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First published 2003 by Radcliffe Publishing
Published 2018 hr CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2003 Ed Peile, Glynis Buckle and Derek Gallen
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-85775-968-6 (pbk)
This book contains information obtained from authentic and highly regarded
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publishers wish to make clear that any views or opinions expressed in this
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f
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British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library.
Typeset by Advance Typesetting Ltd, Oxfordshire
 Contents
Foreword iv

Preface vi

About the authors viii

Acknowledgements X

1 An introduction to higher professional education (HPE) 1

2 What do trainers offer that has lasting value? 13
3 Vocational training: the bits that vocational
training does not reach (identifying the gaps) 39
4 Educational needs assessment 61
5 Fit for purpose: continuing professional development 85
6 Curriculum planning 103
7 Action learning and learning groups 125
8 Planning and delivering education and learning 147
9 Conclusions 165

Index 169
 Foreword
If medical education has a holy grail then it must be the con­
tinuum. Years of striving, acres of print and hours of discussion
have only succeeded in defining the transitions.
The HPE movement grew out of a realisation that the three
years of vocational training for general practice were not an
adequate preparation for GP principalship. The background is
recorded in this book. If this narrative describes the conception
and gestation, then the birth was managed through the first
two Cambridge Conferences.
Several important principles were defined. Amongst these
were that HPE is a case study within continuing professional
development, the transitions are a necessary element of profes­
sional development and that they can be managed well or
badly. The case for HPE needed to be made in educational and
political terms; and out of the many possible names ‘Higher
Professional Education’ was felt to be the most appropriate. It
is, of course, inevitable that other countries have subsequently
used the term differently. The Dutch, for instance, use HPE to
define the further education undertaken by established prac­
titioners to do what we in the UK would describe as a ‘GP with
a Special Interest’.
This book describes both the transitions and the curriculum
and, through the case study that is HPE, offers theoretically
argued practical solutions. In so doing it offers clinical educators a
rationale for curriculum building in any and all of the phases
of professional development. This is not just a book for HPE
programme directors or tutors, nor do its conclusions confine
it to UK practice.
As such, it also adds to the growing, powerful arguments
for the professionalisation of medical education. Educational
 Foreword v

supervision in medicine requires the same depth of knowledge

and skills as does doctoring. This theoretical base manifests
itself in the praxis of defining learning needs, delivering the
solutions and making the assessments.
The future of HPE as a distinct phase in UK GP education
will need to be argued as it seeks to move from development to
establishment. Several tests will be applied by the funders and
the educators. These must include - how is the transition
between supervised and autonomous practice managed?, and -
does the young professional have a sustainable way of defining
her continuing personal professional development within the
context of practice? In short, are the educational programmes
delivering GPs fit for today’s and tomorrow’s health service?
Only the active practitioners can provide the answers through
critical reflective action research, and this book offers a clear
framework from which to derive the questions that will deliver
the answers.

Professor Arthur Hibble

Director of Postgraduate General Practice Education
Eastern Deanery PGMDE
Cambridge
May 2003
 Preface

Continuing professional development is a concept that doctors

still struggle to comprehend and introduce into their professional
lives. All too often we see our education split into discrete entities
like passing finals, passing summative assessment and under­
taking 30 hours of education each year to obtain our postgraduate
education allowance. The concept that medical education is a
continuum from entering medical school through to retirement
needs to be embraced if we are to make full use of the oppor­
tunities available to us by finding the right time to improve our
knowledge and skills. This improvement could then be reflected
in better care for our patients.
There is a need for individual doctors to have an overview of
the educational opportunities that are available when they are
in training and when they have qualified. This would also
allow those who plan educational provision to target the needs
of the profession more specifically, and to produce doctors ‘fit
for purpose’.
The introduction of higher professional education (HPE) is
a great asset in delivering better-qualified GPs at a time when
many feel ill-equipped for partnerships. Newly qualified GPs
often seek work as a non-principal because they feel too in­
experienced for partnership or because their domestic situ­
ation prevents them from settling in a particular area.
Although vocational training has been seen as an end-point
of training we know that it is just the start of continuing
professional development. HPE enables newly qualified doctors
to focus on areas in which they still feel unsure or need
more training. It enables those planning vocational training
schemes to acknowledge the impact and place of the period of
 Preface vti

HPE. It can therefore relieve some of the obvious pressures on

an already full vocational training curriculum.
In this book we have sought to outline the issues concerning
the introduction of HPE. We hope to engage readers in reflect­
ing on their own past experiences and planning their future
educational needs. This book should help those who are currently
undertaking HPE and those that are responsible for the delivery
of educational programmes for those in their first year post-
vocational training scheme. Above all we hope readers enjoy
this book and embrace the opportunities presented in HPE to
become life-long learners.

Ed Peile
Glynis Buckle
Derek Gallen
May 2003
 About the authors

Dr Ed Peile leads on Higher Professional Education for Oxford

Deanery, where he is an Associate Adviser. Ed started a single-
handed practice in 1983 and began GP Registrar training in
1986. He still contributes to the teaching at Aston Clinton
Surgery, which is now part of a larger PMS grouping, focused
on education from undergraduates to GP Retainers. Since 1998,
Ed has been at the University of Oxford, where he has been
undertaking Doctoral studies on process and outcome in GP
Registrar education. Ed directs the Oxford Deanery New
Teachers’ Course, and has responsibilities for faculty develop­
ment. Ed’s interests in medical education include appraisal and
interprofessional education. He is an elected Board Member
at CAIPE and an Editorial Adviser on medical education to
the BMJ.

Glynis Buckle has been a practice manager since 1989 and still
has an active role in her Northamptonshire practice. She became
a Continuing Professional Development (CPD) Tutor in 2001
and a Clinical Tutor in General Practice in 2003. She is also a
tutor on the Oxford Deanery New Teachers’ Course. Glynis
has co-authored four books on primary care management and
personal and practice development plans. Her particular areas
of interest are in interprofessional learning and organisational
development.

Dr Derek Gallen is the Director of Postgraduate General

Practice Education for the Oxford Deanery. He was appointed
as a trainer in 1993 and a GP tutor in 1996. He then became
the associate adviser for Northamptonshire in 1999 and then
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 About the authors Ix

Director in 2001. Derek’s interest in medical education include

educational needs assessment and interprofessional learning.
He has written three books on topics related to starting in
practice, primary care management and personal and practice
development plans. He is editorial adviser to Update magazine
and Doctor newspaper and still does one day a week in general
practice.
 Acknowledgements

We particularly wish to acknowledge the following people:

• Dr Regina Conradt for her collation and interpretation of
data.
• Gillian Nineham (Radcliffe Medical Press) for her support
throughout the process.
• Verna Kitchener, our very accomplished and very under­
standing PA.
• Marion Lynch, Honor Merriman and Bren Sainsbury who
make up the Oxford Deanery HPE team.
To Linda for putting up with my struggles to work on the
book at the same time as everything else.
Ed

To Noel for all the TLC.

Glynis

To my family for their continued support.

Derek
 i

An introduction to
higher professional
education (HPE)

Higher professional education (HPE) was introduced in October

2001 in response to requests from the profession to cater for
the needs of newly qualified general practitioners (GPs). In
essence, HPE is the provision of 20 days of education, with
locum costs, and a small contribution to course fees. It is applic­
able in the first year after a doctor has finished the vocational
training scheme. The profession had clearly hoped that funding
would be for 20 days per year for the first two years after voca­
tional training, but has had to accept a pragmatic solution in
the current economic climate.
HPE is not a criticism of the gaps that vocational training
has failed to cover. Indeed, one of the successes of vocational
training is the breadth and scope of the education offered. HPE
should be seen as a further opportunity for individuals to
develop skills and knowledge while actually undertaking the
role of GPs. The curriculum to develop a doctor ‘fit for pur­
pose’ will change over time. We need to look at the relationship
between undergraduate learning, pre-registration house jobs,
vocational training and HPE to grasp whether at each stage we
have a doctor ‘fit for purpose’. In this model, HPE will free up
time on vocational training schemes as the curriculum is honed
to look at the specific achievable knowledge, skills and attitudes
pertinent to the three-year programme.
 2 HPE for general practitioners

Vocational training
The current arrangements of vocational training for general
practice in the UK were developed in the late 1960s and early
1970s. They became embodied in the vocational training
regulations (NHS, England and Wales, 1979) that have been
mandatory for entering practice as a principal within the
British National Health Service (NHS) since 1982. The purpose
of vocational training for general practice is to give doctors in
the UK skills, the knowledge and competencies necessary to
work in general practice and meet the needs of NHS patients.
The vocational training regulations that were passed by an act
of Parliament in 1976 stipulated only a three-year training
programme.
Many question whether a standard vocational training
scheme of only three years’ duration is long enough. Are doctors
ready for a lifetime of practice at completion of their vocational
training scheme? The Royal College of General Practitioners
(RCGP) did not think so when vocational training schemes
were about to be introduced. The RCGP argued for a five-year
scheme, which would have put GPs more on a level with their
specialist trainee colleagues (RCGP, 1996). Giving evidence to
a Royal Commission on Education in 1996, the College con­
sidered the options for ‘Senior Registrars’ and other ways of
extending the learning experience of young doctors. It was not
alone in considering three years too short, and already govern­
ment thinking was moving this way (Caiman, 1998). Experience
from around the country was that vocational training could
not possibly meet all the young doctors’ needs in practice
(Bonsor et al., 1998). However, the vocational training scheme
has remained a three-year programme, of which 18 months
may be taken in general practice. In reality, because of funding
implications and the need for service provision in hospitals, 12
rather than 18 months has become the normal time spent in
general practice, with the remaining two years spent in hospital.
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