Generic barriers to training
  • Space:

    ‘You need the space as well, and it used to be in our old surgery we were limited in space … we have a bit more space when [area X] health centre was done years ago so we got a bit more space. But I’m sure we would have worked round the space side of things, so it was more the physical capacity of GPs.’ (GP 2, non-training)

  • Application process:

    ‘Em, the paperwork I think, I’m sure you’ve have heard it said is quite onerous. In some ways I think it needs to be, em, particularly for that first assessment. I suppose I would slightly question whether they need as much paperwork and proof once you have been approved at the beginning but, obviously, things can slip so I understand the need for quality.’ (GP 7, training)

  • E-portfolio and assessment demands:

    ‘ ... then, obviously, the assessments dominate our tutorial time, um, so I feel we are having less time to teach, especially if you are the lead trainer who does most of the assessments.’ (GP 1, training)

  • Impact on non-training colleagues:

    ‘I suppose the only thing I would say is, at times, there has been some tensions in terms of partners questioning the time needed for training. It has been a source of tension at times, and discussion.’ GP 7, training)

  • Finance:

    ‘ ... suppose money can be an issue, not that it ever was with us, but I think sometimes people are undervalued with the time that they spend and I’m not really sure, and I go to all these meetings and there is backfill for locums, but it only really pays your locum.’ (GP 10, non-training)

Barriers more pertinent in deprived areas
  • Time:

    ‘ ... just patient’s ability to comply with systems and medication compliance, so I think though it’s very difficult to demonstrate, just the day to day work, we are busier than those in practices where the patients are much more self-reliant, much more self-starting, much more able to navigate the systems, know where to go and when to go. So, that doesn’t leave us as much extra time, or as much slack in the day to undertake training. Em, and certainly in this practice, it’s the time issue that stops us considering being a training practice.’ (GP 5, non-training)

  • Overwhelming workload:

    ‘ ... think a lot of practices in deprived areas just feel they’re creaking at the seams and they can’t see enough patients because patient demand, you know. Research has shown the number of times your average patient sees the doctor is much higher in a deprived area than it is in a more better off area.’ (GP 6, non-training)

  • Trainees not an extra pair of hands or requiring extra supervision:

    ‘Because it’s not just the medical problem, it’s the whole patient context. Which I think we found the junior staff were just not grasping, and all the additional things like communication with chemists, compliance devices for medication, em, liaison with different agencies, they just didn’t know about. So you were almost doing it all over again on their behalf, so actually we didn’t find we were given any extra time at all.’ (GP 5, non-training)

    ‘So we have to protect them, especially at the beginning of their training, um, trying to look a bit what kind of patients are being booked in. Admin team needs to be on top of that, if they see that, um, for example, for emergencies that they protect the trainee a bit. And supervision, I think, has to be much much closer because, um, the risk is so much higher in an area like ours.’ (GP 1, training)

  • Poorly performing trainees:

    ‘ ... um, we absolutely need, um, fairly good and solid GP trainees. We could not cope with an underperforming trainee, um, because of the complexity of the patients, um, and it can be very challenging even with good trainees. Because there is such a complexity to the patients that you can easily feel overwhelmed.’ (GP 1, training)

Barriers specific to deprived areas
  • Less exposure to better educated patients:

    ‘ ... think the worried well, we have some, so it’s not all deprived, but not nearly as much and actually, the potential straightforward who have condition A: for condition A to get better you need to do plan B and please go away and do plan B … oh okay you are going to do plan B. And I think that they probably wouldn’t get that, and I think they would miss out on the very informed patient who knows exactly, or who knows exactly what they want with their illness, who researched it all, and and ... sharing decision-making.’ (GP 8, training)

  • Busyness discouraging trainee (mentioned by two responders):

    ‘I would be concerned about a trainee only training in this area of becoming discouraged actually, em, ‘cause even for we who are used to it, it often feels like wading through treacle, like you are getting absolutely nowhere. And I would be concerned for a young doctor that that might be a bit overwhelming.’ (GP 5, non-training)