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Training fundamentals

 

 

 

General Medical Council (GMC)

 

The GMC is an independent organisation whose primary role is to protect patients, whilst supporting medical education and practice across the UK.

The GMC has five aspects to its role as laid out in law by the Medical Act 1983, which you can find out more about here. These five elements are:

1. Maintaining the medical register

2. Setting the standards for doctors

3. Overseeing medical education and training

4. Maintaining and improving standards through revalidation of doctors

5. Investigating and Acting upon concerns about doctors

For a doctor to practice medicine in the UK, they must be registered with a license to practice with the GMC. Anyone can check if a doctor is on the register and licensed to practice using the online list of registered medical practitioners.

The GMC make the decision as to which doctors qualify to have a license to work in the UK. It is not the purpose of this resource hub to describe the necessary steps needed to apply for GMC registration. You can find out more about this on the GMC website.

The GMC sets the standards that doctors are expected to adhere to in terms of their professional values, knowledge, skills and behaviours. The most important guidance for doctors to adhere to is the GMC’s ‘Good Medical Practice’ (more info below). The GMC also oversee medical education and training. They make sure doctors get the education and training they need to be able to deliver high-quality care throughout their careers. The GMC does this by setting standards for undergraduate and postgraduate medical education and then undertakes monitoring of these training environments.

The GMC help maintain and improve standards through revalidation (more details below). It is important that every doctor with a license to practice in the UK is keeping their skills and knowledge up to date. The GMC check this through making sure every doctor has an annual appraisal with an experienced senior doctor. Every 5 years doctors must go through revalidation with their appraiser making a recommendation to the GMC about whether they should be revalidated or not on the basis of the evidence provided by the doctor. Doctors in training do have to revalidate as all licensed doctors do. However, doctors in training undertake an Annual Review of Competence Progression and this meets the revalidation requirements (more info below), so by engaging with your training programme you should meet the revalidation requirements. You can find out more about this here.

If it is felt that a doctor’s practice is putting patient safety at risk or there are concerns that their fitness to practice is impaired or falls well below the standards outlined in the GMC’s guidance on ‘Good Medical Practice’, these concerns can be reported to the GMC and it is the GMC’s responsibility to investigate and take appropriate action. When a concern is reported to the GMC they will assess whether they need to investigate it. If it does need investigating, the GMC will collect and review evidence. At the end of their investigation they may issue advice or a warning to the doctor. They might agree with the doctor that they will restrict their practice, retrain or work under supervision. Sometimes cases need to be referred to the Medical  Practitioners Tribunal Service.

It may be of interest to note that all doctors must pay a fee to register with the GMC and then an annual retention fee to remain on the register. Details of how much you will be expected to pay can be found on the GMC website.

 

 

 

British Medical Association (BMA)

 

The BMA is an independent trade union and professional body for doctors and medical students in the UK.

Becoming a member of the BMA is not a mandatory requirement of working in the UK, however, there are recognised benefits of being a member. These benefits include:

• Ethics toolkits

• Getting expert advice on issues such as contracts, pay and pensions

• Legal advice on partnership agreements and practice mergers (in general practice)

• A free contract checking service

• Access to the BMA Library with a free UK postal loan service and online access to learning resources such as ebooks and journals.

• Expert financial advice

• Confidential counselling and guidance

• A free copy of The BMJ (online and/or in print) to keep up to date with the latest clinical research and information on professional development, careers and jobs.

• The BMA offers online and face-to-face learning courses, often free or at reduced cost to members.

You have to pay for membership of the BMA, but there are significant discounts available for those in their first year working in the UK, those earning below certain thresholds and those on parental leave.

 

 

 

Get to know Good UK Medical Practice

 

Good medical practice

The core guidance for all doctors working in the UK, regardless of stage of training or level of seniority, is Good Medical Practice (GMP). This is produced by the GMC. GMP requires doctors to maintain their knowledge and skills throughout their working life and to maintain and improve their performance. All doctors must be familiar with and follow GMP.

Good Medical Practice is available online, in PDF and hard copy; in English and Welsh.

Explanatory guidance that shows how the principles described in GMP apply in real life is also available online using the following link: https://www.gmc-uk.org/guidance/ethical_guidance.asp. Interactive learning materials, decision tools and a range of case scenarios relating to GMP can also be accessed at ‘Good Medical Practice in action’.

In order to gain insight into the level of your knowledge and understanding of how the GMP standards apply to your daily practice, we would recommend using the Welcome to UK Practice self-assessment tool. The results of this tool can be used as part of your continued learning and professional development and may also help you decide whether to attend further courses and workshops to improve any identified areas of weakness. If you are new to the UK, the GMC offers free ‘Welcome to UK practice’ workshops - see below.

Welcome to UK medical practice workshops

Starting work in a new and unfamiliar place can be extremely daunting and starting work in the UK will be no different. We recognise that there will be significant differences between the way medicine is practised here and the way it may have been practised in your home country. In order to help doctors who have moved to the UK to prepare, the GMC run a workshop called Welcome to UK Practice. This workshop provides a great opportunity to meet other doctors, ask questions and learn from real-life experiences of others who have moved to the UK. The session deals with the role of the GMC, experiences from senior UK doctors in video format, ethical scenarios on issues faced by doctors new to UK practice including consent, confidentiality, raising concerns in 0-18 care and prescribing and creating learning logs and reflections. The workshop is held in various locations and a place can be booked via the GMC website.

Full liList of workshops: https://www.gmc-uk.org/about/what-we-do-and-why/learning-and-support/workshops-for-doctors

National Institute for Health and Care Excellence (NICE)

NICE provides national guidance and advice to improve health and social care. They are a Non-Departmental Public Body and independent of the government.

NICE’s role is to improve outcomes for people using the NHS and other public health and social care services. They produce evidence-based guidance and advice for health, public health and social care practitioners. They also develop quality standards and performance metrics for those providing and commissioning health, public health and social care services.

NICE guidelines make evidence-based recommendations on a wide range of topics from preventing and managing specific conditions, improving health and managing medicines in different settings, to providing social care to adults and children. NICE is also responsible for providing NHS access to the British National Formulary (BNF) and British National Formulary for Children (BNFC), which are published jointly by the Royal Pharmaceutical Society and the British Medical Association (BMA).

British National Formulary (BNF)

The BNF aims to provide prescribers, pharmacists and other healthcare professionals with sound up-to-date information about the use of medicines. It includes key information on the selection, prescribing, dispensing and administration of medicines.

The BNF for children (BNFC) provides practical information on the use of medicines in children of all ages from birth to adolescence.

The BNF is found online, in book format or can be accessed via the BNF app available on google play or the app store.

General Medical Council

As mentioned above the GMC is an independent organisation whose primary role is to protect patients, whilst supporting medical education and practice across the UK. They have a key role in providing guidance on professional standards and medical ethics outlining values, knowledge, skills and behaviours expected of doctors working in the UK. All of their learning materials, professional guidance and resources for ethical topics can be found here.

Local guidance

It is important to note that although the national guidance referred to by NICE and BNF should be used to aid your decision making, each Trust will have local guidelines for the management of certain conditions and importantly local antibiotic protocols. Upon starting work, it would be prudent to seek out this guidance and become familiar with its content. It is typically stored on the local intranet and you will receive instruction upon induction to the Trust as to how you can access this.

 

General Dental Council (GDC)

The GDC is an independent organisation which regulates dentists and dental care professionals in the UK.

 

British National Formulary

The British National Formulary aims to provide prescribers, pharmacists and other healthcare professionals with sound up-to-date information about the use of medicines in the UK> it also includes information specifically for dental practitioners.  

 

 

 

Employment Contract

 

Throughout England there is a national contract specifically for doctors in training that governs their terms and conditions of service, including such areas as work rostering, salary and leave arrangements amongst others. You can find out more about this contract on the NHS  Employers’ website.  Generally, doctors in training are employed by the trust at which they are rotated to work at as part of their training programme. Some training programmes use a different ‘Lead Employer’ model, where doctors and dentists in training are employed by  one NHS trust, but move to different locations for their training programme. It is important to check which employment model you are on, as there can be some minor differences in policy and processes between the two models.

 

 

 

Medical Indemnity

 

As a doctor working in the UK, it is a legal requirement that you hold adequate and appropriate indemnity cover. The GMC has the power to check this.  The types of work a doctor undertakes will affect what indemnity cover they will need. There is some government backed indemnity cover for many healthcare organisations, but generally this will not provide regulatory support and medico-legal advice to individual doctors. Thus, it is important to take out your own individual insurance or indemnity cover.

It is important to review the indemnity requirements for your area of practice and level of training. There are differing arrangements in primary and secondary care and for locum or private work. You can find out more about the different requirements here.

Medical Defence Organisations (MDOs) are non-profit making organisations that provide members with 24-hour access to advice and assistance on medico-legal issues arising from clinical practice which fall outside the scope of indemnity provided by NHS bodies. There are 3 major MDOs operating in the UK: Medical Defence Union (MDU), Medical Protection Society  (MPS) and Medical and Dental Defence Union of Scotland (MDDUS). They also provide educational resources and publications on medico-legal issues that arise for doctors in practice. There are also other smaller or specialised insurance companies for medical insurance.

Each MDO offers different membership benefits and therefore it is important to consider each one carefully before deciding which is right for you.

 

 

 

Key Figures in your training

 

Educational Supervisor and Clinical Supervsisor

As a doctor in training you will be allocated a clinical supervisor for each post, who is usually a consultant working in the same department as you and can provide supervision for the clinical work you undertake in your role. You will also be assigned an educational supervisor, who will help you develop a personal development plan and will monitor your education and professional development in training. Sometimes these posts may be held by the same person. You may keep the same educational supervisor for some time throughout your training programme or even for the whole of your training programme. You can find out more about the role of clinical and educational supervisors here.

You will be expected to have regular discussions with your supervisors regarding your progress and outstanding learning needs. The discussions should also include summarising and reflecting on strengths and weaknesses, and significant achievements or difficulties, which will usually encompass information on significant events, and complaints and compliments.

Training Programme Director (TPD)

This is a senior consultant or GP who works for NHS England in overseeing training for a specialty in a region. They report to a region’s ‘Head of School’ who will be the doctor in charge of specialty training for that specialty within the East Midlands. The exact roles and responsibilities of TPDs will vary depending on the specialty school they sit within.

Director of Medical Education (DME)/Clinical Tutor

This will normally be a consultant within a hospital or NHS trust who is responsible for overseeing the delivery of medical education in the trust. This may be both undergraduate and postgraduate or solely postgraduate medical education.

Education Lead/College Tutor

This is usually a person within a specialty at a particular trust or hospital site who leads on overseeing education and training within that particular department.

Royal Colleges

There are a number of royal colleges and faculties that form the Academy of Medical Royal Colleges. Each Royal College or faculty represents a specialty (some specialties e.g. surgeons and physicians may have more than one college each) and the AoMRC brings these organisations together. It is Royal Colleges and faculties who set postgraduate exams for doctors in training.

NHS England

NHS England (formerly Health Education England) supports the delivery of excellent healthcare and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place. See: https://www.england.nhs.uk/

 

 

Eportfolio and Assessments and Revalidation

 

 

 

 

ePortfolio

As a doctor in training, whichever training programme you are on, you will be required to complete a portfolio. The portfolio is typically an electronic portfolio (eportfolio). You will be provided with a username and password by either the UK Foundation Programme Office (UKFPO) for Foundation training or the Royal College to which your training programme is aligned for Core and Higher Specialty training.

Every specialty will have a slightly different e-portfolio affording to the differing curriculum requirements of each training programme.

Foundation Training – doctors completing Foundation training will be expected to complete the Horus ePortfolio. Further explanation and guidance surrounding the use of this e-portfolio should be provided in the Trust induction. You can also find out more about Horus by reading the Horus Frequently Asked Questions Website.

Specialty and GP Training – every specialty has its own e-portfolio that is expected to be completed by their trainees. These eportfolios are usually run by the Royal college(s) aligned to your specialty training programme and you will need to be a member of the relevant royal college to be provided with access to the relevant eportfolio. You will usually receive further explanation and guidance about how to use the relevant eportfolio when you receive induction to your training programme. There will also usually be further guidance on the website of the relevant royal college(s) about eportfolio use. You may also need to keep an electronic logbook to record procedures and you should receive information about that from your training programme.

Non-training or Trust doctors – doctors who are not on a training programme do not have access to a specific e-portfolio. Many royal colleges have a membership option for non-training doctors that can include eportfolio access, but this is not always the case, so it is worth exploring with the relevant royal college. However, the British Medical Journal (BMJ) has the BMJ Portfolio, which is a free, online portfolio tool that can be helpful for planning and recording continuing medical education. There are also several online and app-based free or low-cost logbooks you can also use if you want to record procedures undertaken.

Assessments

As part of your training, you will be expected to complete a minimum number and variety of assessments. These include: workplace-based assessments (WPBAs), case-based discussions (CBDs), mini clinical examinations/encounters (mini-CEXs) and direct observation of procedures (DOPs) amongst others assessments defined for your training programme. Details of these assessments should be given at the induction to your training programme and can be found on your relevant e-portfolio or associated royal college/training programme website. If you encounter any difficulty completing these assessments, it advised that you contact your clinical and/or educational supervisor in the first instance. You will likely have guidance from the UKFPO or Royal College about how many assessments of the different types you need to complete and when these need to be done by.

Annual Review of Competence Progression (ARCP)

Whilst in a training programme you will have an Annual Review of Competence Progression (ARCP) (this is similar to the appraisal process for non-training doctors). You can find out more about ARCP here. The ARCP process is the means by which doctors in training are reviewed each year to ensure that they are offering safe, quality patient care, and to assess their progression against standards set down in the curriculum for their training programme.It is also the process through which their full scope of work review is undertaken to satisfy revalidation requirements.

Doctors who have completed their training must participate in an annual appraisal and use supporting evidence to demonstrate their ongoing fitness to practice, irrespective of specialty or branch of medicine. It is a key opportunity to focus on professional development needs. The process involves a facilitated self-review supported by information gathered from the full scope of the doctor’s work. It is an important source for agreeing and monitoring personal development objectives.

The Good medical practice framework for appraisal and revalidation sets out the broad areas that all doctors are expected to address and the responsibilities of both doctors and employers in the process. During their appraisals, doctors will discuss their practice and performance with their appraiser and use supporting information to demonstrate that they are continuing to meet the principles and values set out in Good medical practice.

Revalidation

This is the process by which doctors are required to demonstrate on a regular basis that they are up to date and fit to practise in their chosen field and able to provide a good level of care. It provides doctors with the support to maintain and develop their practice throughout their career and ensures that they have the opportunity to reflect regularly on how change and improvements can be made to their practice. Doctors in training revalidate through the Annual Review of Competence Progression (ARCP). A recommendation for revalidation will be made to the GMC on behalf of the doctor in training by the Responsible Officer connected to their designated body. Your Responsible Officer will be in the organisation that is supporting you with revalidation. This organisation is called your designated body. If you are a trainee in England, your designated body is your Local Education and Training Board (LETB). As a trainee in the East Midlands, your designated body is NHS England (NHSE East Midlands). As a doctor in training, you will be generating the supporting information required for revalidation by meeting the requirements of your curriculum and training programme. You will also be in regular discussion about your progress and any outstanding learning needs with your supervisors. Completion of the above will mean that you are ready for revalidation by ARCP. Further information about the ARCP process can be found on the GMC website.

 

 

 

Study Leave

 

Study leave policy and guidance:https://eastmidlandsdeanery.nhs.uk/policies/Study_Leave

As a doctor in training you will be entitled to study leave and to claim study leave expenses to attend courses and events relevant to your learning. There may also be the opportunity to use study leave for personal study. There are some differences in study leave availability for Foundation doctors, but within core and specialty training you will be able to take leave to attend courses and events relevant to your training and that enable you to meet your personal development plan. You can also claim expenses for the cost of the course and any associated travel/accommodation costs. You need to check who you need to claim study leave expenses through as it may vary depending on your employer model. Also, aspirational and international study leave requests need to be approved via NHS England. 

It is best practice when requesting study leave to plan early so you can get the leave and costs approved in advance (retrospective requests are usually refused). You also need to plan the leave in conjunction with your rota and let your rota coordinator know. It is also courteous to plan leave in conjunction with colleagues. There may be instances where many colleagues want to attend the same educational event and it may not be possible for all to go or attendance may need to be split and shared.