Programme summary

What is the scheme?

The General Practice Fellowship programme is a national commitment announced in the NHS Long Term Plan and restated in the February 2020 Update to the GP Contract.

It is a two year programme of support, available to all newly-qualified GPs and nurses working substantively in general practice, as well as doctors completing the International Induction Programme (IIP) and nurses who are new to general practice in the last 12 months, with an explicit focus on working within and across a Primary Care Network (PCN).  Integrated Care Boards (ICBs) should encourage all eligible clinicians to sign up and aim for as close to 100% coverage as possible.

It is a programme of support, learning and development and PCN portfolio working. The programme supports nurses and GPs to take up substantive roles, understand the context they are working in, become embedded in the PCN, and to increase and maintain high levels of participation in the primary care workforce.

Participants receive funded CPD opportunities of one session per week (pro rata), and rotational placements within or across PCNs to develop experience and support transition into the workforce, with funded mentorship being available for GPs.

Who is it for?

Fellowship is an entitlement for:

• All newly-qualified GPs and nurses working/about to work in substantive roles in general practice to provide primary medical services,
• doctors completing the International Induction Programme (IIP) and
• general practice nurses new to general practice in the last 12 months.

Participants may be employed by a practice, across a PCN, cluster of PCNs or another body. The scheme is also open to those who work less than full-time (LTFT), with time and funding calculated on a pro-rata basis.

The scheme supports all eligible GPs and nurses to participate in the scheme, and there is no application process to join. That said, local areas may wish to implement a registration process. Where an individual wishes to benefit from the scheme and fits the eligibility criteria there must be local provision in place to do so.

What do fellows receive?

Participants to the scheme are released from their practice clinical role for up to one session per week (pro rata) in order for them to participate in the activities relating to the fellowship programme.

Fellows benefit from support and networking, PCN portfolio working, and structured learning opportunities. GP fellows also receive funded mentoring.

Delivery

The offer is a set national construct, with the opportunity for systems to agree how each of the components is delivered locally.

Funding

This programme is nationally funded, with allocations made on a quarterly basis to systems. The first tranche of funding is calculated on a weighted capitation basis, released at end Q1, with subsequent payments calculated based on levels of delivery.

Funding covers:

1. reimbursement of up to one session per week plus on-costs to the employer (pro rata),
2. provision of learning,
3. a smaller amount for programme delivery and oversight.

A separate Supporting Mentors Scheme is available to fund the GP mentorship aspect of this Fellowship initiative.

Going forward

The scheme is subject to ongoing consideration and review and a decision will be made during the 2023/24 financial year about the future of the scheme​. 

Where participants begin the programme in 2023/24, there will be further funding available in 2024/25 to support their continued participation in the two-year fellowship scheme.

Programme delivery

Purpose of guidance

This guidance sets the principles and framework for the 2023/24 national General Practice Fellowship programme. All ICBs must have this programme available for 100% of their newly-qualified GPs and nurses, and should utilise this document to shape their delivery.

Programme delivery

All ICBs should have had programme delivery underway since August 2020, and continue into 2023/24. The scheme should sit within the overall ICB workforce strategy and align with leadership development activities and workstreams.

To ensure national consistency, ICBs should implement the programme as described in Annex 1 – Fellowship Framework. All ten components should be available equally to both GPs and nurses, with the one exception being that GPs are supported through ‘mentorship’, whereas for nurses it is ‘supervision’, as agreed with the respective professional bodies.

This programme should be open to new joiners, as well as act as continuation for GPs and nurses who are part-way through the two-year programme.

Delivery options

ICBs and PCNs may also choose to work in partnership with federations, LMCs, at scale providers and other stakeholders, according to local circumstances, while ensuring they are delivering a single offer for all fellows in a system or place. There will be a mixed location for delivery as some aspects of the scheme can be delivered in-practice, such as ‘induction’, and others elsewhere, such as online development activities from home, or in-person learning sessions at another site. In some ICBs, it will make sense to coordinate the scheme at system level; for others, the place level will be more appropriate.

Delivery approach

Participants to the scheme should be released from their practice clinical role for up to one session per week (pro rata) in order for them to participate in the activities relating to the fellowship programme. This includes learning through a likely mix of training days and self-directed online sessions, mentorship/supervision sessions and peer support conversations. Activities will vary week by week and will evolve across the two-year period as new aspects from the model are added. For example, in the first six months an individual might expect to spend their weekly fellowship session undertaking a range of induction and peer support activities, whereas in their final six months on the programme they may utilise this weekly session for career coaching and plugging into system-wide leadership development and learning opportunities, amongst other things.

Whilst elements of the fellowship model can be staggered across the two years in this way, schemes must be designed in a way that fellows have access to every aspect of the fellowships model at some point across their time on the scheme. The ‘modular delivery approach’ found in Annex 2 demonstrates how this can work in practice across the two year timeline. There is a different timeline for the two professions to allow for the fact there will be a clinical education need for newly-qualified nurses, delivered and funded outside of this programme.

PCN portfolio working

‘PCN Portfolio Working’ should be accessible to participants after their first six months on the programme. Participants of the programme should have the opportunity to work on a rotational basis outside of their usual practice environment, working across the PCN, experiencing other ways of working and stretching their skills. The intention of this aspect is to create interesting roles through building variety, whilst exposing newly-qualified clinicians to different settings and other ways of working. As well as developing clinicians, this variation to traditional working should support clinicians to remain in substantive roles and is intended to create a viable alternative to GP locuming. This flexibility is aligned with the expanded role PCNs are taking in delivering out of hospital activities, such as providing enhanced support to care homes. As the delivery responsibilities for PCNs grow, fellows can contribute to the PCN by taking each of these things forward as their PCN portfolio working opportunity. Thus, it is expected the breadth and volume of local PCN portfolio working opportunities will grow in time.

PCNs should work together to understand and articulate their offer and begin to create a directory of opportunities for fellows to be placed onto. Each opportunity should be for no less than three months –ideally longer – in order the participant has an opportunity to gain a full sense of what is involved in the role in that setting.

Learning provision

ICBs and PCNs should commission learning provision from their local training hub and/or other providers according to an agreed specification. They may also choose to work in partnership with federations, at scale providers and other partners, reflecting local circumstances, while ensuring they are delivering a single offer for all fellows in the system or place.

Less than full time participants

Annex 3 highlights how the scheme programme can be adapted for participants who work less than full time.

Roles and responsibilities

Roles and responsibilities of Systems, Delivery Partners and employers are tabled in Annex 4.

Programme evaluation

ICBs should be monitoring the uptake of schemes, including the collection of Equality, Diversity and Inclusion data to ensure any inequalities are being identified and addressed.

An Equality and Health Inequalities Impact Assessment should be completed by the ICB.  ICBs are encouraged to regularly evaluate the scheme and share the learning with NHS England.

Programme financials

2023/24 funding

National funding is available to ICBs to deliver the programme locally, either themselves or through partners. The Primary Care System Development Funding letter confirms ringfenced funding is allocated directly to ICBs on a quarterly basis, limited to delivery of this scheme.

Funding for the first quarter is calculated on a fair-shares basis, with subsequent quarterly allocations calculated against actual delivery. Each ICB is required to submit a system delivery plan in early 2023-24 outlining their planned numbers of GPs and nurses for that financial year. ICBs will need to ensure accurate updates to the Primary Care Monitoring Survey and input to the financial ledger to ensure accurate allocations are made to ICBs in the remaining quarters of the year.  All local system partners should work together to support effective delivery of this programme, and ICBs are encouraged to release funding in a timely way to both employers and providers.

Fellowships funding is ringfenced and cannot be used in any circumstance for anything outside of the scheme description, even where activity is related. This includes clinical education – for example nursing ‘fundamentals’.

Funding breakdown

Programme financials are calculated on a per head basis which are summarised below. The value of funding per person will depend on the individual participant’s FTE. The ICB should utilise the aggregate delivery aspect of the budget to deliver their scheme and maximise scaled opportunities.

The ‘unit cost’/ per head calculation comprises two elements:

1. Pro-rata reimbursement to the employer for up to one session per week so the individual can be released from the practice to participate in Fellowship activities

• This is calculated at the individual’s actual salary cost
• It is further supported by an additional 30% toward on-costs of tax, NI and pension

2.  Funding for programme delivery including CPD provision, administration and oversight at £3,000 per participant (pro-rata)

Calculations are based on:

• FTE is 37.5 hours
• A nine session week
• Reimbursement for up to one session p/w (4hr 10 mins / 52 weeks)

Participant eligibility and participation

Participant eligibility criteria

The Fellowship initiative is focused on newly-qualified GPs and nurses who are within their first 12 months since qualifying and hold a substantive contract to deliver GMS services. Also eligible for the Fellowship initiative are doctors completing the International Induction Programme (IIP) and general practice nurses who are new to general practice in the last 12 months. The scheme is open to both salaried employees and partners. Participants may also be international recruits, where they meet the other criteria. There is scope to extend the post-qualifying period to 18 months in the instances of maternity/adoption/parental leave, long-term sickness or other caring responsibilities. Local delivery leads should consider such instances on an individual basis.

Pausing time on the scheme

Similarly, where an individual is already on the scheme and has a period of absence due to maternity/adoption/parental leave or long-term sickness whilst participating, their time on the scheme can be paused until they are ready to return.

Locums

The scheme is for substantively employed GPs and nurses only.

Employment model

There is no set or unique employment contract for Fellows. The individual participant should be recruited in the usual way, utilising the respective practice’s usual employment contract.

Where to go for support

GP Workforce Scheme Delivery Hub: GP Workforce Scheme Delivery Hub – FutureNHS Collaboration Platform

This website offers further delivery resources for ICBs, including workforce modelling tools and retention guidance and support.  There is also a community of others leading the programme locally, so you can use the forum to ask questions and learn from other areas.  If you haven’t used it before, you will need to set up a username and password which should only take a few minutes.

GP Career Support Hub: GP Career Support Hub – FutureNHS Collaboration Platform

This is a one stop shop online space dedicated to providing GPs with information and signposting about a wide range of support available to help them to realise a rewarding and fulfilling career. Please encourage your GPs to access the information hosted here.

NHS England GP Workforce Policy Team: Any queries for the NHS GP Workforce Team that developed this guidance can be directed to england.primarycareworkforce@nhs.net

Annex 1 – Fellowship framework

The summary below defines the single national Fellowship framework with key components, purpose and expectations. In order to deliver the Fellowship programme, each one of these ten components must be active as a minimum offer, with local autonomy on how, in order that there is flexibility to meet the local need.

Support and networking 

Induction

• An individual should feel supported in their transition from training to employment.
• Induction is to the PCN, the local practice environment and to the wider environment such as the place and system.
• This should enable the GP/GPN to understand the requirements of their new role in a structured format, feel oriented within the place and its population, and to feel confident in their ability to work safely and effectively within it

GP mentorship/GPN supervision

• Mentors/ supervisors should provide support, direction and an objective view on how the fellow can develop and progress in their clinical environment.
• Conversations are a minimum of one hour each month

Coaching

• All participants to have access to six one-hour sessions with a qualified coach at one or two points over the course of the two-year period –to consider personal development and career development 

Peer support

• Peer support involves programme participants sharing knowledge, experience or practical help with each other.
• Delivery should consider various forms each quarter including: setup and maintenance of social media groups, informal online forums, as well as Action Learning Sets

Learning and development

Practice management skills

• Learning sessions should deliver skills in: managing staff and financial resources, HR and developing staff, legalities of partnerships, strategy and change management, working in Networks, IT, patient engagement

Leadership

• Opportunities for learning and reflection about self, including values and behaviours, creating positive cultures and climate, influencing others, personal resilience, sharing and receiving feedback

Quality improvement

• Learning to develop skills in helping primary care free up time to deliver initiatives and embed new approaches into the practice/PCN, utilising an evidence-based approach

Mentoring, supervision and coaching skills

• Developing personal mentoring, supervision and coaching skills to be utilised in practice with patients when discussing e.g. lifestyle options, and supporting self-care; as well as supporting other members of the workforce, including future fellowship scheme participants

Remote working

• Learning on this new form of consultation skills to facilitate patient access, including understanding the appropriate culture, when a patient needs a physical examination, and running group online consultations

Portfolio working

Opportunities for experience and integrated working

• PCN portfolio working supports the new ways in which the modern workforce prefer their roles to operate, and is supportive of workforce retention.
• This can be delivered through rotational working or on a more permanent arrangement basis.
• See the ‘PCN portfolio working’ section for more detail on this aspect.

Annex 2 – modular delivery: year one GPs

In order for the Fellow to have the opportunity to establish themselves clinically, it is recommended that a modular approach is taken to stagger programme elements. This means in the early months of the Fellowship programme the participant can benefit from support and networking opportunities and begin to experience PCN portfolio working and learning aspects after six months in role.

Staging in this way is also beneficial for programme delivery, allowing systems to get delivery of the initial aspects underway quickly, whilst developing and planning for future programme aspects, including building the PCN portfolio working opportunities.

The tables below demonstrate how this type of phased delivery approach might be taken. It is not intended to be followed precisely in every system.

GP modular delivery stage 1: 0-6 months

Support and Networking

• Recruitment and induction
• Induction to PCN/ICB
• Assigned GP Mentor and Supervisor
• Personal Development Plan (PDP
• Join GP Network

PCN portfolio working

• Portfolio opportunity agreed

Expected outcomes

• Supported transition into PC role
• Awareness of PCNs, ICBs and their role
• PDP in place
• Individual’s ambitions understood
• Supportive network built around the individual
• Connected to Training Hub or other delivery partner
• System awareness
• Planned PCN Portfolio working options
• Network of support grows contextual confidence 

GP modular delivery stage 2: 7-12 months

Support and networking

• Access to GP mentor and supervision
• Access GP network
• Access to Action Learning Sets

Learning and development

• Practice management learning
• Quality improvement learning

PCN portfolio working

• Access to shadowing opportunities
• Commence portfolio working

Expected outcomes:

• Embedded mentor/mentee relationship
• Support network aids personal development
• Learning and development opportunities underway with known ways of embedding learning
• PCN portfolio options embedded
• Access to shadowing opportunities within PCN
• Increase specialist skills in chosen area

Modular delivery: year 2 GPs

GP modular delivery stage 3: 13-18 months

Support and networking

• Access GP mentor and supervisor
• Access to coaching for personal development
• Access to Action Learning Set
• Access GP Network

Learning and development

• Access leadership development opportunities/shadowing
• Mentorship/coaching learning
• Remote working learning

PCN portfolio working

• Portfolio working underway on a regular basis

Expected outcomes:

• Coaching sessions inform future development plan
• Clear personal development goals
• Leadership aspirations established and trajectories planned
• Undergone learning in a range of non-clinical topics
• System level awareness and connectivity established
• PCN level awareness and connectivity established

GP modular delivery stage 4: 19-24 months

Support and networking

• Access GP mentor and supervisor
• Access to coaching for career development
• Access to Action Learning Set
• Access GP Network

Learning and development

• Enhanced leadership development

PCN portfolio working

• Integrated MDT working exposure
• Embedded within portfolio role

Expected outcomes:

• Leadership development established with clear plan for development 
• Understanding and experience of MDT integrated working approach 
• Confident to lead element of PCN work 
• PCN/system-wide relationships established 
• Understanding of partnership roles 

Modular delivery: year one nurses 

Nurses modular delivery stage 1: 0-6 months

Support and networking

• Recruitment and induction
• Induction to PCN/ICB
• Assigned GPN supervisor
• Training Needs Assessment undertaken by Education Supervisor.
• Join GPN Peer Network

Learning and development

• Commence GPN Fundamentals programme (outside the scope of this programme). Note that Fellowship funding cannot be utilised for clinical education

PCN portfolio working

• Portfolio opportunity agreed

Expected outcomes

• Supported transition into Primary Care
• Awareness of PCNs/ICBs and their role
• Connected to Training Hub other delivery partner
• Personal Development Plan in place
• Individual’s ambitions understood
• Supportive network built around the individual
• Network of support grows with contextual confidence
• PCN portfolio opportunity engaged with

Nurses modular delivery stage 2: 7-12 months

Support and networking

• Access to supervisor
• Access to coaching for personal development
• Access to Action Learning Set
• Access to GPN Peer Network

Learning and development

• Quality Improvement learning
• Practice Management learning

PCN portfolio working

• Access to shadowing opportunities
• Commence portfolio working

Expected outcomes

• Embedded supervisor relationship
• Coaching sessions have informed future development plan
• Peer relationships embedded
• Shadowing opportunities within PCN increases learning
• Increased skills in quality improvement and practice management
• Accessed portfolio working opportunity
• Increased specialist skills in chosen area

Modular delivery: year two nurses

Nurses modular delivery stage 3: 13 – 18 months

Support and networking

• Access GPN supervisor
• Access to Action Learning Set
• Access to GPN Peer Network

Learning and development

• Mentorship/coaching learning
• Remote consultation learning

PCN portfolio working

• Access to shadowing opportunities
• Integrated MDT working exposure

Expected outcomes

• Accessed learning in mentorship/coaching skills and remote consultation
• PCN level awareness and connectivity established
• System level awareness and connectivity established

Nurses modular delivery stage 4: 19 – 24 months

Support and networking

• Access GPN supervisor
• Coaching for career development
• Access to Action Learning Set
• Access to GPN Peer Network

Learning and development

• Access leadership development opportunities

PCN portfolio working

• Integrated MDT working exposure
• Embedded within PCN role

Expected outcomes

• Future leadership aspirations established with clear plan for development
• Understanding and experience of MDT integrated working approach
• Confident to lead element of PCN work

Annex 3 – participants who work less than full-time (LTFT)

The below demonstrates how a 0.5FTE Fellow can utilise their one session per fortnight to participate in all ten aspects of the scheme within two years. In addition to the below, participants should utilise one hour per month for mentorship / supervision conversations. 

Stage 1: 0-6 months

• Month 1: Begins induction activities
• Month 2: Completes induction activities. Considers and agrees mentor/ supervisor relationship
• Month 3: Peer network introduction morning event. Introductory session with mentor
• Month 4: Attends peer networking session. Considers PDP and PCN portfolio working
• Month 5: Finalises and agrees Personal Development Plan. Considers Coach relationship for next stage of programme
• Month 6: Agrees PCN portfolio working opportunity. Writes reflections of first six months on programme

Stage 2: 7-12 months

• Month 7: Attends Action Learning Set. Introductory session with Coach –personal development
• Month 8: One day learning (online or face to face) in Practice Management. Session 2 with Coach
• Month 9: One day of shadowing elsewhere in PCN. Session 3 with Coach
• Month 10: Attends peer networking session. Session 4 with Coach
• Month 11: One day learning (online or face to face) in Quarter 1. Session 5 with Coach
• Month 12: Final session with Coach, updates Personal Development Plan to reflect progress. Writes reflections of first year on programme

Stage 3: 13-18 months

• Month 13: Attends Action Learning Set
• Month 14: One day learning (online or face to face) in Mentorship
• Month 15: One day of shadowing elsewhere in PCN
• Month 16: Attends peer networking session
• Month 17: One day learning in Remote Working
• Month 18: One day of shadowing elsewhere in ICB. Writes reflections of time to date on programme

Stage 4: 19-24 months

• Month 19: Attends Action Learning Set. Introductory session with Coach -career development
• Month 20: One day learning (online or face to face) in Leadership. Session 2 with Coach
• Month 21: Shadowing Day with Leadership focus. Session 3 with Coach
• Month 22: Attends peer networking session. Session 4 with Coach
• Month 23: Further leadership learning online. Session 5 with Coach
• Month 24: Final session with Coach, updates PDP to reflect progress. Writes reflections of overall experience of programme

Annex 4 – roles and responsibilities 

The below table suggests ways in which local partners play a role in the execution of the programme, and where responsibilities sit. 

Publication reference: PRN00839