We all hope that your time at our surgery will be both enjoyable and educational. We are happy for you to approach us at any time if you have any problems.
Please address us by our first names. Although at first things may be unfamiliar we hope that this period is very brief as we consider you a very important member of our team. Enclosed is an introductory package with lots of information some of which you will find useful immediately, some at a later stage and some perhaps never!
You may also find the following useful:
• Local map of the area (Aerial Photo)
• Practice formulary
• Practice Guidelines
We have been a training practice since 1979. Paul Miller was the trainer for many years, followed by Alison Evans and then Steve Holmes. Ian Sangster has been a trainer since Feb 2000 and Esther Smith became a trainer in 2003.We are keen on a team approach to most situations; hence we share out emergency appointments and visits. We also give each other informal support at various times of the day. It is not uncommon for us to seek advice from partners or the GP registrar.
Dr Miller was a partner in the practice for 21 years, he left in 1998 as did Dr Loud and they were replaced by Phil Huxley and Ian Sangster. Dr Alison Evans is an ex course organiser for the Airedale VTS and now works part-time in the Practice and part-time in the Department of General Practice at the University of Leeds . Dr Holmes was also an Airedale course organiser (and Clinical Tutor in Burnley ) – he left in July 2002 to pursue his interests in education and standards in Primary Care, becoming Clinical Governance lead in the Mendip region. We have been fortunate to fill the vacancy with Mike Horsfield who started in Feb 2003. Esther Smith joined us in 2001 and is our expert in women's health, she is now also a trainer and we are able to accommodate 2 GP registrars each six months. The above changes have obviously been challenging to the Practice but we have a philosophy of seizing opportunity with each change and although the pace has been rapid we work in a happy, stable environment.
The practice is computerised (EMIS system since 2001) and we try to provide top quality care for the patients we serve. The GP registrars have their own consulting rooms, and we have a comfortable library for private study. All consulting room PCs have internet access but we try to keep the library up to date with books and journals. Please tell us if there are any useful textbooks missing from our collection.
In June 2004 the Practice was successful in its application for the RCGP Quality Practice Award. We are very proud of this achievement as it recognises high standards of clinical care and a team approach to delivery of care.
Summative Assessment Package : (National Criteria)
Requirement for approval by JCPTGP
• Submission of videotape of consultations (single route MRCGP)
• Submission of Project (NPMS)
(Or Submission of 8 point audit)) – recommended in first 6m
• Report from Trainer with supporting evidence
• MCQ paper
Project Timetable (suggested)
0-2 weeks |
Trainer encourages/raises awareness |
2-4 weeks |
Question developed |
6 weeks |
Literatures survey completed |
8 weeks |
Protocol written |
12 weeks |
Data collection completed |
18 weeks |
First draft of project, present to practice |
24-26 weeks |
Complete audit cycle (if appropriate) |
26 weeks |
Final draft for presentation |
This curriculum is written in an attempt to outline a basic teaching programme which we can use and modify for the registrar's individual education. We recognise that the educational needs of each registrar will be different and that we can't cover everything, hence it would probably be useful to outline our aims and objectives.
The overall aim is to ensure that you leave the practice with the abilities to have a happy and fulfilling life as a General Practitioner.
AIMS
• 1) to have knowledge of the common acute and chronic diseases, their natural history and final outcome, whilst being aware of the less common which have potentially serious outcomes
• 2) to realise that the presentation of health problems can be affected by interpersonal relationships in the family
• 3) to have a knowledge of the scope of preventative medicine and the potential for opportunistic health education in General Practice
• 4) to realise how health and disease can be affected by environmental and social factors
• 5) to understand how the health and social security services can facilitate the care of the patient and his family
• 6) to have an understanding of human development such that it enhances the day to day management of patients
• 7) to acquire a practical working knowledge of practice management and the organisation of the NHS so that clinical work is facilitated rather than hindered by administration
• 8) to be able to recall the incidence of disease in general practice, especially in association with individual consultations
• 9) to realise that time can be both diagnostic and therapeutic
• 10) to be able to identify those in need and know how to react appropriately to the need
• 11) to understand the full extent of the role of the PHCT within the community
• 12) to understand that our own feelings and attitudes can affect those of the patients for whom we care (consciously and subconsciously)
• 13) to feel stimulated to accept that lifelong medical practice involves a commitment to lifelong medical education and self assessment (including audit)
• 14) to commence a personal portfolio of learning (in whatever form is most suitable) that will meet appraisal and reapproval requirements, but that will do so with regard to 13) above
Introductory Period (approx 1-2 weeks)
Aims
To meet the people involved in our PHCT, know something of their roles and strengths and begin to develop a happy working relationship with the team.
During the introductory period you should also get a taste of the patients in our practice and perhaps some of the eccentricities of the partners!
You should also be developing an awareness of the role of a GP.
Objectives
• to meet the members of the PHCT individually
• to be aware of the role of each of the members of the PHCT within the practice
• prepare for on-call and emergencies that present in GP
• know how you will use the computer and develop these skills
• prepare a list of tutorial areas to cover in the early stages of your attachment
In discussion with your trainer you should adapt the first two weeks in the way that is best suited for you. Previous registrars have found the following useful:
Spend time with:
Initial tutorials
Work experience
In subsequent weeks the Registrar will do seven or eight surgeries per week and four visiting sessions. The trainer or partner will be available at these times and time is set aside after each to discuss cases seen
The Registrar will have the opportunity to sit in with the trainer and partners throughout the six-month attachment.
The Registrar will also be encouraged/expected to attend and participate in special clinics:
Meetings
• primary health care
• partners business meetings
• clinical meetings
• significant event audit meetings (SEAM)
Hospital out patient clinics
• (where further experience needed)
Others
• attend case conferences
• sit in with other members of the team
• visit osteopath/physiotherapy
• visit local factories
• visit to a practice in a different setting
Emergency medicine/On Call commitment
We would try during the training period to ensure that adequate experience is gained in out of hours medicine. There are rapid changes occurring in emergency medicine in primary care. We would expect a GP registrar to undertake an equivalent amount of on call work to a normal partner in the practice - currently one Saturday morning session every four weeks and two six-hour sessions in the local co-operative.
Tutorial Teaching
This is flexibly arranged to fit in with half-day release meetings or “hot/warm” cases.
The topics should be a balance of:
“hot case analysis”
“warm case analysis”
“formal” (where prior preparation has occurred)
consultation analysis (video/verbatim/theory)
Topics should be chosen in advance according to the registrars needs and will be arranged with the appropriate resource (in advance where possible) from within or outwith the practice. A minimum of three hours protected time will be set aside for tutorials.
Regular tutorials will be devoted to the study of consultation theory and skills, along with detailed analysis of the Registrar's consultations, principally through analysis of videotape.
Project Work
The Registrar will be encouraged to carry out a small piece of research or audit and to write it up for presentation. This will involve the use of library and literature search for background reading and tuition on research methodology and presentation.
Audits/meetings
The Registrar will be encouraged to learn along with the partners in our monthly meetings and to realise that personal and professional development is a continuing need for “contented” and competent practise.
We hope that during these meetings we may be able to tap the knowledge of the Registrar where his previous experience is superior to ours.
The practice has an active programme of audit which the registrar would be encouraged to participate in.
Career Guidance
Depending on the stage of their training, trainees may require assistance with job hunting or preparation for examinations. Counselling and advice for these will be provided when needed.
Assessment
This will be carried out according to the National Summative Assessment guidelines. Encouragement will also be given to prepare for and sit the MRCGP examination during the Vocational Training Scheme.
Along with this self-assessment is encouraged throughout the period in practice so that any areas in which the Registrar feels weak can be strengthened.
We hope that following the Registrar's time with our Practice both practice and registrar can benefit from two-way follow up. We would like to know of any deficiencies in our training programme. We want to continue to develop as a training practice and feedback is useful. Equally so we do not see our role as a training practice finishing at the end of six months. We are always happy to be contacted if independent advice is needed during the further hospital jobs or during the period as a new principal.
Remember it is currently essential that you fill in the logbook provided by the Course Organisers.
Timetable
|
am |
|
pm |
Monday
|
Surgery 0830 – 1030 |
Visits 1330 - 1530 |
Surgery 1600 - 1730 |
Tuesday
|
Surgery 0830 - 1030 |
|
VTS half day |
Wednesday
|
Surgery 0830 - 1030 |
Visits 1330 - 1530 |
Surgery 1600 -1730 |
Thursday
|
Tutorial 0830 - 1130 |
Visits 1330 - 1530 |
Surgery 1600 -1730 |
Friday
|
Surgery 0830 - 1030 |
Visits or extras 1200 - 1300 |
Half day |
In addition to the above surgery times we see patients for ‘assessment appointments' booked at 10min intervals from 1100 to 1230 and for evening ‘emergency appointments' from 1730 onwards. These appointments are for patients who are unable to wait for the next routine bookable appointment and hence can see any available doctor. We therefore share those appointments between the available doctors and minor illness nurse.
All doctors also take telephone calls from patients for 30minutes during the day (usually between 1100 and 1230). It is expected that the registrar will also share in these calls when they are confident in their telephone triage skills.
Out of hours cover
We currently work as members of Burnley and Pendle Medical Co-operative based at Pendle Community Hospital in Nelson. We all aim to work 2 or 3 sessions per month but overnight sessions are covered by a separate organisation. Each shift lasts 4-6 hours and includes telephone triage, surgery consultations and home visits. The provision of out of hours services will change in the near future and most partners are still likely to remain involved in the delivery of out of hours emergency primary care. This should allow us to fulfil the training requirements for summative assessment but registrars may elect to attend session with other out of hours providers if they wish.