GP Supervisors Guide
Thank you for agreeing to support Foundation Programme Year 2 (F2) doctors in their Foundation Training. This is not intended to be definitive but a framework that you can build on and adapt to suit your circumstances. Every practice is different and will offer different learning opportunities for their Foundation doctor.
The content of the guide draws from a combination of the
- experiences of GPs who have trained F2s
- experiences of F2 doctors in GP
- experiences of NHS England South West teams
- national guidelines and directives
Becoming a Foundation Supervisor
GPs wishing to develop their educational career as a Foundation Supervisor must have MRCGP (or equivalent) and complete the Prospective Educational Supervisors Course (or equivalent). New trainers must be at least 18 months post-CCT and have worked in the practice for a minimum of 12 months, not necessarily as a GP Partner.
Many of you may already be experienced trainers of GP Registrars or Medical Students or have previously had F2 doctors, for others this is a very new undertaking, but we hope that everyone will find the Guide helpful.
CONTENTS
Supervised learning events (SLEs) and assessment
The Foundation Doctor in Practice
Appendix - Examples of procedures for DOPS assessment in GP
The Foundation Programme Doctor - Frequently asked questions
Who are the F2 doctors?
Doctors entering F1 are eligible for provisional registration. F2s are eligible for full registration upon successful completion of F1. As well as the 2-year Severn Foundation posts, we have several doctors in one year F2 posts. Some of this group may have not been through the first year of Foundation training in the UK but their general experience and skills are judged to be at an equivalent level.
The F2 doctors in General Practice will have a range of experience, skills and level of familiarity with the NHS and local area. Your assessment of their individual strengths and needs will be a vital part of ensuring that you and they get the most from their GP placement.
The Curriculum
A revised Curriculum has been introduced from August 2021.
The 2021 full curriculum is available from the UKFPO’s website at: https://foundationprogramme.nhs.uk/curriculum/
This website also has links to various Foundation Programme Guides which you may find useful.
It is important to remember that:
- the rotation in your practice is part of a programme
- the F2 will not cover all competencies during their time with you
- some competencies may well be more readily met in General Practice than in some other posts e.g. Relationships with Patients and Communications
- the doctor is aiming to achieve generic F2 competencies in their GP post, not training to be a GP
Supervised learning events (SLEs) and assessment
F2s are required to complete SLEs and formal assessments as evidence of their professional development. These are recorded on the e-portfolio. There are no longer prescribed minimum numbers of SLEs, but they remain the strongest form of evidence by which the F2 can demonstrate competency.
As a clinical supervisor, you will have your own Horus e-portfolio log-in and be able to access the F2’s portfolio directly. When your F2 asks you to complete an SLE or assessment, you can do so by selecting the appropriate assessment form from within their e-portfolio. Once you submit a completed form online it will be visible to the F2 from within their portfolio
TAB
The Team Assessment of Behaviour (TAB) is a multi-source feedback tool used to assess professional behaviour of an F2 by a variety of healthcare colleagues. They are completed by means of an e-ticket generated by the F2 – the individual responses cannot be seen by the F2 immediately, however the anonymised feedback is made available to the F2 once it has been released by the educational supervisor.
Placement Supervision Groups
We ask you to use a Placement Supervision Group (PSG), to inform your End of Placement report. The PSG is made up of trainers nominated at the start of each placement by the named clinical supervisor. The makeup of the Placement Supervision Group will vary depending on the placement, but in General Practice is most likely to include:
- Doctors more senior than F2, including at least one consultant or GP principal.
- Allied Health Professionals.
The Placement Supervision Group is responsible for:
- observing the foundation doctor’s performance in the workplace.
- providing feedback on practice to the foundation doctor.
- providing structured feedback to the named clinical supervisor.
- undertaking and facilitating supervised learning events (SLEs).
The Foundation Doctor in Practice
We have prepared information for F2s in GP. This gives them a general introduction to the post and advises them to contact you prior to starting, although not all will.
The Induction
This is really an orientation process so that the F2 can find their way around the practice, understand a bit about the area and population, learn about the resources and services to which your practice has access, meet doctors and staff, be introduced to your protocols, and know where to get a cup of coffee! F2s have highlighted that they need training on your computer systems in this early part of their placement. Induction also provides the opportunity for F2s to sit in with different GPs and for you and them to be confident about starting to see patients independently under supervision. This process will probably last about 1-2 weeks. It is also very helpful if you have an introduction pack for the F2, which you might develop over the year with input from the F2s themselves.
How should induction in GP be structured for the F2 doctor?
- Rotation dates are the first Wednesday of August, December and April. The foundation doctors will attend a Trust induction the week before the August rotation commences. 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 (e.g., pregnant women, neonates, elderly etc.)
- Computer systems and record keeping
- Timetable
- Tutorials and preparation
- Project work
- Debriefing after consultations
- Supervision and patient safety
- 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 call if they need help.
An induction week might look something like the timetable below, but this is only a guideline and should be adapted to suit your F2 and your practice.
| 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 GP 3-5 |
| Day 2 |
Treatment Room |
Chronic disease nurse clinic 11-1 |
Computer training 2-3 |
Surgery with another GP |
|
| Day 3 | District Nurses 9-12 |
Computer training 12-1 |
Local pharmacist 2-4 |
Surgery with another GP 4-5 |
|
| Day 4 | Health Visitors 9-11 |
Admin staff 11-12 |
Shadowing on call doctor 1-5 |
||
| Day 5 | Surgery and home visits with another doctor 9-12 |
Practice meeting 12-1 |
Computer training 2-3 |
Surgery with GP 3-5 |
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 F2)
- The Clinical Supervisor should have every third appointment of their surgery blocked so they review each case with the F2 doctor throughout the day.
Sitting in with other members of the team exposes the learner to different styles of communication and consultation and makes a considerable difference to the whole practice’s engagement with the F2.
The working and learning week
The working/learning week for a Foundation doctor is 40 hours, to be worked on Monday to Friday only. The F2 must not do out of hours work during their General Practice rotation as this affects their pay entitlement and are not funded for this, so please do not support such working arrangements. We do not encourage the use of Time off in Lieu (TOIL) but recognise that sometimes it is used in exceptional circumstances with the agreement of the F2. If the F2 has agreed to time off in lieu for any extra hours this time must be taken within the GP placement as it is not guaranteed that the next placement in the hospital will be able to accommodate it. Any leave/absence matters are an employment issue, and the practice should liaise with the postgraduate centre admin who will advise on individual trust policy.
Travel time from home to the practice may count as work time too if the time taken to travel to the practice is greater than their journey time from home to the base hospital. It may be reasonable to consider a 4 day working week if the travel time is significant. Travel expenses can be claimed by the F2 in line with the revised HEE Relocation policy detailed in the Excess Mileage Claims Section point 30 onwards.
Every experience that your Foundation doctor has should 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.
The table below is an indicator as to how you might plan the learning programme over a typical week with a doctor who is in your surgery on the standard 4-month rotation. The next section will look in more detail at each of these learning opportunities.
|
6 x Surgeries |
|
|
2 x sessions in other learning opportunities |
This could be:
|
|
1 x session on |
It may be possible for you to undertake a project or audit during your time in GP. As part of your Self Development Time, you may be able to do some research, collect the data, write up the project and present your work to the practice team |
| F2 teaching session | You can attend a teaching session from the regional teaching programme. You should book study leave in advance with sufficient notice to the practice to plan clinical work. |
Supervision
Initially, GPs should review all patients seen by the F2. This can then be tailored by agreement depending on the competency of the F2 and the complexity of the patients. Consultations should be checked at random by the supervisor to assess and monitor the practice of the F2 and the effectiveness of the supervisory arrangements. The GP and F2 should agree how the supervisor can be accessed during surgeries.
In the absence of the main named supervisor, for example during annual leave, a substitute named supervisor should be identified. F2s should never be left with only a locum or other senior trainee supervising.
We recommend that supervisors should have protected time during surgeries to review patients and provide support by
- 10 minute catch up slots between patients
- End of surgery reviews
F2s report that joint surgeries throughout the placement are an invaluable supervisory tool.
As a minimum, the F2 must have one hour’s observed clinical practice every two weeks.
A safe environment should be created for the F2 to feel they are able to give feedback to their supervisor and practice regarding their placement experience.
Tutorials
Tutorials are not an essential requirement but are valued by F2s and can be given either on a 1:1 basis or as part of a small group with other learners in the practice.
Any member of the practice team can be involved in giving a tutorial and the Foundation School would encourage this practice. Preparation for the tutorial can be by the teacher or the learner or a combination of both.
You can use the Curriculum to provide tutorial topics or respond to issues as they arise in practice.
Home Visits - Under Supervision
Home visits are not a requirement for an F2 but may be negotiated between the GP supervisor and F2. Some practices do not allow F2s to do home visits and some F2s do not want to do them. Both these positions are acceptable.
If F2s do home visits, the following are recommended:
- For at least the early part of the rotation, the F2 and supervisor should carry out joint home visits. The F2 should be supported to move from observing to taking the lead role.
- All home visit requests should be triaged by a member of the practice team so that F2s see appropriate patients only, anticipated as being well within their competence to manage.
- If the home visit includes a difficult or problematic patient, the F2 should be accompanied by the supervisor. F2s should not be exposed to unnecessary risks – (difficult patients or situations).
- F2 doctors must have a nominated supervisor to contact when they are out on home visits and to discuss the patients seen on their return.
- The supervisor should have protected time to review all the patients who have had a home visit with the F2.
- F2s should have their own doctors’ bag with all equipment required for the visit.
- The visits should contain a variety of cases.
- If the F2 doctor does not have their own transport, they could be accompanied by their supervisor or see patients within walking distance of the surgery.
- An F2 should not be pressurised to do visits or criticised if they don’t want to do visits. It would be good practice to explore the issues of why an F2 does not want to do visits and offer appropriate support.
Community Hospitals
Working in a Community Hospital is not a requirement of the programme but may be of benefit to the F2 if the opportunity is available. The following are recommended if the F2 is to work in the community hospital:
- F2s should have a nominated supervisor to whom they will have access whilst out of the practice.
- F2s should be encouraged to seek supervision and support from hospital staff.
- F2s should not be sent to the community hospital just because nobody else in the practice wants to go.
- Patients should be discussed before the F2 goes to the hospital (possible treatments etc).
- Supervisors should have protected time for F2 to feedback and discuss patients on their return.
- F2s need to be given the opportunity to say if they feel they are doing too many visits to the community hospital.
- Ward rounds can be useful for F2s – this will be dependent on the size of the hospital.
F2 Study Leave/Teaching
Each F2 doctor is entitled to 30 days’ study leave per year. The Trust Foundation Administrator will be able to advise you how much study leave the F2 in your practice has and the F2 themselves will learn from the Trust what this can be used for. Some study leave is used to attend F2 regional teaching programme and Tasters. The F2 is also entitled to 27 days’ annual leave and it’s worth establishing early on when the F2 would like to take a proportion of this during their placement with you. The school expects that leave should be distributed evenly across the training year. This is not always possible with Study Leave but should apply to Annual Leave.
It is the F2’s responsibility to ensure that they book the time out of practice with the appropriate period of notice given. An individual F2’s study leave is managed by the education team at the acute trust.
Depending on the time of year, your F2 may require time off for interviews. This time off should be agreed with you in advance and the F2 should also seek approval from the employing trust. Paid interview leave is usually granted by the trust, but the F2 should confirm these arrangements before taking any leave.
Self-Development Time (SDT)
All F2s are now entitled to an average of 2 hours per week Self Development Time (SDT).
The following are examples of the intended uses of SDT:
- Formal meetings with Educational Supervisor (ES) and named Clinical Supervisors (CS).
- Reflecting on their clinical practice and development needs.
- Use of the ePortfolio to record educational activities and development.
- Preparing and delivering teaching.
- Quality Improvement activity.
- Career exploration, decision making and applications.
Further information and guidance on SDT can be found can be found on both the NHS Employers website and the Health Education England website.
Your role as a supervisor
Throughout the year, Foundation Programme doctors will have an educational supervisor and a clinical supervisor. There is local variation between the Trusts in the arrangements, but the typical model is:
- An F2 doctor will have one educational supervisor, typically a hospital consultant, for the whole programme. They will have a different clinical supervisor for each of their three 4-month placements.
- You will be the clinical supervisor for every F2 that comes into post with you and are responsible for their overall day-to-day supervision. You will not have any on-going responsibility for an F2 once they have finished their placement with you.
- As a clinical supervisor in GP, you will need to start by discussing the F2’s learning to date in order to help them identify the learning needs they wish to address during the rotation with you. You should discuss the learning opportunities available in the practice. For the first F2 of the year, it is likely that you will need to complete a more thorough initial appraisal. We ask that all supervisors meet with their F2s for a review at least at the start and end of the placement. A mid-point review is encouraged, particularly if there are concerns.
The Clinical Supervisor must at least have completed the PESC course days 1-3 to be an F2 supervisor in their practice and be 18 months post CCT.
Continuing Professional Development: named Clinical Supervisors
Requirement for CS: 1.5 days within 5 years, as recommended by the GMC.
If the required CPD is not undertaken the supervisor will be advised of this and must undertake training to maintain their accreditation status.
If no CPD has been done after 5 years since initial accreditation, the Clinical Supervisor will have to repeat the full initial Clinical Supervisor training to enable re-accreditation.
They must also have completed relevant Equality & Diversity training within the last 3 years which must include reference to unconscious bias and differential attainment.
End of Placement Report
At the end of each rotation, you will be asked to complete a Clinical Supervisor’s report via the e-portfolio. This is your overall assessment of the doctor’s performance during the time they have spent with you. You should discuss the end of placement report with the F2 before they leave the practice. During the April to August rotation because of the timing of the ARCP process you will be asked to complete this report very early in the placement.
The clinical supervisor’s end of placement report should be informed by a Placement Supervision Group, which is made up of trainers nominated at the start of each placement by the named clinical supervisor. Their observations and feedback will inform the clinical supervisor’s end of placement report.
If there are any significant issues with respect to your F2, you will be made aware of them by the Foundation School or the trust. It would be good practice to contact the F2’s educational supervisor at the start/end of placement for any other handover information, although you can access educational supervisor meeting reports via the e-portfolio.
Further guidance on completing the end of placement report can found on the UKFPO website.
Performance Issues
The vast majority of F2 doctors will complete the programme without any major problems. However, some doctors may need more support than others for example ill-health, personal issues, learning needs or attitude to career. If you feel at any time that the doctor under your supervision has performance issues, you should contact the Foundation Programme Director in the Acute Trust who will work with you to ensure that the appropriate level of support is given both to you and the F2 doctor. Please select the F2's associated Trust for a contact list.
It is very important that you keep written records of the issues as they arise and that you document any discussions that you have with the F2 doctor regarding your concerns on their portfolio as an ‘other’ meeting. You should also document any concern in a letter to the Trust Foundation Programme Director (or, in their absence, Clare van Hamel, Head of Foundation School).
The Supervision Payment
The supervision payment of £3080 (2022 figure) is paid for each 4-month post.
- You can have more than one F2 at any one time if you have sufficient capacity in terms of space and resources.
Contacts
If you have any concerns, problems or good news about the foundation experience please contact the acute Trust who will be supporting you as a supervisor. Alternatively, please feel free to contact us at any time. The team at the Foundation School managing F2s in General Practice is:
| Head of Severn Foundation School |
Clare van Hamel |
| Foundation School Manager | Natalie Band natalie.band@nhs.net |
| Foundation School Administrator | england.sevfoundation.sw@nhs.net |
Appendix: Examples of procedures for DOPS assessment in GP
- Aspiration elbow bursa
- Aspiration of ganglion
- Cervical Smear
- Child development assessment, 3.5year check
- Cryosurgery
- Drainage and injection of olecranon bursitis
- Ear syringing
- ECG
- Female breast examination
- Flu vaccine
- IM Injection
- Injection of right trochanteric bursa
- Injection of trigger finger
- INR star finger prick
- Intra articular steroid injection
- IV Injection Fundoscopy
- Joint injection
- Local anaesthesia
- Minor op - removal on sebaceous cyst
- Minor surgery - excision of skin tags
- Minor surgery - removal of skin lesion
- Minor surgery and suturing
- Minor surgical procedure - curettage and cautery
- Pelvic examination
- Penile swabs
- Point of care testing INR and use of INR
- Removal of clips
- Shoulder injection
- Speculum examination
- Spirometry
- Steroid injection
- STI swabs - urethral, HVS and endocervical
- Suturing
- Swab taking
- Urethral catheterisation
The Foundation Programme Doctor - Frequently asked questions
What is a Foundation Programme Year 2 Doctor (F2)?
- F2 doctors will either have completed an F1 post in the UK training scheme or will have been recruited from outside the Foundation Programme. Those recruited through the UKFPO National Recruitment process from outside the Programme will have completed the equivalent of the F1 year and may have some experience at SHO level.
- F2s have 12 months’ clinical experience as a doctor in 3 posts. Very few F2s will have had previous experience in primary care.
- They are trust employees for the whole of their F2 year
- An F2 doctor will have full GMC registration.
How is an F2 doctor different from a GP registrar?
- The F2 doctor is fundamentally different from a GP Registrar as the F2 doctor is not learning to be a GP and will have less clinical experience.
- You are not trying to teach an F2 doctor the same things as a GP Registrar in a shorter time.
- The aim of this rotation is to give the F2 doctor a meaningful experience in General Practice, with exposure to the acutely and chronically ill patient in the community, which will enable them to achieve the required competencies.
- The F2 doctor will not attend the VTS half-day release sessions.
- The F2 doctors are not required to attend any weekly teaching in their home trust anymore – this has been replaced by Regional Teaching for which they must book Study Leave usually with 6 weeks’ notice.
Do Foundation Doctors need to be on the Performers’ List?
F2s in GP are exempt from being on the Performers List. Exemption is contingent on host Trust employment. At the start of the F2 year the Foundation School sends a list to the relevant PCTs, identifying the F2s that will be working in their area and asking them to notify the pharmacists that these doctors are eligible to prescribe.
What about medical defence cover?
NHS indemnity through the employing Trust will cover the GP period provided that the employment contract between the host Trust and the Foundation doctor specifies that the F2 will be undergoing a placement in general practice.
Can an F2 doctor sign prescriptions?
Yes. Doctors will have full registration when they start F2. Doctors with full registration can undertake unsupervised medical practice in the UK health service or private practice in the UK, although the GMC states that the first two years work following graduation have to take place in an approved practice setting.
What about their Contract of Employment?
- The Contract of Employment is held by one of the acute Trusts. They are responsible for paying salaries and other HR related issues, including pre-employment checks and payroll. The host Trust has an educational contract with NHS England South West.
- Each supervisor will have an Educational Contract with their F2 held in the e-portfolio.
What about Study Leave?
The F2 doctor is entitled to 30 days’ study leave during the year. The expectation of the Foundation school is that this leave will be taken proportionally across the full year as far as possible.
What are the F2 doctor’s hours of work?
- F2s in GPs are funded to work no more than 40 hours a week between Monday to Friday. It is very important that the hours of work are restricted in this way – otherwise there could be significant and unanticipated cost implications for the Trust.
- In some cases, the acute Trust may have arranged for the GP F2 to work some out of hours shifts in the hospital, but they are not funded by NHS England South West to work out of hours shifts in their GP post.
- We do not encourage the use of Time off in Lieu (TOIL) but recognise that sometimes it is used in exceptional circumstances with the agreement of the F2. If the F2 has agreed to time off in lieu of any extra hours, this time must be taken within the GP placement
- Travel time from the F2’s home to the GP Practice that is more than the time it normally takes to travel to the hospital base will count towards the F2’s working week. For example; journey from home to base hospital 30 mins, journey from home to GP Practice 60 mins. The extra 30 mins each way (total 60 mins per day) can be deducted from their 40 hour working week. F2s should discuss this with their supervisor and agree clinical working hours before commencing their GP post.
Why have F2 placements 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 doctor 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.