Medical Education Capacity in General Practice in Scotland Working Group: interim report

Annex 1: Progress on the recommendations of the Increasing Undergraduate Education in Primary Care (IUEPC) Group

A working group, chaired by Professor John Gillies, was established in 2018 to explore ways to enhance undergraduate education in primary care. The output of this group — the 2019 report, Undergraduate medical education in Scotland: more General Practice-based teaching — set out a series of recommendations to increase undergraduate medical education in Scotland by enabling more General Practice-based teaching within primary care. The recommendations covered three main areas:

• addressing issues identified by the teaching capacity survey, including space in primary care premises, digital infrastructure and funding for teaching
• strengthening the GP educator workforce to deliver increased capacity
• developing consistent approaches to monitoring, evaluation and accountability.

These recommendations were progressed to varying degrees. Some were achieved or integrated into wider system reform, while others were slowed by the coronavirus (COVID-19) pandemic, financial constraints or have been overtaken by the wider evolution of the General Practice landscape. Across all areas, clinicians, universities, and partners worked with commitment and innovation to maintain progress despite challenging circumstances. The current working group for medical education capacity in General Practice has revisited the IUEPC recommendations to assess progress, reflect on subsequent changes, and broaden the scope to consider challenges across all training grades.

This section summarises the current position and ongoing relevance of the IUEPC recommendations, recognising both the advances made and the continuing barriers. The themes of premises, digital infrastructure and funding remain central to capacity, while the importance of data, evaluation and national coordination continues to underpin efforts to strengthen General Practice-based education across Scotland.

1. Physical and digital infrastructure (recommendations 1–4)

The IUEPC report highlighted the importance of investing in fit-for-purpose primary care premises and reliable digital connectivity to support medical education. While large-scale capital investment has been impacted by wider financial constraints, many Health Boards have continued to improve facilities through local modernisation programmes and targeted refurbishment projects. These have created modest but meaningful increases in teaching space within existing practices. These developments reflect the ongoing effort of practices and educators to find practical solutions within existing resources.

The COVID-19 pandemic also acted as a major catalyst for innovation, driving the rapid adoption of virtual and hybrid teaching models (62-63). These developments helped sustain delivery through periods of disruption and have since been incorporated into many university curricula as complementary tools. Although digital connectivity has improved significantly through the Reaching 100% (R100) and Scottish Wide Area Network (SWAN) initiatives, practical barriers such as IT security and access protocols persist in some areas. Ongoing joint working between universities, Health Boards and the Scottish Government provides a strong foundation to address these, ensuring that both physical and digital infrastructure evolve in step with educational need.

2. Funding and tariffs (recommendations 5–6)

The 2019 recommendations called for a fair and sustainable funding model for undergraduate teaching in General Practice. The Scottish Government responded by increasing the Category A tariff from £40 to £85 per student session. These changes were welcomed across the education and practice communities as an important milestone in recognising the value of primary care-based teaching.

Stakeholder have expressed the view that while the uplift represented significant progress, its real-terms value has been impacted by the absence of regular indexation. Stakeholders have noted the importance of establishing a predictable review mechanism to protect funding parity and stability. Continued collaboration between the Scottish Government, NES and universities offers an opportunity to develop a long-term, transparent approach that sustains both quality and participation in General Practice education.

Since the report, there has also been a review of Category B tariffs which highlighted the complexity of the system. In response to ongoing challenges raised around Additional Cost of Teaching (ACT) funding, the Scottish Government has established plans for a full review of the funding structure in 2026.

3. Educational capacity and workforce (recommendations 7–8)

Considerable work has been undertaken across Scotland’s medical schools to expand exposure to General Practice and grow the GP educator workforce. Progress toward the report’s proposed target of 25% of the medical curriculum being delivered in General Practice varies between institutions but in some universities this target has faced challenges, highlighting the need to reinforce these efforts.

The strengthening of early-career educator pathways and trainer development programmes has strengthened teaching capacity, while the visibility and recognition of General Practice education within universities has increased. This progress owes much to the sustained work of GP educators and academic leaders who have continued to prioritise teaching despite competing demands and pressures.

Although a formal national forum for GP Heads of Teaching (HoTs) has not been commenced, collaboration between institutions has continued informally and effectively.

4. Monitoring, evaluation and governance (recommendations 9–10)

The IUEPC report emphasised the need for ongoing evaluation and clear governance structures to track progress and assess impact. Early progress was made through the IUEPC delivery group, which introduced structured reporting mechanisms. Over time, however, these arrangements have evolved to become less formal, which has created a need to re-establish clearly visible feedback systems.

Although formal large-scale evaluations have not taken place, universities and NES have carried out smaller-scale assessments that have generated useful insights.

Progress on the IUEPC report - summary

Overall, there has been modest progress since 2019. The collective effort and resilience of clinicians, universities, NES and government partners have been central to maintaining the system through a period of unprecedented challenge. Some recommendations have been delivered or incorporated into wider reform, while others have advanced less quickly due to fiscal and operational pressures. Importantly, the IUEPC Report has had a lasting influence — prompting tariff reform, advancing digital infrastructure, and embedding General Practice more firmly within Scotland’s medical education landscape, alongside continuing to provide a benchmark for improvement.

The shared commitment across organisations provides a strong base on which to build. With renewed coordination, sustained investment, and a focus on strategic evaluation, further improvements can be made.