news
  • With colleagues   
  • Listening skills
  • Discharge information
  • Complaints; dealing with dissatisfied patients

Maintaining Good Medical Practice

Lifelong learning

Using learning opportunities

Personal learning plans

Evidence, Audits & Guidelines

 

EBM Principles, implementation and limitations
Audit

Principles, practical aspects

  Managing change
Guidelines Advantages and limitations

 

Maintaining Trust

Professional Behaviour and Probity

 

Dr-Pt relationship  
Continuity of care  
Working with others

Team-working
Communication between team member

 

Ethical & Legal Issues

 

Consent

Children’s rights and Gillick competency
Confirming patient’s understanding

Legal issues

Child protection
DVLA
Advance directives, living will

 

Patient Partnership & Health Promotion

 

Educating patients

Understanding natural history of common diseases
Negotiating treatment plans
Encouraging ownership & responsibility

Lifestyle factors Recognising risk factors
Advising on lifestyle changes
Involving other professionals

 

Appendix 4: A few learning areas suitable for tutorials

The list below is a suggestion for tutorial topics. It is by no means prescriptive or definitive.

Clinical Supervisors should agree a realistic programme early in the attachment to meet the needs of each individual F2 in GP.

  • Managing the practice patient record systems – electronic or paper
    • History taking and record keeping
    • Accessing information
    • Referrals and letter writing
    • Certification and completion of forms
  • General Practice Emergencies
    • The doctors’ bag (being prepared)
    • House visits
    • Physical, psychological and social aspects of acute care in GP
  • Primary Healthcare Team working
    • The doctor as part of the team
    • Who does what and why
    • The wider team
  • Clinical Governance and Audit
    • Who is responsible for what
    • What is the role of audit
    • What does a good audit look like
  • Primary and Secondary Care interface
    • Developing relationships
    • Understanding patient pathways
    • Care in the Community
  • Interagency working
    • Who else is involved in patient care
    • What is the role of the voluntary sector
    • Liaising with Social Services
  • Personal Management
    • Coping with stress
    • Dealing with Uncertainty
    • Time Management
  • Chronic Disease Management
  • The sick child in General Practice
  • Palliative Care
  • Social issues specific to your area which have an impact on health

 


 

Appendix 5: Foundation Programme Contacts in the Severn Deanery

Deanery Contacts

Foundation School Director

Dr. Clare Van Hamel

Clare.vanhamel@hee.nhs.uk

01454 252656

Foundation Programme Manager

Maisie Shrubsall

Maisie.Shrubsall@hee.nhs.uk

01454 252660

Foundation Programme Co-ordinator

Eloise Ambrose

 

eloise.ambrose@hee.nhs.uk

01454 252669

 

GP Associate Dean for Foundation Programme

Dr. Tom Pelly

Tom.Pelly@hee.nhs.uk

 

GP Foundation leads in Severn

 

Bristol and N. Somerset

Somerset

Gloucestershire

Bath

Swindon

 

Dr Pippa Stables

Dr Sue Neville

Dr Tom Agombar

Dr Becca Duffy

Dr Jess White

 

p.stables@mac.com

Sue.Neville@harleyhouse.nhs.uk

thomas.agombar@hee.nhs.uk

becca.duffy@hee.nhs.uk

jesswhite@nhs.net

 

 


 

Appendix 6: Job Description

Foundation Programme Year 2 placement in General Practice in the Severn Deanery

Job Description

Job Title:                  Foundation Doctor in General Practice

Reports To:              …………………………GP Clinical or Educational Supervisor

Location:                  …………………………  (name of practice, contact details including website and ES e-mail)

Hours:                     40 hours per week[1]

Contract Type:        full time

Background:           see below

Key Working 

relationships:          GP Clinical Supervisor or Educational Supervisor. Foundation Programme Director.

 

Background

There has been a strong feeling that exposing all new doctors to a placement in General Practice would enhance their generic and clinical skills for any future career. The GP placement introduces the doctor to General Practice and to a range of skills that are transferable to a career in any speciality. The 4-month placement will be based in a training practice or a practice that has a well-established educational background and is likely to fulfil the criteria for qualification as a training practice.

Job Purpose

The basic principles of the Foundation Programme form the focus of the timetable for this placement. These are an emphasis on work-based learning to develop clinical and professional skills, skills in acute medical care, understanding of the primary – secondary care interface and the development of personal life-long learning skills and continuing professional development.

Main Duties and Responsibilities

  • Induction to practice
  • Observed and supervised surgeries
  • Attendance at practice meetings
  • Individual study and preparation of case studies and written work
  • Joint study in tutorials with Clinical Supervisor and other members of the primary health care team
  • Joint surgeries with another GP
  • Communication and consultation skills development

 

The F2 doctor should maintain their portfolio and make regular entries as evidence of their learning.

 

Travel to the practice from the Trust base and travel related to work in the practice is reimbursed from the Acute Trust.

An Educational contract should be signed with the practice at the beginning of the placement

Example of timetable

The working week is 40 hours between 08.00 and 18.30. There is no funded work outside these hours. The place of work is   ………………………. [add name of practice]

There will be core training days which occur monthly and are covered by study leave. The practice will have their own programme of educational meetings and practice meetings that you will be expected to attend.


[1] No more than 40 hours per week are to be spent in the GP placement.  The employing Trust may offer up to 8 hours per week additional duties, back in the Trust, to remain compliant with European Working Time Directives but this will need to be negotiated and agreed outside this contract.