This GP policy is part of the Severn PGME Trainee Support Unit policy  and should be read in conjunction with it.   It formalises and defines best practice and provides a flexible and consistent approach to trainees needing support.

The strategy has three main components;

  • Identification
  • Diagnosis
  • Support


It is important to actively seek trainees needing support rather than wait for problems to develop. The SoPC has therefore developed criteria for trainees to automatically enter the trainee support system. These are based on;

  • Accumulated SoPC experience of working with trainees needing support
  • Severn Trainee Support Unit’s experiences
  • Systems adopted in other PGME areas, particularly Wessex which has a well established Professional Support Unit and a GP School with extensive experience of trainees needing support

Criteria to enter the support system

At recruitment;

  • In the bottom 10% of recruitment scores
  • Arriving via an Inter or Intra Deanery Transfer (IDT)
  • Significant factors identified on Foundation transfer of information (TOI) form

Once in training;

  • ARCP unsatisfactory outcome
  • Assessment at ESR of “Unsatisfactory” or “Panel opinion requested”
  • Single exam failure (CSA or AKT)
  • Lack of eportfolio engagement (usually in the first post in the programme)
  • Teaching attendance at day release below 70%
  • Sickness absence of greater than 2 weeks in a training year
  • Concerns identified by supervisors or TPDs suggesting difficulties in training, e.g. personal difficulties, attitudinal issues etc.
  • Self-nomination

Although International Medical Graduates (IMGs) statistically have higher failure rates not all IMGs will be TINS. IMGs are interviewed by a TPD in the first 3 months of training to decide if a trainee needs additional support.

Programme review meetings

The core of this identification process is a regular programme-based meeting where all trainees are reviewed. There are two reasons to review all trainees;

  • To identify every TINS all trainees need to be regularly reviewed to pick up new issues
  • It reduces the likelihood of these trainees perceiving themselves as being victimized if the progress of all trainees is being regularly reviewed.

For most trainees this is a brief discussion. For a few however it is the first step in identifying and following up trainees in need of support. Trainees usually enter and leave the support system at this review meeting. However sometimes trainees may be identified outside these meetings through more ad hoc processes.

Review meetings have access to;

  • Recruitment scores
  • TOI forms
  • IDT yes/no
  • Teaching attendance figures
  • Sickness record
  • ARCP data
  • Trainees’ eportfolios
  • Supervisor feedback and any other soft intelligence

Other data sources

Programmes contact each trainee and each trainee’s educational supervisor (ES) during the trainee’s first post to check if either have any concerns. (Appendix A)

The trainee support database is maintained by the programme administration team. They provide a monthly update to the Deputy Director. Review of those trainees receiving support is a standing item at the monthly SoPC business meeting.

Exiting trainee support

The programme team decides at its regular meeting which trainees are able to leave the support system, usually after agreeing this with the trainee. All trainees are reviewed regularly so there are opportunities to reinstate support if needed.


Once identified at the programme meeting as potentially in need of support, the trainee is invited to meet with a member of the programme team – this invitation is recorded in the ‘Educator Notes’ section of the eportfolio.

Meeting the trainee

An explanation of the TINS review system is part of trainees’ induction and also included in the initial invitation to meet. Trainees need to know why they have been identified as potentially needing additional support and this is discussed at the first meeting with the trainee. The programme team takes account of issues of equality, diversity and transparency during all its interactions with trainees.

The interview is a flexible process. Trainees’ needs vary. Initial assessment uses the NCAS performance triangle model as adopted by the Severn Trainee Support Unit (Appendix B). Support and guidance is provided by the SoPC to educators taking on this role.

The meeting is summarized in the Educator notes section of the eportfolio, with the content of the entry discussed beforehand with the trainee . An email is sent to the ES and current clinical supervisor (CS) summarising the interview (this can be pasted from the educator notes).

The interview sometimes confirms that there is no need for support at the moment.


By the end of the initial meeting the educator will have a preliminary idea of the issues and the type of support required.

TINS are then divided into two groups;

Those who remain in the SoPC support system

This corresponds to Level 2 of the Severn TSU system (Appendix C). These trainees can be offered;

  • Ongoing educator support in their programmes
  • Advanced consultations skills course
  • Specific help with the CSA
  • Triangulation of assessments/supervision using a second assessor
  • Support for the trainee’s supervisor in the workplace

Those referred to the Severn TSU

This corresponds to Level 3 of the Severn TSU system (Appendix C). If the educator feels that they need other specialist forms of support then, after discussion with the Deputy Director the trainee is referred to the TSU. This could include;

  • Exam/Study Skills technique
  • Psychological assessment
  • Educational psychology assessment
  • Dyslexia screening/support
  • Coaching
  • Counselling
  • Career counselling
  • Mental health assessment and support

Database Management

The actions/notes section of intrepid is used to record those trainees needing support. This allows programmes to:

  • Record support start and end dates
  • Maintain a current and inactive status
  • Record general notes
  • Set up administration reminders for any follow up work
  • Report a list of identified trainee contact details

In the future we expect that this information will be maintained using intrepid version 10. 


Appendix A

Exemplar emails from programmes to ES and trainee during 1st post in rotation:

‘Dear Educational Supervisor

I would like to introduce myself as one of the Training Programme Directors (TPDs) for the (name) GP Training Programme.
I am the Small Group Facilitator for the ST (name) who you are currently educationally supervising.

We are always keen to encourage communication between Educational Supervisors and TPDs, so please do not hesitate to contact us should you have any queries.

We are also keen to identify any trainees who may be in need of additional support and I am writing to encourage you to get in touch with me should any issues arise. Recent experience has shown that if we can provide additional support for trainees early on then problems are more easily resolved.

We have found that a specific red flag for identifying a trainee in need of additional support is lack of early engagement with the e-portfolio. The Transfer Of Information form (TOI) from your trainee’s foundation posts can also help identify concerns from earlier in their career. We would be grateful if you could ensure that you review the e-portfolio within the first 3 months of the year and encourage your trainee to make entries. We would also like you to review and discuss the TOI form at the first meeting with your trainee. Please do let us know if there are any problems with this.

Many thanks, we look forward to seeing you at one of our forthcoming Educational Supervisors Conferences.

Best wishes

TPD name’


‘Dear Trainee

I’m writing as your current small group facilitator on the (name) training programme. I hope you are settling in well to your training programme and getting the most out of your current post.

You may remember from your induction that we have a Trainee Support System in Severn. This provides additional support to trainees who are experiencing difficulties during their training. Sometimes these are difficulties trainees experience related to their work environment. Sometimes issues in trainee’s home lives or with their health can also affect their training. You can access this support by talking to me at any stage of your training. This note is a reminder of our offer – please contact me if you would like to discuss this further.

Best wishes

TPD name’ 


Appendix B

NCAS Performance triangle; from Severn PGME Trainee Support pages.


Appendix C

Description of the Severn Trainee Support Unit Three Level Framework.