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 gptrainingwales@cardiff.ac.uk 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 membership@rcgp.org.uk. 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 gptrainingwales@cardiff.ac.uk 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.

E: davewilson2@gmail.com

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 cjlee@doctors.org.uk, Laura Mackenzie (ST3 GP/ Medical Student Buddy Scheme Coordinator) on

lalmackenzie@googlemail.com, or James Kerrigan on jameskerrigan@doctors.org.uk

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:

swwales@rcgp.org.uk

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

laura.dunning@vale-healthcare.com

STIF Courses – Sexually Transmitted Infection Foundation Course

STIF Cwmbran (Janet.Campbell@wales.nhs.uk)

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

E: hottopics@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: medicaleducation@cardiff.ac.uk

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: gptrainingwales@cardiff.ac.uk

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 Janet.Campbell@wales.nhs.uk

Telephone: 01633 623628

15