Observation Placement

During the induction period at the start of the Observation placement clinical activity will be restricted to those under direct supervision and observation. This will allow the doctor to better understand local practice and the supervising GP to:

• assess clinical method and competency
• assess use of IT systems and understanding of the internal workings of the practice, including management systems, team structures and wider NHS requirements
• demonstrate prescribing, referrals and use of Choose and Book or other on-line appointment systems (including Two Week Wait processes)
• assess the doctor’s approach to appropriate use of resources within and external to the practice
• assess the doctor’s communication and consultation skills in general and their ability to manage expectations. Examples would be in how to deal with requests for inappropriate medication, sick notes and letters of support
• involve the doctor in planning patient care and use of supporting evidence, but not necessarily defining NICE and other guidance
• discuss other local primary care providers and their interface with the practice, and the place of the practice in the local health system
• discuss the nature of NHS appraisals, revalidation and continuing professional development in practice, including local sources of educational support

While most of this induction period will be under the scrutiny of the supervising GP direct observation can be agreed with other clinical staff. This will allow the doctor to fully understand the roles of all clinical staff in the context of UK general practice.

Supervised Clinical Consultations in the Observation Placement

As the doctor’s directly observed clinical skills evolve, the Educational Supervisor (ES) and Clinical Supervisor (CS) will agree with the doctor when it is safe and appropriate for them begin undertaking individual independent clinical activities while remaining under direct supervision. At this stage they are not on the MPL and cannot request investigations or prescribe treatment.

This will normally allow the doctor to spend up to 20 minutes independently consulting with the patient, and then the ES and/or CS will join the consultation to review with the doctor and the patient the history, confirm as appropriate the findings of any examination, the proposed treatment and/or investigation plan, and follow up arrangements.

The above phasing and clinical practice is standard HEE policy with GPRs and Foundation Year 2 Trainees, medical and nursing students who after a period of direct observation of them consulting and where it has been assessed that they are competent and safe, are allowed to take histories and appropriate examinations on a one to one basis.

Each doctor’s level of competence and, the safety of the patient, will have been judged appropriate before allowing them to move on to this stage of more independent practice and where each case is checked and then signed off with the patient present by the ES and/or CS.

The ES and/or CS must assess after each case to agree the actions, diagnosis, and arrange any treatment required themselves. This means they will be checking and managing every case - the doctor is not permitted to undertake any unsupervised clinical decisions at any time.

Supporting information 

Host GPs receive a small payment of £500 to support the cost of their time, up to a maximum of £2,000 for four weeks. To claim, download the invoice template and fill out the necessary information. Then return the form to your local HEE GP Return to Practice (RtP) or International Induction Programme (IIP) team.