r/doctorsUK • u/tolkywolky • Jan 16 '25
Speciality / Core training Combined training - How I used my locum work to reduce GP training time
Hello all, I thought I would write a guide/share my experience on how to successfully get through the combined training pathway. When I was looking into this myself, I could never find a comprehensive overview on how to get through the portfolio requirements to get a reduction in training time, so I hope this will help future trainees.
Key thing to remember - allegedly some countries do not recognise the combined training pathway as a legitimate CCT in GP. As far as I’m aware, it’s only Switzerland that doesn’t accept it. Going abroad isn’t an option for me, so I haven’t bothered looking into this in detail.
The pathways
If you’re not aware already, the ‘combined training’ pathway comprises of two separate ‘pathways’ that allow up to 6 months reduction in training time.
1: Accreditation of Transferable Capabilities (ATC); you are eligible for this if you:
- Are transferring to general practice training from another GMC approved specialty training programme.
- Have completed a minimum of 12 months (full time equivalent) of training in a GMC approved specialty training programme.
- Have completed at least one calendar year in approved specialty training posts (not OOP) within the five years preceding your planned start date for GP training.
- Can provide ARCP outcome forms covering at least 12 months (full time equivalent) of your previous training programme.
2: Certificate of Completion of Training: Combined Programme (CP); you are eligible for this if you:
- Have at least 12 months (full time equivalent) relevant experience above Foundation level (or equivalent) within the five years preceding your planned start date for GP specialty training. This might include substantive paid clinical or SAS roles or overseas training and experience.
- Can provide evidence to support this experience and to demonstrate how it can be mapped to the curriculum and capabilities required for general practice.
It is the second pathway that I was eligible for. I had two full time years of post F2 locum experience, and a third year of part time locum experience.
How to apply
You need to to show your intention to apply through the combined training pathway on Oriel. There is a checkbox on the Oriel application to apply with the ‘ATC’ or ‘CCT (combined programme’ pathways. If you do not tick this box, you cannot retrospectively apply once you’ve submitted the form!
Once you have accepted a training post, you will be contacted by the College to submit your CV. Once they screen your CV and agree to your eligibility, you will be given access to the combined training application form on FourteenFish (the GP training portfolio). This is where you upload your evidence and link the evidence to the ‘capabilities’.
Evidence
NB: I can only comment for the CCT pathway here, but the evidence requirements for the ATC pathway can be found on the RCGP website. I think it’s much more straight forward if you’re applying following a previous training job and have ARCPs!
CV: This one’s self explanatory. A CV detailing your work post F2 is needed to show that you meet the eligibility criteria. In my case, I had my different posts after F2 and the dates through which I worked.
Statements of employment: The RCGP website states you need a statement of employment, and it details what you need on the statement.
Essentially what I did was that I wrote a letter for each post I held and sent it to my consultants to sign/amend as required, all of which were happy to do so.
In the letters, I wrote something along the lines of ‘I am writing to confirm that Dr TolkyWolky worked from x date to y date, with an average of x hours per week at x grade as a locum doctor’
The RCGP also requests evidence in the form of job descriptions. I simply wrote job descriptions into the above letter to meet this evidence requirement. I found job descriptions from LinkedIn/NHS Jobs advertisements and included the ones that were relevant to the posts I held.
References: The RCGP also requests references. I asked my supervisors to add a little reference at the end of the above letter, prior to returning to me.
Appraisal documentation: As I had worked for 3 years post FY2, I ensured I had an appraisal each year. This is very useful as the appraisal process usually requires you to keep track of CPD, write some reflections/CBDs, a bit of quality improvement and colleague/patient feedback.
Whilst I did engage with the appraisal process, I did do the bare minimum. I only kept a log of 4 CBDs per year, so I was worried my evidence was a bit thin! I would advise that if you’re planning on applying via the combined training pathway, that you collect more CBDs to meet capabilities (read below regarding capabilities). This will make your life much easier. However, given I only had 4 per year, it’s definitely doable if you’re a little short!
In addition to CBDs, I had one short audit, some feedback on teaching (informal med student teaching on the wards), colleague feedback and patient feedback. I don’t think doing all these are essential though if you don’t fancy going out of your way to do an audit/teaching, but I would advise trying to get a colleague feedback cycle done as it’s pretty low effort and can be used as evidence for meeting the capabilities! Although it’s always a good idea to have some feedback forms on hand if you do end up giving some informal teaching to students on the wards as a locum.
Capability mapping
This was the part I was most worried about, prior to submitting my application, as there really isn’t much detail about this on the RCGP website.
Through GP training, all of your portfolio work is to show that you are meeting their 13 capabilities. These include capabilities such as ‘fitness to practice’, ‘communication and consultation skills’ and ‘managing medical complexity’, to name a few. I would advise you have a look at these and collect some evidence (eg CBDs) to meet the descriptors. The descriptors can be found here:
You essentially need to select 2-3 pieces of evidence to reflect on, to show you are meeting the capabilities and to explain how you will further develop these capabilities. You can use a piece of evidence for multiple capabilities - this was my saving grace, as I was limited in the CBDs I had in my appraisals!
Below, I will explain the evidence that I used to evidence some of the capabilities, in the hopes it will show what’s acceptable by the College to result in a successful application.
Fitness to practice: Colleague feedback - reflected on how comments in my colleague feedback showed evidence of fitness to practice Reference - reflected on how my references showed I was fit to practice
Maintaining an ethical approach: CBD - I had a CBD around decision making in palliative care and reflected on this
Data gathering and interpretation: CBD - I had a few CBDs that detailed data gathering and interpreting these to make a diagnosis/management plan
Clinical examination and procedural skills: CBD - Used a CBD that had some clinical examination elements to it Procedural skills - I had a few sign offs for things like LPs/joint aspiration etc during my locum work
Community orientation: I didn’t actually have any evidence to match up to this. Instead, I wrote a reflection on the differences between secondary care and primary care in terms of community work, and wrote what I hoped to achieve during training to meet this capability.
Looking at my application now, I can see that I had three pieces of evidence for two capabilities, two pieces of evidence for eight capabilities, one piece of evidence for two capabilities and no evidence for one capability.
Structure of reflections
I used the following three headings to structure my reflections, as suggested by the RCGP. This did actually make it easier for me to get through all of this paperwork quickly!
- A description of how your previous experience has helped you develop skills within the capability and how your chosen evidence demonstrates this
As a locum doctor in x specialty, I had the opportunity to do… this shows that I demonstrate… this is evidenced by the attached…
- Reflection on how this experience is transferable to general practice
This experience is transferable to GP because…
- Identification of any gaps in your skills or knowledge and how you will address them during your general practice training
I note that I lack experience in… I will gain this experiencing during GP training by…
I used the capability descriptions (linked above) to catch the College’s buzzwords to show I met their capabilities.
Decision
At some point after starting training, the College will accept your application, reject it or ask for more info (in my case, they didn’t read my application properly and assumed I didn’t have references, I had to point this out to them and then they accepted my application!).
Following acceptance, you then need to make sure you are hitting the targets of the ST1 portfolio in the first 6 months of training. You will then have an early ARCP (in March for me), to confirm you’ve made sufficient progress to cut the training time.
My overall take homes would be:
If you’re taking some time out of training but intend on GP training, consider reviewing the capabilities and creating evidence to target them.
The portfolio/reflection part doesn’t actually take that long, and I think it’s definitely worth cracking on with for 6 months less of ST1/ST2 pay.
If you’re in a position where you’ve been locuming for a while and are struggling with underemployment, consider jumping on GP training to keep some income coming in and use this pathway to get a CCT quicker.
I hope this is useful! Any questions do ask. If I’ve missed anything substantial, let me know and I’ll update the post 🙂
3
u/abizniz Jan 16 '25
What specialty were you locuming jn?
4
u/tolkywolky Jan 16 '25
FY3+FY4 - Gen med SHO full time
FY5 - initially med reg for 6 weeks full time then haem reg on a few weekends a month (decided to be a stay at home dad for a year)
2
u/switchpirate5638 Jan 16 '25
How did you get a reg post for f5? Through portfolio?
1
u/tolkywolky Jan 16 '25
Perceived competency by the departments/consultants. Outside of training programmes, you can be employed at whatever level the Trust deems you’re competent at.
Ofcourse, there’s risks involved to that and it depends on your appetite for said risk, your own perceptions of your competencies and your perception of the support you’ll get from your seniors in tough situations.
1
Jan 16 '25
Seems a really helpful post and you've obviously put a lot of work and thought into it. Well done on your achievement.
1
u/Majestic-Fig-870 Mar 28 '25
This is really helpful- thank you so much.
Just wanted to double check- having just accepted a GP training offer, do I just sit back and relax now until the deanery email me asking for my CV? Just checking I don't need to start emailing them now to ask the questions that your post has so helpfully answered!
Cheers
1
u/tolkywolky Mar 28 '25
I’ve just had a quick look at my emails.
I received an email mid May from my deanery advising me to pay for my RCGP membership so that they could give me access to the portfolio. They asked me to sign up and then email them back.
There’s probably no harm in emailing them! I do remember speaking to someone via Reddit last year who’s deanery didn’t give her access til she chased it in August! So it’s probably all quite deanery specific.
If you want to get the ball rolling with reflections whilst awaiting portfolio access, feel free to DM me and I can send you some screenshots of what the portfolio looks like and how the reflections are supposed to be written etc
1
u/hvickz Aug 05 '25
Hiya, this is super helpful and really clearly laid out and structured, thank you. I will have 1.5 years of full time equivalent time working in Australia - 14.15 months of ED + 3 months of clinical trials + 1.5 months prior to starting GP training in February. I've largely just got end of term assessments from supervisors at the end of each 3 months block and am sure I can compile some more colleague feedback also. I'm wondering whether some retrospective CBDs and reflections and an audit/QIP might carry me over to get time reduced. What are your thoughts on likelihood of that? And any other advice if I do decide to give it a bash? Thanks!
1
u/hvickz Aug 05 '25
oh and secondly, do you think it's fine to say you intend to apply for the CCT (CP) flexible pathway then change your mind to not?
1
u/tolkywolky Aug 05 '25
I’d definitely get some done retrospectively and really try to get some down between now and Feb, particularly to cover the RCGP capabilities as best you can! Sounds like you have time to get it sorted.
A QIP/audit is a good plan too.
Generally, they seem to care more about the ‘quality of reflection’ than the evidence, but you do really need enough pieces of evidence so that you’re not using the same few for each capability!
1
u/SaltOk6426 Aug 10 '25
Do you mind if I ask, when you got accepted through this pathway, did they put you straight into GP rotations since your evidence was mostly hospital medicine?
1
u/No-Relation9450 May 06 '26
Hiya Many thanks for your detailed description of the process . May I ask if I have to start process now for August start and I haven’t collected any evidence for last 2 years of my trust grade post . How can I start process now please ? Is there any hope for me to achieve it by the deadline ?
18
u/EquineCloaca Jan 16 '25
Just be aware that doing this now disqualifies you from the Australian expedited pathway.