TRAINING PRACTICE CRITERIA A. The Trainer as Doctor 1. Professional Values

Teachers should be doctors committed to providing a high standard of care for their patients. They should believe in the importance of continuity of care, give a personal service and try to make it as comprehensive as possible. They should balance their own convenience against that of their patients and keep the interests of the wider community in mind. They should be of good repute and known for their integrity and have good relationships with their colleagues and staff. They should encourage patients’ self help and keep in balance their need to be needed. Their clinical decisions should reflect the true long-term interests of their patients. They should see themselves as providing a service to their practice population, sharing with others the responsibility for promoting, preserving and restoring the health of the individual patients. Teachers should not display racial or sexual prejudice either in their practices or their teaching. 2. Revalidation All teachers and teaching practices are expected to observe diligently and teach the professional guidance contained within the GMC publications Good Medical Practice and Maintaining Good Medical Practice. All teachers will be revalidated when required by the GMC. They will aspire to the excellent general practitioner as defined in Good Medical Practice for GP’s. They should be able to display a high standard of  clinical competence in their consultations, the long term care of patients, preventative medicine, prescribing, record keeping, auditing their own work and appropriate use of other members of the practice healthcare team and of colleagues in agencies outside. 3. Continuing Education Teachers should subject their work to critical self-scrutiny and peer review and accept a commitment to keep up-to-date, to improve their skills and widen their range of services in response to needs identified. They must fulfill the annual requirements for the postgraduate educational allowance. They should have and make available for inspection on the visit an educational personal development plan. B. The Practice General principles of good practice: The teaching practice should provide a high standard of care for its patients in order to provide an example for learners and to provide opportunities for learning. The practice will need to demonstrate in its application a commitment to performance review and development over time.  The primary care team is an essential part of general practice and working within it a vital part of the learning experience. The teaching practice must therefore be able to demonstrate an effective primary care team, including appropriate values, team working, staff appraisal and continuing professional development, patient involvement, quality improvement, records, registers, information technology, management, premises. Specific areas of good practice:  1. GMS Quality Outcomes Framework The practice will be one of the top practices in the PCT for QOF points (or PMS equivalent). The training practice application form will include reflection on the QOF score, highlighting strengths and areas for improvement, and plans for future development. 2. Performance Review, Quality Control and Evidence Based Decision Making General practitioners are required to audit their work as a means of performance review, quality control and evidence based decision making. It is important that registrars are fully aware of this process and the role it has in the management of change. The practice must have in place an active programme of audit, which demostrates the full audit cycle and the application of both standards and criteria. The practice will demonstrate the changes that have resulted from its audit programme and discuss the process of selection of areas for audit.   The training practice must be able to demonstrate that the audit process is being modelled and taught. The practice will have a practice development plan, and there will be evidence that audit is generated from need identified within the practice like significant event meetings. Where audit has been undertaken for the purpose of QoF the practice must be able to demonstrate the process of reflection leading (when appropriate) to change.   3. Medical Records The standard of medical records in a teaching practice should be sufficient to support a high standard of clinical care. Reliable information must be readily available to health carers. The purpose of this criterion is to look at the quality of summaries as well as the quantity. Notes must be accurately summarised including appropriate prioritisation of problems following a written practice protocol outlining the system for notes summarising and updates. Patient records should be 80% summarised and this should be demonstrated at the practice visit. Records of consultations must include a formulation of the clinical problem together with a management plan, which the registrar would have no problem following from the records. Because medical records contain confidential information the GMC has advised that practices inform patients that their records may be inspected by other doctors for the purposes of education and training and that they have the right to object if they wish to do so. This information may be provided in the form of a notice in the waiting room and in statements in practice brochures. C. The Teacher 1. Previous Experience A teacher must have at least two years experience in general practice. This can be either as a principal or salaried partner or assistant in a GMS or PMS practice. They should have a minimum four sessions per week regular commitment to the practice. They must be able to demonstrate (if not full time) that the teaching and arrangements for the learner are not compromised by their absence, and that the registrar has access to the breadth of teaching from all members of the primary healthcare team. 2. Preparation for Teaching A new trainer will be expected to have attended an approved course for new trainers. (Under exceptional circumstances, a new trainer will be able to demonstrate that they have equivalent experience to be able to teach and train. The demonstration of equivalent experience will be by the production of a portfolio outlining courses and experience that demonstrates the individual’s ability to train. This could include attendance at consultation skills courses, having already gained a certificate or higher degree in medical education and experience of teaching other members of the primary healthcare team or undergraduates. Portfolios will be reviewed by the selection committee who will advise if an individual needs to produce further evidence to fulfil the criteria). New trainers must have the MRCGP (either by examination or by assessment of performance). A Certificate of Medical Education (or equivalent) will be mandatory for all new trainers. All individuals are expected to be regular members of their local training group for at least 6 months prior to application. New trainers must be familiar with educational aims for vocational training and methods of teaching and assessment. A trainer should also be able to help the registrar prepare to sit the MRCGP Examination at the end of vocational training. Trainers will need to be able to demonstrate that they are able to teach and prepare the registrar for summative assessment and understands the criteria and components of both summative assessment and the MRCGP. 3. Continuing Commitment to Teaching Teachers will regard teaching and meeting the educational needs of their registrar/student as a major commitment. This will be reflected in time, enthusiasm, and the desire to develop as a professional teacher. They should be aware of new ideas and developments in general practice and with the main literature of general practice. By the end of their first two years approval they must have attended a course for the general development of their teaching skills which includes communication and consultation skills. Thereafter they must attend appropriate courses for teachers every three years. The teachers should demonstrate this commitment by ensuring that their personal development plan includes their own development as a teacher. 4. Contribution to the Local Scheme/Departmental teaching and Deanery/University Trainers must belong and contribute to the local trainers group. They should be willing to work with, to support  and be supported by colleagues in the development of teaching. Trainers should be prepared to assist and support the Course Organiser with the organisation of the scheme including help with the day release courses, and assessment of progress of SHO’s and GPR’s in training. After appointment, trainers will be required to become members of a visiting panel for re-approval of other trainers and their practices in the Deanery. They will be expected to have undertaken an assessment visit and will need to highlight that they have done so with their application. Such visits are a mandatory part of being a trainer and are a useful educational experience for all trainers. The trainers are also expected to take part in the Deanery recruitment and selection process for new GP Registrars. 5. Relationships Teachers should be able to develop and maintain an open, honest relationship with their registrar/student and generate enthusiasm and motivation in them. They should have the ability to understand their learner’s problems and to communicate with them. They should demonstrate ability for logical and critical thought and a willingness and ability to encourage the registrar/student to direct their own learning. 6. Assessment and Curriculum Planning The trainer must be familiar with the Oxford Deanery Priority Objectives of General Practice Vocational Training (RCGP Oct Paper 30). The trainer and registrar must jointly assess the registrar’s needs at the start of the programme and these needs must be regularly reassessed during the course of the attachment. These assessments must be guided by the trainer’s aims of what needs to be achieved by the end of the attachment and must cover appropriate aspects of knowledge, skills and attitudes. The trainer and registrar must negotiate appropriate educational goals and curriculum planning in the light of these regular assessments and the trainer will need to keep in mind both short and long term aims. These must reflect the increasing confidence and competence of the registrar as well as their personal growth. 7. Teaching Records   Records and logs must be kept by each trainer and each registrar so that it is possible to ensure that important aspects of training have been covered, that comprehensive assessments have been made and that curriculum plans are logically laid out. 8. Methods The teaching must be planned and prepared on a logical basis in relation to the educational goals. The teacher should encourage the registrar/student to direct his or her own learning and to develop self-awareness and critical thought. They should be able to use a variety of appropriate and effective teaching methods and be able to direct the learner to additional resources when required. The teacher will be expected to demonstrate to the visiting team that they practice student centred teaching and patient centred consultations. It is expected that this will be demonstrated by video evidence and in discussion at the assessment visit. Teachers should be able to direct learners to the use of additional resources especially those involving information technology. Other members of the partnership and the primary health care team will have important contributions to make.  D. The Registrar Experience 1. Practice Responsibilities The learner needs to be accepted and welcomed as a colleague in the practice. Effective workplace learning depends on legitimate participation in the work of the practice, members of the practice have a responsibility to make all learning opportunities available to the learner, and provide guided supervision for clinical care. The learner should benefit from the full potential range of the primary health care team. Attendance should be encouraged at primary health care team meetings, educational meetings, and partnership meetings. Registrars should have access to all aspects of practice management, including business finance and employment. All partners should be willing to accept the educational purpose of the learner's attachment and their own responsibilities as members of the teaching practice. They should also recognize the financial contribution that teaching makes to the practice and be willing to participate in and support the development of the practice for teaching. 2. Practice Premises, Equipment and Reference facilities The learning shluld be able to consult in a well-equipped room and it is desirable that they should have a consulting room of their own. The practice should ensure that the registrar/student is provided with adequate equipment to carry out consultations and home visits. Access to video cameras must be provided. Appropriate IT support should be available in the practice. This includes a computer with appropriate search facilities, internet and electronic reference access as well as facilities for private study. The practice must have an organised library that is accessible to all member of the team and the registrar/student. The library should contain adequate up-to-date reference books, books relevant to general practice and recent copies of the major journals relevant to general practice. 3. Induction Programme There should be an organised induction programme for learners joining the practice, during which time they have the opportunity to meet all members of the primary health care team, and appreciate the individual contributions of all members to the practice. The induction period should include training on the practice computer system.

4. Protected Time for Teaching and Learning The trainer and partners must make adequate time available for the provision of teaching and supervision within the practice and for other outside activities for the teacher. The trainer will require a minimum of four hours per week. The trainer will need time to attend the trainers’ group, trainers’ courses, take part in visits to other practices and scheme activities, and also time for his/her own educational activities. The trainer and partners will need to be accessible at all times to the registrar to provide guided supervision when required. The trainer must provide uninterrupted teaching time of at least two hours a week for teaching in normal working hours. This will normally be in one session and may be delegated usefully at times to partners and other members of the practice team. The learner will also require the opportunity for regular joint consultations and must be free to attend courses organised outside the practice. 5. Workload and Arrangements for seeing patients The list size and workload of the teaching practice should be large enough to offer the learner adequate clinical experience but not too large to prevent time being available for teaching and for attending courses by both trainer and learner. The practice needs to be able to offer a package of experience that would be regarded as normal everyday general practice not just specialist clinics. Workload should increase under guided supervision throughout the year to full participation in practice clinical responsibilities, always with the educational need of the registrar rather than the service need of the practice as the guiding principle.

The arrangements for the registrars to see patients should be planned to meet their educational needs. Learners need to have the opportunity both to have the time to study patients and their problems in depth and also to experience working at a similar rate to the partners in practice. This includes seeing a representative cross-section of patients including those with long-term problems, and opportunities to establish continuity of care for patients. Learners must not be seeing patients at times when they do not have the opportunity to obtain advice from a partner present in the practice. 6. GP Registrar Appraisal All doctors registered with the GMC, including those in training posts, must undergo annual appraisal. The GP trainer is expected to undertake a developmental appraisal of the GP registrar towards the end of the training year, with the specific focus of agreeing a personal developmental plan for independent practice. The GP trainer should send the completed Form 4 to the Deanery, who will officially inform the PCT at the end of the training year, that the appraisal has taken place and confirm the satisfactory completion of training for clinical governance purposes. 7. Out of Hours Work Training for Out of Hours remains part of the GP vocational training scheme. Registrars must have sufficient exposure to all aspects of out of hours care to prepare them for independent practice. The Committee of General Practice Educational Directors (COGPED) has developed a work-book for out of hours training, with specified out of hours competencies. Registrars are expected to work a minimum of 12 sessions in formal out of hours provision, in addition to the unscheduled care they will provide during the training year in the practice. Although the trainer may no longer have out of hours responsibility for patient care, it remains the trainer’s responsibility to arrange out of hours training with the local out of hours provider for the registrar. Clinical supervision approved by the Deanery is the responsibility of the out of hours provider, but the final certification of out of hours competency remains the responsibility of the GP trainer, based on the evidence of assessment within the practice over the year and the evidence recorded in the out of hours workbook.  8. Employment Arrangements The Registrar is an employee of the teaching practice and must be provided with a letter of employment or written contract. This contract must not contain conditions that restrict the registrar’s rights under the Statement of Fees and Allowances, or that interfere with their training. Oxford Deanery recommends the BMA model contract. Doctors in training must be appointed through Deanery selection processes, and matched to practices through local scheme arrangements approved by the local trainers' group. Practice managers should attempt to complete all paperwork for the relevant health authority at the earliest possible moment, the ensure inclusion of the doctor on the Performers' List and reimbursement of salary.