NHS Education for Scotland
Enhanced Induction through Practice
Attachment Scheme
Enhanced Induction through Practice Attachment Scheme
Context
General practice has always attracted doctors whose preference is to have a portfolio career.
This allows a rounded professional experience to the benefit of patients but can also present
problems in assessing suitability of doctors wishing to join the Performer List as an independent
practitioner.
There is no single yardstick against which post CCT competency can be measured. Doctors have
been eligible to be included on the Performer List since 2006 by providing evidence of a
Certificate of Completion of Training (CCT), full registration with the GMC with a licence to
practice, inclusion on the GMC GP Register and two recent clinical references
For doctors whose training has been outside the UK, the GMC makes a judgment about whether
these doctors have equivalent training and should be included in the GP Specialty Register, and
therefore licenced to practice as a GP in the UK.
EU doctors need only supply evidence of equivalent training as detailed in EU Directive
2005/36/ec.
EUDirectiveProfQualifications
This has proved so problematic that a proposal to update this has been passed but will not come
into effect until 2014. The Performer List was not designed to assess doctors’ capability for
General Practice and relies on National Appraisal as a measure of skills and knowledge. One
problem is the timing of the two processes – a doctor can apply for and be included on the
Performer List well in advance of their annual appraisal. There have been a number of high
profile media cases elsewhere in Britain highlighting the problem of doctors ‘slipping through the
net’ of the system. There is therefore a need to provide some form of minimal standard for GPs
who fall outside the normal career pathway, in order to reassure patients as to the clinical
excellence and probity of their doctors.
There are four main groups of doctors who would benefit from this Enhanced Induction Scheme
and currently pose a challenge to those assessing their suitability for inclusion on the Performer
List. Normally these doctors would be identified at the time of application to the Performer List
For the purposes of this programme, GP Returners (GPs who have had a career break for more
than 2 years) are not considered, as arrangements for their support are already in place.
However funding is not always available and some of those who have been out of clinical practice
may be better served by enhanced induction. This scheme should be considered as being
between the training programme that would be relevant for a GPST3 year and the Returner
Scheme. The final outcome should be compared with the competencies of a GP Specialty
Trainee successfully completing a GPST programme and being signed off by the Educational
Supervisor as being competent for independent practice
The four groups who would benefit from this scheme are:
1. GPs who have worked exclusively in OOH services
2. EU/IMG Doctors who have a right to work as GPs in the UK (registered by the GMC with
a licence to practice and on the GP Register) but who have never worked within NHS
3. UK CCT doctors who have worked abroad for a period of time in a primary care or family
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Enhanced Induction through Practice Attachment Scheme
medicine post but are not eligible for the GP Returner scheme
4. GPs who have been off because of ill health, have been signed off by Occupational
Health as fit to return but are not eligible for GP Retainer or GP Returner Programmes.
Each group has differing learning needs and the induction programme would require some
flexibility to accommodate this.
Aims
The aims of the programme would be to:
1. Provide a supportive and clinically relevant educational environment
2. Provide a formative assessment
3. Provide a clinical reference in the form of an Educational Review Document,
supported by evidence, to those managing the Performer List
4. Identify doctors whose induction suggests that they require further
educational input beyond the remit of the programme and make suggestions
as to how these might be addressed,
Eligibility Criteria
To be eligible for the programme, the following criteria must be met:
1. Full registration with the GMC with a license to practice and inclusion on the GP Register
2. Medical Defence Organisation membership
3. Recommendation from a suitable sponsor/employer
4. Inclusion on local Performer Lists
Method
A scoping exercise will be undertaken of training practices to determine 3 or 4 that are
willing to take on induction of these doctors. These practices will be established training
practices with experienced trainers. Once recruitment is completed, a brief training
exercise for practices will need to be undertaken.
The candidate would enter the system having been assessed by the Performer List as
being conditionally eligible for inclusion.
The doctor will be matched with a suitable practice. The attachment will normally be for
three months full-time. If the doctor wishes to work part-time then the minimum that is
educationally sound would be 5 sessions per week. This must include a period of
induction to the practice and the NHS with clinical sessions designed to be appropriate to
the learner’s experience. The purpose of the post is to maximise experiential learning in a
supported environment.
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Enhanced Induction through Practice Attachment Scheme
Teaching and learning
The doctor will be supervised by a named Educational Supervisor (ES) who will have overarching
clinical and educational responsibility for the doctor. The ES will:

Arrange a thorough induction to the practice and the NHS, including any recent changes,
before the attached doctor embarks on the formal agreed timetable.

Facilitate a learning needs assessment using self-rating scale such as Lanarkshire
checklist LanarkChecklist. Learning needs will be discussed during the first mentoring
session with the ES and a plan designed to meet these needs

Tailor the weekly timetable to the learning needs of the doctor

Provide an educational contract in the first week for mutual signature modelled on the
timetable suggested below.

Send a copy of the timetable to the relevant NES Regional Associate Advisor responsible
for the programme (who will be happy to advise re content and suitability), for approval.

Provide weekly educational supervision meetings

Give regular formative feedback to the attached doctor with explicit documented
comments about progress

Advise about PDP & evidence required for appraisal and revalidation
Suggested weekly timetable
Day
Monday
Am
Surgery
Pm
Self directed learning to address areas identified as weak
in nPEP, and through educational needs assessment
Tuesday
Surgery
Surgery
Wednesday
Surgery
A face-face session with the ES
Thursday
Surgery
Surgery
Friday
Surgery
Planned educational session as suggested by ES e.g.
 combined surgery
 recorded surgery for submission to WoS
 appraisal preparation
 reflective log entries
 CDM Clinic with nurse

A session is defined as four hours

A ‘surgery’ is to include direct patient contact, telephone advice, on-call responsibilities,
home visits, and administration.

Initially each surgery will require close supervision appropriate to the experience,
competence and confidence of the attached doctor.
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Enhanced Induction through Practice Attachment Scheme

The consultation rate should be gradated so that by end of attachment, the doctor has
achieved the standard of an independent general practitioner with an average of 10
minute appointment to include documentation in line with other clinicians working in the
practice.

Combined surgeries to allow observation of an experienced practitioner’s behaviour is to
be used on a regular basis.

We would recommend a maximum of seven general surgeries per week but this should
be negotiated in line with the educational needs of the attached doctor.

The ES will be encouraged to contact the named GP Director, Assistant Director or
Associate Advisor (Deanery Contact) for any advice needed or with any concerns.

Out of Hours experience, if considered relevant by the ES, can be arranged during the
attachment through arrangement with the local OOH provider.
Assessment of the doctors would be made using similar tools to those used on the Scottish GP
Returner Programme and for MRCPG.
Minimum requirements

RCGP PEP which should be completed within first two weeks of attachment and if first
PEP score is below peer average, also at the end of the attachment to demonstrate
progression
RCGP.pep

Work place based assessments
o
o
o
at least four each of COT and CBD (paper versions completed by ES, calibrated
to same standard as for GP ST3)
one Patient Satisfaction Questionnaire (PSQ)
one Multi Source Feedback exercise (MSF)
PSQ and MSF can both be used towards appraisal and revalidation; it is thus in the
GP’s interests to complete these during a stable funded post. Details of all of these
requirements can be found on the RCGP website RCGPAppraisal and through the
Scottish Online Appraisal Resource SOAR

External Analysis of consultation skills reviewed through the West of Scotland peer
review system (minimum of four consultations to be submitted).
WoSPeerReview

Reflective educational diary to be shared with the ES (see appendix 1).
Outcomes of Attachment

The intention is that the Educational Supervisor will be in a position to provide an
evidence-based clinical reference to support the decision whether to recommend
unconditional inclusion on the local Performer List.
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Enhanced Induction through Practice Attachment Scheme

The possible recommendations will be as follows
i)
no concerns
ii)
needs further development
Review of progress
There will be a review of progress at the beginning, midpoint and end of attachment with a
summative conclusion being reached at the end of month 3, using the Educational Review
Document (see Appendix 2). This will be shared with the learner and should demonstrate
satisfactory and incremental progress throughout the programme, and continuing ability to reflect
and learn from the doctor’s own and colleagues’ practice.
The NES Regional Contact will make contact at the midpoint of the attachment to help with any
problems
1. The overall time allotted to the programme will not be extended.
2. A failure to progress in achieving the agreed objectives (reaching the standard of an
independent General Practitioner) may result in Performer List action.
3. If a failure to progress raises concerns in relation to patient safety or professional probity,
the ES may make a referral to the GMC.
4. If a failure to progress is related to sickness absence, it may be appropriate to defer the
plan’s completion date. The normal quota of annual leave may be taken during the period
of the action plan, but this must be pro-rata. Any period of sickness absence greater than
that covered by self-certification must be supported by a doctor’s certificate. A cumulative
absence due to illness of more than four weeks in six months will trigger a referral to the
Occupational Health Service unless seen as unnecessary in the opinion of the clinical
supervisor. Reasons for not making an OH referral will be given.
5. On completion of the programme, the ES will make an evidence-based summative
recommendation to the sponsor. This is not subject to appeal.
Pilot & Feedback/evaluation
The first attachments of this scheme will be as pilots, with surveys sent to the practice, the
doctor and the administrator of the Performers List to assess satisfaction. Follow up at 1 year
and 5 years will be undertaken to track the doctor’s career trajectory including posts held,
appraisal and NHS/GMC complaints.
Funding

The costs of assessments (which are RCGP PEP (if not RCGP member in good
standing) and externally validated video analysis), are the responsibility of the doctor.

Financial support of the doctor whilst on the programme is not a NES responsibility

The attachment will be agreed for a fixed period of time with explicit start and end dates.
Absence during this fixed period may result in a clinical reference that reflects failure to
complete the programme.
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Enhanced Induction through Practice Attachment Scheme
Appendix 1
Reflective Educational Diary
SPECIMEN
Date and activity
Learning points
Impact/change in
practice
What further do
I need to know?
01/01/2000
Directed reading
following consultation
with patient suffering
from Heart failure
-HF commonest cause of hospital
admission >65yrs
-Average age diagnosis 76yrs and
2/3rds have IHD
-NYHA system based on symptoms and
guides treatment not echo or Ix
findings. ( NYHA1-4 see page 8 re
treatments)
-Understand need for
referral for urgent
assessment
-Would now consider
classification as guide to
treatment
-High risk condition
with very poor prognosis
- Clarification on
lipid testing and
when to fast
- Confirm target of
BP treatment 140/90
in HF /IHD
Date and activity
Learning points
Impact/change in
practice
What further do
I need to know?
Add further rows as required
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Enhanced Induction through Practice Attachment Scheme
Workbook for enhanced Induction
Appendix 2
NHS EDUCATION SCOTLAND
EDUCATIONAL REVIEW
WORKBOOK
ENHANCED GP INDUCTION
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Enhanced Induction through Practice Attachment Scheme
Acknowledgement: to North Western Deanery Department of Postgraduate General
Practice and Dr Julian Page for developing the outline of this logbook.
Name of Doctor
Name of Trainer
(Educational
Supervisor)
Practice
Date of appointment
to programme
Duration of
programme
Full or part time
Summary of Review dates
Review Date:
April 2014
Completed by:
9
Enhanced Induction through Practice Attachment Scheme
1
1
2
Incomplete, inaccurate,
confusing history taking,
cannot get patient cooperation for examination,
technique poor
Date
History taking and examination
3
4
5
6
7
Clear history taking,
appreciates the importance
of clinical, psychological
and social factors,
performs adequate and
appropriate examinations
Score
2
Inappropriate, random,
unnecessary
investigations no thought
given. Often fails to
perform investigations
requested
Date
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9
Accomplished and concise
history taker; including
clinical,
Psychological and social
factors.
Skilled examination
technique
effective listener
Comments
2
1
8
3
Investigations
4
5
6
7
Investigates appropriately,
ensures all investigations
requested by the team are
completed, knows what to
do with abnormal results
Score
Comments
10
8
9
Arranges, completes and
acts on
investigations intelligently,
economically and diligently
Enhanced Induction through Practice Attachment Scheme
3
1
2
Poor, confusing records.
Inadequate, illegible
Date
1
2
9
Records his/her information
accurately and efficiently.
Easy
for others to follow
Problem solving/ making a diagnosis
3
4
5
6
7
8
Can make a sound
diagnosis, and produce
safe, appropriate
management plans.
Involves patients in
decision-making. Good
recognition of own limits
Score
9
Plus – shows intelligent
Interpretation of available
data
to form an effective
hypothesis,
understands the
importance
of probability in diagnosis
Comments
5
2
Manages health problems
separately, without
considering implications of
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Comments
Unable to make decisions,
or even make a working
diagnosis. Fails to involve
patients in decisionmaking. Unaware of own
limits
1
Clear records made in
notes, medico-legally
sound, others are able to
understand
Score
4
Date
3
Record Keeping
4
5
6
7
Multimorbidity and medical complexity
3
4
5
6
7
8
Simultaneously manages
both acute and chronic
health problems. Can
11
9
Accepts a key role in coordination and management
of acute and chronic
Enhanced Induction through Practice Attachment Scheme
multimorbidity. Maintains
positive approach to
patient’s health.
Date
tolerate uncertainty,
including that of the patient
where appropriate.
Communicates risk
effectively to patients.
Encourages patient
involvement in health
promotion and disease
prevention.
Score
Comments
6
1
2
3
Does not respond to
emergency calls, chaos
and panic in emergency
situations
Date
April 2014
Emergency care
4
5
6
7
Responds quickly to
emergency calls, works
well within team,
appropriate management
of situation
Score
8
9
Shows ability in evaluating
the
Emergency situation
calmly and
intelligently, establishes
priorities correctly,
organises
assistance and treatment
promptly.
Comments
7
1
problems. Anticipates and
uses strategies to manage
uncertainty. Co-ordinates
team-based approach to
health promotion,
prevention, cure, care and
palliation and rehabilitation.
2
Attitude to and relationship with patients
3
4
5
6
7
8
12
9
Enhanced Induction through Practice Attachment Scheme
Discourteous,
inconsiderate of patients
views, dignity & privacy.
Unable to reassure,
subject of repeated
complaints
Date
Score
1
2
Team working/relationship with colleagues
3
4
5
6
7
8
Unable/refuses to
communicate with
colleagues. Can’t work to
common goal, selfish,
inflexible
9
Able to bring together views
for a common goal. Team
goal is put
before personal agenda
Comments
2
Life long learning/ Involvement in Teaching
3
4
5
6
7
8
Does not see the need for
learning, does not learn
from mistakes. Fixed
April 2014
Listens to colleagues –
accepts the views of
others. Flexible – ability to
change in the face of valid
argument
Score
9
1
Excellent bedside manner,
able to anticipate patients
emotional and physical
needs and plans to
meet them. Explains
clearly and checks
understanding.
Comments
8
Date
Courteous & polite,
communicates well with
patients, shows
appropriate level of
emotional involvement in
the patient and family.
Respects privacy & dignity
Positive approach to
learning, participated in
teaching, learns from
13
9
Enthusiastic approach to
learning,
reports own errors
Enhanced Induction through Practice Attachment Scheme
blinkered approach, poor
attendance at teaching
sessions
Date
10
mistakes > 50%
attendance at teaching
sessions
Score
unhesitatingly and shows
ability to learn from the
experience, good
attendance
> 75%
Comments
Has a responsible and professional attitude and approach to their work, in the
following areas:
Manners
Dress code
Time management
Punctuality
1
2
3
Poor attitude/ approach in
above areas, possible
concerns Fails to make
care of patient first
concern, own beliefs
prejudice care, abuses
position as a doctor
Date
5
6
7
Reasonable attitude/
approach in above areas, a
good doctor
8
9
Excellent attitude/ approach
in above the areas, a credit
to the profession. Patient
care is the priority.
Comments
2
Poor comprehension of
even simple sentences,
unable to follow a
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Score
11
1
Ethics
Honesty
Trustworthy
Confidentiality
Verbal Communication – Understanding
3
4
5
6
7
8
Good comprehension of
English, can follow a
conversation, few
14
9
Can understand all that is
said,
can cope with “difficult”
Enhanced Induction through Practice Attachment Scheme
conversation, no understanding of medical
terminology and
abbreviations
Date
misunderstandings,
understands most medical
terminology and
abbreviations
Score
Comments
12
1
2
Verbal Communication – Being Understood
3
4
5
6
7
8
Such a difficult accent that
patients unable to
understand. Unable to
construct sentences.
Liable to be
misunderstood
Date
2
Cannot understand a
simple typed medical
letter. Frequent
misunderstandings
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9
Clear speech, little or no
accent, no
misunderstandings
Comments
13
Date
Has a good command of
spoken English, may have
some accent, can use
appropriate medical
terminology
Score
1
accents
Written Communication – Comprehension
3
4
5
6
7
8
Can read typed letters, can
mostly understand written
notes of others, may have
some difficulty with doctor’s
handwriting!
Score
Comments
15
9
Can easily comprehend
both
typed and hand written
text
Enhanced Induction through Practice Attachment Scheme
14
1
2
Written Communication – Being Understood
3
4
5
6
7
8
Cannot dictate or write a
simple letter, cannot make
suitable records that are
understandable. Misuses
medical terminology.
Illegible!
Date
Can dictate or write clear
letters, notes in records
understandable. Legible.
Uses appropriate medical
terminology.
Score
9
Good clear letters, able to
deliver
complex messages
Comments
15
Social Integration
For this section a score was felt to be inappropriate, a simple discussion on how the
Doctor and family are settling in to their new life (e.g. making friends, accommodation,
children’s schooling etc.) may be helpful.
Date
Comments
15
Integration with the National Health Service
1
2
No awareness of NHS
systems, unable to adapt
to new ways of working
Date
April 2014
3
4
5
6
7
Coping well with NHS
systems, can overcome
teething problems and is
learning the new ways of
working
Score
Comments
16
8
9
Working well within the
confines of the NHS, aware
and correct use of systems.
Good awareness of
professional etiquette
Enhanced Induction through Practice Attachment Scheme
Comments/ learning objectives after first review
Signed
Date
Comments/ learning objectives after second review
Signed
Date
Comments/ learning objectives after third review
Signed
Date
Comments/ learning objectives after fourth review
Signed
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Date
17
Enhanced Induction through Practice Attachment Scheme
Final Conclusion (please tick as appropriate)
No concerns
Needs further development in areas identified above
Signed
Director of Postgraduate GP Training
Name
Date
Or nominated deputy
Name
Date
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