Trainees Experiencing Difficulties

All those GPStRs who are identified as having problems or indicators of potential future difficulty will be monitored either at Training Programme level or central School level depending on the level of concern. View the policies section to see the overall Health Education England Working Across Yorkshire and the Humber policy provides the formal framework that is followed. There is however specific guidance for the GP school.

The school policy follows a similar format to the generic Health Education Working Across Yorkshire and the Humber policy on the policies section,  for managing performance concerns and falls within that policy, however it has been adapted to be more specific for the different challenges of the GP training programme. If a discrepancy arises, the overall Health Education England Working Across Yorkshire and the Humber policy is the one that should be followed.

For further support you can visit the Support for Doctors page on the Academy of Medical Royal Colleges website. 

Performance Team

The School Lead is Dr Karen Bradley (please contact via

The Locality Leads are:

Dr Elena Pamphilon - South Yorkshire (please contact via
Dr John Featherstone - East and West Yorkshire (please contact via
Dr Natalie Hodgson - East and West Yorkshire (please contact via

Each Scheme has a nominated Performance Champion. 


The GP school has written a short summary of the courses available for those who may benefit from them.

Other HEE Policies

Trainees may have a variety of difficulties including sickness. 

There are a range of support systems available within HEE:

Workplace Wellbing/Take Time

Sickness/Parental Leave

Less Than Full Time


Out of Programme

Assessment RDM-p, SKIPE, I-SID Resources

These are resources that help identify particular problems with a trainee in difficulty. 

One of the tools that most trainers find helpful is the RDM-p model which stands for:

  • Relationship
  • Diagnostics
  • Management
  • And professionalism

The RDM-p screening tool can help you identify trainees in difficult and the nature of that difficulty:

This is also the structure that the new Clinical Supervisors Report is based on and can be linked back to the GP trainee competencies that we are all familiar with.

SKIPE - Skills, Knowledge, Internal, Past, External.

Internal would include personality traits, attitudes, health issues.

Past would include previous educational experiences, medical training, upbringing culture.

External includes current stressors, such as family issues, long commutes, work environment.


I-SID (Identify, Share, Involve, Document) is a way of bringing all this information together, please see PowerPoint here.


There is a Supported Return to Training (SuppoRTT) programme for trainees that have had an absence from clinical work of more than three months.

ST1s with educational concerns

If there are concerns raised that a new ST1 trainee is not performing at the required level, please use the attached flowchart and explanation on how to manage this situation.

Concerns may be raised within a GP practice or from hospital colleagues in a hospital post.

Please raise concerns with TPDs and the performance team.


AKT Support

AKT Revision and Exam Technique Guide 

AKT Courses - Various options are available. Please discuss with your Performance TPD in the first instance. 

AKT Flowchart

Please see PowerPoints below:

Evidence Based Practice 

AKT Overview

Organisation and management 

Successful AKT preparation example - Dr Raj Dhaliwal, GP trainee

My AKT Prep

RCA Support

RCA Flowchart

Please see below RCA Course material 


Consultation skills for RCA

CSA Support

Useful CSA Documents:

All trainees will be able to access a centrally run CSA course. For ST3s that have been unsuccessful as CSA there is further support through the SOX scheme. 

All trainers have been purchased the CSA Toolkit, used in Northwest England as part of their successful SOX  (support on extension) programme for GP trainees, which is hosted by FourteenFish.  There has been enthusiasm for this toolkit from trainers and trainees alike, so I hope you will find it useful.

Please sign up using the link below to create an account and sign up to access the Toolkit, accompanied by some explanatory videos and some CSA calibrated trainee videos:

As part of Y and H Trainers online community you can share questions and give feedback on the resources.

Schools Neurodiversity Screening Policy

Please click here to access free neurodiversity screening provided by genius screening.

Here is the link to the Neurodiversity Pathway

Link below for Schools Neurodiversity Screening Policy including the Referral Process flowchart:

Schools Dyslexia Screening Policy

RCGP dyslexia advice


Wellbeing Support and Integration

The Academy of Medical Royal Colleges has developed a useful support page for doctors, click here to go to their website.

There is a specifically designed website for Nigerian GPs in the UK, click here.

A useful resource for trainees is our Social Integration page, it explains the ways of finding accomodation, taxes, transport and more, click here

Useful Documents

GP Educators should also hopefully find following documents relating to the identification and management of under performance useful:

RCGP Indicators of Under Performance Framework 

RCGP Competence Areas (word pictures)

Occupational Health Referral template letter and additional information

Enhanced Trainers Grant

Performance Team PowerPoint Resources (Intending Trainers & Experienced Trainers

View further information in the Trainee section