In Brief
The GP Registrar Support Tool is a reflection aid that helps GP trainers identify registrars who may benefit from additional support. It's based on Paice's warning signs and current UK guidance, designed to prompt early supportive conversations — not to replace formal Deanery assessment processes.
With early identification and good support, 90% of registrars in difficulty successfully remediate. This tool helps trainers spot patterns early, when intervention is most effective.
Use the Tool →💡 Why We Built This Tool
▼The Problem
Every GP trainer has been there. Something doesn't feel quite right about a registrar's progress, but it's hard to put your finger on exactly what. You notice they're staying late more often. Or the practice manager mentions they've been short with reception staff. Or you realise you haven't seen many ePortfolio entries lately.
These observations matter. Research consistently shows that early identification is the single most important factor in successfully supporting trainees who are struggling. Yet many trainers tell us they:
- Don't feel confident recognising early warning signs
- Worry about "labelling" a registrar unfairly
- Aren't sure when concerns warrant escalation
- Feel isolated in managing difficult situations
The result? Problems often aren't identified until they've become serious — by which point intervention is harder and outcomes are worse.
Excellent Resources Already Exist
There are some wonderful resources available for GP trainers:
| Resource | Strength |
|---|---|
| FourteenFish | The go-to platform for ePortfolio management and formal WPBA assessment |
| Bradford VTS | Comprehensive, evidence-based resources freely available — an invaluable reference for trainers |
| RCGP Curriculum | The definitive capability framework with IPUs — essential for formal assessment |
| Deanery Policies | Clear processes and support structures once concerns are identified |
Where This Tool Fits In
This tool is designed to complement these existing resources by focusing on one specific moment: the very first step — when a trainer has a nagging feeling that something might not be quite right, but hasn't yet articulated what.
It's a simple, practical aid to help trainers notice patterns early and structure their thinking before concerns escalate to formal processes.
📚 The Evidence Base
▼Paice's Seven Warning Signs (2006)
Our tool is built on research by Professor Elizabeth Paice, who identified seven behavioural patterns that often indicate a trainee in difficulty:
- The Disappearing Act — patterns of absence, lateness, being hard to find
- Low Work Rate — taking longer than expected, needing extra time
- Ward Rage — temper outbursts, irritability, conflict with colleagues
- Rigidity — poor tolerance of ambiguity, difficulty adapting
- Bypass Syndrome — colleagues routing around the trainee
- Career Problems — exam failures, uncertainty about career choice
- Insight Failure — inability to recognise limitations or respond to feedback
These warning signs remain widely cited in current UK guidance, including HEE policies and NACT resources. They focus on observable behaviours — things a trainer can actually notice — rather than abstract competencies.
Current UK Framework
While Paice's work provides the practical foundation, we ensured the tool aligns with current guidance:
- Gold Guide 10th Edition (August 2024) — the definitive reference for postgraduate training
- RCGP 13 Capabilities with IPUs — the formal assessment framework used in WPBA
- NHS England PSW guidance — Professional Support and Wellbeing services
- HEE regional policies — the 3-level support framework used across deaneries
Key Statistics
The message is clear: early identification works. The challenge is helping trainers do it.
🛠 How We Designed It
▼Three Core Principles
1. Reflection, not assessment
The tool prompts trainers to reflect on what they've observed. It does not make judgments, calculate scores, or produce "diagnoses." The output is a structured summary of the trainer's own observations — nothing more.
2. Complement, not compete
Formal assessment of GP trainee capabilities belongs with WPBA, ESR, and ARCP processes managed by the Deanery. Our tool sits before these processes, helping trainers identify concerns early so they can have supportive conversations and involve their TPD when appropriate.
3. Practical, not academic
The tool uses plain language and focuses on observable behaviours. Trainers don't need to understand capability frameworks or assessment terminology — they just need to recognise patterns they've seen.
The Seven Categories
| Category | Based On | Example Indicators |
|---|---|---|
| Attendance & Reliability | "Disappearing Act" | Frequent lateness, unexplained absences |
| Work Rate & Engagement | "Low Work Rate" | Slow decisions, poor ePortfolio engagement |
| Interpersonal & Behaviour | "Ward Rage" / "Bypass" | Temper outbursts, staff avoiding them |
| Clinical Performance | Clinical safety | Knowledge gaps, prescribing concerns |
| Insight & Feedback | "Insight Failure" / "Rigidity" | Defensive to feedback, externalising blame |
| Career & Exam Progress | "Career Problems" | Exam failures, ARCP concerns |
| Health & Wellbeing | Health factors | Signs of burnout, mood changes |
📈 Where This Tool Fits
▼The Formal Assessment Pathway
This is the Deanery's domain:
↓
Educational Supervisor Review (ESR)
↓
Annual Review of Competency Progression (ARCP)
↓
Formal outcomes (1-6)
Where This Tool Helps
↓
Supportive conversation with registrar
↓
Discussion with TPD if needed
↓
Formal processes if required
You observe. The Deanery assesses. Your role is early identification and support — the formal capability assessment remains with WPBA, ESR, and ARCP processes.
The Support Pathway
The simplest first step is always to contact your TPD:
- Have a conversation with the registrar
- Contact your TPD / VTS training team
- Professional Support and Wellbeing (PSW) service if needed
- Deanery case management for serious concerns
Most situations never need to go beyond step 2. Your TPD would much rather hear from you early than late.
⚠ What This Tool Does NOT Do
▼This is important. The tool:
- Does not diagnose "problem trainees" — it prompts reflection, not conclusions
- Does not assess capabilities — that's for WPBA and ARCP
- Does not replace clinical judgment — trainers know their registrars best
- Does not store any data — nothing leaves your browser
- Does not generate reports for Deaneries — it's for trainer reflection only
The language throughout emphasises that these are "indicators that may warrant further exploration" — not evidence of problems.
Target Users
Designed for:
- GP Educational Supervisors — the primary audience
- GP Clinical Supervisors — who may notice issues in day-to-day work
- Training Programme Directors — as a discussion aid with trainers
- GP Educator courses — as a teaching resource on early identification
Not designed for:
- Registrars to self-assess (though they're welcome to look)
- Deanery panels or ARCP processes
- Formal documentation or evidence
📖 References
▼Current UK Guidance (2024)
- Conference of Postgraduate Medical Deans. The Gold Guide 10th Edition. August 2024.
- Royal College of General Practitioners. GP Capabilities and Progression Point Descriptors with IPUs. RCGP Curriculum.
- NHS England. Professional Support for Postgraduate Medical and Dental Trainees.
- Health Education England. Managing Trainees in Difficulty: A Framework for Action.
Foundational Research
- Paice E. Identifying the trainee in difficulty. BMJ Careers, 2006.
- Steinert Y. The "problem" junior: whose problem is it? AMEE Guide No. 76, Medical Teacher, 2013.
- Davies MG et al. Graduate Medical Education "Trainee in difficulty": A systematic review and meta-analysis. American Journal of Surgery, 2021.
Practical Resources
- Bradford VTS. Trainee in Difficulty Resources. Dr Ramesh Mehay.
- General Practice Supervision Australia. Identifying and Supporting GP Registrars at Risk Guide. 2024.