The normal working week for a GP Trainee in a GP practice is contractually between the hours of 8.00am and 6.30pm. In addition a practice might offer extended hours (e.g. 6.30 to 9.30pm) and some are open 24 hours a day.
Out of Hours (OOH)
Out of hours is defined as outside the normal day extended hours. A GP trainee is nominally paid for a 40 hours for which he or she gets a basic salary. There is also a supplement on top of the basic pay for out of hours work. Out of hours sessions should average to 18 over the 18 months that the trainee is placed in a GP post.
The 48-Hour Working Time Directive
GP trainees are governed by the 48-hour working time directive. This put limits on the working week and should be reflected in the contract of employment. The working week is limited to 48 hours, and the working day to 8 hours. Working includes travelling where it is part of the job, working lunches and job-related training. Working time does not include travelling between home and work, lunch breaks, evening classes or day-release courses. These regulations are based on an average over a 17 week period.
Using the BMA contract as a template training practices can agree the working week with the trainee early in the post to avoid any dispute. The split between clinical, educational, rest periods all need clarification. The Programme Directors are always willing to offer advice, although it is recommended that the trainer or trainee seeks advice from their BMA employment advisor if there is disagreement with the contract.
Clinical & Educational Sessions
A session is 4 hours and so the working week can be divided into 10 sessions. Seven of these sessions or 28 hours should be undertaking clinical work. Clinical work includes surgery, visits, and administration, practice business meetings. Typically during a session, a GP trainee would be undertaking between 2 to 2.5 hours of face to face patient contact.
Three sessions or 12 hours should be devoted to education. Educational sessions include the VTS day release, updating the e-portfolio, reading, and protected time for tutorials, practice educational meetings. Educational sessions can include patient contact time for example COTs, attending an outpatient session, sitting with another doctor or clinic.
Outside of term time for the VTS days, the free educational session is an opportunity for the trainee to further gain some competencies. This time can fruitfully be used for an agreed educational plan that could be clinical (e.g. attending an ENT clinic) or educational (e.g. undertaking an audit). If no agreed plan is made for this session outside of term time, the trainee is expected to do a clinical session instead.
Extended hours do not count towards a trainees OOH commitment. A trainee can undertake extended hours as long as the average day is still 8 hours. This does not usually affect Saturday mornings. Saturday working should be limited to once a month, if more often then time in lieu will be required. At no time should a GP trainee work Saturdays alone without clinical supervision.
For every clinical session that the trainee is in contact with patients, there should be a named clinician, ideally the nominated trainer (for the majority of the sessions) or another suitably trained supervisor to address issues that may arise with consultations with the trainee. There should also be an opportunity to debrief any issues with the nominated supervisor at the end of the session.
|Working Week||10 scheduled sessions per week||Normally 40 hours day time commitment||Maximum permitted is 48 hours per week|
|Practice Based||7 sessions per week for full time||Session is 4 hours||Week must be EWTD compliant|
|Clinical Sessions||7 sessions maximum||Must include ‘In Practice Learning’||May include some extended hours|
|In Practice Learning||1 session (4 hours) minimum planned according to trainee needs||Minimum of a weekly scheduled 2 hour tutorial plus 2 further hours teaching across the week||Tutorial must be fully protected and planned in the weekly timetable and recorded in the e-Portfolio|
|Structured Educational (VTS)||Nominally 1 session per week||One whole day allocated to the VTS day release over 2 weeks.||Alternative weeks to be discussed between trainer and trainee|
|1 session per week||Based on learning needs assessment and planned with the Trainer||Personal Study out of the practice and should be documented in e-Portfolio|
|Out of Hours||18 sessions across the training programme||In addition to 10 sessions working week||See OOH section for further details|