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Scotland Deanery

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FAQs - Enhanced Induction Programme

    • You will be required to undertake more formalised assessment through validated Multiple Choice Question (MCQ) papers which assess knowledge and values.
    • You will be required to sit the simulated surgery if you score band 3 in the MCQ/SJT.
    • Your assessments enable NES and the Health Board Medical Director to identify whether you are suitable for acceptance onto the programme and have the potential to successfully contribute to General Practice in Scotland.
    • Your assessments also help to determine the length of workplace experience and clinical supervision required up to a maximum of six months (whole time equivalent).
    • If offered a placement then you will be included on the Performers' List as "in training for a fixed period".
    • If you wish to take up the offer of a placement, funding will be applied for and a suitable GP placement will be identified. 
    • The MCQ is a computer based test delivered across the UK by computer using Pearson Vue testing centres and also some venues outside the UK. The assessments are held four times a year. You will be able to schedule a place at your nearest test centre once your application has been accepted. There is a fee of £150. You are allowed a maximum of four attempts. The cost of the first two attempts will be covered by NES; further funding may be available depending on your performance trajectory. The Clinical Knowledge Test and Professional Dilemmas Test form the two parts of this exam. The schedule of sittings in the UK is published on the NRO website.
    • The Deanery Educational Adviser will advise on how you can book a place. 
    • The cost of the first two attempts will be covered by NES; further funding may be available depending on your performance trajectory.

    The aim of the GP Enhanced Induction Programme is to provide a period of supervised practice that seeks to support applicants and bridge any gaps in their knowledge or skills relating to General Practice in Scotland. Depending on the outcome of your MCQ scores, applicants are awarded a banding which helps determine the structure and duration of the educational placement required for each individual.

    Guide to scores for candidates

    The MCQ assessment consists of two papers - a Clinical Problem Solving paper (CPS), which requires the application of clinical knowledge, and the Professional Dilemmas paper (PD), which explores your approach to work. The PD paper measures competencies such as Coping with Pressure, Empathy, and Sensitivity and Professional Integrity. The papers have been rigorously developed and researched to help in the selection of candidates onto the Induction & Refresher scheme.

    Responses across all questions are totalled to give a single score. There are no subdivisions within either test. For the PD paper, you receive more points the closer your response is to that of an expert panel of GPs. Only questions where there is consensus between experts regarding the correct response are used.

    Your final scores are determined by comparing your performance to a group of other similar applicants to GP training posts. The use of a comparison group allows your performance to be benchmarked. The comparison is acheived by converting your score to a T score scale with a mean of 50 and a standard deviation of 10. This allows the scores for both papers to be compared. 

    A minimum passing score for each paper has been determined to be a T score of 46, based on a standard setting exercise. Around 33% of candidates can be expected to score below this level on average. 

    T scores have been assigned to 5 bands. Band 1 contains those scores which are well below the determined minimum cut score. Band 2 is scores which while still below the determined minimum are closer to the required standard. 

    Band 3 contains scores that range from the cut score to the mean score. This band represents an acceptable, but below average level of performance. Band 4 ranges from the mean to one standard deviation above the mean. This is the broadest band and reflects a good level of performance on the paper. Band 5 is the highest band and scores in this band are well above the average.

    Your score band shows how well you are performing compared to other candidates. Scores in Bands 1 and 2 suggest that substantial areas of performance need to be addressed. Scores in Band 3 suggest an adequate level of performance that is sufficient to progress an application for the Enhanced Induction Programme. However, candidates scoring in this band are likely to benefit from work to improve the relevant skills. 

    Scores in Bands 4 and 5 show a good to excellent level of performance.

    Band 1 scores on either paper suggest substantial deficiencies in performance.

    Band 1, 2 and 3 scores on the CPS paper suggest a need to brush up clinical knowledge. Some candidates may find their knowledge has deteriorated through lack of use. Others may need to update their knowledge. Low scores on the CPS paper may also be due to poor problem solving skills, that is difficulty applying knowledge in clinical situations. This can include difficulties in identifying the key issues in a situation, poor integration of knowledge or failure to determine the most likely or critical possibilities in a situation.

    Band 1, 2 and 3 scores on the PD paper suggest a difficulty in identifying the best response to situations. This may be the result of inappropriate assumptions about the role of a doctor both in the provision of care and as part of an organisation providing clinical care. This can include a poor understanding of professional ethics or use of less patient-centred approaches to the provision of care. Candidates with scores in this band may sometimes fail to take account of how others are feeling, have difficulty making decisions under pressure or cope less well with the stresses and strains of being a medical practitioner.

    Allocation of scores to bands

    Band Approximate percentage in band T score range Interpretation
    Band 1   12% 38 and below Well below the minimum standard
    Band 2   19% 39-45 Below the minimum standard required
    Band 3   19% 46-50 Adequate level of performance
    Band 4   32% 51-59 Good level of performance
    Band 5   18% 60 and above Excellent level of performance

     

    Those applying for the Scotland GP Enhanced Induction Programme must achieve a score of at least 46. 

    Those scoring less than 46 (Band 1 and 2) may resit the MCQ up to 4 times in total. If they fail to achieve the required mark after four attempts they will not be offered a place on the enhanced induction programme, this result will be shared with the Health Board Medical Director and career advice will be offered. 

    Those scoring 46-50 (Band 3) demonstrate a good level of knowledge but require an additional assessment of their consultation skills. They will be invited to sit a Simulated Surgery assessment.

    This assessment will determine the nature and period of a funded placement (up to three months, whole time equivalent WTE) in the first instance, which will be reviewed by the GP Adviser who will recommend whether a further three months will be required. The maximum time spent by the doctor in supervised practice will be six months.

    If you score a Band 4 or 5 you will not be required to sit the Simulated Surgery and will be accepted directly onto the Enhanced Induction programme. You will then be asked to complete Video Consultation Peer Review during you placement.

    • Simulated surgeries are held quarterly at the RCGP examination centre in London. The schedule of assessments is published on the NRO website. 
    • The purpose of the assessments is to determine your suitability for the scheme and the appropriate length of scheme up to 6 months whole time equivalent. All candidates taking the simulated surgery are provided with feedback about their performance to inform their learning needs and professional development planning. These are held 4 times a year in London usually 4-6 weeks after the MCQ. There is a fee of £850. You are allowed a maximum of 2 attempts.
    • The cost of your attempts at the simulated surgery will be funded by NES.
    • The GP NRO will provide further information about both assessments, including example assessments and answers to frequently asked questions once your application has been received. Simulated Surgery: Candidate Notes
    • The Royal Medical Benevolent Fund - www.rmbf.org - or the Cameron fund http://www.cameronfund.org.uk/ may be able to provide financial assistance for the GP Induction & Refresher assessments

    MCQ Assessment dates can be found here.

    Simulated Surgery dates can be found here. 

     

    Once you have successfully completed these assessments and have your results, you must make an appointment to meet your NES GP Associate Advisor whom you met earlier in the process. Your start date on the programme will be subject to the availability of funding and a suitable placement. 

    In order to undertake the programme, you will need to be registered on the Performer's List as being "in training for a fixed period".

    If you fail to reach the standard required, then you will be offered career advice from the NES GP Advisor. This will provide you with information about other options that might be available to you. 

     

    The practice to which you will be attached will be a GMC approved training practice with experience of teaching and assessments. The GP Unit will offer you a practice that as closely as possible suits your situation however the actual location is dependent upon availability. 

    Your supervisor will be an experienced GP Educator who will establish your educational needs and construct an educational contract to address these. This will describe the number of clinical sessions you will be expected to do every week, your programme and timetable for completing assessments and clinical and educational supervision arrangements.

    Your supervisor will be paid a standard trainer's grant (pro rata if you are part time)

    No, this payment will be made to your training practice by NHS Education for Scotland.

    There is no study leave entitlement however your supervisor will help you establish a PDP and look at how your specific educational needs can be met.

    You will be required to do a specified number of formative assessments during your practice attachment.

    • An assessment of clinical knowledge using the RCGP SelfTest.
    • Regular workplace based assessments which should be recorded in the NHS Induction logbook. These assessments include assessments of clinical skills, communication skills & teamwork and are based around observed consultations, case based discussions, 360 degree feedback from patients (Patient Satisfaction Questionnaire) and colleagues (Multisource Feedback MSF) and observations of clinical procedures. 
    • Normally this will be at least one Case Based Discussion (CBD) and one Clinical Exam and Procedural Skills (CEPS) assessment per month (pro-rata if doing the programme part-time over a longer period of time)
    • If you did not have to sit the Simulated Surgery, you will need to submit a video of your consulting for peer review.

    The RCGP PEP should be done early in your attachment to give you time to remedy any identified gaps in your knowledge.

    The work place based assessments should be done regularly throughout your attachment. Your educational supervisor will advise how many assessments are required to enable him/her to make a summative recommendation.

    The video of your consulting skills (if required) should be submitted in the first third of your placement. This is to allow adequate time for the videos to be processed and for you to develop your skills from the feedback received. If your initial video submissions highlight any cause for concern, you may be asked to submit further videos towards the end of your attachment. 

    There is no formal exit exam. Regular feedback should be documented in your logbook. Your educational supervisor will advise what assessments and how many should be completed but normally we would expect a minimum of one CBD and one CEPS per month as well as a PSQ and MSF (pro rata). The standard expected is that of a GPST3 on completion of training. You should also have a PDP in preparation for early appraisal which will be arranged soon after you start working in independent practice.

    The SelfTest currently costs £30 for 6 months access.

    The workplace based assessments are free of charge. 

    The analysis of video consultations (if required) costs £175.

    You will be responsible for the payment of these fees.

     

    Your programme cannot normally be extended beyond the maximum of six months whole time equivalent (wte). The length of time you will be in the programme will be agreed before you start. If it is agreed that less than six months would be appropriate and the standards for independent practice are not achieved, provided there is sufficient evidence of progress, then this may be extended to a maximum of six months (wte).

    This employment is for a fixed term of 3-6 months. It is anticipated that by the end of this period you will have received adequate induction in an educationally supportive environment to allow you to work independently, enabling an experienced clinical supervisor to be in a position to provide a recommendation which will be required by the Medical Director in his/her decision about unconditional inclusion on the Health Board Performers’ List.

    Your supervisor will write a structured report based on your work place based assessments and performance whilst under their supervision. They will provide a recommendation in relation to readiness for independent general practice. This will either recommend inclusion on the Performers’ List unconditionally or recommend that further development is necessary. The areas that need further development will be identified.

    This recommendation will be provided to the Health Board Medical Director who will make a decision about inclusion on the Performers’ List. This decision lies with the Medical Director.

    Once you are on the local performer's list, the healthboard is responsible for your appraisial. It is your responsibility to discuss the timing of your first appraisal with your local appraisal advisor depending on your revalidation date given by the GMC.

    NES is responsible through the Deanery for the delivery of the educational assessment and the provision of the Scotland GP Enhanced Induction Programme. Applicants who wish to complain or appeal against the outcome of any assessment or recommendation would do so through an appeal process with NES. If you feel that your EI post has not been compliant with the terms of your educational contract, you will be expected to have registered your concerns contemporaneously with documented evidence during the course of your post rather than after receiving your educational supervisor’s assessment. In the absence of valid grounds for appeal, the educational supervisor’s assessment is final

    Admission to the Performers’ List is the decision of the individual Health Board’s Medical Director. A decision to refuse an application or to apply conditions on a registration is taken by the Medical Director. Any appeal regarding the outcome of this decision should be made to the Health Board.

    For the duration of the GP Enhanced Induction Programme, you will be employed by NES who will provide you with an employment contract. Your appointment is subject to you being registered on the performers list as ‘in training for a fixed period’, being registered with the General Medical Council (GMC) with a licence to practice and included on the GP Register, and having a Certificate of Completion of Training or equivalent.

    This contract is conditional on satisfactory completion of pre-employment checks; which may include Occupational Health, Disclosure/PVG, satisfactory references and immigration (maintaining the right to work in the UK).

    You will be paid the basic salary, equivalent to the third point of the General Practice Specialty Training Scale (pro rata). The 2018 rate for this point on the scale is £35,799. An additional supplementary payment may be available if you are willing to do Out Of Hours sessions and the local OOH provider is able to accommodate your training needs.

    The supplement is currently 45% of basic salary (2018). The requirement is that you will do one supervised session per fortnight with the OOH service and that you will be willing to contribute to OOH work in the future. Your ES will confirm if you are ready to take this on. The programme is funded by the Scottish Government.

    Whilst employed by NES, the clinical work that you do in your practice attachment will be covered by CNORIS (The Scottish Clinical Negligence and Other Risks Indemnity Scheme) arrangements. It is essential that you also have supplementary medical indemnity to cover situations that may occur whilst not in NES employment as well as providing support and advice around other professional matters.

    Your hours of work in the training practice and regular periods of protected educational time will be agreed with you. Both during and outside normal hours, they will be appropriate to your educational needs and shall be bound by the provisions of the UK Working Time Regulations.

    The normal working week will comprise of 10 sessions which will be broken down as follows: 8 clinical and 2 educational. A degree of flexibility may be required from time to time in order to meet your training needs i.e. increasing either the number of educational or clinical sessions in order to gain specified competencies (having decreased the number of clinical or educational sessions accordingly/respectively). The nominal length of a session is 4 hours.

    You are an integral part of the training practice team but you are supernumerary to the workforce of the training practice. At no point should the effective running of the training practice be dependent on your attendance and you will not be used as a substitute for a locum in the training practice.

    Your normal timetable is to be agreed with your Educational Supervisor.

    There is no requirement for the GP Returner to work in Out of Hours (OOH) but if the GP Returner anticipates applying to do OOH sessions in the future, then this must be discussed at the placement interview with the NES GP AA. Provided the local OOH service can accommodate the request and once the ES is satisfied that the GP Returner is ready to do this, then if the GP Returner is willing to do two sessions in OOH per month, then a pay supplement will be available.

    Yes however there must be well founded reasons (e.g. caring responsibilities as defined within NES LTFT policy documents) that would prevent you from working on a full-time basis.

    Part-time training will fulfil the following requirements:

    A minimum of 50% of normal working week to be worked (including protected educational time each week)

    All arrangements relating to part-time training are subject to approval by the NES Director of Postgraduate GP Education.

    In accordance with delegated responsibility from NES, your Educational Supervisor may agree and you may arrange to undertake any professional activities outside those of the training practice whether remunerated or not.

    Any outside activity should not exceed the Working Time Regulations and will not be unreasonably withheld. Any medical duties or appointments outside the training practice area must not compete with the Educational Supervisor’s practice or impinge on your contracted duties. This applies equally whether such duties are remunerated or not.

    Consent does not imply any responsibility by NES or your Educational Supervisor or the training practice for your acts and omissions in the course of such activities. You are advised to ensure that your membership of a recognised medical defence organisation is commensurate with these activities.

    If you are absent owing to sickness, accident or disablement not arising from or attributable to your own misconduct you may receive payments under the Occupational Sick Pay scheme based on your absence record for the period of 12 months immediately preceding the first day of absence as follows:

     Service at Commencement of Absence

     Full pay

     Half pay

          

     First year of service

     one month

     two months

     Second year of service

     two months

     two months

     Third year of service

     four months

     four months

     Fourth and fifth years of service

     five months

     five months

     After five years’ service

     six months

     six months

    Any payment under the statutory sick pay scheme will be offset against your entitlement as stated in above.

    You must notify NES and your Educational Supervisor of any absence due to sickness on the first day. A self-certification form should be completed for any sickness absence lasting for fewer than seven days. If the sickness absence lasts longer than seven days you must first notify your Educational Supervisor and also request a self-certification form from your own GP which should be sent to NES at the end of the first week of absence. If the absence continues beyond seven days a medical certificate should be submitted from your own registered GP.

    You should register with a local GP for medical care and normally should not be registered with your training practice.

    This is in line with that of all NES employees.

    You are entitled to thirty days paid annual leave per annum for full time employment. Reasonable notice must be given of your intention to take leave. You must discuss the proposed dates with your Educational Supervisor (acting on delegated responsibility from NES) and have them agreed. Leave dates must be agreed before booking holidays. Such agreement will not be unreasonably withheld. If you have exceeded leave entitlement at the date of leaving the practice, for whatever reason, NES will be entitled to deduct a sum equivalent to the salary paid in respect of such excess leave from your final salary payment. Payment may be made in lieu of leave owing at the end of the post.

    Unpaid leave

    Unpaid leave other than for parental, dependent (including adoption) or maternity purposes is normally granted only when you have exhausted your annual leave entitlement. This type of leave is discretionary and permission must be obtained before it is taken. Unpaid leave may be granted only in exceptional circumstances if and when the needs of the training practice allow (acting on delegated responsibility from NES).

    Public holidays

    Subject to the provisions of this paragraph, you are entitled to 10 public holidays or days in lieu per calendar year and any public holidays proclaimed from time to time. When you are required to work on one of these days on a rostered basis you will be entitled to a day off in lieu. [If you work part-time, you will be entitled to public holidays or days in lieu on a pro rata basis according to the number of hours you work compared with full time hours.

    Study leave

    The aim of the EI programme is to refresh and adapt GP skills. NES believes that practice based sessions are the best way to gain confidence in one's GP skills in the NHS. There are 2 educational sessions allocated per week (pro rata). Consequently study leave out with the sessions dedicated for personal study within the employment contract is normally not granted but may be considered in exceptional circumstances. There are no additional funds to support course fees.

    If you have any questions regarding the Scotland GP Returner Programme, please do not hesitate to contact us at:

    gpcareersadvice@nes.scot.nhs.uk




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