COVID-19 -  School of Primary Care Update

This page is designed to keep all parties updated on current developments in GP Training in the east of England, related to the outbreak of COVID-19.

This is likely to evolve over the next few weeks and we will update this information when necessary.

Please find the recently published Contingency Plan, 'New Updates' section and the FAQs below.  

Please do check the 'New Updates' section for details on 'RCGP Examinations' 

For further information please visit the HEE national website

For professional support and wellbeing please visit the PSW webpage or email covid19-psw.eoe@hee.nhs.uk

Janet Rutherford 

Head of School for General Practice 

Contingency Plan

Please click here to view the latest version the COVID-19 Contingency Plan, for the School of Primary Care. 

NEW UPDATES - Updated 27/03/2020

This area will contain update information, as updates are made. 

RCGP updates on exams and ARCPs - Posted 27/03/2020

  • Please click here some FAQs the college has put in place with the latest update on the AKT, CSA and WPBA.
  • Please note that these FAQs mention an online BLS will be acceptable as long as the evidence is attached to your Eportfolio and you complete a face to face BLS as soon as possible
  • During this period, we will be concentrating on doing ARCPs for trainees who are due to qualify. These will all be done on a virtual basis centrally and you will either be notified by email afterwards or there might be a telephone discussion. This will depend upon your outcome.
  • Please do continue to add whatever evidence you are able to and ensure that you have an ESR of some nature completed on your Eportfolio prior to your ARCP as well as your Form R. It would be helpful to annotate your ESR as having been done during Covid-19.
  • Here the RCGP updates webpage

We appreciate that there are potentially 2 groups of trainees here. Those who have already taken and passed both exams and those whose exam attempt has been cancelled as a result of Covid-19. We will be able to proceed with a normal ARCP for the first group. We are still awaiting national advice on how to manage the second group. We are also awaiting advice on the specifics about the degree of flexibility around WPBA requirements during this period

Educational update - Posted 24/03/2020

I want to share with you some national guidance on educational time for trainees. The guidance is that in the current unprecedented situation it has been recognised that there will be times when educational and training time is not available because of clinical pressure. This will affect trainees in hospital and in General Practice placements. In General practice placements where the work plan is for 28 hours of clinical time and 12 hours of educational time there is guidance that we need to drop educational time to allow focus on clinical pressures. It will still be essential for trainees to have clinical support and debriefs.

 

We recognise how important support and contact with colleagues is to help us manage the challenges we face. Many programmes have set up methods of communication via WhatsApp groups and other approaches, and we would want them to continue. Some programmes have been delivering remote teaching sessions with some excellent resources and links and various approaches to facilitating virtual group discussion. Where clinical commitments allow, we hope these will continue, and resources will be available to use at other times. I realise that clinicians at all levels are under pressure - it may be that colleagues who are self-isolating could provide virtual support to one or several trainees either as debriefs or short tutorials. Educators are looking at ways to provide support to individual trainees where that would help.

There is national acknowledgement that time lost to training will be reviewed after the current crisis and we will work together to address these changes in the recovery period.

We are so grateful for the work you are all doing.

In these unprecedented times HEE has taken the decision to suspend all education events to ensure sufficient clinicians at the front line.  This has already been announced and more details can be found on our website https://www.hee.nhs.uk/coronavirus-covid-19 .

We would expect trainees to have supervision and support including opportunities for debriefs to support their wellbeing and safe care but recognise that novel solutions may be required. This may by Teams or Skype whilst isolated. 

The 12 hours of education per week are suspended pro term.  We will work together to address these changes in the recovery phase.

All these hours will be reduced pro rata for LTFT trainees.

National work is going on in other matters such as WPBA and I will share more detail as soon as I can.

 

Message from Prof Simon Gregory, Deputy Medical Director, Primary and Integrated Care, Health Education England

Please can I ask that you communicate again to all GP trainees and educators that in these unprecedented times HEE has taken the decision to suspend all education events to ensure sufficient clinicians at the front line.  This has already been announced and more details can be found on our website https://www.hee.nhs.uk/coronavirus-covid-19 .

We would expect trainees to have supervision and support including opportunities for debriefs to support their wellbeing and safe care but recognise that novel solutions may be required. Indeed I have offered to debrief learners in my practice by Teams or Skype whilst isolated.  The 3 sessions education per week is suspended pro term.  We will work together to address these changes in the recovery phase.

We are working with all Colleges / AoMRC  and across the 4-nations on other matters such as WPBA and will share more as soon as we can.

 

Update on both the CSA and AKT Exams – Posted 23/03/2020

We understand that the AKT examination originally scheduled for April 29th 2020 has also now been cancelled. The College intend to re-schedule this when the exam can be run safely. We appreciate that this will be very disappointing news for several of you and we will update you on any future plans as soon as we can.

Please do not ring the college with any queries. They will be updating their website on a regular basis. The link below will take you to their current advice on both the CSA and the AKT

https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview.aspx

 

CSA examination cancellation - Posted 18/03/2020

Please find below an announcement from the RCGP that the CSA will not be running from tomorrow until further notice. We can understand that this will be hugely disappointing to all those trainees expecting to take their CSA over the next few months. We are aware that there is lots of national debate at the moment between the GP Deans as to what impact this will have on your CCT plans. We will update you all as soon as we have anything definite to share.
RCGP announcement -  Click here

 

Enhanced Induction Day March 26th 2020 - Posted 17/03/2020 

We regret to inform you that we will not be able to run this day as currently planned. So, please do not attend at Novotel Stansted Hotel on Thursday March 26th. However, please do keep this day free for now as we are working hard to see if we can arrange to deliver some of the day via an online learning platform that you can access remotely. We will keep you updated on this by email when we have further news.

 

Planned Rotation Change in April 2020 – Updated 17/03/2020

We are aware of the advice released yesterday afternoon (16/03/2020) to halt planned rotation changes in April 2020. There are some exceptions to this, including where trainees are due to rotate into areas of reduced clinical need. We are liaising with all relevant parties in the EOE on an urgent basis as to how this will be implemented locally and will update you all when possible.

 

Planned Teaching – Updated 17/03/2020

Following the heightened social isolation advice issued by the government yesterday, we are now cancelling all remaining regional teaching events. This includes the AKT day planned for today although we have made plans to share this day on an online learning platform. Trainees who were planning to attend this day should already have received some information about this. Where possible, we will do this for any future training days as well.

  1. Half Day Release Teaching

We understand that local decisions have already been made in most areas to temporarily suspend the half day release teaching. Following the heightened social isolation advice issued by the government yesterday, we would now advise that all half day release teaching on a face to face basis is cancelled.

In this situation, we envisage 2 main scenarios

  • Service delivery is functioning at close to normal levels – the decision to suspend training is based on social isolation – in this case, alternatives to the usual face to face teaching should be explored eg online learning. We are investigating options for this and will share these with you as soon as possible
  • Increased service delivery putting a strain on secondary and/or primary care – in this case, trainees will be undertaking clinical work until the situation eases in their locality

These local decisions will be led by the patch Associate Dean and the hospital DME.

Where GP trainees are preparing for an exam, one solution would be for them to arrange some small group work to work on this together, preferably using Skype or another form of remote connection.

  1. Practice Based Teaching

Decisions will again be made on a local basis when it will be advisable to temporarily suspend practice based teaching. This may well be variable from practice to practice, depending upon the staffing levels in a practice at any one time. Clinical supervision appropriate for each GP trainee should remain a priority.

We would encourage all GP trainees to continue to update their Eportfolio wherever possible throughout this period

 

16/03/2020 - Important Update Regarding RCGP Examinations

The official RCGP advice is as below. Please can we ask you NOT to ring the RCGP as the staff there are being overwhelmed by telephone calls meaning that they are not able to attend to other work. At the moment, the CSA examinations are underway. Should this change, the RCGP will update their website. So, if you are due to take an exam soon, please ensure that you check the exam pages on the RCGP website regularly  

The College is continuing to follow Government guidance and the CSA exams are currently planned to go ahead, starting on Friday 13 March 2020 until Saturday 28 March 2020. However, given the current situation, it is possible that Government advice will change and it may be necessary to cancel some or all of these exam sittings at short notice. If this happens, all candidates will be notified by email as soon as that decision is taken.

We are working closely with COGPED to consider the impact of the current COVID-19 pandemic on GP vocational training within the UK.

The College will continue to follow national guidelines and we are making appropriate adjustments to our assessment processes as and when these guidelines change. In the context of an emerging situation, the College is unable to answer specific questions surrounding individual training circumstances.

The RCGP and COGPED are liaising with other Colleges and Faculties and are working with each of the four National Education Training Authorities and the GMC to provide consistent advice. Contingency arrangements for post-graduate medical education and training processes are constantly being reviewed during this emergent phase of the COVID-19 outbreak and the College will continue to monitor and advise over the coming days and weeks. 

 

FAQ - What are the suggested communication routes for updated information on Covid-19? - Posted 13/03/2020
  • The usual email groups could be used at both the individual programme and GP school level. However, we would also suggest that each local programme establishes a What’s App group to include all GP trainees, the GP TPDs, the local administrator, the patch GP AD and the DME, (should they be agreeable to this). This will allow more instant communication and mitigate against emails not being read

FAQ - What about Trainee Welfare? - Updated 27/03/2020

Your welfare is extremely important to us. These are stressful and difficult times. HEE, hospitals and General Practices are working closely together to provide safe patient care and a supportive environment for our trainees. Please do contact your local TPDs or patch GP AD with any concerns

Every GP trainee should familiarise themselves with the Public Health England (PHE) advice about safe practice during the Covid-19 outbreak https://www.gov.uk/government/collections/wuhan-novel-coronavirus  

FAQ: Professional Support and Wellbeing Unit – Posted 23/03/2020

With the current circumstances in relation to the outbreak of COVID-19, we appreciate that this may be a difficult time for all.

 The PSW website pages have been updated with current information and FAQs along with sources of advice and support for all trainee doctors.  

The information can be found here

 In addition, the PSW will be offering a self – referral process for the foreseeable future.

 If trainees wish to speak to somebody to receive support regarding the impact COVID-19 is having on them and their training, please email  COVID19-PSW.EoE@hee.nhs.uk.

They  aim to get back to trainees within 24 working hours with suitable advice and guidance along with access to external support where appropriate.

FAQ - What will happen about planned educational activity?- Updated 23/03/2020
  • No local half day release programmes are running on a face to face basis anymore
  • HEE have recently announced that the 3 educational sessions which usually form part of a GP trainee’s working week have now been suspended so that all GP trainees can contribute to clinical work during these hours. We would expect trainees to have supervision and support including opportunities for debriefs to support their wellbeing and safe care but recognise that novel solutions may be required for this
  • All planned regional training days have also been cancelled
  • We are hoping to deliver the enhanced induction day as part of our Transition Project in an alternative format and will update you on this as soon as we are able to
  • The central GP School and TPDs are working hard on developing alternative online virtual learning opportunities for you and we will update you all on this as soon as we can
  • All planned study leave has now been cancelled.
FAQ - What will happen to my placement from April 2020? - Updated 23/03/2020

This regional plan has been agreed with the Incident Coordination Centre (ICC) for Covid-19 at NHSE+I. Whilst the underlying agreement is that GP trainees will largely remain working in their current host provider so that they are already familiar with the environment, it has also been agreed that appropriate local priorities will determine which specific hospital speciality each trainee is placed in.  The DME at each trust will liaise with the relevant GP Associate Dean and, where necessary, individual trainee circumstances will be taken into account.

ST3 GP Trainees

  • All ST3 GP trainees will remain working in their current practice
  • If any out-of-sync GP trainee is due to rotate into their ST3 GP placement over the next 4 months, they will remain in their current hospital placement, or an alternative placement as specified by the relevant hospital trust

 

ST1 and ST2 GP Trainees

  • Where GP trainees are currently working in a GP placement, they should remain in that placement until August 2020
  • Where GP trainees are currently working in a speciality placement, they should remain in that speciality placement. The Director of Medical Education (DME) of the acute trust, working with the medical staffing department, will coordinate which department the trainee will be placed in. This placement will continue until August 2020
  • The above applies to GP trainee posts in mental health trusts too
  • GP trainees due to rotate to a placement in palliative care will continue to do so unless locally an alternative decision is made between the DME and the patch GP AD
  • GP trainees due to rotate to a placement in Public Health will instead take up a post in the acute trust linked to their training programme. The post will be determined locally by the DME.

We are aware that GP trainees who are currently pregnant and/or in high risk groups may be concerned about the best placement for them to be working in. Please can we ask that you discuss this with your local host provider/local administrator/TPD to discuss how your individual circumstances can be best accommodated? If you have remaining queries, please contact the lead employer

There may also be individual situations that need resolving locally eg innovative posts, trainees returning from maternity leave etc. Please discuss this with your local host provider/local administrator/TPD.

We appreciate that this is a disruption to your anticipated training programme and would like to thank you for your help and cooperation at this time.

FAQ - How will clinical supervision be provided?- Updated 23/03/2020

The winter pressures guidance describes the clinical supervision arrangements - https://www.hee.nhs.uk/sites/default/files/documents/HEE%20winter%20pressures%20guidance%20FINAL.pdf

 

FAQ - What will happen to my GP post? - Updated 23/03/2020
  • Local factors will be considered when determining any change to placements in primary care.
  • Please work with your educators to agree appropriate work areas for you. There is likely to be a focus on remote consultations, same day and emergency appointments.
  • All GP trainees should receive appropriate clinical supervision with at least a daily debrief and the opportunity, wherever possible, for appropriate workplace based assessments. The debrief is likely to concentrate on patient safety issues.
  • As telephone and video consultations are likely to be increasingly used, where needed, GP trainees should request appropriate training and induction for this.
  • Telephone Triage
FAQ - What will happen with GP educators?- Posted 13/03/2020
  • This is a time of rare, extenuating circumstances and local decisions will be made in terms of responding to patient care needs on the ground

  • All GP educators should retain a focus on clinical supervision during this time and should help their trainees undertake WPBA when appropriate

  • More information will be provided as deemed necessary by local circumstances

FAQ - What will happen to my progress with training?- Posted 13/03/2020
  • It is possible that the half day release programme and practice-based teaching may be temporarily halted in order to ensure that all available resources are directed to frontline care
  • We are aware that GP trainees are likely to be concerned about their training progression and we will do all we can to support you to maintain your progress
  • Please continue to ensure that your e-portfolio is up to date
  • We will update you as more information becomes available
  • We will also endeavour to replace any missed educational opportunities
FAQ - What will happen if I need to take any sick leave or self-isolate?- UPDATED 23/03/2020
  • The lead employer has provided advice on how this will be dealt with and you should all have received an email from them recently.
  • Please see the information provided on this page in the section 'Updates from the Lead Employer'.
FAQ - What will happen after the outbreak has been controlled?- Posted 13/03/2020
  • As soon as the increased pressures on patient care have eased at individual trusts or GP practices, we will resume our usual training and educational input and, where necessary, we will provide alternative educational opportunities
FAQ - Clinical Supervision for GP Trainees in General Practice Undertaking Remote Work – Updated 23/03/2020

The situation might arise where trainees in GP placements need to self-isolate although they are not unwell themselves. In this situation, there is the potential for them to support the overall practice workload by working remotely at home. Appropriate clinical supervision for this would involve the below

  • GP Trainee is physically well although needs to self-isolate at home
  • Educational Supervisor and/or Clinical Supervisor feel that the GP trainee has sufficient competence to be able to undertake remote working
  • GP trainee has the appropriate IT equipment to work from home (we understand that there may well be further advice issued on the nature of this IT equipment – this is not within our remit though)
  • Individual practices should decide if the trainee will be processing results/letters/prescriptions or whether they will also undertake telephone triage
  • GP trainee has appropriate work space at home – desk, chair, private confidential area so that patient calls can’t be overheard, secure area to store any paperwork
  • GP trainee has a mobile number for a named GP in case they need advice (this wouldn’t necessarily need to be an educator)
  • Pre-arranged telephone debrief session with an educator towards the end of the ‘day’

As long as you follow this guidance, we have been advised by the MDU that your current indemnity arrangements will cover you for this work.

Updates from the Lead Employer - Updated 09/04/2020

09/04/2020 - The Lead Employer has produced 3 different risk assessments for host providers (GP practices and trusts) to use when discussing with a GP trainee if they fall into a group where working in a low risk environment is advised. Please see below those risk assessments
LE At Risk Assessment - LE Covid Extremely Vulnerable Household member Assessment - LE Extremely Vulerable Trainee Assessment

23/03/2020 - Lead Employer has a dedicated Covid-19 webpage where you can find all the daily  updated FAQs - visit the LE website

17/03/2020 - Lead Employer communication to Trainees - click here

FAQ - Which advice is available for pregnant trainees? - Posted 27/03/2020

 

The RCOG updated their guidance on 26th March 2020, link as below:

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

What is the advice if I am a healthcare worker and pregnant?

The guidance was updated on 26 March to emphasise that pregnant women of any gestation should be offered the choice of whether to work in direct patient-facing roles during the coronavirus pandemic. Your choices on whether you continue to work in direct patient-facing roles during the coronavirus pandemic should be respected and supported by your employers.

Advice for pregnant healthcare workers before 28 weeks gestation

If you are in your first or second trimester (less than 28 weeks pregnant), with no underlying health conditions, you should practise social distancing but can choose to continue to work in a patient-facing role. If you choose to continue working, it is strongly recommended the necessary precautions are taken. You should avoid, where possible, caring for patients with suspected or confirmed coronavirus infection. If this is not possible, you should use personal protective equipment (PPE) and ensure a thorough risk assessment is undertaken.

Some working environments, such as operating theatres, respiratory wards and intensive care/high dependency units, carry a higher risk for all pregnant women of exposure to the virus and all healthcare workers in these settings are recommended to use appropriate PPE.

Advice for pregnant healthcare workers after 28 weeks gestation, or with an underlying health condition

If you are in your third trimester (more than 28 weeks pregnant), or have an underlying health condition – such as heart or lung disease – we strongly recommend you avoid direct patient contact. It is better to work from home where possible, avoid contact with anyone with symptoms of coronavirus, and significantly reduce unnecessary social contact.

We encourage employers to seek opportunities for pregnant healthcare workers in their third trimester to work flexibly in a different capacity, to avoid roles where they are working directly with patients.

Whatever gestation of your pregnancy, you should discuss your individual circumstances with your local Occupational Health department.

The evidence base for this new virus is growing rapidly and, as and when new information emerges, the Government and professional bodies will update the guidance. 

Maternity Action has published FAQs around rights and benefits during pregnancy and maternity leave which you may find helpful: maternityaction.org.uk/covidmaternityfaqs/

 

The main difference to the advice we issued earlier in the week is that women less than 28 weeks pregnant and no underlying health concerns can choose if they wish to continue in a patient-facing role and are advised to follow social distancing; avoid working, where possible, with patients who have suspected or actual coronavirus infection; and to use PPE where this is not possible. Whereas women more than 28 weeks pregnant and/or underlying health concerns are strongly advised to avoid direct patient-facing work and that it would be better for them to work from home.

Having considered this, our summary advice is as below:

ALL pregnant trainees in the 3rd trimester are strongly advised to work remotely from home.

ALL pregnant trainees with underlying at risk health conditions are strongly advised to work remotely from home.

ALL pregnant trainees, whatever trimester, are strongly advised to avoid, wherever possible working in high risk in-patient settings.

Trainees in the First and Second trimester can choose continue to work subject to social distancing precautions in the work environment, UNLESS they have underlying at risk health conditions.

When working from home, there are valuable administrative functions that GP trainees can undertake, such as writing discharge summaries, as well as remote telephone or video consulting. We would remind you to follow appropriate clinical supervision guidance when consulting remotely from home. This guidance is summarized in a FAQ on our Covid-19 website page https://heeoe.hee.nhs.uk/general_practice/covid-19-gp-training-update-page

 

FAQ - Clinical Supervision Arrangements for GP Trainees Working in Community Hot Hubs - Posted 03/04/2020

Please see the link HERE for a summary of our guidance for GP trainees working in Community Hot Hubs.

GP Trainees Voluntarily Undertaking Additional Shifts for the NHS 111 Service, OOH Provider, Acute Trust or GP Practice - Advice for GP Educators - Updated 16.04.2020

Additional Hours Update  (including additional shifts at your GP Practice) - 16/04/2020

This is an update for any GP trainee who might be considering working additional shifts during this period. It is mainly going to apply to ST3 trainees keen to undertake additional shifts for the 111 service, their OOH provider, their local acute trust or their GP practice. The letter in the  LINK HERE (asd attached) provides more information on some of the aspects to consider. Also, we are now able to confirm if any trainee wishes to voluntarily undertake additional shifts at their GP practice, payment for this would be directly from the practice and would not originate from the lead employer.

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In responding to the Covid-19 pandemic, GPSTs may volunteer to undertake additional work in an out of hours provider or the NHS 111 service or at their local acute hospital trust.

Please see HERE the guidance for GP Educators.

The Lead Employer have advised that where GP trainees voluntarily undertake to work additional hours at their GP practice, that GP practice should put the trainee  on their payroll for any overtime work done by the trainee.  This would mean that there is no need for the GP practice to send any details to the lead employer. Appropriate rest breaks should still be available to the trainee, both for their own wellbeing and that of the patients.

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