2. Programme construction

2.1. Five different types of posts can form part of a GP specialty training programme:

1. General Practice - experience purely in general practice posts based only in the GP surgery (including remote consultation).
2. Integrated Training Post (ITP) - experience in a combination of general practice and other relevant posts including outreach posts based in the community, specialty posts usually based in hospital, and integrated care. It can also include a non-specialty element such as Research or Leadership.
3. Blended Learning Post (BLP) - an innovative training placement that integrates clinical work in general practice with a structured modular programme of curriculum-linked education and self-determined learning via electronic and online media as well as traditional face-to-face teaching. Blended Learning posts should be treated and managed in the same way as ITPs.
4. Specialty - experience purely in a formal specialty post usually based in hospital.
5. Academic - designated posts in research and academic areas (ACF or ACL) which are in addition to the GP training programme requirements. These posts do not count towards the specialty nor general practice components of the programme.

2.2. The programme should include a balance of experience driven by the learning needs of the GP registrar and should be designed to enable the GP registrar to acquire all the capabilities necessary to practise independently to standards of safety, and capability set out in the GP Curriculum.

2.3. Programmes should be constructed based on local post availability and funding and contain an appropriate balance between service and education, general practice, and experience in other relevant settings.

2.4. At least 12 months whole time equivalent (wte) must be spent in general practice with the final 12 months ideally all spent in general practice.

2.5. A minimum of 18 months should be spent in a combination of GP posts and ITPs or BLPs. The remaining time can be a combination of any approved post type.

2.6. Specialty posts should be focused on the learning needed to demonstrate the required capabilities of the GP Curriculum and should allow relevant experiential learning.

2.7. All GP training posts must facilitate the completion of the mandatory Workplace Based Assessments (WPBAs) specified by the GP Curriculum. It is recognised there are non-patient facing, but clinically relevant specialities or posts which offer useful learning and experiences. If it is not possible to complete the WPBA requirements within these posts, then alternative arrangements need to be considered. This could for example include incorporating the post with general practice as part of an ITP. WPBA is a longitudinal assessment programme, and all GP registrars should be given reasonable and equitable opportunity to complete their assessments throughout training.

2.8. Time spent in posts such as Leadership, Medical Education, Research and Commissioning which are non-clinical and are not formal specialties, will not count as specialty time but can contribute to the overall three year training programme if they are part of an ITP. A maximum of six months in total may be spent in posts which are non-patient facing and / or non-clinical.

2.9. Deaneries must clearly show how each post within a programme will deliver aspects of the GP Curriculum and its 13 capabilities. It is particularly helpful to provide this as justification for non-specialty elements to ensure they can contribute to the training programme and for GP registrars to understand what is expected in terms of learning and progress.

2.10. To ensure programmes are broad and balanced, training in any one specialty other than general practice should not normally last for more than six months (wte). Any previous specialty experience being donated to the GP training programme should ideally not be repeated.

2.11. Training in any one non-GP post should not normally last for less than two months (wte). As engagement with the provision of evidence of learning in the Training Portfolio is a requirement for all GP registrars, for short posts to contribute, evidence of learning relevant to the post must be demonstrated, and a named Clinical Supervisor’s Report (CSR) should be included.

2.12. If a GP registrar is training at less than full time (LTFT), the percentage of LTFT training should be no less than 50%. In exceptional circumstances this can be reduced as per GMC guidance.

2.13. These flexible and innovative posts are considered as general practice posts and include Blended Learning. Posts may include a range of different clinics or specialties relevant to general practice and could be based in the community, remotely, online, or where work is undertaken by integrated teams.

2.14. Posts should ideally not be shorter than four months to ensure there is enough time spent in all elements of the post to provide sufficient opportunity for learning and documenting that learning.

2.15. A CSR is expected for each element of the post where time is spent in general practice and one other specialty. For other experience, one CSR which covers all elements of the post is acceptable. It is the responsibility of the GP registrar to show learning across the entirety of the post and document the full scope of learning.

2.16. GP registrars in posts with no clinical activity must have a named supervisor and regular supervision for these posts which must be linked to an approved learning environment, normally the location of the supervisor (usually a GP practice but could be hospital or other environment). A CSR or ESR to cover the learning not directly carried out at the approved learning environment is essential.

2.17. All posts must be recorded and labelled clearly in the Training Portfolio so that there is an accurate record of training. This is a GMC requirement.

For ITPs and BLPs:

• These posts must be labelled correctly on the post list and include the specialty and approved location of each component.
• A prompt appears when adding a new post to confirm if it is an ITP (which includes BLPs). If ITP is selected, post details can be added for a second specialty within the training period.
• If an ITP or BLP includes more than two components or the experience type is not available in the drop-down list, the post description can be used to add additional information about the construction of the post, or the experience included.

2.18. GP registrars can apply to combine previous relevant experience with a GP training programme through a Combined Training pathway: the Accreditation of Transferable Capabilities (ATC) pathway or the Combined Programme (CP) pathway.

2.19. A GP registrar applying for a Combined Training pathway must show that previous experience and capabilities are relevant to GP training and the capabilities required of the GP Curriculum. They must apply through the Training Portfolio and complete a gap analysis and capability mapping.

2.20. GP registrars on either Combined Training pathway will not plan to complete a full three year GP CCT programme. Deaneries should consider how best to construct the training programme to allow the GP registrar to acquire all the capabilities and requirements for CCT.

2.21. A maximum of one year of previous experience may be approved to contribute towards the GP training programme and any contributing time from previous training or experience should ideally not be repeated in GP training.

2.22. GP registrars on a Combined Training pathway will be eligible to apply for a CCT on successful completion of their training programme. Those using previous experience that was not approved UK specialty training must apply for a CCT (CP).

2.23. Time spent in academic training posts will not contribute towards CCT training requirements. Time spent in posts that combine academic and clinical activity should be carefully documented in the Training Portfolio to show how much of the post was in the clinical environment.

2.24. An ARCP form issued during an academic programme should make reference to progress in both the clinical and academic elements.

2.25. If an academic GP registrar is also LTFT, the clinical and academic components should ideally be split 50/50. The clinical element must not fall below 20%. Any clinical component less than 50% should normally be for a maximum of a one-year period. It is recommended that at least the final month of training is completed at a minimum of 50% clinical time in general practice to allow best preparation for independent practice.