A new scheme for specialty training in general practice was introduced on 1 March 2019. Before a doctor can apply to become a specialist in general practice, various criteria and recommended learning objectives need to be met. This includes five years of clinical practice, including a minimum of two years’ open, unselected general practice and a minimum of six months at an institution. One of the main changes in the new scheme is the local authorities’ responsibility to ensure that general practitioners (GPs) in training and GP trainees in other clinical positions in primary health care have the opportunity to achieve a number of specific learning objectives and complete their specialisation.
Fafo, the Norwegian Centre for Rural Medicine and Agenda Kaupang have followed the implementation of the new specialisation arrangements based on the experiences of local health leaders in the municipalities, GP trainees and other stakeholders during the process. A broad selection of local authorities in Norway were included in the follow-up study.
We have written several reports during the process, and this final report summarises the work. We present our findings based on the following questions
This is brief summary of some general experiences from the implementation work:
The transition to a new speciality training scheme has entailed additional work and increased administrative costs for local authorities. This is linked to the local authorities having to facilitate a comprehensive speciality training programme and the necessary learning activities, document how the specialist training is organised, distribute responsibilities and devise plans for the specialty training.
All the key stakeholders, including GP trainees, supervisors and local health leaders in the municipalities, have found it difficult to adapt to the new scheme, and have spent considerable time doing so. In particular, the local health leaders have called for better standard agreement templates and standardised routines for the new scheme.
The regulations state that at least two years of the new specialty training in general practice must take place in open, unselected general practice at a GP office. This requirement is automatically met for GP trainees doing the job of a GP (or locum GP), while those whose main job is in a nursing home or emergency clinic must transfer to a GP practice to satisfy this requirement. Providing open, unselected general practice places for primary care doctors who are not GPs is a particular challenge.
The new model for specialty training in general practice stipulates that much of the learning must be supervised by GP specialists. Local health leaders have expressed concern that recruiting formally qualified supervisors may be a challenge. It may therefore be necessary to develop models for inter-municipal cooperation on the supervision of GP trainees.
Many of the GP trainees in our study have changed jobs during their specialty training. The procedures for approving learning objectives differ between local authorities, which can create problems with documentation. To avoid such problems, the learning objectives should be approved as they are completed. However, many of the learning objectives require in-depth experience in a subject area before they can be approved.
A key element of the specialty training is learnings objectives gained by working in an institution (e.g., hospital). At the time of writing, several of the ‘first’ generation of GP trainees are approaching this point in their education. Different forms of cooperation have been established between local authorities and regional hospital trusts to facilitate this part of the training. From the local authorities’ perspective, recruiting locums to cover the period when GP trainees are working in an institution will be a challenge.
Based on the findings in this project, our recommendations to the local and national health authorities are as follows: