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August 2011
Dr Tim Evans
ST3, Swansea Bay
Dr Sonia Taneja
ST3, Swansea Bay
Dr Madeleine Ginns
ST3, Bridgend
Dr Claire Campbell
ST3, Glamorgan Valleys
Dr Joan Hoare (Editor)
ST3, Carmarthen
Hello Reader, The Wales Deanery GP Specialty
Training Reps, your Reps, are de-
lighted to have produced this bumper
edition of our Newsletter aimed pri-
marily at ST1‟s. On July 4 2011 we had
a meeting at the Deanery in Cardiff
(yes, that was just 30 days ago!),
where we unanimously decided that
there was a great need for informa-
tion to be more readily available to all
new ST1‟s on the very first day of
their training in General Practice.
With this in mind, every one of us
Reps has contributed in a whole host
of ways to making this Newsletter
happen. Although we have a number of
articles aimed at the ST1‟s, we have
not forgotten the ST2‟s and 3‟s (e.g.
“Preparing for the AKT” etc). We are
very grateful to our Guest Writer, Dr
Mair Hopkin, Associate Dean in Gen-
eral Practice, for her in depth article
aiming to dispel the myths surrounding
Less Than Full Time Training
(LTFT). This Newsletter would
never have been published without
the very supportive and profes-
sional help received from the GP
Training Wales Team at the Dean-
ery – thank you very much!
We hope that the Articles, Reviews
and Adverts are informative and
interesting. I have learnt buckets
whilst editing this! Any comments
about the Newsletter and sugges-
tions about future Articles/
Reviews/Guest writers/Adverts
will be very welcome indeed. Our
intention is to produce another
Newsletter in Nov/Dec 2011, for all
GP ST Trainees, with more infor-
mation that is relevant to all of us
and to our training, both locally,
nationally and across the UK.
Please enjoy! Joan,
Editor.
Dr Laura Mackenzie
ST2, Gwent
Dr Julie Taylor
ST2, Swansea Bay
Dr Sally Chow
ST3, Swansea Bay
Dr James Kerrigan
ST3, Swansea Bay
Dr David Wilson
ST3, Pembrokeshire
Dr Stephen Wadsworth
ST3, Wrexham
Introducing your Current GP ST Reps...
Contents:
Page 2: How to get the Most from your Hospital Posts!
Page 3: Getting Involved, GP Trainee Representatives
Page 4: E-Portfolio
Page 5 and 6: Supervision: Educational Supervisors and Clinical Supervisors
Page 7: Starting in ST2 GP for the First Time
Page 8: Preparation for the AKT
Page 9 and 10: Less than Full Time Training, Myths, Mrs and Mr...
Page 11: The BMA and GPC Committee from a GP Trainee‟s Perspective
Page 12: Diagnostic study Day, a Review and
RCGP Certificate in the Man-agement of Alcohol Problems in Primary Care, a Review
Page 13: GP Medical Student Buddy Scheme and
Consulting Skills for GP Reg-istrars with Roger Neighbour, a Review
Page 14: GP Update Day, a Review and
ENT Study Day, a Review
Page 15: What‟s on?
1
We would like to say goodbye to Dr Isolde Shore-Nye, Dr Keith Hawkins, Dr Anna Gaskell, & Dr Simon Davies who have just finished their GP ST training. Guys, we wish you success in your ca-reers and want to thank you for all your hard work and enthusiasm as GP ST Rep-
resentatives. Diolch yn fawr iawn!
By Dr Laura Mackenzie
Clinical skills and examination Hospital posts present ideal situations to
learn from the specialists around you. Never
again will you have the option of taking a psy-
chiatric history with a consultant psychiatrist
observing you, or have someone peering over
your shoulder while you're doing a speculum
exam, so even though it seems like hassle at
the time, having specialists observe your his-
tory-taking, examination or clinical skills is a
valuable opportunity which you shouldn't miss
while working in secondary care.
Tutorials Some posts have a pre-set departmental
teaching programme, but you may also be able
to request certain topics to be covered. If
there is no set rota for teaching, you could
ask the registrars for tutorials or even sug-
gest that you set up a programme which en-
courages everyone to present a clinical topic.
It might sound like hard work, but you will
benefit from both presenting and learning
from others. If you are able to give sugges-
tions for tutorials, try to think of topics
which are common to general practice rather
than just focussing on acute or emergency
type scenarios.
Clinics This is where everyone should want to be.
Here you will see common problems that will
present to general practice that you may
never see on the ward, and you will have the
benefit of seeing how the consultant or regis-
trar manages the patient. e.g. infertility, mild
childhood constipation. It can be difficult to
have opportunities to go to outpatient clinics,
but discuss this with your clinical supervisor
or consultant early on and stress how useful
it will be to your training.
Audit The obligatory audit! If you've been asked to
do an audit or have chosen to get involved,
you can try and make it more relevant to GP
training For example, an audit based on the
guidelines for the management of atrial fib-
rillation will not only keep your consultant
happy but may benefit you too by giving you
one less topic to revise when it comes to ex-
ams. Also, audits of referral criteria to sec-
ondary care can be helpful to give you an idea
of appropriate and not so appropriate refer-
rals.
What are you not seeing in hospital? After you've been working in your hospital
post for a few weeks, have a look at the
RCGP trainee curriculum guidelines. You will
note key areas that you may not have come
across so far in hospital practice which could
give you the opportunity to look for those
types of clinical scenarios during the rest of
the post. Alternatively, you may not have
covered those curriculum areas because
these patients are generally managed in pri-
mary care and so never need to attend hospi-
tal. You could then discuss these topics with
your consultant or registrar to further your
knowledge, or learn about them in other ways
such as reading from textbooks or complet-
ing e-learning modules.
When you start General Practice training with a hospital post, it is sometimes easy to forget that you
are a GP trainee at all! Caught up with acute intakes and hospital protocols, the relevance to primary care
can be sidelined. So here are some tips to make the most of your hospital jobs.
2
GP training in Wales has changed dramatically over the last 5 years. This is a dynamic process and attitudes to-wards training to become a GP are constantly changing. In the RCGP manifesto there is a call for a 5 year training scheme to replace the current 3 year scheme. This goes some way to recognising the fact that General Practice is becoming a more respected career choice and many prob-lems that were once managed in secondary care are mov-ing into primary care. This leads to an ever expanding knowledge base for today‟s GP, which the training in turn needs to reflect. In addition to this the RCGP have devel-oped a state of the art exit exam (CSA) simulating a complex morn-ings surgery to improve the quality of those completing training. To support these changes it is impor-tant to have GP trainees who are interested in their training and the future of General Practice as a whole. This is where Training Rep-resentatives come in. At present in Wales there are 2 groups of GP Trainees that you can get involved with by becoming a GPST representative or a RCGP AiT representative.
GPST Rep’s – The GPST
(GP Specialty Training) Representative group were first
formed by the Deanery in 2009. It is a group of trainees
who gave feedback to the deanery on training issues in
Wales and in return are given opportunities to view the
selection process and feedback on scheme/practice visits.
Nearly every scheme in Wales is represented so that the
feedback given can give a good idea of training in Wales
as a whole. I would encourage you to volunteer to become
a GPST Rep if you care about training and are interesting
in learning more about training in Wales. Particularly as an
ST1 looking to meet with your peers and to have an input
into training matters in Wales this is an excellent way to
get your foot in the door.
RCGP AiT Wales Committee – This commit-
tee was born this year from the GPST group when we de-
cided there was more we could do as a group to support
trainees in Wales and run with our own projects. With the
blessing of the RCGP Wales Council the Committee was
formed which consists of the Chair, Deputy Chair, 3 Fac-
ulty Members (North, South West and South East
Wales), Newsletter Editor, Events Coordinator, Buddy
Scheme Coordinator, Junior International Committee
Representative, BMA GP Representative and Research
Representative. As a group this committee is in its in-
fancy establishing roles and tasks and coordinating
events all over Wales. The chair is the RCGP AiT repre-
sentative for Wales – it is their responsibility to attend the
national meetings where every
Deanery in the UK is represented
and training issues are discussed
on a higher level and feedback is
given to the powers that be. In ad-
dition they feed the outcomes back
to their Deanery. This brings back
fresh ideas from trainees all over
the UK. If you are elected as RCGP
AiT Wales Rep you also have a
chance to serve on other national
committees and have a chance to
get involved with the annual RCGP
Conference.
As a Representative you will be expected to attend around 3 meetings or events in a year, and you are given additional study leave to meet these commitments. The Deanery and the College have a lot to offer but to make the most of what‟s available it is worthwhile getting in-volved. This can be done in two ways. The first is as a representative for your scheme by becoming a GPST Rep. If you are interested in doing this please contact [email protected] The second way to get involved is at a Faculty level. Every AiT is allocated to a Faculty on registration accord-ing to where you are working. Wales is split into 3 facul-ties North, South West and South East Wales. To find out your Faculty please refer to your RCGP wel-come pack or email [email protected]. To find out more about the RCGP AiT national committee follow
this link: http://www.rcgp.org.uk/new_professionals/associates_in_training/ait_committee_1.aspx
By Dr Claire Campbell
3
In GP training, there is much more emphasis on the e-portfolio and reflective learning than in any other spe-
cialty training programme. It is important to learn how to get the most out of it from the very beginning.
Learning logs All trainees should be regularly recording learning logs at a rate of about 2-3 per week. One of the most common causes of unsatisfactory outcomes at the annual progression panels (ARCPs) is a poor number of log entries with minimal input throughout the year and then a rush closer to the end of review period. However, the focus should be on producing good quality reflective logs. Learning log entries should:
describe what happened
critically analyse the situation, appraising your role/performance and how it made you feel
reflect on what you have learnt and its relevance to general practice
describe any learning needs identified and how these might be achieved It‟s relatively easy to generate enough learning log entries. Think about all the educational activities you do most weeks:
we are all sent copies of the BJGP and InnovAiT – read and reflect on an interesting article
we often ponder over clinical encounters – put one down in writing in your e-portfolio
most departments/practices have weekly tutorials or seminars that you attend – reflect on an inter-esting presentation or discussion
e-GP modules – these are automatically sent to your learning log for you to reflect on Your educational supervisor (ES) should read your logs at regular intervals. They may comment on some, help-ing you to reflect further or direct you to useful educational sources. It‟s a great way to keep the dialogue open especially when you are in a hospital post and don‟t see them very often. Make sure you don‟t save up logs and then add these entries right at the end of your review period as your ES might not have the time to go through them all before your review is due to be submitted! Another tip – if you are spending a long time reflecting, save your work intermittently as the website is prone to crashing from time to time.
Personal Development Plan (PDP) This can be developed in many different ways, from a plan for the next 6-12 months to a more dynamic docu-ment with a range of objectives that may cover the whole training period. My advice is whichever approach you decide to take, keep the number of learning objec-tives small and manageable. It is also important that the entries are SMART (ie specific, measurable, achiev-able, realistic and timebound) so that you can demon-strate your achievements.
Work-place based assessments (WPBAs)
These are similar to those you would have completed in foundation or other training programmes, although the acronyms may be different. The requirements vary de-pending on what year you are and the type of place-ment you are on (see http://www.rcgp-curriculum.org.uk/nmrcgp/wpba/minimum_evidence.aspx for more de-tails). Ensure you submit these assessments through-out the review period, not just before your review is due, as the ARCP panel will not see this as evidence of con-tinuous, progressive learning.
Reviews Reviews with your ES take place twice a year, usually in January and May. You need to ensure you have completed all your WPBAs and have a Clinical Super-visors report prior to these meetings. You also need to complete a self rating against the 12 competency areas before you meet, as these form the basis of the discussion. This will take longer than you think so don‟t leave it until the last minute. During the first two years of training, you should be rating yourself somewhere in the “needs further devel-opment category” You need to document evidence for your self-rating level by citing appropriate learning logs or WPBAs, and outline further development during your next post. A list of log entries linked to the com-petency areas are at the top of the page. I find it helps to have the e-portfolio open in two windows, one with the curriculum item evidence page open, and the other with the self rating window. Save it as you go along, but don‟t submit until you are sure you‟ve finished as you cannot edit it afterwards.
Finally The e-portfolio can seem like a bit of an unwieldy beast and a waste of time. However, it can be a valuable tool to help you to progress through your training. The RCGP has developed a useful booklet which can be found at http://www.rcgp-curriculum.org.uk/PDF/ePortfolio_Trainee_Manual.pdf. My final piece of advice is to try and keep up to date with entries, getting into the habit of doing some every week. It makes preparing for your six-month review much less stressful.
By Dr Julie Taylor
Hello there, congratulations and welcome to GP Training in the Wales Deanery! From day 1 of your training and when you log into your eportfolio (which
should happen frequently!) you will notice that you have 2 supervisors: an Educational Supervisor and a Clinical Supervisor. So why do you need 2, and what does each one do?
Your Educational Supervisor (ES) is a practising GP
trainer, in a local surgery within your NHS trust.
He/she remains your ES throughout the year. The
supervisor checks your progress over the year to
make sure it is satisfactory. You should meet your
ES within the first 6 weeks of starting ST1 – you
start to get to know each other. You can let them
know if there have been any problems so far in your
hospital job (which hopefully there won‟t be!) and
talk about previous experience, learning goals, and
Personal Development Plan as well as what you want
to achieve over the first 6 months of your job.
They will also remind you how many assessments you
need to do every 6 months. They know the eportfo-
lio very well and help you to become familiar with
and navigate round it e.g. show you how to link PDPs
with learning logs. If you want to attend a clinic in a
completely different speciality from your current
hospital job, they may be able to tell you who you
need to contact as they will know people in various
departments inside and outside the hospital setting.
You will have reviews with your ES at 6-monthly
intervals in all 3 years of your GP training. Your ES
changes each year. Therefore in ST1 you will have a
6-month and 12-month review. In ST2 you will have
an 18-month and 24-month review. In ST3 you will
have a 30-month and 34-month “final review” (prior
to gaining the full nMRCGP). All meetings with your
ES are documented in your eportfolio.
The mid-year reviews (i.e. 6-month, 18-month
and 30-month reviews) are to check everything is
progressing well with regards to your job and
eportfolio, and to make plans about what needs to
be done over the next 6-months. These reviews are
not checked by the deanery, however they are man-
datory, and a report of the meeting must be docu-
mented in your eportfolio
The 12-month, 24-month and final review are
the end-of-year reviews that are used by the dean-
ery for your ARCP (Annual Review of Competence
Progression) which determines if your progress is sat-
isfactory for you to proceed into your next year of GP
training. Your educational supervisor will meet with
you to check that you have all the required evidence
for the ARCP, but ultimately it is YOUR responsibility
to make sure that you do. Therefore you will need to
be certain that you have done all your assessments by
this date. It is also vital that you keep your learning
logs up-to-date over the whole year. Your supervisor
doesn‟t want to be reading the 100 entries you have
made during the week before your meeting....they
have busy lives too, and you should be reflecting on
your learning throughout the year (not just the week
before). Also, the deanery can see exactly when each
entry was made and can see how much reflecting went
on throughout the year.
At the end of each year, you will have an appraisal
to do where you reflect on the year as a whole with
your ES: what has been achieved, any constraints to
your learning and any plans for the following year but
I won‟t dwell on this too much at this stage.
The ES will keep an eye on your eportfolio to make
sure you are doing your Workplace-Based Assess-
ments (WBPAs eg DOPS/CBDs etc), as well as look at
your learning logs. They may occasionally make a com-
ment about a learning log entry they have read, for
example encourage you to read something/attend a
clinic/generally reflect with you (shared reflection) if
they have encountered a similar scenario. It is impor-
tant to keep your eportfolio up-to-date...it is recom-
mended that you put in 3 entries per week. This makes
it easier for you to do, and easier for your ES to read.
If you have any concerns regarding your hospital
post that you aren‟t able to resolve with your Clinical
Supervisor, then you could speak to your ES. They are
all very approachable and have had hospital jobs them-
selves in the past! He/she may be able to provide you
with advice or be able to signpost you to someone else.
They want you to enjoy your GP training as much as
possible.
Continues over the page... 5
Your Clinical Supervisor (CS) is your hos-
pital consultant whom you will be working
for. Your CS will change whenever your
hospital job changes. As with all your
previous hospital jobs and consultants,
your CS will oversee your day-to-day
work and is responsible for ensuring you
are adequately supervised and not per-
forming tasks beyond your competence
level.
If you have any concerns in your hospital
job, then it would be wise to discuss
them directly with your Clinical Supervi-
sor (e.g. issues regarding supervision or
assessments). If you feel that concerns
are still not being sorted, then discuss it
with your ES/Programme Directors.
Equally, if your CS has concerns about
you, then depending on the severity of
the concerns he/she will approach you
directly to discuss them and may involve
your ES or Programme Directors. The CS
doesn‟t have access to read your eport-
folio entries (that‟s not their role), but
they do have a role in your WBPAs and
can mark you as unsatisfactory if they
feel it appropriate.
You will need to meet with your Clinical
Supervisor at the start, middle and end of
your rotation. This is to discuss your aims
and objectives for that job, your pro-
gress, and then your final review of that
placement. The first two meetings are re-
corded as “Professional Conversations”
within your eportfolio. The last meeting is
discussed below.
You may do WBPAs with your Clinical Su-
pervisor, as you will see them frequently.
There is a section in your eportfolio for
your clinical supervisor to write a report
(Clinical Supervisor Report “CSR”) at the
end of your rotation. This should be based
on a discussion that you and your CS have,
where you discuss what has been learnt in
the post, your clinical skills and profes-
sionalism in the job and any practical skills
acquired in the post. There is also space
for free text where your clinical supervi-
sor can document anything (good or bad)
that he/she may feel is appropriate to
mention.
In summary, both your Educational Supervisor and Clinical Supervisor are here
to make sure you are adequately trained and performing your job well. The assess-
ments and eportfolio are a mandatory part of your job. The onus is on you to make
sure things get done. My final word is that GP Training in Wales is fantastic; I
would strongly recommend it to anyone. You‟ve made the right decision…
congratulations on getting in, and all the best over the next few years. If there
are any questions, there are plenty of people willing to help.
By Dr Sonia Taneja 6
This article is intended to give trainees help and advice on going into GP. For those of you
who are entering practice for the first time there are a few notable differences from hos-
pital medicine.
By Dr Isolde Shore–Nye
1. Sessions- In General Practice the working
week is split into sessions. Each session is half
a day. This can be a little difficult to get your
head around initially. 30 days annual leave be-
comes 60 sessions and the same for study
leave. Some practices will ask you to book leave
as sessions.
2. Working Week- Your week should con-
sist of 7 clinical sessions where you are
seeing patients routinely. There are 3 non-
clinical sessions: one for Half Day Release,
one for Self Directed Learning, and one for
a Tutorial. It is important to realise that
the SDL and Tutorial should be a whole ses-
sion each, (all morning or afternoon). SDL
session are meant to be used as sessions to
improve skills or knowledge, they may in-
clude computer based learning, attendance
at hospital clinics or to do additional
courses such as family planning etc. You
can also use SDL to do a combined or ob-
served surgery. SDL is not intended to be
used solely for exam revision. Your Educa-
tional Supervisor (ES) will probably ask you
for an SDL learning plan for the time that
you are in practice.
5. Equipment– Practices provide
equipment for the Registrar to use,
both in the rooms and as a home visit
bag. This can be variable, but prac-
tices are funded to provide this.
Personally I purchased my own bag
and transferred the contents from
the one the practice provided. As I
progressed through training I gradu-
ally bought more of my own equip-
ment.
3. Travel Expenses– As in hospital medicine you
can claim travel from your base. There are clear
rules in GP for this and your Business Service
Centre (BSC) will give you the guidance and claim
forms. You can claim for all home visits and travel
between main and branch surgeries and a maxi-
mum of 10 miles each way home to surgery travel
if you have travelled on official business on that
day. Your car needs to be insured for business use
but this doesn‟t cost extra usually.
I hope that these tips will help in the transition from hospital practice to GP, the list isn‟t
exhaustive, but is based on what I have learnt and would have found useful myself.
4. Study Leave– Trainees in GP are entitled to 60 ses-
sions study leave per year (30 if in practice for 6
months) LTFT check with your course organisers. Your
half day release (HDR) sessions are included in this. The
schemes may be different on the number of sessions but
is usually 46 sessions in the year as HDR and the other 14
sessions as personal study leave. (i.e. 7 days personal
study or for courses).
7
The Applied Knowledge Test (AKT) is the first part of the member-
ship exam for the Royal College of General Practitioners. The
computerised exam consists of 200 questions over a 3 hour period; mainly „best of 5‟ format,
but there are a few extended matching questions and recently single word/number answer
type questions have been added. 80% of questions are based on clinical management, with
10% each on evidence interpretation/statistics and organisational aspects of general prac-
tice. The current cost of entry is £441 with full payment upfront. Exam dates for the three sit-
tings and the window for applications are available through the RCGP website.
Questions can be drawn from the whole RCGP Curriculum State-
ment Headings. The college website gives detailed feedback on each sitting of the exam and
guidance as to where candidates‟ weaker areas were in previous sittings. Questions do
range in difficulty from those that a medical student should find derogatory to some which
would cause debate amongst senior doctors, and also the odd bizarre question that no-one
could ever be sure on the correct answer. Overall, there are few nasty surprises. Each cor-
rect answer is worth just 0.5% and going into the exam knowing this should help to avoid
wasting time agonising over one tough question.
Lighter reading starting from 3 months before the exam, gradually stepping up to more serious efforts 6-8 weeks before the exam
should be enough for the majority. A wide range of revision sources alongside day to day clinical practice will maximise chances of success. The Oxford Handbook of General Practice is a good general text. Questions on guidelines & evidence are common and relevant NICE/BTS/SIGN guidelines should be read. E-learning modules can help with weak areas – doc-tors.net, BMJ and eLfH are amongst those offering a good range of modules.
Questions should be a staple in anyone‟s revision – it‟s all about practice, practice, practice!
Libraries will have books with practice questions but many tend to go online to revise. Two
commonly used websites are “Onexamination.com” – 3 months access for £82, and
“PassMedicine.com” – 4 months access for £20. Both have over 2000 questions available.
Onexamination.com is a more established website and although more expensive, the ques-
tions tend to be more like those in the real exam. The passmedicine.com questions tend to
be a bit tougher and the average scores on this website are lower, but there are good expla-
nations. Other sites are also available. Revision courses do exist – naturally they are expen-
sive and are no substitute for spending time doing as many practice questions as possible.
The choice to book a course is down to the individual.
The earliest you can sit the AKT is in ST2, but traditionally it is taken in October of ST3 a few months before sitting the CSA exam. A com-
fortable pass should not be beyond an able ST2 in the April/May sitting. Attempting the AKT without any experience in general practice is either brave or stupid (depending on who you talk to) and not advisable without a knowledge of working in general practice. ST2 trainees who do their first 6 months in a GP post before returning to a hospital rotation can consider the April/May sitting if in a quieter post but are advised to remember that knowledge for the AKT also underpins the CSA exam and to wait until ST3 if not entirely comfortable with an early attempt. A pass mark around 68-70% may seem on the tough side but reassuringly the first time pass rate tends to be around 75% and higher again for first time ST3 candidates. Results are released via the “Progress to Certification” tab on the e-portfolio 3 weeks after the exam and for recent exams, have been released the evening before the official published date on the RCGP website.
By Dr James Kerrigan
8
By Dr Mair Hopkin,
Associate Dean for General Practice
Less than full time training (LTFTT) sometimes causes confusion for Train-
ees, Trainers and employers. LTFTT often allows trainees, who would oth-
erwise struggle with or suspend training, to continue a training programme.
The regulations are available at the website below. There is also useful
Deanery information and access to forms at the Cardiff web link. This link
also explains the process in Wales and has lots of helpful resources.
So what are the myths and truths about less than full time training?
This is only for pregnant women? No, this scheme is open to men and women who meet the criteria. Any doctor involved in caring for a dependant or
who has health problems will be given priority according to the principles outlined in the NHS employers document.
It’s a given right for all trainees? Well, anyone can apply for LTFTT but they must meet the criteria set down by the NHS. Category 1 will be given pri-
ority and category 2 will be accommodated if finances and circumstances allow. Very few applications are refused.
LTFTT is a difficult process to access?
No, the process is simple and straightforward. See the deanery web pages for application forms and the process
progresses from there. Once you have Deanery approval for LTFTT you will need to access the AD responsible for
LTFTT through [email protected] and your local Programme Directors to sort out your programme.
GP placements are generally easy to arrange but hospital posts can be more difficult as these usually need to be slot
shares with another LTFTT. You may be required to take up a post that is part of another scheme but your AD and
local PDs will ensure your programme will be suitable for you to apply for a CCT.
I’ve worked with LTFT trainees and they’re never in work? Most junior doctors now work a shift system so it can be difficult to maintain contact with peers. This is particularly
a problem if you work less than full time. It is recommended that LTFTTs are part of the department rota otherwise
they can be seen to “cherry pick” their on call sessions or be used to fill in ad hoc for absent colleagues. Either sce-
nario is undesirable. LTFTTs should be part of the normal rota for their department. Remember that full time
trainee colleagues may also be mothers, carers or have their own health issues to contend with.
LTFT is available immediately if I need it? No, the regulations state that any application will be considered within 3 months. Most applications are processed
well within this time. The Deanery will try to accommodate unforeseen circumstances that make it difficult for a
Trainee to continue full time training. Remember that hospitals need a minimum of 6 weeks to advertise and appoint
to a vacant post. Your GMC requirement is that you give a minimum of 4 weeks notice if you will not be taking up a
post.
GP scheme rotations are often arranged 3 years in advance, so making last minute changes can be difficult. Please
give as much notice as practical so that your AD & PDs can make the best possible training programme for you.
Also, if you wish to revert to full time training you will need to ensure you have a post to go to and you cannot expect
another trainee to alter their rotation to accommodate your desire to return to full time training so there may be a
delay in finding a suitable placement.
9
LTFTs have more time to do less work?
There are specific requirements for LTFTT that can be found at: http://www.rcgp-curriculum.org.uk/nmrgcp/
less_than_full_time_trainees.aspx
Remember that while less than full time trainees have less clinical patient contact they do have to meet the
same minimum criteria for WPBA for training as full time trainees. For most LTFTTs this means double the
CBDs and COTs/ miniCEX in an equivalent training period as their full time peers. This requires organisation
and commitment for training.
LTFTT is not well advertised or encouraged?
There is ample information on the deanery website and we have still not met the government target of 20% train-
ees training LTFT. Anyone who meets the criteria will be considered (Miss, Mrs or Mr) and we encourage trainees
who are struggling to cope with full time training to apply if they are eligible and it will help them complete train-
ing.
Remember that many GPs of both sexes choose to work part time in their practices as either salaried doctors or
partners. GP is particularly flexible as a specialty so your chances of employment after CCT are as good for full or
part time doctors.
Have seen trainees
going from strug-
gling to blossoming when give opportu-
nity to train LTFT
LTFTTs can “cherry pick” the best parts of the post? All LTFT posts need to give the trainee the full range of experiences that a full time trainee would acquire
but over a longer time period. The LTFT programme should include the same proportion of clinical work, edu-
cation sessions and on call as a full time trainee in that post. This may require changing working days to access
these experiences during the post and child care arrangements should be made to allow the trainee to partici-
pate in the full range of training experiences. Childcare should be arranged to accommodate the training pro-
It is everyone’s responsi-
bility to include a LTFT
in the team including the
line managers themselves
Consultant was against hav-ing a slot-share... that was really stressful....but in fact, it worked really well
http://www.nhsemployers.org/SiteCollectionDocuments/doctorstraining_flexible_principles_cd_080405.pdf http://www.cardiff.ac.uk/pgmde/careersandrecruitment/ltft/index.html
10
Hi, I‟m Dave and I am an ST3 in Pem-
brokeshire. I am also the Welsh repre-
sentative on the BMA GP trainee sub-
committee of the GPC and also the
trainee rep on the Welsh GPC.
What does this mean?
Most of you have probably heard of the
BMA at some point; some of you are
probably members. While acting as a
trade union for it‟s members, the BMA
also has a representative role for the
profession as a whole in negotiations
with bodies such as the Department of
Health and the Welsh Government.
UK GP‟s are represented collectively by
the UK General Practitioners Committee
which in turn has subcommittees repre-
senting specific groups such as trainees
and salaried doctors. The devolved na-
tions have their own committees which
also in turn feed into the national com-
mittee.
Topics of discussion at our meetings
have been varied and included topics
such as exams through to considering
the possible impact of the proposed
health reforms on GP trainees across
the UK.
As a trainee, there are some differences
between working in practice and working
in hospital and I‟m hoping to write on
some of these differences throughout
the year. I hope also to feed back on any
significant changes on the political land-
scape that might affect trainees.
One of the key goals this year is to try
and get Welsh trainees engaged by try-
ing to seek out your ideas, concerns and
expectations (please excuse the pun).
If you would like to get involved or if
there is something you have a particu-
larly strong opinion about or think the GP
trainee committee ought to consider
then please feel free to drop me a line.
By Dr Dave Wilson
11
The Welsh Government have acknowl-edged alcohol misuse as a priority for pri-mary care and at the time I took this course, there were covering the £250 fee for health professionals in Wales. The course was an online exercise, work-book and then a face to face day. The face to face day offered a chance to dis-cuss questions etc and used small group teaching and role play to develop consul-tation skills. I‟m usually a bit of a cynic when it comes to role play but from a trainee perspective with a view to the CSA next year, I felt I took home some useful pointers.
Has the course changed my practice? Well it was only two weeks ago but I can honestly say it has. I have tried to incorpo-rate some of the screening tools into my consultation and have felt more comfort-able in bringing up a patient‟s potentially hazardous drinking with them and then having a discussion around this. In summary, this was a good course. The materials were up to date and I was im-pressed by their high standard. I wouldn‟t suggest it to those in their hospital posts but after spending some time in primary care I would definitely recommend it.
By Dr Dave Wilson
By Dr Steve Wadsworth
I attended the GP-CPD Diagnostics Study Day on the 19/5/11. The day was hosted at Ysbyty
Gwynedd in Bangor and was a very useful learning experience. It started at 2 in the afternoon
and ran until about 8pm. While the timing was a bit unusual it did allow the local GPs to do their
morning surgery as normal, and meant that trainees only needed to take half a day of study
leave. It also meant that those of us coming from a bit further afield did not have to leave at
the crack of dawn!
There were 5 talks in total. Three were given by consultants from Ysbyty Gwynedd and they
covered topics such as the use of common investigations in primary care – Radiology, Biochemis-
try and Microbiology. These were very interesting and useful talks as they covered all the com-
mon tests we use as GPs, including urine culture and plain radiology.
The fourth talk was on Allergy, delivered by a Consultant Immunologist from Liverpool, and the
fifth talk was on Cancer Genetics, delivered by a Clinical Geneticist from the Cancer Genetics
Service for Wales. These were also useful as they gave good information on how to access and
refer to these services, as well as giving a good outline of what they offer. This was a very in-
formative and useful study day to attend. It was well delivered and copies of the talks were
provided on a CD for future reference. I would definitely recommend attending a study day
like this if the opportunity arises in your area.
RCGP Certificate in the Management
of Alcohol Problems in Primary Care,
a Review
12
Hello to all GPST‟s in Wales! This year, we are looking to launch a mentoring programme between GP trainees
(ST1‟s & ST2‟s) and year 5 Medical Students as a pilot. It will be called a “GP/ Medi-
cal Student Buddy Scheme”. A survey has gone out to last year‟s ST1‟s already and
new ST1‟s should expect an email about this in the next few weeks. We would really
value your opinion and would be grateful if you could take 5 minutes to complete this
survey when it arrives. Advantages of this scheme include:
Time to develop mentoring skills
Opportunities to teach, and develop further teaching skills
More entries for your e portfolio - covering the important teaching and mentoring section
Through teaching we are constantly reminding ourselves about certain topics so it‟s an excellent
way to revise and keep up to date
Something for your CV in the future
An important part of appraisal and revalidation – essential as part of maintaining the GMC „Duties
of a good doctor‟
An opportunity to encourage students to think about General Practice after they complete their
foundation training.
We are really proud of GP training in Wales and want to encourage recruitment into Wales. By strengthening
the links between the Medical School and ourselves, this gives us good opportunities to make Medical Stu-
dents consider General Practice early on and help with career planning.
If anyone has any queries or would like further information then please contact myself (Claire Campbell) by
email on [email protected], Laura Mackenzie (ST3 GP/ Medical Student Buddy Scheme Coordinator) on
[email protected], or James Kerrigan on [email protected]
Look out for the Survey coming to you by email soon. We look forward to hearing from you and working
with you all over the coming year!
By Dr Claire Campbell RCGP AiT Rep for Wales
This 2 day course was aimed at GP registrars and held in the RCGP headquarters in London.
It was very much based around Roger Neighbour‟s book „The Inner Consultation‟. Dr Neighbour has a good presentation style and kept us entertained with anecdotes about clinical encounters. The days were well structured with a good mix of presentations and group work and plenty of breaks! Course material was provided and guidance on take home exercises to further refine those newly developed skills. I felt that I left with a number of use-ful tools that helped me to be more effective in the GP consultation and in communicating with patients in general. I‟m sure it helped me with the selection centre (I did it as an FP2) and would probably be useful for those preparing for the CSA. Future courses are now run over one day and are advertised on the RCGP website.
By Dr Julie Taylor
Consulting Skills for GP Registrars
with Roger Neighbour, a Review
13
Working as a GP trainee for the last 2 years I have often
been unsure how best to use my study leave and budget en-
titlement. I wanted to briefly write about two courses I at-
tended during my ST2 year which have been helpful.
This was a very useful one day course in Cardiff but also held annually in centres nation-
wide. It cost around £150 for the day including lunch. GP Update presents a comprehensive
overview of current evidence based practice as applied to GP. The two speakers (Dr Lucy
Jenkins and Dr Peter Rose, both GPs from Oxford) specifically focus on key areas of cur-
rent research. For example, I attended in October 2010 and they gave a great summary on
the latest NICE and SIGN guidance for managing diabetes. Another good example was pick-
ing apart the evidence behind prescribing antibiotics for sore throats and how to use the
Centor criteria effectively. The latter was certainly something I was able to adopt into my
own day to day work. To supplement the presentations they provide you with a well pre-
sented but detailed book that covers almost every specialty in some way.
I would recommend this course particularly as part of preparation for the AKT and intend to
go again this year. In addition they offer courses on consultation and communication skills,
well aimed at those taking the CSA.
I have not worked in ENT and have limited experience beyond my Medical School training so
this was a definite learning need for me. The course was directed by Dr Rakesh Chopra who
is a GPwSI in ENT, held in London and I attended in December 2010. It was presented in
the style of „Revision for GPs‟ and did give a good practical overview of clinical ENT in Pri-
mary Care. The most satisfying outcome was actually being able to perform Epley‟s manoeu-
vre on a patient thus helping to improve their symptoms! The course provided a helpful ac-
companying booklet and information sheets. Dr Chopra spent a lot of time going through pic-
tures of E‟s, N‟s and T‟s constantly quizzing the audience...by the end you really felt like you
had seen plenty of the common problems.
Again this course was approx £150 and included lunch. I would recommend it to anyone who,
like me, felt their ENT knowledge and understanding needed to be a bit sharper than the 5
days experience gained as a 4th year medical student!
By Dr Tim Evans
1. GP Update Day, a Review
2. ENT Study Day, a Review
14
7th Welsh Integrated Sexual Health meeting Wednesday 5th of October
Village Hotel Swansea, SA1 8QY
E-Mail: shonda@spcorporateservices.
com Phone: 01225 436129.
ENHANCE YOUR TELEPHONE CONSULTATION
Village Hotel, M4 Junction 42, Swansea
WEDNESDAY 17TH AUGUST 2011 9:00 – 13:30 (includes lunch) RCGP SOUTH WEST WALES FACULTY
Costs: £85 for Members/Associates/AiTs (RCGP) Telephone no. for enquiries: 02920 504855 Email:
Ear Nose & Throat (ENT) Educational Evening for GP practice
“Red Flag signs for ENT”
&
“Snoring & Sleep Apnoea: The ENT Perspective” The Vale Hospital, Hensol, Vale of Glamorgan | Wed 21st September 2011 6.30pm
RSVP: Contact Laura Dunning by calling 01443 449 230, or by emailing
STIF Courses – Sexually Transmitted Infection Foundation Course
STIF Cwmbran ([email protected])
Hot Topics
GP Update Course Led by Dr
Simon Curtis This highly acclaimed and extremely popular one day course on the current Hot Topics in General Practice has been running for 13 years in multiple venues around the UK and Ireland. It is being held in Cardiff for the first time on Sept 30th 2011 The course is ideal for:
Busy, working GPs wanting an update of
recent developments
GPs preparing for appraisal and revalidation
GP Registrars preparing for MRCGP
GPs returning from maternity leave
GP Trainers Practice Nurses and Nurse Practitioners The course is available at a discounted rate of £150 for GP Registrars
W:www.nbmedical.co.uk
Opportunities to Formalise your Educational Credentials
The Wales Deanery runs a variety of accredited academic programmes leading to Postgraduate Certificate, Diploma and MSc awards in Medical Education. Specifically designed for clinicians who wish to improve and formalise their skills in planning, teaching, assessing and evaluating educational activities in a variety of different settings, these courses are available face to face in Cardiff or via e-learning
For further information please visit the Wales Deanery Medical Education website: http://www.cardiff.ac.uk/pgmde/sections/medicaleducation/index.html or contact us via email: [email protected]
Get in Touch!
Thank you for taking the time to read this newslet-ter. We look forward to compiling further updates for you. For now, we would like to invite you to direct any queries regarding training or issues raised in this newsletter to: [email protected]
Or ring General Enquires:
02920 687 508
Diploma of the Faculty of Sexual and Reproduction Healthcare (DFSRH)
Course of 5 Friday 21st October 2011
Malpas Court, Oliphant Circle,
Malpas, Newport NP20 6AD
£225*
Janet Campbell (Sexual & Reproductive Health)
Email [email protected]
Telephone: 01633 623628
15