HEE SW GP Trainee Support Strategy

1. Executive Summary

This webpage describes the current support systems available to GP trainees from HEE in the SW. The document also includes guidance and supporting materials for use by educators in working with these trainees. It forms part of the HEE SW Professional Support Unit (PSU) strategy, available at:



and describes how their guidance is implemented in the Severn and Peninsula Schools of Primary Care (SoPC).

2. Introduction

2.1. This strategy is designed to produce a consistent and structured approach to supporting GP trainees. It fomalises and defines best practice and provides a flexible and consistent approach to trainees needing support.

2.2. It forms part of the HEE SW PSU strategy which describes three levels of support;

  • Level 1. This level describes support required for trainees with minor concerns or dilemmas, presenting a potentially low risk to patients, themselves or others, for which a formative developmental approach is appropriate. This is usually managed by educational and clinical supervisors
  • Level 2. This describes trainees with issues that, if left undetected or unresolved could pose a moderate risk to the individual trainee, patients or the organisation, but are not yet sufficiently serious to warrant disciplinary action. This is usually managed by local programme teams
  • Level 3. This describes trainees with serious concerns and/or repetitious performance issues for which specialist input and resources are appropriate. These trainees will need support from the central PSU as well as their programme teams.


This guide talks mainly about Level 2 support.

2.2. Patient safety should always be of overriding importance if concerns are raised about a trainee. If the Trainee in Need of Support (TINS) has evidence of impaired performance then the first step should be to assess whether there is an impact on patient safety and if so to mitigate that impact by whatever steps are thought necessary

The strategy has three main components;


  • Identification
  • Diagnosis
  • Support


3. Identification

3.1. It is important to stress that trainees can identify themselves as needing additional support from the GP programme team at any stage of their training. Part of trainee induction is to advertise the availability of additional support and to tell trainees who to approach on their programme to access it.

3.2 As well as self-nomination we actively seek trainees who need support rather than wait for problems to develop. The Schools of Primary Care have therefore developed criteria for trainees to automatically enter the trainee support system. These are based on;

  • Accumulated SoPC experience of working with trainees needing support
  • HEE SW Professional Support Unit’s experiences
  • Systems adopted in other PGME areas

3.3 Criteria for consideration of entry into the support system:

At recruitment;

         1. Arriving via an Inter or Intra Deanery Transfer (IDT)

         2. Significant factors identified on Foundation transfer of information (TOI) form

 Once in training;


         3. ARCP unsatisfactory outcomes 2 and 3.
         4. Assessment at ESR of “Unsatisfactory” or “Panel opinion requested”
         5. Single exam failure (CSA or AKT)
         6. Lack of eportfolio engagement (usually demonstrated in the first post in the programme)
         7. Teaching attendance at day release below 70%
         8. Sickness absence of greater than 2 weeks in a training year
         9. Concerns identified by supervisors or TPDs suggesting difficulties in training, e.g. personal difficulties, attitudinal issues etc.

 3.4. Although International Medical Graduates (IMGs) statistically have higher failure rates not all IMGs will be TINS. IMGs are interviewed by a TPD in the first 3 months of training to decide if a trainee needs additional support.


3.5. Programme review meetings:

The core of this identification process is a regular programme-based meeting where alltrainees are reviewed. There are two reasons to review all trainees;

  • To identify every TINS all trainees need to be regularly reviewed to pick up new issues
  • It reduces the likelihood of these trainees perceiving themselves as being victimized if the progress of all trainees is being regularly reviewed.

For most trainees this is a brief discussion. For a few however it is the first step in identifying and following up trainees in need of support (see Appendix B for a list of trainee characteristics as indicators of risk). Trainees usually enter and leave the support system at this review meeting. However sometimes trainees may be identified outside these meetings through more ad hoc processes.


3.6. Review meetings should have access to;

  • Recruitment scores
  • TOI forms
  • Teaching attendance figures
  • Sickness record
  • ARCP data
  • Trainees’ eportfolios
  • Supervisor feedback and any other soft intelligence


3.7. Other data sources:

  • Programmes can contact each trainee and each trainee’s Educational Supervisor (ES) during the trainee’s first post to check if either have any concerns. (Appendix E for sample letter)      

3.8. The local programme trainee support database is maintained by the programme administration team. They provide a monthly update to the appropriate Head of School.


3.9. Exiting trainee support - The programme team decides at its regular meeting which trainees are able to leave the support system, usually after agreeing this with the trainee. All trainees are reviewed regularly so there are opportunities to reinstate support if needed.



4. Diagnosis


4.1. Once identified at the programme meeting as potentially in need of support, the trainee is invited to meet with a member of the programme team – this invitation is recorded in the ‘Educator Notes’ section of the eportfolio. The trainee should be involved in the setting up of the meeting and have a say in which TPD is involved. Programmes should also have in place guidance for trainees on who to contact if they feel their relationship with their TPD is breaking down. The programme team takes account of issues of equality, diversity and transparency during all its interactions with trainees

 4.2. Meeting the trainee:

An explanation of the TINS support system is part of trainees’ induction and also included in the initial invitation to meet. Trainees need to know why they have been identified as potentially needing additional support and this is discussed at the first meeting with the trainee.

 4.3. The interview is a flexible process. Trainees’ needs vary. Initial assessment uses the NCAS performance triangle model as adopted by the HEE SW PSU (Appendix A). Support and guidance is provided by the SoPC to educators taking on this role (see Appendix C for further guidance for educators about this interview).

 4.4. The meeting is summarized in the Educator notes section of the eportfolio, with the content of the entry discussed beforehand with the trainee. An email is sent to the ES and current clinical supervisor (CS) summarising the interview (this can be pasted from the educator notes).

4.5. The interview sometimes confirms that there is no current need for support.


 5. Support


5.1. By the end of the initial meeting the educator will have a preliminary idea of the issues and the type of support required.


5.2. TINS are then divided into two groups;

 1. Those who remain in the SoPC support system


This corresponds to Level 2 of the PSU system (Appendix D). These trainees can be offered;

  • Ongoing educator support in their programmes
  • Advanced consultations skills course
  • Specific help with the CSA
  • Triangulation of assessments/supervision using a second assessor
  • Support for the trainee’s supervisor in the workplace

 2. Those referred to the Severn or Peninsula PSU


This corresponds to Level 3 of the PSU system (Appendix D). If the educator feels that they need other specialist forms of support then the trainee is referred to the PSU. This could include;

  • Exam/Study Skills technique
  • Psychological assessment
  • Educational psychology assessment
  • Dyslexia screening/support
  • Coaching
  • Counselling
  • Career counselling
  • Mental health assessment and support


As per PSU policy trainees are free to refer themselves at any time to their respective PSU outside this programme-based support system.


6. Database Management

6.1 The actions/notes section of intrepid is used to record those trainees needing support.  This allows programmes to:

  • Record support start and end dates
  • Maintain a current and inactive status
  • Record general notes
  • Set up administration reminders for any follow up work
  • Report a list of identified trainee contact details




                                                                                    Version 1.3    

                                                                                    Author: Dr. Simon Newton

Head Of School of Primary Care, Severn PGME

July 2016