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

Annex 3. Training grades and funding models

Training grades

Across the training grades there is substantial variation in learner numbers, supervision requirements, reimbursement, and contribution to service delivery. Furthermore, individual learner competence and confidence vary, influencing the level of supervision required. This variation makes it difficult to predict, with precision, the number of supervisors, practices, or total hours of supervision required at any given time, and the overall impact on practice workload.

The following subsections outline the key expectations and funding arrangements associated with each major training cohort.

Undergraduate training

Traditional programmes

Students undertaking traditional undergraduate medical degrees typically spend days to weeks per academic year in General Practice. Early exposure is often group-based, progressing to individual placements in later years. While senior medical students may consult patients independently, close supervision remains essential. GPs may also deliver teaching on university or NHS premises, which can either supplement or compete with practice-based capacity.

Newer educational models

Alongside traditional degrees, new community-focused courses, such as ScotGEM (delivered jointly by the Universities of St Andrews and Dundee), have been developed to strengthen generalist and rural competencies. These programmes involve substantially greater General Practice exposure than traditional degrees, though on a smaller scale.

Funding allocation:

Undergraduate General Practice teaching is supported through Additional Cost of Teaching (ACT) funding. Category A ACT funding is currently £85 per student per session.

Postgraduate training

Foundation doctors

Foundation year 2 (FY2) doctors on a General Practice placement typically spend four months in a single practice, progressing from observation and joint consulting to supervised, independent consultations. Clinical Supervisors are responsible for induction, supervision, one-to-one teaching, and educational sign-off. Variation in prior General Practice exposure (depending on medical school and individual experience), alongside confidence and competence, affects supervision demand; by the end of placement, some FY2 doctors contribute substantially to service delivery, whereas others require intensive supervision throughout.

Funding allocation:

Trainer grant = £11,595 per FY2 per annum.

GP Registrars

Full-time GPST in Scotland is three years, typically including six months in General Practice during GPST1 or 2, followed by 12 months in GPST3. Although GP Registrars contribute to clinical workload, training practices invest considerable time in education and supervision. Each Registrar is assigned an Educational Supervisor (ES), responsible for induction, assessments, educational progression and Annual Review of Competence Progression (ARCP) reviews. Supervisors debrief and oversee Registrars throughout their placements, which may reduce their own clinical capacity.

Increasingly, early-career GPs are being encouraged to train as supervisors, and Registrars can begin this process through “trainer-ready” at CCT (Certificate of Completion of Training, awarded following completion of specialty training) courses—reflecting the wider move towards portfolio careers.

Typical ES expectations:

• minimum four hours per week of direct teaching (can be shared across the team).
• additional induction support in the first 6–12 weeks.
• weekly assessments and e-portfolio review (~1 session/month).
• ES Reports every 6 months (1–2 sessions).
• targeted exam support in ST3.
• bespoke input for Registrars requiring additional support.
• attendance at 4–6 trainer meetings (2–3 hours each) plus an annual workshop (one day).

Funding allocation:

Trainer grant = £11,595 per Registrar per annum.

Supervisors also receive a continuing professional development grant of £750 per year.

GPs who have completed GPST

There are structured development programmes available for fully qualified GPs such as ScotGP Retain and Sustain (formerly the GP Retainer Scheme) and the GP Returner Scheme. While these posts are shorter and participants more experienced (theoretically requiring less supervision), their inclusion highlights the breadth of educational need influencing overall training capacity in General Practice.

ScotGP Retain and Sustain

Those on the ScotGP Retain and Sustain (ScotGPRS) programme, typically working four sessions per week and receive one hour per month of mentoring (pro rata). Some may use this protected time for teaching or mentoring others, with approval from the retainer advisor.

Funding allocation: £76.92 per session per Retained GP.

Returner GPs

Returners are GPs returning to practice after a career break of two years or more. Eligible participants work up to six months full time equivalent (or up to 50 % LTFT) under supervision. Each has an ES responsible for induction, learning-needs assessment, and supervision. Salaries are paid by NES, but returners provide clinical service during the programme.

Funding allocation - Trainer grant = £11,595 per returner per annum.