F2 General Practice Guide

The Foundation Programme is a two-year generic training programme which is intended to equip doctors with generic skills and professional capabilities to progress to speciality training. During F1 they will have 12 month’s clinical experience as a doctor in the secondary care setting where they will usually have undertaken 3 different rotations. During this year they hold provisional registration with the GMC. As an F2 doctor they will have full GMC registration and a licence to practise.

Foundation year 2 training consists of 4‐monthly rotations between different specialties. A four‐month placement in General Practice is offered in the second year of the Foundation Training Programme. This guidance is to provide a framework, guided by the GMC standards for the learning environment and for educational supervision, and F2s that can be adapted to suit the practice’s local circumstances.

An F2 attachment in General Practice will allow a unique experience of patient pathways, both in the community and between the hospital and secondary care services and the community. This pathway includes the transition of patients with acute illness from investigation to diagnosis, management, and treatment then on to recovery and rehabilitation. Managing long term conditions and providing health promotion advice is a key part of the Foundation curriculum and GP posts are key to delivering this experience. The interface between the hospital and the GP environment would be important to F2s, especially many who are continuing a career in secondary care.

General Practice gives added experience of looking at patients and the impact of disease on their lives, and within their own environments. This will give general clinical experience and not specialty training. General Practice is unique in its clinical method and risk assessment in care, especially with uncertainty in diagnosis with early presentation of disease.

The F2 doctor is fundamentally different from a GPST. The F2 doctor is not learning to be a GP. Some may, in the future, want to be GPs, some will be intent on pursuing other careers. You are not trying to teach an F2 doctor the same things as a GPST but 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 ill patient in the community and to patients with long term conditions, which will enable them to achieve the required competencies as laid down in the Foundation Curriculum.

A Foundation Doctor in General Practice must have a named Educational Supervisor in the practice who has the overall educational responsibility for them whilst they are on placement.

The GP Educational Supervisor is responsible for ensuring both educational and clinical supervision. You must ensure are being provided. Clinical supervision cannot be provided by locum doctors.

The UK Foundation Programme Curriculum 2021 is available.

There are 13 Foundation Professional Capabilities (FPC) and for the foundation doctor to successfully complete they will be able to demonstrate they are:

• accountable, capable, and compassionate doctors (FPC 1‐5)
• a valuable member of the healthcare workforce (FPC 6‐10)
• a professional, responsible for their own practice and portfolio development (FPC 11‐13)

These will be demonstrated by behaviour in the workplace and training programme, the trainee is not expected to demonstrate every behaviour in each FPC but must demonstrate that capability.

All foundation doctors in Scotland have to use the Turas Training Portfolio. This is an online portfolio that they need to regularly access to record learning, teaching, have skills signed off and to log the fixed assessments and supervised learning events that occur over the two years. 

The GP Educational Supervisor has access to all shared elements of the portfolio and the F2 doctor’s FPD has full access to the portfolio to monitor progress. The F2 should be encouraged to engage as much as possible with their e-portfolio as this facilitates the completion of their end of placement and end of year reports.

As an educational supervisor, you will have two "formal" meetings with the F2:

• At the start of the attachment to review progress so far, to discuss educational targets and to complete the combined induction form in the Turas Training Portfolio.
• The F2 should construct a PDP following this meeting. You will have access to the previous Educational Supervisor's Report to inform this first meeting.
• A mid‐point meeting - optional but useful, especially for career advice discussions and focusing any choices for next 2 months. Also, useful for a struggling trainee.
• A final meeting to complete the combined "end of placement" (all reports can be accessed through the Foundation Training Portfolio on Turas)

Foundation doctors are responsible for meeting their annual portfolio requirement across all posts in the year. 

In one year they must gather: 

• One end of placement report per post
• At least one TAB (Team Assessment of Behaviour)
• At least one PSG (Placement Supervision Group)
• Multiple SLEs, which include Case- base discussion, Mini CEX, DOPS and other forms to evidence teaching and leadership there is no minimum number or mix of SLEs
• One QI project
• Demonstration of ALS competencies (usually by attending an ALS course)
• Documentation of core and non-core hours of learning
• Summary Narrative reflecting on how they have met learning throughout the year

It is important to gather evidence of progress from different members of the team. In practical terms we recommend that different teams members complete SLEs. Also, the Foundation doctor’s progress could be a standing agenda item on the regular practice meeting to inform the educational supervisor of their progress.

Every F2 who commences in the practice must have an induction to ensure they understand their duties and reporting arrangements; their role in the inter‐professional and inter‐disciplinary team; workplace/ practice policies and to meet key staff.

The F2 doctor is fundamentally different from a GPST as they are not learning to be a GP. You are not trying to teach an F2 doctor the same things as a GPST.

The F2 should have their own stethoscope but all other equipment they need for doing any work should be provided by the practice. It is also very helpful if you have an induction pack for the Foundation Doctor, which includes “Who’s Who”, computer use and housekeeping information.

A starting point would be an initial one‐week period with introduction to all aspects of practice work. Thereafter there would be a period of gradually providing an increasing service commitment which is planned, depending on curricular areas to cover, assessments to be done and specific career and learning needs of the doctor.

By the second month the foundation doctor should be providing a minimal level of service commitment to allow the clinical/educational supervisor the time required to provide ongoing support. There should always be appropriate clinical supervision for the F2 throughout their post.

From a practical practice administrative team perspective, you may consider the following. Again, this is only a guideline and should be adapted to suit your learner and your practice.

The working/learning week for a Foundation Doctor is 10 sessions i.e., 40 hours per week over 5 days regardless of lunch/coffee breaks. They are allowed 30 mins for lunch but this counts as part of the 40 hours; this is a New Deal issue not a EWTD issue. It is shifting length and frequency that counts regardless of your practice working week arrangements. The F2 may be required to cross‐cover in the hospital on a pre‐arranged rota. If this cross‐cover is at the weekend this is in addition to the 40‐hour week and appropriately remunerated. If this is between Monday and Friday this is instead of time in the practice.

Worked example:

A F2 working 9‐5 Monday to Friday with a 30 min lunch break (40 hours in total including lunch) will be compliant, but a F2 working 9‐5.30 with an hour‐long lunch (42.5 hours in total including lunch) break will not.

The 1 PA educational time in particular week would be covered if the F2 was taking study leave. They would not be expected to have additional education time in that week.

The table below is an indicator as to how you might plan the learning programme over a typical week with a F2 who is in your surgery on the standard four‐month rotation

In addition to the weekly timetable organised by the practice, the regional teams organise a number of teaching sessions. F2s are notified of these teaching sessions through their Turas Learn account which give foundation doctors a list of educational teaching sessions they are been scheduled to attend with the topics, date, time and location.

It is the F2’s responsibility to ensure that they book the time out of practice. All Foundation doctors are expected to demonstrate a total of 60 hours of teaching attendance over the year. Firstly, they must demonstrate attendance at 30 hours of the formal Foundation Delivered Educational Programme plus they must also complete 30 hours of additional learning.

F2 doctors are also required to pass ALS and date are co‐ordinated by the regional teams and F2s are required to be released to attend and a study leave form will to be completed for this.

The 1 PA educational time in particular week would be covered if the F2 was taking study leave. They would not be expected to have additional education time in that week.

The F2 doctor is entitled to apply for study leave. The Deanery Study Leave policy is available. The majority of this leave will be used as part of the mandatory educational teaching programme organised by the deanery as well as other mandatory training such as ALS. It is not anticipated that there should be any other study leave requests and if any queries arise, contact the local regional foundation administrator or FPD. 

Tasters

• F2 doctors may need advice about taster sessions, therefore, please see the following link on the Scotland Deanery website: Tasters and How to Apply 
• For any taster weeks/days or additional study days out with the regional Educational Programme trainees will need to fill in a study leave form, and have it signed off by yourself and their Foundation Programme Director (FPD)
• All leave is at the discretion of the practice, both parties are expected to be reasonable

In the first four-month block, F2 doctors may request the opportunity to have ‘Taster Sessions’ in another specialty if they have not had experience in that specialty before. Application to most medical and surgical training posts from Foundation is to core programmes. Applications for tasters in medical and surgical subspecialties will not be approved, unless there is direct entry from Foundation e.g. ENT. 

It is important that applications are approved by the FPD. Please see the Taster Guidance information. This is to allow the F2 to make a more informed decision before submitting a run through training application. These should be supported but also have to be agreed by the relevant FPD. 

Any taster weeks should be requested using the study leave process via Turas. It may be that you will be asked whether you want to take a different F2 doctor for a Taster Week in General Practice who is requesting a GP block. There is no specific format for this week, but it would be hoped that any F2 doctor asking for a taster week in GP would be exposed to the broadest range of activity during that short placement. 

The 1 PA educational time in particular week would be covered if the F2 was taking study leave. They would not be expected to have additional education time in that week

Self Development Time (SDT)

Within each working week F2 doctors must be allocated self‐development time (SDT) of 2 hours per week in order support health and wellbeing and to focus on:

• Maintenance of their portfolio
• Ensuring that all curriculum requirements are linked and evidenced
• Informing themselves about potential future career
• Preparing and equipping themselves for specialty application
• Completing reflections as part of learning
• Preparing material to develop teaching events for others
• Undertake e‐learning and statutory/mandatory

This can be taken as 2 hours per week or averaged over the block but must be timetabled. It may take place at a location away from the GP premises. F2 doctors should discuss with their supervisors in practice how they plan to use this time.

ES allows F2 doctors, when suitably competent and appropriately supervised, to take graduated responsibility for care appropriate to the needs of the patient.

The F2 must know who their supervising clinician is for every clinical session. This can be their educational supervisor or any doctor who is permanently in the practice (i.e., not a locum or doctor in training). The supervising clinician must be on site while the F2 is consulting. 

Supervision of face‐to‐face consultation will involve a graded approach:

• Initially the F2 doctor will need to observe other doctors consulting moving to shared consulting (this can occur during the induction period).
• It is then recommended that the supervisor (either educational supervisor or clinical supervisor) will sit in to observe the F2 consulting.
• When the Foundation doctor starts consulting on their own, it is expected that they will debrief with their educational supervisor, or deputy, after each consultation
• Later, the F2 doctor can be consulting in parallel to the supervising GP who will have time to be available for queries as necessary.
• There needs to be a gradual build‐up of the number of patients seen.
• As the F2 doctor becomes more confident, debriefs can occur at the end of the session. In any case all patients and prescription must be discussed.

It is not expected that Foundation doctors

• Undertake duty doctor work in the practice alone but could shadow this activity with a GP
• Work on their own in other location out with the practice (e.g., nursing homes, community hospitals)

Home visits have the potential to provide valuable educational experience for Foundation Doctors.  Home visits allow the Foundation Doctor to be exposed to the assessment and management of medical and psychosocial problems in the home setting, and the challenges that this entails. 

If Foundation Doctors are to be involved in home visiting, a graduated approach must be followed.  Foundation Doctors should initially accompany GPs/ANPs on home visits. This may progress to the Foundation Doctor taking the lead on a home visit while being directly observed by a supervisor.

For the more able Foundation Doctors, it may be appropriate for them to undertake unaccompanied ("solo") home visits to appropriately triaged requests which are within their capability.  This activity may not be within the capability of some Foundation Doctors and is more likely to be possible with those on their second or third placement.

Criteria for solo home visits:

• Suitability for participating: the Educational Supervisor must be satisfied that the Foundation doctor is capable to attend visits alone, on the basis of previously directly-observed consultations and home visits. Foundation doctors are not required to have cars, and practices cannot insist that Foundation Doctors who have cars use these for home visits. Practices should ensure that Foundation Doctors who use their own car for home visits have adequate business insurance in place for this purpose. 
• Home visit requests: requests must be approved by the supervising clinician as being suitable for the Foundation Doctor to attend alone. Suitable home visits should involve relatively simple presentations (e.g. ?chest infection, ?UTI, MSK pain, off legs, acute on chronic confusion etc). Particular consideration should also be paid to: competency of the Foundation Doctor; location and transport required; safety of environment; whether or not a chaperone is likely to be required.
• Prior to home visit: the Foundation doctor must discuss case in detail with the supervising clinician in person at GP surgery. This should include the forming of clear yes/no questions, e.g.: "does the patient have clinical signs that would warrant antibiotics?" or "can the patient remain under primary care, or do they need hospital at home/admission". Prior to embarking on the home visit, the Foundation Doctor must be clear on the questions being asked. It should also be checked that the Foundation Doctor has what they need for the visit: relevant medical equipment, home visit summary, mobile phone, transport and access to directions.
• During home visit: the Foundation doctor must be given the mobile number of the supervising clinician, who should be directly available throughout, and able to join the visit if needed (in exceptional circumstances).
• After home visit: the supervising clinician must provide an in-person debrief at GP surgery with Foundation Doctor. This should take place at an agreed time as soon as possible on return, and certainly on the day of the home visit. Investigations should be made in the name of the supervising clinician, who will be responsible for the follow-up of the patient.
• Frequency of solo home visits: Foundation doctors must not be considered part of a "home visit team", and should not be required to attend daily home visits. The reason for this is that it is difficult for the above criteria to be met on a daily basis in the average busy GP practice.

Initially it is expected that a supervisor will discuss each prescription with a Foundation doctor. This can gradually develop to the Foundation doctor working independently, with help for queries available in the building. It would be appropriate to check a proportion of the F2's prescriptions on a regular basis.

An F2 doctor is fully registered and is therefore able to sign a prescription. It is up to the GP Educational Supervisor to ensure that there has been adequate training towards this and that the limits of the F2 doctor’s freedom to sign prescriptions is made clear. 

The F2 should have a unique cipher number which Practitioner Services at the local Health Board can supply. Practice Managers should have the specific local contact details. 

F2 can sign repeat prescriptions for patients known to them or with whom they are consulting. There is useful learning around repeat prescribing that can be incorporated into F2 experience.

F2 Foundation doctors can sign fit notes for patients known to them.

All referrals from Foundation doctors should be reviewed prior to the referral being sent by the Educational Supervisor, or another GP in the practice.

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.

If you feel at any time that the doctor under your educational or clinical supervision has performance issues, you should contact the appropriate Foundation Programme Director (FPD) who will work with you to ensure that the appropriate level of support is given both to you and the F2 doctor.

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.

F2 doctors will be making decisions regarding future careers during their first placement.

Most F2s do apply for training programmes when the process commences around October/November.

The supervision payment is paid for each Foundation doctor on a pro‐rata basis (i.e., a third of the training grant if only one F2 in a 12‐month period).

Support can be provided by the regional teams. This is by means of this simple guide and Turas Training Portfolio training sessions.

The Foundation Programme Director (FPD) for a F2 doctor can be contacted with any specific queries.

Additional resources and support for Educational Supervisors, including trainer groups are available on the Scotland Deanery website here.

The F2 doctor will be able to claim for travel to the Practice from the Placement Board’s HR department where they are based. The F2 doctor can also claim for any travel associated with work. Travel claims are made through the Placement Board and it is up to the F2 doctor to initiate these claims. 

The F2 doctor’s car should be insured for business use. Prior to any claim being submitted trainee should complete and submit a copy of the 'DDIT Authorised User Form' and/or a copy of the NHS Scotland Excess Travel Form - Doctors in Training Grades Only to the Expenses Department in their Lead Employer Board. 

When making a claim the Foundation doctor should complete the 'DDiT Expenses Claim Form' and have this signed by an authorised signatory within their Placement Board department; this will then be submitted to the Expenses Department at the Lead Employer Board via email or post. 

All the forms can be found on Turas Hub.

Yes, the F2 doctor needs to be on the performers list for them to have a placement in General Practice.  This is arranged by NHS Education for Scotland.

Please check the Turas Hub for details about Annual Leave and Public Holidays for each local Health Board area and check with your local employer about your specific entitlement.

All resident doctor posts are monitored by the placement Health Board to ensure compliance with European Working Time. It is very important that posts are compliant, both on paper and in practice. There are various specific EWT rules, regarding breaks and rest days. For example, the FY2 cannot work more than 5 hours without a (paid) break. FY2s in unbanded posts (with no out of hours commitment) cannot work beyond 7pm. FY2s who are doing out of hours cannot work more than 7 days in a row without rest days. If you need further details on EWT regulations, or have concerns about whether your rota is compliant on paper, please contact the HR team at the placement health board. 

All health boards actively monitor posts to check that they are also compliant in practice, by asking resident doctors to complete monitoring diaries. Some (but not all) health boards currently monitor GP placements. If the F2 attached to your practice is going to take part in a monitoring exercise, you will be contacted in advance by the monitoring team from the Health Board. If FY2 doctors fail monitoring, posts may have to be re-banded, which would have financial implications.

F2 doctors have NHS indemnity cover, known as CNORIS (Clinical Negligence and Other Risks Indemnity Scheme), for the clinical work they undertake in both Primary and Secondary care. There are situations where this indemnity does not apply, so F2 doctors are strongly advised to have medical defence organisation cover (which is inexpensive) for representation at GMC hearings, fatal accident inquiries, Good Samaritan work and for personal advice and help including responding to complaints.

They need to inform their defence organisation that they have a General Practice post as part of their F2 rotation and can confirm that they are covered by the NHS indemnity scheme whilst in that post.

The Contract of Employment is retained by the Placement Board on behalf of the Lead Employment Board which hosts the F2 programme (not the GP Practice). The Lead Employer is responsible for paying salaries and some other HR related issues. 

It is essential that any agreed periods of leave and any sickness absence are reported to both the Lead Employment and Placement Board HR departments. These should be recorded in the F2 e-portfolio. If in doubt, contact your local Foundation Programme Director (FPD).

The majority of foundation doctors are allocated to a named practice as part of the annual recruitment and allocation process. 

Foundation doctors who are unallocated named to practice are administered by the NES Training programme Management Team, which usually includes F2 having some choice.

F2s are now governed by 7-day working. This means that they cannot work more than 7 days in a row. After working 7 days in a row, they need the next day off. Some F2s are required to work hospital shifts at weekends. Thus, if they work both Saturday and Sunday they must be off the Friday before or the Monday afterwards at the practice. 

The F2s get a banding supplement to reflect this work. They are still contracted to work an average of 40 hours per week over their 4-months in General Practice allowing for holidays. It is probably best for the F2 to spread the time they need to make up from an enforced day off, evenly over their 4-month time in General Practice. 

The educational component to their job could be used for Portfolio work and other quality improvement activities such as quality improvement projects.