Tackling differential attainment in specialist GP training in England and Scotland.

In this article NHS England and NHS Education for Scotland describe practical ways we are tackling differences in the attainment of people training as general practitioners (GPs).Trainees from minority ethnic groups and international medical graduates are less likely than others to qualify as GPs. It is difficult to change systemic inequalities, but over the past five years we have made practical changes to GP speciality training. Educators recognise there is an issue and are trying to tackle it.For example, people who had not successfully qualified had an opportunity to return to GP training. When we provided individualised targeted support, the proportion who completed training significantly increased (76%).This was a catalyst for reviewing unconscious bias in GP training. We implemented a national programme to tackle differential attainment and system-level bias. Educators now work with all GP trainees to identify their individual needs. Supervisors are trained to recognise bias and provide targeted support. There is mental health support and regular reviews to see whether trainees are ready to sit exams. Trainee representatives are championing the learner voice in national committees. Exams are being altered to reduce unconscious bias. We are monitoring attainment over time.The key message is that differential attainment should not be in the 'too hard basket'. The narrative is changing from 'can't do' to 'must do', supported by appropriate leadership, promotion and resourcing. There is much more to do, but we are making changes, evaluating and applying our learning. We have moved from talking to taking action.

A survey of the retention of GPs following the induction and refresher scheme in London.

The NHS faces challenges in recruiting and retaining GPs. The NHS Long Term Plan aims to increase NHS staffing levels as one of its objectives. The Induction and Refresher (I&R) Scheme supports this aim by providing a safe induction or return to UK practice for GPs who are new to UK general practice or who have been away from it for 2 years or more.An evaluation of the I&R Scheme in London shows that 94% of all doctors who have been through the Scheme remain on the Medical Performers List with 82% of respondents continuing to work in UK general practice. The implication is that the Scheme is successful in its aim of retaining GPs in NHS practice. Additionally, most respondents found the Scheme to be of value, practically and emotionally in supporting their return to practice whether they were UK returners or if they were new to UK general practice.

How can medical schools create the general practice workforce? An international perspective.

This article was migrated. The article was marked as recommended. Medical schools are responsible for producing the future medical workforce that is fit for purpose to meet the needs of patients. The burden of care largely falls upon primary care, a specialty which has been under-doctored, under-resourced, culturally not valued, and whose status has been subordinate to secondary care. In addition, the demographic changes of increasing longevity and chronic diseases, have increased the demand for healthcare at a time when governments' finances are stretched more than ever. The poor state of recruitment to the primary care workforce is a global phenomenon as evidenced by similar issues in North America, UK and the Middle East including Turkey. This contradicts the fact that the strength of primary care has a direct effect on the health of the nation. This paper presents an international perspective of why primary care is important, the reasons why new graduates shy away from a career in primary care, and what steps medical schools, residency programmes and governments should undertake to encourage medical students to make primary care a preferred career choice.

Candidate feedback on the Induction and Refresher (I&R) scheme-simulated surgery.

The simulated surgery examination is one of the tripos of entry assessments for the Induction and Refresher (I&R) Scheme. It is used to assess the clinical and consulting skills of GPs prior to a period of supervised practice. The assessment involves observing candidates consulting with simulated patients played by role-players presenting standardised cases. Additionally, this assessment provides an 'educational prescription' for both passing and failing candidates as well as evidence of linguistic competency for overseas candidates. A feedback questionnaire is administered to candidates immediately after the examination, to seek their views and to evaluate their experience of the exam. Between July 2015 and July 2018, 401 candidates completed the examination and questionnaire. Quantitative and qualitative data has been collected and analysed with the findings reported in this paper. Overall candidates are satisfied with the examination, and regard it as a valid assessment of their GP consulting skills. However, there are still concerns regarding the I&R application process although there is evidence that there has been a trajectory of improvement over the past three years. Candidate feedback obtained has been used in an iterative manner to ensure quality control of the examination as well as for prompting improvements in the process.