Practice Managers & GP Training
Because behind every brilliant GP trainer, there's usually an equally brilliant Practice Manager holding everything together.
Practice Managers are the unsung heroes of GP training. This page explains exactly what the role involves, how to manage common challenges with trainees, and how to make your practice a genuinely excellent training environment — not just a technically approved one.
Last updated: April 2025
📥 Downloads
Handouts, summaries, and teaching extras — ready when you are.
📂 Practice Managers
Presentations, employment guidance, induction packs, and training scenarios for Practice Managers.
path: PRACTICE MANAGERS
- 01 gp training basics for practice managers.ppt
- 02 practice managers - expectations of trainees and training practices.ppt
- 03 practice managers - becoming a training practice.ppt
- 04 practice managers - systems in gp training.ppt
- common gp training scenarios for practice managers.doc
- employment recommendations for training practices.doc
- expectations of gp trainers.doc
- practice managers - induction to gp training (TEACHING RESOURCE).doc
📂 Becoming a Training Practice
Everything you need to understand or set up a GP training practice for the first time.
path: BECOMING A TRAINING PRACTICE
- basics about gp training.pptx
- becoming a training practice by yorks deanery.doc
- becoming a training practice.ppt
- checklist for the new trainees room.pdf
- is your practice ready for training.pdf
- recommendations for new training practices.doc
- summarising medical notes for gp training.doc
- the drives and blocks to training.doc
📂 Mileage Claims
Claim forms and guidance for GP trainees and their managers — because mileage admin shouldn't be a mystery.
path: MILEAGE CLAIMS
🌐 Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls aren't hiding in the official documents.
💡 Why Practice Managers Matter in GP Training
This isn't HR admin. This is what makes or breaks a training practice.
Over many years of observing GP training practices across the UK, the evidence consistently points to three factors that separate excellent training practices from merely adequate ones:
- A GP Trainer who is passionate and committed — not just technically approved, but genuinely invested in their trainee's development.
- A whole-practice ethos — where receptionists, nurses, admin staff, and partners all see training as part of what the practice does, not a burden it tolerates.
- A Practice Manager who is fully engaged — not just administering the trainee, but actively championing the training culture from within.
📈 What great PM involvement looks like
- Proactively induciting new trainees before Day 1
- Protecting HDR and tutorial time from clinical pressures
- Knowing what the 14Fish ePortfolio is — and why it matters
- Having a WhatsApp group with other training PMs
- Being the first port of call when something feels "off" with a trainee
- Advocating for training in partners' meetings
- Running the sickness absence process properly from day one
⚠️ Signs a training practice is struggling
- Trainees consistently late for HDR because of practice workload
- Sickness records not maintained or not reported
- No formal induction for new trainees
- Training seen as "the trainer's job" by the rest of the practice
- PM unaware of mileage claim processes
- Poor communication between PM, trainer and scheme
- No understanding of what ARCP, HDR or CCT means
The practices where trainees flourish are almost always the ones where the Practice Manager has taken ownership of the training environment — not just the paperwork. When the PM is enthusiastic, it's contagious. Staff notice. The trainee notices. And the TPDs certainly notice.
🗣 Voices From the Field
These are patterns drawn from real UK GP training discussions — things trainees, trainers, and experienced PMs consistently say. Distilled, verified, and presented here for you.
"The practices I've loved most are the ones where someone — often the Practice Manager — actually knew my name on Day 1. It sounds small. It isn't."
"I had no idea how to claim mileage for three months. It was thousands of pounds. Nobody had explained it to me. A two-minute conversation on Day 1 would have changed everything."
"I kept being booked for home visits right before HDR. By the time I fought traffic, I was always 15 minutes late. The TPDs thought I was being lazy. The practice never adjusted the rota."
"My IT login wasn't ready until Week 3. I had to use a colleague's login in the meantime. No one seemed to think this was a problem. It is. You cannot practise safely without your own login."
"The PM at my second practice ran a monthly 'check-in' — not clinical, just a welfare chat. It meant problems got caught early. Brilliant idea. I wish all practices did it."
"Having my own pigeonhole, a dedicated parking space, and being introduced to the whole team in the first morning meeting — it told me I was welcome here. That feeling stayed for the entire placement."
"When the PM is engaged, the whole practice follows. When the PM isn't interested, even good trainers can feel unsupported."
"Absence recording is the one thing PMs consistently underdo. It feels like admin but it's actually patient safety — and it protects the trainee too."
"The best PMs treat a trainee's wellbeing as seriously as a member of staff's. Because legally and ethically, it is."
⚡ Quick Summary — If You Only Read One Thing
The essential PM cheat sheet for GP training. Read this before your next trainee arrives.
🗝 The 12 Things Every GP Training PM Needs to Know
🎓 GP Training 101 — What Every PM Needs to Understand
A clear map of how someone becomes a GP in the UK — so you understand exactly where your trainee sits in the journey.
🗺 How GP Training Schemes Are Organised
The UK is divided into large regional GP Schools (e.g. Yorkshire & Humber, London, South West). Each GP School oversees multiple local GP Training Schemes — one for each major town or city. Each scheme is led by Training Programme Directors (TPDs) and has an administrator. Trainees are allocated to schemes and rotate through approved training posts within them.
| Term | What it means | Relevant to PM? |
|---|---|---|
| ARCP | Annual Review of Competence Progression — the formal yearly panel review of each trainee's progress | Yes — absences and concerns feed into this |
| CCT | Certificate of Completion of Training — the final qualification confirming a trainee is ready to practise as a GP | Yes — extended absences can delay it |
| HDR | Half Day Release — protected weekly structured teaching for all GP trainees at the scheme's teaching venue | Essential — must be protected in the timetable |
| TPD | Training Programme Director — senior GP educator who oversees the scheme and supports both trainees and trainers | Yes — key escalation contact for PM |
| 14Fish ePortfolio | FourteenFish — the online platform where trainees log their learning, assessments, and workplace-based evidence | Awareness useful; direct access not required |
| AKT | Applied Knowledge Test — one of the MRCGP written exams, testing clinical and non-clinical knowledge | Low — awareness only |
| SCA | Simulated Consultation Assessment — the MRCGP consultation exam, replaced the old CSA | Low — awareness only |
| Lead Employer | The NHS Trust that formally employs GP trainees and processes their pay, leave and absence — NOT the practice | Critical — all formal HR goes through them |
This confuses many PMs. The GP trainee is not directly employed by your practice. They are employed by a Lead Employer — usually a large NHS Trust designated by the Deanery/NHS England. Your practice hosts and supervises them. This distinction matters enormously when it comes to sickness pay, contracts, and formal HR processes.
🏥 The Practice Manager's Role in GP Training
More than admin. More than compliance. You set the tone.
Environment Creator
You shape the physical and cultural environment in which the trainee learns. That includes the trainee's room, IT access, rotas, and the attitudes of the whole team.
Liaison Hub
You are the key contact between the practice, the Lead Employer, and the training scheme. Communication gaps cause problems — you prevent them.
HR Anchor
You manage sickness records, absence reporting, back-to-work interviews, and escalation. You do not replace occupational health or the trainee's own GP.
📋 Core PM Responsibilities — At a Glance
Before the trainee arrives
- Confirm start date and rotation details with the scheme
- Prepare the trainee's room, desk, and IT login
- Ensure consultation room is ready
- Brief the whole team — include reception, nurses, admin
- Check the trainee's indemnity is in place (MDO membership)
- Prepare the induction timetable in collaboration with the trainer
- Have mileage claim process ready to explain on Day 1
During the placement
- Protect HDR and tutorial time from clinical over-run
- Maintain an up-to-date absence and holiday record
- Report any absence to the Lead Employer promptly
- Conduct back-to-work conversations after sick leave
- Liaise with the GP Trainer on any concerns
- Be available to the trainee as a non-clinical support point
- Process study leave and mileage claims efficiently
Assuming training admin runs itself once a trainee is inducted. The practice sickness policy, absence reporting, HDR protection, and liaison with the scheme all require active, ongoing management — not just a one-off setup.
📊 Visual Guides
Sometimes a picture really is worth a thousand words. Here are some key concepts shown visually.
🏛 The Three Pillars of a Great Training Practice
Research across UK training practices consistently shows these three factors explain most of the variation in training quality.
🥧 Where Does a GP Training PM's Time Actually Go?
⚖️ Good Practice vs Poor Practice — Side by Side
🗓 The PM's Induction Masterplan
What trainees consistently say they wish had happened on Day 1 — and the week after. This is the gold standard.
📋 Before the Trainee Arrives — PM Checklist
- ✓ Clinical system login (EMIS/SystmOne) activated
- ✓ NHS email address set up
- ✓ Smartcard access arranged
- ✓ Intranet / practice shared drive access
- ✓ Confirm indemnity (MDO membership) is in place
- ✓ Confirm Performers List registration is done
- ✓ Know the Lead Employer HR contact details
- ✓ Prepare mileage claim forms and process guide
- ✓ Clean, tidy consulting room with working equipment
- ✓ Doctor's bag checked and stocked (including emergency drugs)
- ✓ Named pigeonhole or mailbox
- ✓ Car parking arranged (if applicable)
- ✓ All staff briefed — including reception and admin
- ✓ Safeguarding lead identified and brief planned
- ✓ Induction timetable (first 2 weeks) prepared with trainer
- ✓ Practice welcome booklet or pack ready to hand over
Trainees consistently report that receiving a proper printed or digital welcome booklet on Day 1 makes them feel valued and prepared. It removes the anxiety of "I don't know who to ask." It doesn't need to be long — just a staff list, key contact numbers, practice policies, IT login guide, and how to claim mileage. Practices that do this say trainees settle in weeks faster.
📅 Week 1 — What Should Happen (and When)
Welcome from PM personally. Tour of the building. Meet the whole team — especially reception. Hand over the welcome booklet. Explain the mileage claims process. Check IT login is working. Check Performers List status.
Safeguarding briefing (face-to-face — e-learning alone is not sufficient). Introduce to clinical system — supervised login and navigation. Explain the sickness reporting process. Confirm HDR dates are already blocked in the rota.
Shadow sessions with different members of the MDT — GP, nurse, pharmacist, receptionist. Not about clinical learning yet — about understanding how the practice works together. Trainee appointment length starts at 30 minutes (ST1) or 15–20 minutes (ST3). All sessions followed by a 20–30 minute debrief with a qualified GP.
PM checks in informally — "How are you settling in?" This is NOT a clinical review. It is a human check-in. It costs five minutes. It builds the relationship that will matter enormously if something goes wrong later.
📅 The Trainee Timetable & Protected Time
Get this wrong and everything else unravels. Get this right and training flows beautifully.
GP trainees have mandated protected time that the practice cannot override. Half Day Release (HDR), tutorial time, and OOH sessions are all part of the structured training programme. Consistently overrunning into this time is a training quality issue that the TPD can and will act on.
| Protected Time | What It Is | PM Action |
|---|---|---|
| Half Day Release (HDR) | Weekly (usually Wed PM or similar) — structured group teaching at scheme venue with all trainees and TPDs | Block out in rota. Limit home visits on HDR day. Ensure surgeries finish on time. |
| Tutorial Time | Protected one-to-one teaching time between trainee and trainer — minimum 1 hour per week | Put in the diary as a fixed weekly appointment — not ad hoc. |
| Out-of-Hours (OOH) | Required OOH sessions as part of training — trainee must do a minimum number during their GP post | Coordinate with trainer to ensure these are scheduled and recorded. |
| Study Leave | Time for courses, exams, revision, and professional development | Process claims promptly. Trainees have a study leave budget — ensure they can access it. |
| Annual Leave | Trainees have annual leave entitlement per their contract with the Lead Employer | Plan with the trainer. Record and report to the Lead Employer as required. |
One of the most common scheme complaints is trainees arriving late for HDR. Before assuming it's the trainee's fault, check the rota: are they finishing a surgery with no run-off time? Are they doing home visits just before HDR day? Limiting home visits to a maximum of one or two on HDR days is a small change that makes a big difference.
🧩 Handling Difficult Scenarios
Real situations. Practical approaches. The kind of wisdom you won't find in any official handbook.
Before escalating, labelling, or disciplining — explore. In almost every difficult trainee situation, there is a reason behind the behaviour. Your job is to find it, not to punish it. A trainee who seems difficult is more likely struggling than lazy. Approach every conversation with curiosity, not judgement.
The Training Programme Directors have flagged that your trainee consistently arrives 20 minutes late for Half Day Release and Wednesday tutorials. The trainer has raised it with you.
Step 1 — Define the scope
Before acting, gather facts. Ask: is the trainee late only at HDR, or late for everything including their own surgeries at the practice?
- Late for everything → systemic issue; raise with the GP Trainer to explore with the trainee directly
- Late only for HDR → likely a practice scheduling problem, not a trainee attitude problem
Step 2 — Use a register
Suggest a simple late arrivals register — separate from the standard attendance register — at both the practice and the scheme. Record arrival times and reasons. After two weeks, compare both. The data tells the story.
Step 3 — Look inward first
Audit the trainee's rota on HDR days. Are they being given home visits that push them past the time they need to leave? Is their surgery over-running? Are there administrative tasks assigned to them on HDR afternoons?
Limit home visits to a maximum of one or two for trainees on HDR days. This single change resolves the problem in the majority of cases. The trainee isn't being difficult — the rota is.
Step 4 — If it's genuinely the trainee
Have an open, neutral conversation. Avoid leading with blame. Frame it as "I've noticed this pattern and I want to help you figure out what's getting in the way." There may be traffic issues, childcare, a medical condition, or anxiety about the teaching environment. All are solvable once understood.
Staff have noticed the trainee never spontaneously helps, doesn't smile, and seems low in mood or resentful. You're not sure why, but the atmosphere is affected.
The PM has a significant role here
Don't wait for the trainer to pick this up. As PM, you have the advantage of being a non-clinical contact — some trainees find it easier to open up to you than to their trainer, who also assesses them.
Possible underlying causes — keep an open mind
- Bereavement or family crisis
- Relationship breakdown
- New parenthood / childcare stress
- Financial difficulty
- Sleep deprivation
- Depression or anxiety (undiagnosed)
- Feeling disrespected or unsupported
- Burnout from workload
- Comparing their conditions unfavourably with other trainees
- Concern about ARCP or exam performance
How to approach the conversation
- Choose neutral territory — not the trainer's consulting room, not a corridor. A quiet meeting room works well.
- Lead with curiosity, not judgement: "I've noticed you seem like you have a lot on your plate at the moment. I just wanted to check in."
- Listen without interrupting. Your aim is to understand, not to resolve immediately.
- If there's something the practice can change (flexible hours, reduced visits, quieter days), say so.
- Involve the GP Trainer once you have a clearer picture.
Trainees sometimes become resentful when they feel their neighbouring trainee is having a "better deal" at their practice. Acknowledge this reality openly: different training practices are autonomous organisations, and there will always be some variation. This is the real world — and exactly what they'll experience as a qualified GP job-hunting too. No two posts are the same.
A trainee with moderately severe asthma conducts a home visit to a COPD patient who smokes heavily. The trainee suffers a significant asthma attack during the visit.
Immediate actions
- Ensure the trainee receives immediate medical attention. Document the incident as a significant event.
- Complete a workplace health and safety incident report.
- Notify the GP Trainer and TPD.
Legal position and prevention
Under health and safety legislation, the practice has a duty of care to all workers — including trainees. For future visits of this kind, arrangements can include: asking the patient to stop smoking and fully ventilate their home for at least 4 hours before the visit; or asking the patient to receive the doctor in a smoke-free room (kitchen, hallway).
Any healthcare professional has the right to prioritise their own safety. A trainee with asthma should never feel obliged to enter a heavily smoke-polluted environment. This applies equally to all clinicians — even those without asthma.
- Flag any patients known to be heavy smokers when assigning home visit lists to trainees with respiratory conditions
- Brief all staff on the process for pre-arranging visits to smoking households
- Document the trainee's health condition in their risk assessment file (with their consent)
- Consider a general practice policy on smoke-free home visits for all staff
The trainee consistently calls in sick at 8:30am when their surgery starts at 9am. The absences are mostly minor illnesses, sometimes caring for a sick child. It's causing real disruption.
Start with the basics — have you actually explained the policy?
Before assuming poor intent, ask yourself: has anyone actually told the trainee when and how to report sickness absence? Many trainees call late because they're genuinely hoping they'll feel better and want to avoid "unnecessary" absence. They're trying to do the right thing — just doing it in a way that doesn't help the practice. A clear early conversation about process often resolves this immediately.
What the PM should do
- Implement the normal practice sickness policy from the outset — trainees are not exempt.
- Conduct a back-to-work conversation after every episode of sick leave. Keep it brief, warm, and exploratory — not interrogatory.
- After 3 episodes in 6 months, conduct a formal interview. This is a standard HR process, not a disciplinary action.
- Maintain and report all absences to the Lead Employer monthly.
- Raise the pattern with the GP Trainer if it continues — jointly decide how to proceed.
If total absence (excluding annual leave and study leave) exceeds 14 days in any training year, this triggers a mandatory review by the ARCP panel and may result in the trainee's CCT date being extended. It is the PM's responsibility to maintain accurate records and to ensure the Lead Employer and TPD are informed promptly.
Common reasons for repeated short-term absences include: depression or anxiety, a chronic condition with unpredictable flares (e.g. rheumatoid arthritis, migraine), childcare breakdown, relationship difficulties, financial stress, or secondary employment (moonlighting). The "lazy trainee" explanation is statistically the least likely. Always explore before concluding.
- Referral to the trainee's own GP (not their GP trainer) if health issues emerge
- Referral to Occupational Health via the Lead Employer for complex or persistent health-related absence
- The GP Trainer must never assume the role of the trainee's temporary personal GP
Your GP Trainer feels that training is seen as less important than money-generating activities like GPwER (GP with Extended Role) income. They feel undervalued compared to their partners.
Start with honest self-reflection
As PM, ask yourself: have you inadvertently perpetuated this? If training never comes up in practice meetings, if complaints about training are consistently ignored, or if operational priorities have gradually crowded out the training conversation — the culture will reflect that. The PM's attitude shapes practice culture more than most PMs realise.
- Have an honest, private conversation with the trainer on neutral territory. Listen fully. Do not defend. Do not minimise. The goal is to understand, not to rebut.
- Reflect on your own contribution to the current culture — with honesty.
- Co-design a plan with the trainer for what "good" would look like.
- Arrange a whole-practice discussion — doctors, nurses, admin — to surface perceptions and reset expectations.
- Use the session to educate partners about the real value of training: the trainer grant, the positive reputational effect, the clinical stimulus, the extra pair of hands, and the contribution to UK GP workforce.
- Trainer grant paid to the practice (6-monthly in arrears)
- Extra clinical capacity — trainees see their own list of patients
- Clinical stimulation — trainees ask questions that make the whole team think
- Strong recruitment pipeline — many trainees return to practices where they trained
- Positive GMC/CQC profile as a teaching organisation
- Access to training scheme resources, events, and networks
- Contribution to the NHS GP workforce — the bigger picture
🤒 Sickness Absence — A PM's Practical Guide
The rules, the triggers, the process. Get this right from day one.
📋 The Sickness Absence Process — Step by Step
- Day 1 of absence: Trainee notifies the practice (PM or trainer). PM then notifies the Lead Employer — this is mandatory. Do not delay.
- Self-certification: For absences up to 7 days, the trainee provides a self-certification form to the Lead Employer.
- Fit note: For absences over 7 calendar days, a GP-issued fit note is required.
- Return to work conversation: Conduct this after every single episode of absence — brief, warm, and exploratory. Document it.
- Formal review trigger: 4 separate episodes, or 8+ working days absent in a rolling 12-month period.
- CCT extension trigger: Total absence exceeding 14 days in any one training year triggers mandatory ARCP review and likely CCT date extension.
- Occupational Health referral: Available through the Lead Employer for complex or persistent absence. Discuss with the trainee first.
- Report ALL absences to the Lead Employer monthly
- Maintain a continuous record — including across rotations
- The trainer must never be the trainee's personal GP
- Moonlighting (secondary employment) causing absence = possible conduct issue
- Unauthorised absence = potential disciplinary matter
- Back-to-work conversation = every episode, no exceptions
- Maintain own practice register, separate from Lead Employer record
- Know who the Lead Employer HR contact is before the trainee starts
- Ensure the TPD and trainer are kept informed of patterns
- Refer to Occupational Health early — don't wait for a crisis
| Threshold | What Happens | Who Acts |
|---|---|---|
| 4 episodes or 8+ days in 12 months | Formal absence review triggered | PM + Lead Employer HR |
| 14 days in any ST year | ARCP review + likely CCT extension | TPD + ARCP panel |
| 3+ months (continuous or cumulative) | Complex absence — considered as long-term | Occ Health + TPD + Lead Employer |
| Over 12 months total | CCT extension required; minimum clinical period before CCT | RCGP + GMC |
🔀 Decision Flowcharts
Know exactly who to contact, and when. These flowcharts make the decision straightforward.
📍 Flowchart 1 — Something Feels Wrong With the Trainee
📍 Flowchart 2 — Trainee Keeps Arriving Late for HDR
📍 The Sickness Absence Escalation Pyramid
🧑🏫 Supporting Your GP Trainer
The trainer-PM relationship is a partnership. When it works well, everyone benefits.
🤝 How PMs Can Actively Champion Training
In the practice
- Raise GP training as a standing agenda item at team meetings
- Brief new staff about the training ethos and the trainee's role
- Celebrate when trainees pass exams or complete their CCT
- Ensure the trainer's teaching time is protected in the rota
- Advocate for training when budget discussions arise
In difficult times
- Be the trainer's sounding board when a trainee is struggling
- Help distinguish HR issues (PM-led) from educational issues (trainer-led)
- Keep communication flowing between trainer, trainee, and scheme
- Know when to escalate to the TPD — and do so without delay
- Ensure the trainer never feels alone in managing a complex situation
Use data, not emotion. Calculate the trainer grant income and the effective clinical workload contribution of the trainee (they see their own patient list from week 8–10 of the placement). Add the reputational benefits and recruitment pipeline. A well-presented business case, supported by the PM, is far more persuasive than an impassioned plea. Then follow up with a structured practice discussion to get everyone on board.
💎 Insider Pearls — What Nobody Tells You at First
Hard-won wisdom from experienced training practice managers and trainers across the UK.
The best training practices don't treat the trainer grant as the reason to train. They treat it as a bonus. The real reason is the culture it creates — curious staff, engaged teams, and a practice that thinks rather than just processes.
Trainees notice everything on Day 1. A warm welcome, a working login, a tidy room, and someone who knows their name changes the entire trajectory of the placement. Induction is not a box to tick — it's the first lesson you teach them.
When a trainee struggles, the instinct is often to manage upwards — tell the trainer, escalate to the TPD. Sometimes the most powerful intervention is a quiet ten-minute conversation with the PM over a cup of tea. Try that first.
PMs who join a WhatsApp group or network of other training practice managers don't just share tips — they share the emotional load. Training can be complex. A PM peer network is enormously valuable and costs nothing to set up.
The 14Fish ePortfolio isn't the PM's job — but knowing what it is, and why the trainee needs protected time to complete it, prevents a lot of unnecessary tension. If a trainee is asking for 30 minutes to log a reflection, that's training, not admin-avoidance.
Mileage claims may seem trivial, but for trainees on a tight budget, a delayed claim can cause real financial stress. Processing claims promptly is a small thing that has an outsized effect on trainee wellbeing and practice relationships.
Good PM support means the paperwork is correct, the absences are reported, and the induction pack is ready. Great PM support means the trainee feels safe, the trainer feels valued, the practice culture is warm, and when something goes wrong — there's already a relationship of trust in place to address it. That's not administration. That's leadership.
🧠 PM Wisdom — Things They Don't Put in Official Handbooks
Practical advice from experienced training practice managers, trainers, and GP educators across the UK.
On difficult conversations
Start every difficult conversation with curiosity, not judgement. Say "I wanted to understand what's been happening" — not "I've noticed you've been…" The first invites openness. The second invites defensiveness. You'll get much further with curiosity.
On building your PM network
The most valuable professional development a training practice PM can do costs nothing: set up a WhatsApp group with other training PMs in your area. Share templates, ask questions, vent when needed. You'll solve problems in minutes that might otherwise take days.
On investigating behaviour
Before you escalate, ask yourself: "What don't I know yet?" A trainee who looks lazy might be exhausted. One who seems rude might be frightened. One who keeps calling in sick might have a condition they're embarrassed about. The simplest questions often unlock the most important answers.
On the 14-day rule
Do not wait until a trainee has had 14 days off to start proper absence management. By then you've already passed the threshold. Good absence management means acting consistently from the very first episode — not waiting for a trigger you hoped wouldn't arrive.
On the GP trainer's role
The GP trainer must never become the trainee's personal GP. If health concerns emerge, signpost to the trainee's own GP (outside the practice) and Occupational Health. The trainer who starts prescribing or informally managing a trainee's health is creating a serious professional boundary problem.
On advocating for training
When partners question whether training is "worth it", remember: trainees see their own patient list from around week 8–10. They are clinical capacity. They stimulate learning for the whole team. They are often the most likely future recruits to the practice. The case makes itself — but only if you make it.
🧩 The EXPLORE Framework
When a trainee's behaviour concerns you — use this before anything else.
❓ Frequently Asked Questions
Quick answers to questions PMs ask most often.
The trainee is employed by a Lead Employer — usually a large NHS Trust designated by the Deanery/NHS England. Your practice hosts and supervises them, but the formal employment contract, salary, and most HR processes belong to the Lead Employer. This matters for sickness reporting, pay queries, and any formal HR action.
Listen without judgement and thank them for trusting you. You are not their therapist or GP. Your role is to signpost to appropriate support: their own GP (not their trainer), the TPD for educational and pastoral support, Occupational Health via the Lead Employer, and NHS Practitioner Health for doctors with mental health or addiction concerns. Document the conversation briefly and in confidence. Inform the trainer that support may be needed, without breaching confidentiality unless there is a patient safety concern.
More than 14 days absent in any one training year (ST1, ST2 or ST3) triggers a mandatory ARCP panel review. Any excess above 14 days is typically added to the CCT date. This includes sickness, but excludes annual leave and study leave. Accurate and timely reporting by the PM is essential — delays in reporting can create significant problems later.
No. HDR is mandated protected teaching time and cannot be overridden by practice workload. Persistently preventing a trainee from attending HDR is a training quality failure that the TPD can escalate, and in serious cases, a practice's training approval can be affected. The correct response when the practice is under pressure is to manage the rota to ensure the trainee can leave on time — not to keep them back.
Moonlighting (taking additional paid clinical work outside the training programme without approval) is subject to rules around safe working hours and the European Working Time Directive. If you suspect a trainee is moonlighting and it is affecting their attendance or performance, raise it with the GP Trainer first. The trainer should discuss it with the TPD. Trainees must have secondary employment approved — it is not automatically prohibited but must not compromise the training programme or patient safety.
Your first contact should always be the GP Trainer. If the trainer shares or escalates the concern, the next contact is the TPD (Training Programme Director). For employment and HR matters, contact the Lead Employer. For urgent patient safety concerns, the TPD should be informed immediately. Trainers and PMs should never feel alone in managing a concerning situation — the scheme has pastoral and support structures specifically for this.
Training practices receive a trainer grant paid 6-monthly in arrears by NHS England / the Lead Employer. The grant is paid to the practice, not to the individual trainer. How the grant is used within the practice is a matter for the partners and PM to agree — typically it offsets the cost of the trainer's protected time for teaching. The amount varies by region and may be updated periodically.
🏁 Final Take-Home Points
- You are not just the trainee's administrator — you are a core member of the training team. Own that role.
- Explore before you judge. Every trainee behaviour has a context. Find the context first.
- Protected time (HDR, tutorials, OOH) is non-negotiable. Protect it in the rota — or you'll be managing the fallout.
- Report all absence to the Lead Employer promptly. The 14-day threshold is not a guideline — it is a formal trigger with real consequences.
- The GP Trainer must never become the trainee's personal GP. Know the referral pathways and use them.
- The lazy trainee is a myth. When something seems wrong, something usually is — just not what you first assumed.
- Connect with other training practice managers. Share ideas, share burdens, share the joy of doing something genuinely important.
- The most powerful investment you can make is a warm, well-planned induction. It sets the tone for everything that follows.
- Advocate for training in your practice. The trainer grant is real, the clinical benefit is real, and the NHS needs more GPs — your practice is part of making that happen.
- The best training practices don't feel like it's an extra job. They feel like it's just part of who they are.