Rachel Roberts is Primary Care Dean for London at Health Education England.

John Launer is Training Programme Director for Educational Innovation for London at Health Education England.

Rowena Viney is a Lecturer in Medical Education at UCL Medical School.

Asta Medisauskaite is a Senior Research Fellow at UCL Medical School.

Laura Knight is a Senior Research Fellow at UCL Medical School.

Ann Griffin is Professor of Medical Education Research at UCL Medical School.

 

From this year GP registrars will be spending two years of their training in the community. But what does ‘community’ mean, beyond learning in a GP surgery instead of a hospital?

GP work connects us with colleagues from a range of primary care, social care and voluntary sector professions who may not share the same workplace with us. It also requires an understanding of population health, the geography and culture of the area, and collaboration with patient representatives and agencies.

During the Covid pandemic, GP involvement in community and population-based activities, from identifying clinically vulnerable patients to participation in the Covid vaccination programme, has heightened everyone’s awareness of how far our responsibilities extend beyond individual patient encounters to the community as a whole. It is more important than ever for GP training to reflect this.

What does ‘community’ mean, beyond learning in a GP surgery instead of a hospital?

Training hubs and GP specialty schemes

Since 2014 Health Education England (HEE) has supported the development of Training Hubs (THs), initially called Community Education Provider Networks. These are responsible for education and workforce development for all non-GP professional groups in primary and community care. Many have become thriving networks, with a strong focus on population health and local community-based links. Some have collaborated with GP specialty training schemes, providing educational activities for multi-professional learners and practitioners from across the whole of primary care.

In 2019 HEE launched a pilot in two north London boroughs to encourage closer working between THs and the local GP programmes, with the aim of increasing the orientation of future GPs towards population health and the community. The pilot was then evaluated by the Research Department of Medical Education at University College London.1 Among other features of this initiative, TH and patient representatives became involved in the planning of the GP training programmes and were empowered to suggest topics, mode of delivery, potential speakers, and resources for these.

We had to suspend the pilot in Spring 2020 because of the pandemic, but the research team had obtained baseline data that provided us with valuable information about how well GP trainees were prepared for a community-oriented future. This included information from questionnaires about trainees’ competencies relevant to community orientation, attitudes towards health care teams, and their thoughts on patient engagement. There was also information from focus groups exploring trainees’ sense of community, knowledge of local population health, and patient and TH involvement in their training.

Trainees’ views of community orientation and public health

Detailed publication of this data will be forthcoming but the findings have shed interesting light on trainees’ current views. These were mixed. Trainees understood that networking with other health professionals would help them to navigate local systems and implement change, but not all felt they could engage with local services owing to limited time or because it did not seem relevant to their future roles.

Similarly, some trainees thought that understanding population health would contribute to better treatment of patients, while others considered it challenging due to difficulties involving working with colleagues or time. There was acknowledgement of the importance of patient voices, but some thought they already had sufficient contact with patients anyway and it was more important to develop competencies. Most trainees were not familiar with THs.

[Trainees] may need help to see that a role in the community is very different from how they might currently understand it.

These findings are probably not surprising. They show how trainees may still have a traditional stance of focussing on the core tasks of general practice, rather than taking a wider perspective. Most GP trainees are probably at an early stage in their evolution.

However, their future jobs will undoubtedly involve not just treating the patients in front of them, but thinking of how to engage with the community and address population health as well. They may need help to see that a role in the community is very different from how they might currently understand it.

 

Reference

1. UCL Medical School Research Department of Medical Education. Impact of changes in VTS. Available from: https://www.ucl.ac.uk/medical-school/impact-changes-vts [Accessed 4 June 2021]

 

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