N ews e-GP learning goes live
THE NEWSPAPER OF THE ROYAL COLLEGE OF GENERAL PRACTITIONERS
AUGUST 2009
Inside this issue... Revalidation evolution College prepares to launch Version 2 of Guide
A new online learning resource for all GPs, trainee GPs and other Primary Care professionals has been launched by the RCGP. The resource – e-GP: e-Learning for General Practice – is a comprehensive, free-to-access programme of short online learning sessions written for general practitioners and structured around the GP curriculum. Over 100 sessions of e-learning are now available, with new content being added on a regular basis. Current sessions range from Being a GP, Adolescent Health and Patient Safety to Genetics in Primary Care and Care of People with Learning Disabilities. New e-learning on Safeguarding Children and Young People will also be available shortly to support GPs with the issues surrounding child protection. Once complete, the entire e-GP resource will eventually consist of about 500 sessions of elearning covering the whole curriculum. GP trainees can record each completed e-GP session in their RCGP Associate in Training (AiT) ePortfolio and certified GPs can print off certificates for their appraisal folder. The learning within e-GP is delivered through highly interactive e-learning sessions, case-based scenarios and ‘virtual consultations’. There is an e-learning module for each of the curriculum statements, and each module typically contains two to four hours of e-learning, divided into a variable number of independent sessions. The e-GP resource can be used in conjunction with other existing GP educational methods, filling in knowledge gaps, supporting assessment and appraisal preparation, and providing access to consistent high quality learning anytime and anywhere. It differs from other e-learning resources in that it is explicitly written by GPs for GPs and offers an approach to learning based on curriculum outcomes. It is intended to enhance, rather than replace, existing methods of delivering GP education. General practice trainees were the first group to be given access to e-GP in January this year, followed by a rollout to practising GPs. Over
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Lung age vs long age Groundbreaking research encourages smokers to give up
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Dynamic duo Iona Heath and Amanda Howe join the RCGP top table
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Spotlight on safeguarding children New NICE guideline, plus new confidential service to support GPs
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RCGP Annual Conference Logging on for learning: doctors run though the modules at the launch of e-GP 12,000 GPs and trainees have now signed up to access the e-learning programme. e-GP is the result of a collaboration between the RCGP and e-Learning for Healthcare – a Department of Health programme working in partnership with the NHS and professional bodies to provide high quality e-learning content for the training of the healthcare workforce across the UK. It was formally launched at the College by Dr David Colin-Thome, National Director of Primary Care at the Department of Health. RCGP Professor Steve Field said: “e-GP is a fantastic resource that will benefit every GP working in the NHS, whatever stage they are in their career. It is an invaluable aid to postgraduate training and promotes lifelong learning which, in turn, will have a positive effect on the care we provide for our patients.” Julia Moore, National Director for e-Learning for Healthcare said: “As a mode of delivery for educational material, e-learning harnesses technology to support flexible and self-directed learning for today and tomorrow’s medical workforce.” Dr Ben Riley, e-GP Clinical Lead, said: “GPs
often ask me how e-GP is different from other established e-learning resources. All the e-learning in e-GP is RCGP approved and written specifically for general practice so is steeped in the context of NHS primary care. “This is reflected in both the content of the elearning modules, which feature realistic patient scenarios relevant to primary care, and the design of the resource as a whole. Much of the educational material is delivered in 20-30 minute sessions, to fit with the busy working lives of GPs and trainees.” e-GP is free to NHS GPs and GP Speciality trainees in the UK. It is also free to Armed Forces GPs and others involved in delivering GP education or training whose details are registered with the RCGP (via the e-GP website www.e-GP.org) Access will be rolled out to practice nurses, practice managers and other primary care professionals in the next 12 months. The sessions can be accessed anywhere there is an internet connection (provided local firewalls do not block access). To confirm that you can access the sessions successfully, please visit http://www.e-lfh.org.uk/technicalrequirements.html
e-GP in practice – the trainer/trainee perspective Dr Moontarin Ansar RCGP Associates in Training Representative East of Scotland Deanery RCGP Academy of Medical Royal Colleges Representative
Dr Clare Etherington General Practitioner in London GP Trainer and Tutor nMRCGP Clinical Skills Assessment Examiner InnovAiT News and Views Editor
I was intrigued by the idea of e-GP. It is a useful way to supplement learning, being easily accessible 24 hours a day. The content is up to date and the sources are reliable. New modules are added regularly and there appears to be something for everyone. Given the vast amount of medical information on the web, it is useful to have websites created by the profession for the profession. It is reassuring to know that modules are written by some of the leaders in the field such as Roger Neighbour MBE, a past President of the RCGP. Some modules are aimed at trainees and others for experienced GPs. They are useful tools to refresh one’s memory or help to aid new learning. It is nice to have easy access in one forum to many modules. e-GP also allows trainees to log their learning on their e-portfolio helping them become better doctors and reflect on their learning.
I think it is really useful for specialty trainees to be able to work their way through certain topics, such as 'genetics' or 'learning disability', which they might not have already covered in their training. It is then easy to add the completed session as an entry on their ePortfolio. Study groups preparing for the nMRCGP assessments are able to share out some of the sessions between them and then feedback the key information to one another. Each session of e-learning gives the right quantity of information to discuss in a tutorial. It is very convenient to have GP-related information on a topic grouped into a single session, and to be able to access the links without having to spend a lot of time ‘Googling’. The mix of words, pictures, videos and self-testing exercises makes the sessions easy to read and appealing to people with different learning styles.
Book now for primary care’s event of the year
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RCGP chiefs praise GPs for pandemic flu response The Chairman and President of the RCGP have paid tribute to the “monumental and magnificent” efforts of GPs across the UK in dealing with pandemic flu. In a joint statement, Professor Steve Field and Professor David Haslam said: “We have been overwhelmed by the response of GPs on the ground. The pandemic is putting heavy and prolonged pressure on primary care and the profession but we are extremely proud of how our Members and Fellows are going the extra mile. “GPs across the UK are going above and beyond the call of duty. As well as seeing more patients, they are doing extra surgeries, talking to hundreds of patients and their families on the phone and carrying out more home visits, as well as volunteering to cover out of hours services where the demands have been intense. “Not only are GPs and practices mounting a magnificent response to the challenges of dealing with this outbreak but they are also making sure that routine primary care services are running as normal and preventing a squeeze on other services such as accident and emergency. Professors Field and Haslam added that they had been very encouraged by the public’s response to health advice. “Most people seem to be keeping calm and following instructions but we need to keep reassuring patients that the effects are mild in the vast majority of cases and that the UK is well prepared. “General practice really comes into its own at times of crisis and the current situation is proving that on a daily basis. Based on the efforts so far, the British public can rely on exceptional service from GPs and practices throughout the period of this outbreak.”
NEWS
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Revalidation continues to evolve Professor Mike Pringle RCGP Revalidation Lead
The RCGP’s Guide to the Revalidation of General Practitioners (The Guide) was ‘published’ on 1 April 2009. It is only available on the website because it is a living, evolving document. As if to illustrate that concept, the second edition will be available on the website in the first week of August. Revalidation is a cooperative effort. The Departments of Health need to get the right laws and policies in place; PCTs need to strengthen annual appraisal and clinical governance, and they need to appoint Responsible Officers; the Deaneries must put good support and remediation in place; the GMC has to design the core of revalidation and approve the plans from individual Colleges... The RCGP has specific roles it must fulfil and it is doing so in close collaboration with the GPC. It has to define the overall standard for the revalidation of general practitioners – it did that in Good Medical Practice for General Practitioners (also available on the RCGP website). It has to propose the criteria standards and evidence for revalidation. It has to make it clear what evidence should be collected by GPs. It has to design a system for considering that evidence. All these three points are covered in The Guide. Your College is conducting pilots to establish the practicalities of our proposals and to tease out the problems for specific groups such as locums. We will then have to submit our plans to the GMC for its approval in the spring of next year (2010).
Professor Pringle: Revalidation must be fair and fit for purpose Through next year we will work with a volunteer GPs in a few well advanced areas of the UK – areas with good appraisals, excellent clinical governance and a Responsible Officer ready and waiting – to revalidate the first small group. We still hope that the first recommendations will be made to the GMC in the first quarter of 2011. Revalidation proper will start to be rolled out from April 2011.
What will revalidation mean for you? Any general practitioner who is delivering good care to their patients has nothing to fear. There will be more documenting of evidence but it is vital that revalidation is fair and proportionate
while being fit for purpose. The key new activity for this year is to ensure you record the time spent on your education, keeping attendance certificates and noting all educational activity. This can include formal education (courses, conferences), practice based education and activity such as internet based education (Essential Knowledge Updates etc). Almost all GPs are taking part in annual appraisals, agreeing a personal development plan (PDP) and reviewing last year’s PDP. Taking part significant event auditing and writing up one event per year will give your revalidation folder a head start. In further years you will need to do a patient survey and a colleague questionnaire. The RCGP will develop facilities on its website to help its members with these tasks. Lastly you will need to do two clinical audits over the course of five years. You can comment on these proposals at one of the many meetings up and down the country or at the RCGP Annual National Primary Care Conference. Or you can put your views on the RCGP website. The opinions of general practitioners are vital if we are to have a viable and effective system of revalidation.
What are the issues to be resolved? Everything is far from cut and dried. We need to consider carefully the evidence from the pilots and refine our proposals accordingly. We will take into account the views of GPs and the public. The College is very aware that revalidation creates special challenges for some groups of doctors. About a third of GPs are working sessionally, many as peripatetic locums. We need to ensure that they can collect the evidence without disproportionate difficulty. For example, significant event audits, col-
league surveys and clinical audits present particular problems. One way forward if for locums to either have a ‘base practice’ where they do a fair proportion of their work and where they can be involved in quality assurance, or for locums to form cooperatives. There are several good examples of the latter. Despite such innovations, we have to look carefully at what types of evidence are suited to locums rather than principals. GPs in remote and small practices may have problems with colleague surveys and clinical audits. Prison doctors may find patient surveys challenging. Indeed all doctors in hierarchical organisation such as the Defence Medical Services may face different issues. Some key aspects of a system for revalidation remain vague. We still don’t have the final guidance on Responsible Officers, for example, and until we see the detailed proposals from the other colleges we cannot be sure that revalidation is equitable across disciplines. The main unresolved issue is resourcing. Until we have done some pilot work it is difficult to estimate the resources required and be assured that the resources available will be adequate. The biggest potential cost will be for effective remediation for GPs who are beginning to experience problems. The cost of this cannot fall on the GPs themselves as occurs in some areas at present. It is still unclear how much support we can expect from PCTs or Boards and Deaneries.
The current position It is clear that we have made considerable progress in describing a system of revalidation that commands general support. The skeleton is there although it may need some remoulding over time. We now must put on the flesh and start the first tentative steps towards implementation. The RCGP is very dependent on other organisations doing their part in developing this process. We may yet be delayed by the lack of readiness in others. However with the support of general practitioners we will continue to work towards a design that is fit for the purpose of demonstrating that all GPs are up to date and fit to practise.
Decision day on licences is this month The GMC is urging GPs to make their decisions on licensing before the deadline of 14 August. From 16 November, all doctors will need a licence in addition to their GMC registration in order to practise medicine in the UK. The GMC has been contacting all doctors on its register to find out whether they wish to take a licence. There are three options: ● Registration with a licence to practise ● Remain registered without a licence to practise ● No longer registered
To help you decide, the GMC has produced a simple interactive guide to licensing options. The microsite contains case studies of doctors in different professional situations, answers to FAQs and interviews with high profile doctors who have already made their licensing decisions. ■ You can access Licensing Help at www.gmc-uk.org/licensinghelp The GMC has also produced a guide, Revalidation: Information for Doctors and Frequently Asked Questions, which aims to answer doctors’ queries about revalidation. ■ The guide can be accessed at www.gmc-uk.org/revalidation
Niall Dickson to join GMC as new Chief Executive The GMC has appointed Niall Dickson as the new Chief Executive of the General Medical Council. Niall (left) joins the GMC from The King’s Fund, where he has been Chief Executive since 2004. Prior to that, he was the BBC’s Social Affairs Editor. He will take up his new post in January next year. Niall will be chairing the RCGP annual national conference, Excellence in Practice – Winning Ways in Primary Care, in Glasgow in November this year.
RCGP News invites your comments or letters... Please write to: The Editor, RCGP News Royal College of General Practitioners 14 Princes Gate, Hyde Park London SW7 1PU email: rcgpnews@rcgp.org.uk
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ISSN 1755-7720 © Royal College of General Practitioners. All rights reserved. Published monthly by the Royal College of General Practitioners 14 Princes Gate, London SW7 1PU email: rcgpnews@rcgp.org.uk website: www.rcgp.org.uk
RCGP NEWS • AUGUST 2009
Teaching genetics GP wins award for study into smokers’ ageing lungs training sessions coming your way A Hertfordshire GP who encouraged patients to quit smoking by telling them their true ‘lung age’ has won the RCGP Research Paper of the Year Award.
Rob Newton Education Development Specialist NHS National Genetics Education and Development Centre Michelle Bishop Education Development Officer (Medicine) NHS National Genetics Education and Development Centre
With the inclusion of curriculum statement 6 ‘Genetics in Primary Care’ in the RCGP training curriculum, the NHS National Genetics Education and Development Centre is rolling out half-day sessions entitled Genetics in Primary Care – Tips and tools for general practice. These sessions have been designed to provide support for GP trainers in teaching the genetics component of the curriculum. These sessions introduce a range of teaching resources, developed by the National Genetics Education and Development Centre, that can used in varied educational settings, as well as demonstrations of different approaches to teaching genetics that could be used by educators. To support the roll-out of these GP trainer sessions, the Centre has engaged eight regional Genetics Education Facilitators, genetics professionals based in Regional Genetics Centres who have a special expertise in education. These facilitators are located in London and the South East, the South West, East Anglia, the East Midlands, the West Midlands, the North East, Wales and Scotland. The facilitators are currently approaching Deaneries in these areas, and thus far have provided a total of 35 sessions for GP trainers. To date, the training sessions have been well received by GP trainers who have reported not only an increased understanding of genetic concepts, but also indentified where genetics can be successfully integrated into their teaching of the new RCGP curriculum as highlighted by these comments: “Educational aspect useful – update relevant to primary care” (GP trainer, East Midlands) “Will feel significantly more confident in approaching teaching of genetics in general practice” (GP trainer, East Midlands) “Very well organised – useful resource especially for GP curriculum statement” (GP trainer, East Anglia) “Hugely worthwhile – I will be visiting your site” (GP trainer West Midlands) ■ To find out more about the GP trainer sessions, Genetics in Primary Care – Tips and tools for general practice or any of the teaching resources that have been developed to support the new RCGP curriculum please contact the National Genetics Education and Development Centre at enquiries@geneticseducation.nhs.uk or visit our website www.geneticseducation.nhs.uk
Are you a future leader? The RCGP Leadership Programme is recruiting its new intake. GPs who want to influence the national picture, lead locally or choose their own leadership role have until mid-September to sign up to this oneyear course structured specifically around primary care and its challenges. ■ Contact nicholanightingale@odpn.co.uk A limited number of bursaries are also available to help towards programme fees. More information can be found at www.rcgp.org.uk/leadership RCGP NEWS • AUGUST 2009
Dr Gary Parkes and his team carried out the study in five GP practices in Hertfordshire, involving 561 smokers over the age of 35. After using spirometry tests to estimate their lung age, he found that giving smokers this information significantly improved the likelihood of their quitting smoking. The results showed that 38 people (13.6 per cent) out of 280 smokers had successfully stopped smoking for 12 months after being told the true age of their lungs, compared to 18 (6.4 per cent) in the control group of 281 people. Patients’ saliva was also tested to prove that they really had stopped smoking. According to Dr Parkes, the procedure works because it is non-judgemental and empowers the patient to make their own informed decision. Interestingly, the quitting success in the trial Award-winner Gary Parkes (centre) and his research team celebrate their success was not related to severity of lung damage. with RCGP President Professor David Haslam (third left) and Professor Nigel Mathers, Those with a good result may feel they have Director of the RCGP Clinical Innovation and Research Unit (second right) ‘dodged a bullet’ and be tempted to quit before any further damage is done. Dr Parkes said: “It is a great privilege to win this award and a tribute to the hard work of the team involved in the Step2quit research study. I hope that many more smokers can benefit from knowledge about their lung health. I also want to thank the Health Foundation who funded the two year research project.” The RCGP and the Princess Royal Professor David Haslam, RCGP President, Trust for Carers are piloting a series said: “There are approximately 87,000 tobaccoof half-day workshops around related deaths in England alone every year. This award highlights why research in general pracEngland, to help improve GPs and tice is so important as this study suggests that primary care teams’ knowledge we could make a significant dent in that figure and help people to live much longer, healthier and understanding of carers and lives.” carers’ issues in Primary Care. The Research Paper of the Year Award is run by the RCGP each year to raise awareness of The workshops will be interactive and aim to high quality studies taking place within the genhelp the primary care team support carers by eral practice setting and to encourage more GPs making them aware of their own health needs, to become actively involved in research. A panel supporting them emotionally and practically and of peers, independent of the sponsor, chose the providing useful information. winning paper. Chaired by a local leader and delivered by a Papers are judged on originality, applicabilpractising GP and carer support professional, ity, contribution to the standing of general pracsix pilot workshops will be held during Septemtice, and presentation. Thirty entries were ber and October, hosted by faculties across Engreceived this year and the judges praised the land. high standards on offer. Professor Greg Rubin, RCGP Chair of the ReProfessor Sparrow: Workshops will support GPs Why it matters search Paper of the Year Award, who led the and encourage practical improvements team of judges, said: “Helping people to stop An increasing number of people are taking on the role of carers due to an ageing population having a carers’ register and appointment slots. smoking is a high priority for GPs and the NHS. and other changes in society. Carers often need When a carer falls ill, this can also be disastrous This study gives us a measure – lung age – that to balance these responsibilities with work and for the person they care for, with knock on ef- is really useful to GPs because it can easily be other commitments and currently suffer from a fects upon a wide range of health and commu- done in our surgeries and will double the number of quitters.” lack of support which often results in illness. nity services. The judges praised Dr Parkes as “a working Their first point of contact with the NHS is “One of the most important messages of the usually a GP and it is becoming increasingly im- Action Guide and the training is that there is a GP with a good idea that he makes the subject of a rigorous piece of research. In doing so he adportant that GPs and the primary team under- huge amount of support out there for primary stand the needs of carers and are able to offer care teams to draw on. Getting it right for car- dresses the important and, for GPs, very relethem appropriate support and work in partner- ers is not an extra cost to primary care – it is a vant question of how to more effectively get people to stop smoking. He has also left the ship with them. huge saving.” reader with an enigma – the intervention works, Professor Nigel Sparrow, RCGP Chair of the but it remains unclear how or why.” Professional Development Board, said: “An es- The Pilot Programme The award was presented at a prize giving timated 10 per cent of a practice population are There are a limited number of places available dinner in London with sponsors Merck Sharp & carers and there are many more ‘hidden’ carers for each event, so delegates are encouraged to Dohme Ltd. who for one reason or another are not getting Chris Round from Merck Sharp & Dohme the services and support they need. These book early. A GP, together with a member of the workshops are designed to help GPs and pri- primary care team are encouraged to attend Ltd said: “We are proud to support the Research mary care team to reflect on the services and from each practice. The workshops will be run Paper of the Year Award. It is encouraging to know that a large amount of high quality recare they offer to carers and encourage practical in the following locations: search is taking place within general practice improvements, as well as helping the carer feel Thursday 10 September and primary care. We hope that even more gensupported and valued.” Berkhamsted Beds & Herts Faculty eral practitioners and members of the primary care team will become actively involved in reWednesday 23 September Background to the programme search.” Preston NW England Faculty The RCGP and the Princess Royal Trust for CarDr Parkes was assisted in the findings by ers have been working together for a number of Wednesday 30 September Professor Trisha Greenhalgh from University years to improve understanding of carer’s issues College London; Mark Griffin, Lecturer in MedWessex Faculty in primary care. In October 2008, Supporting Fareham ical Statistics at UCL; and Dr Richard Dent, ConCarers: An action guide for general practitioners Tuesday 6 October sultant Chest Physician at QE II Hospital in and their teams was launched. This self-assess- Nottingham Vale of Trent Faculty Hertfordshire. ment toolkit is designed to allow primary care ■ The winning paper can be viewed at teams to measure their carer services, and will Thursday 8 October www.step2quit.co.uk form the basis for the workshop content. Ealing NW London Faculty ■ Primary Care Guidance on Smoking Alex Fox, Director of Policy & Communicaand Mental Health can be accessed via tions, Princess Royal Trust for Carers said: “Pri- Wednesday 21 October mary care teams are increasingly recognising Rotherham Sheffield Facultywww.primarymentalwellbeing.org.uk, the home page of the Forum for Mental Health the health inequalities faced by carers. in Primary Care, jointly hosted by the Fortunately, these can be addressed through ■ Further information is available at www.rcgp.org.uk/courses RCGP and the Royal College of Psychiatrists. some of the simple actions in the Guide, such as
Caring for carers in primary care
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PROFILE
NEWS
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Talking heads: The new views from the top must make ❛sureWethat GPs are
RCGP Assistant Honorary Secretary Amanda Howe and President-elect Iona Heath will take up their respective new roles in November. Here they talk about their aspirations and ambitions for the next three years.
Stepping out for safety: (clockwise from top left) Professor Mike Pringle; Richard Jenkins, NHS Institute for Innovation and Improvement; Robert Varnum, Associate, Safer Care Priority Programme, NHS Institute; Dr Christine Johnson, GP Adviser, NPSA; RCGP Honorary Secretary Maureen Baker; and Bruce Warner, Head of Primary Care, NPSA at the launch of the crucial new guidance
GPs take seven steps to improve patient safety The National Patient Safety Agency (NPSA) and several national organisations including the Royal College of General Practitioners have launched a new guide to help staff working in general practice provide safer care for patients. Seven Steps to Patient Safety in General Practice recommends the key actions that GPs and their teams can take to avoid harming their patients. Its aim is to ensure that all primary care staff are making patient safety a priority and that effective systems are in place and working. Each step has a set of activities specific to general practice that can be taken to promote a safe culture through the development of policies, strategies and action plans. There are also practical hints and techniques that can be used to promote high quality care. The guide has been adapted from the NPSA’s full reference document Seven Steps to Patient Safety in Primary Care and is one in a series of seven steps publications from the Agency. It was launched with two master classes, one in London at RCGP Princes Gate and one in Rotherham, which were well attended by staff across the primary care spectrum – GPs, practice nurses, practice managers and colleagues from PCTs, Deaneries and wider primary care teams. Launching the guidance, Dr Maureen Baker, RCGP Honorary Secretary, said: “The fact that the master classes were both ‘sold out’ events shows the level of interest and enthusiasm among GPs and their teams for delivering safer patient care. Practices will be able to work through the seven steps and use the questions and actions as part of their ongoing work to improve care for patients.” Dr Bruce Warner, Head of Primary Care at the NPSA, said: “This version of the Seven Steps to Patient Safety has been developed specifically for General Practice, and contains tools and resources that practice teams will see are directly relevant to their day to day work. By working through the steps, practices will be able to make patient safety their number one priority, and make it everyone’s concern.” Lynn Young, Primary Care Adviser at the Royal College of Nursing, said: “The RCN supports all efforts that aim to promote patient safety. These guidelines are very simple, practical and will assist all staff working within general practice to use systems, skills and behaviours that help to ensure patient safety.” ■ Seven Steps to Patient Safety in General Practice is available at: www.npsa.nhs.uk/nrls/ improvingpatientsafety/patient-safety-tools-and-guidance/ 7steps/general-practice/
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in charge of the development of our profession, and of primary care – that means working together
❜ Professor Amanda Howe
and this is an incredibly important time for us. I’m determined to get more people involved with the College
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WANTED TO BE A GP when I was a medical student, despite influences from tutors to do otherwise,” says Professor Amanda Howe. “I’m fascinated by the role that the GP consultation can play in helping patients strengthen themselves psychologically.” Many Members and Fellows may know Amanda best as an academic GP who has tirelessly promoted research and teaching within general practice. She was RCGP Chair of Research from 2000-2005 and her involvement continues through the Society of Academic Primary Care. Now her rich and varied career in general practice is set to take on another dimension when she becomes the next Honorary Secretary of the RCGP, succeeding Dr Maureen Baker who steps down after ten years service in November. She is confident that her academic background – coupled with her enthusiasm for general practice and the College – will stand her in good stead for the challenges to come. “As an academic you learn to structure your thinking to find out what is already known and what changes, if any, need to be made. GPs are out there really trying to do the best they can, often in extremely difficult situations, and the College is there to help avoid problems as well as strengthen the quality of practice. “I like people and I like to help them achieve their potential. Having a life outside general practice does help too, but I must say that general practice is my passion. I’ve been a College member since finishing my VTS, and feel the RCGP is the most important body for professional GPs, especially at this time. It’s a privilege to play a senior role for an organisation that really matters.” Amanda also has a cautious side which she thinks will prove useful in tackling her new responsibilities, not least in acting as the College voice on the hundreds of consultations to which the RCGP responds each year – with issues ranging from safeguarding children to the role of pharma companies. “I do pride myself on being able to watch the back of an organisation, and will do everything I can to protect and enhance the reputation of the College.” She is still very much involved in caring for patients, working one day a week at the Bowthorpe Health Centre in Norwich – and she remains “in awe” of how resilient patients can be. “It’s a privilege to work with people faced by adversity and illness. People are often very courageous and extremely strong, they really do inspire me, that’s why general practice is such a great place to learn.”
Amanda was also convenor of the RCGP Research Paper of the Year Award panel for four years and feels that a rich vein of research running through primary care can give so much more back to the public and the profession. “Very early on I realised that you can influence so many lives as a teacher. I firmly believe that the reason for so many students wanting to be GPs is the standard of teaching and the personal mentoring we provide in the community setting.” In the run-up to taking on her new role, Amanda is already getting her teeth into College business and is heading work on a major new strategy for leadership. “Every doctor needs to be an effective leader at various times in their career but I’m concerned that sometimes GPs just don’t feel they have the time or the confidence to be leaders. We really need to turn that attitude around to ensure the full impact of the profession. “I think that women in particular do not have enough confidence in their abilities. They need to be supported to take on responsibilities where they can build up leadership skills, becoming leaders of teams and then leaders of the profession. “When I entered general practice, women made up one in ten of the profession. While that has improved over the years, the RCGP needs to be conscious that everyone gets an equitable chance within general practice to develop as leaders.” Amanda also feels that members need to start ‘owning’ the College more at local level, getting their voices heard and making the College work even more effectively for them. “I’ve heard the College being described as ‘exclusive’ but I would say to all our Members that its doors are open – you need to come forward and have your dialogue with us so that we can address what you want from your College. “We must make sure that GPs are in charge of the development of our profession, and of primary care – that means working together.” She looks forward to meeting many members in the years to come, and aims to follow Maureen Baker’s example, while bringing something different to the job. “Maureen has done a fantastic job – I’m really hoping to match her achievements. We both love the College and have a lot of stamina and willpower – which help when the workload is high and the decisions are tough,” she says. “I want RCGP members to feel they can give us feedback on anything – e-communication makes it even easier to take part – so let’s talk.” RCGP NEWS • AUGUST 2009
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Two’s company: Professor Amanda Howe (left) and Dr Iona Heath exchange views on the future of the College – and how they will contribute in their new roles
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HE RCGP’S PRESIDENT-ELECT, Dr Iona Heath, admits that “biting her tongue” will be a challenge during her three-year term. The North London GP has been a popular and outspoken voice for GPs over the past 20 years, and says her biggest priority as President will be boosting the morale of the profession. “I’m quite good at making people understand what a good job GPs are doing, and encouraging and reminding them of how important general practice is for patients, the public and the NHS.” This is why she decided to run for President rather than Chairman. “I think my talents are better suited to President. To be Chairman you need to engage with politicians, and believe in them and their goodwill, which I don’t really!” As for biting her tongue: “Yes it’s definitely going to be a challenge! It doesn’t come easy for me, but people know that and it’s a big reason why they voted for me. I shall try!” Dr Heath’s involvement with the College started in 1989 with a dispute over GP trainers in North London, which prompted her to stand for Council. “I found that if you stood for council you got to send a 50 word statement to all members, so I took the opportunity to register a protest. It never occurred to me that I’d be elected, but I’ve been there ever since. Perhaps it shows that sometimes it pays to be angry! “I’ve had a very positive experience on council. I’ve met some extremely talented and committed people and we’ve had some great debates over the years. It’s been a privilege to be there and I don’t regret a minute.” She admits that Professor David Haslam will be a hard act to follow as President. “Yes, he’s an extremely tough act to follow, but I hope to build on what he’s done. He’s worked hard on the morale of GPs, and I think we have similar principles and beliefs. “Morale is really the big issue for me. I think the different directions of health services in the four territories is a challenge, and an opportunity. General practice in England has the most problems because the government here is the least sympathetic to our priorities and values. “Privatisation and competition is a real concern, as is the view that ‘bigger is better’ which I don’t think our patients share.” Getting the pay for performance and quality framework right RCGP NEWS • AUGUST 2009
Health bodies champion Patient Participation Groups The RCGP is spearheading a national campaign to increase the number of Patient Participation Groups (PPGs) in England.
are doing ❛GPs a terrific job,
Dr Iona Heath “
Promoting patient partnerships: (l-r) Dr Laurence Buckman, Sandy Gower, Dr Mike Dixon, Dr Graham Box, Dr Brian Fisher (back), Richard McRae and Professor Steve Field
is also a priority: “Keeping value without it becoming too intrusive or dominant.” Dr Heath is also keen to use her experience as Chair of the RCGP’s International Committee. “There are huge opportunities, and I hope to do a lot more to get UK general practice on the world stage. We may feel under siege here in the UK at times, but we mustn’t forget we have a huge amount to contribute worldwide – and to learn from. “I’d also want to try and sort out fellowships. I think it’s sad we don’t have more people coming through.” She nominates the rise of women and young people as the biggest change in general practice over the last 20 years. “I’m really thrilled at the creation of Associates in Training (AiTs), and of course we have a lot more women involved in general practice. That will only continue in the future. “Exams have changed too. We could have nearly every GP as a member of the College, which would be incredibly positive.” Dr Heath says she wants to dispel any notion the RCGP is an ‘old boys network’. “Of course, we don’t want it to become an old girls network either! We need to make an effort to get more people involved at every level of the College. With electronic communications these days it should be possible. I don’t think people realise just how many fantastic opportunities are out there. “General practice really is a force for good. GPs are doing a terrific job, and this is an incredibly important time for us. I’m determined to get more people involved with the College.” Many GPs have cited Dr Heath as an inspiration, while she herself nominates her patients: “They inspire me and have taught me everything I know. “Reading of all sorts inspires me too – anything from medical books to novels and poetry. I have a strange disease where I can relate everything I read to general practice, even if it’s nuclear physics!” She is adamant this will be the last major College role she takes on. “I think the President should be someone at the end of their career, who can bring the weight of their experience to the role. I’m very honoured and grateful to have been re-elected to council for 20 years, but I won’t stand again. I don’t want to outstay my welcome!”
The College has joined forces with the National Association of Patient Participation (NAPP), the BMA and the NHS Alliance on the campaign which is supported by the Department of Health. Its aim is to raise awareness of PPGs as a way for general practices to engage with their local populations and to encourage more widespread take-up of PPGs by practices and patients. Over the next year, there will be a programme of activity to engage PCTs, practices, patients and the public. Three publications – including one co-authored by RCGP Vice Chair Dr Has Joshi – have been published to provide practical advice and highlight the importance of PPGs. These are: ● Growing patient participation – promoting quality and responsiveness ● Growing patient participation – 21 ways to help your practice thrive ● Growing patient participation – getting started: a step by step guide to setting up a patient participation group In his contribution, Dr Joshi puts forward the GP perspective on PPGs, outlining the benefits for both doctors and patients. He also calls for PPGs to be more responsive to local needs. “Practices can always do more to ensure that patients have a forum that makes them feel comfortable about coming forward and that PPGs are representing the views of the majority of patients. Wherever possible, we need to ensure that membership reflects the age, gender and diversity of the local population. It is hard to accommodate everyone but we need to be aware of factors such as making sure that transport is arranged or meetings times are flexible. “Older people might be reluctant to attend evening meetings while busy working parents are unlikely to participate if meetings are always held in the afternoon. Teenagers are notoriously hard to engage so we need to reach out and communicate with these young people in a language that they understand.” Speaking at the launch, Dr Graham Box, chief executive of NAPP, said: “All PPGs have the common aim of helping ensure GP practices remain accountable, dynamic and responsive to their local populations’ non-clinical needs. “Practical, easy to set up and easy to join, PPGs are implementing real, positive change in their communities – from establishing schemes to helping transport the elderly to and from the practice to introducing counselling or bereavement services, and running fundraising events to buy new equipment for the practice. We hope to see a significant rise in the number being set up over the coming months, with the help of the national campaign, as more GPs, Practice Managers and patients are made aware of their value.” RCGP Chairman Professor Steve Field said: “The relationship between GP and patients is a unique one and an equal one. The Royal College of General Practitioners was the first Royal College to set up a PPG over 25 years ago – patients’ views are now an integral part of every policy we produce and we are a stronger College as a result. “By having an active Patient Partnership Group in a GP practice, both sides can learn from each other and this brings great benefits all round, not least in helping practices run more effectively and providing services that local people need and want. We hope that this important campaign will be a major step forward in helping more practices to set up their own groups and promote patient partnership in its truest sense.” The launch marks a milestone in the evolution of PPGs, which are now present in 41 per cent of practices across the country.
5
CLINICAL UPDATE
NEWS
When to suspect child maltreatment: an introduction to the NICE guidelines Dr Christine Habgood GP, Brighton On behalf of the NICE ‘When to suspect child maltreatment’ guideline development group
Maltreatment of children is common, significant for both short and long-term consequences and undoubtedly under-diagnosed at all levels of health care. It is unlikely any health care professional would take issue with any part of this statement. But how common is it? What are the consequences? And how much are we missing? Front-line professionals may be familiar with features of physical abuse, sexual abuse, emotional abuse, neglect and fabricated or induced illness, but in the consulting room, accident and emergency department, children’s centre or home they are usually dealing with medical problems. What they see is not a diagnosis of maltreatment but observations of injuries, behaviours or investigations. If maltreatment is to be recognised, it is necessary to move from the facts of a case to consideration of possible causes; child maltreatment needs to included in the differential diagnosis. At times professionals may find it difficult to think about maltreatment as a possible cause for the features they observe (see Table 1 on the right). Sometimes the action required is relatively straightforward: in the UK sex with a child under 13 is unlawful, so evidence such as pregnancy means that the child has been maltreated. On other occasions it can be more difficult to identify which features of a case would push maltreatment higher in the list of differential diagnoses. For example, bruises on young children are common, so the professional’s challenge is to identify the small number cases where bruising should suggest that further investigation is necessary. The NICE guideline aims to increase awareness of child maltreatment by starting from clin-
CONSIDER MALTREATMENT If an alerting feature prompts you to consider maltreatment: ● Look for other alerting features of maltreatment in the child or young person’s history, presentation or parent- or carer-interaction with the child or young person now or in the past. Then do one or more of the following: ● Discuss the case with a more
experienced colleague, a community paediatrician, child and adolescent mental health service colleague, or a named or designated professional for safeguarding children. ● Gather collateral information from other agencies and health disciplines having used professional judgement about whether to explain the need to gather this information for an overall assessment of the child. ● Ensure review of the child or young person at a date appropriate to the concern, looking out for repeated presentations of this or any other alerting features. At any stage during the process of considering maltreatment, the level of concern may change and lead to exclude or suspect maltreatment. 6
Table 1: Obstacles to identifying child maltreatment ● Concern about missing
a treatable disorder ● Healthcare professionals are used
●
●
●
●
● ● ●
to working with parents/carers in the care of children and fear of losing positive relationship with a family already under their care Discomfort of disbelieving, thinking ill of, suspecting or wrongly blaming a parent or carer Divided duties to adult and child patients and breaching confidentiality An understanding of the reasons why the maltreatment might have occurred, and that there was no intention to harm the child Losing control over the child protection process and doubts about its benefits Stress Personal safety Fear of complaints
ical presentations and guiding health care professionals (HCPs) about which features should lead them to consider or suspect maltreatment: ‘For the purposes of this guidance, to consider maltreatment means that maltreatment is a possible explanation for a report or clinical feature or is included in the differential diagnosis. To suspect maltreatment means a serious concern about the possibility of child maltreatment but is not proof of it.’ Considering or suspecting would prompt a HCP to their next action, outlined in the panels below. Protecting children does not differ from other areas of diagnostic and therapeutic work; to recognise a condition it is necessary to consider it and apply evidence-based knowledge to confirm or refute a hypothesis. By summarising high quality published evidence and carefully gathered expert consensus, this NICE guideline aims to support individual health care professionals in engaging in that thought process so that appropriate action can be taken. It should also provide support to those who supervise and educate health care professionals in discussing such a difficult subject. ■ The full guideline can be downloaded from the NICE website: www.nice.org.uk/CG89
SUSPECT MALTREATMENT If an alerting feature or considering child maltreatment prompts you to suspect child maltreatment: ● Refer the child or young person
to children’s social care, following Local Safeguarding Children Board procedures.
EXCLUDE MALTREATMENT Exclude child maltreatment if a suitable explanation is found for alerting features. ● This may be the decision following
discussion of the case with a more experienced colleague or gathering collateral information as part of considering child maltreatment.
ContactPoint: Helping GPs support children David Jones is a GP in Throckley, just outside Newcastle upon Tyne. He is the Named GP for Child Protection at Newcastle PCT and works as Clinical Advisor on Children and Family Services for NHS North of Tyne. He also sits on the Department for Children, Schools and Families Information Sharing Advisory Group. Here he explains how ContactPoint – the Government’s online directory for those working with children and young people – will help GPs deliver faster and more coordinated services for patients. AS A GP, it is essential to respect patient confidentiality. We all know that case information is subject to legal and ethical obligations of confidentiality and should not be disclosed without the patient’s consent. As a result, many GPs feel that information sharing is an area that does not fit comfortably with their professional obligations. But ensuring the best outcomes for young people – whether that relates to health, social or educational issues – often means that GPs need to share information with schools, social workers, youth workers or youth justice departments. This is underlined by programmes such as Every Child Matters and the child health strategy Healthy Lives: Brighter Futures. Under these schemes, more people from health and other agencies are being asked to take a multi-agency approach and share information in an effective way. It has therefore never been more important to share information while continuing to maintain patient confidentiality. Information sharing and collaborative working enables a more complete picture of a person’s needs which allows for earlier and more effective intervention. This in turn leads to faster and more coordinated delivery of services, which improves the service experience. In the medium to long term, this may also help reduce the demands made of GPs by ensuring health issues are dealt with early. But identifying other professionals working with a child so that GPs can obtain and share the
appropriate information can be a challenge. Traditionally, it has meant having to draw on local knowledge of services and ‘ringing round’ to get input from a number of different practitioners across many sectors. Doing this wastes precious time – whether it is that of a GP or practice staff – and can result in an incomplete picture of a child’s needs and a delay to appropriate interventions being put in place. However, if GPs can find and liaise with other practitioners quickly – and can therefore find out what other support their young patients may be receiving in a timely way – they will be able to ensure, through a coordinated approach, that they receive the best possible care.
Introducing ContactPoint To achieve this, the introduction of the Government’s online directory for those working with children and young people – ContactPoint – is well underway. This basic directory will provide a quick way for an authorised user to find out who else is working with the same child or young person. ContactPoint holds basic information (name, address, gender, date of birth and an identifying number) for every child in England up to their 18th birthday. Also held on the system are the name and contact details for each child’s parents or carers, their current school and GP practice. It is, therefore, important that staff in GP practices are aware that they will receive calls from other practitioners working with a child. Contact details for other services, such as health visitor and school nurse, will be added over time. Unlike GP patient records, no case information will be held. This ensures that patient confidentiality can be maintained whilst enabling GPs to locate colleagues that they may need to liaise with. From mid-May a limited number of frontline practitioners, based in 18 local authorities in the north west of England and two voluntary sector partners, Barnardo’s and KIDS, began using ContactPoint. These practitioners – who must all go through stringent security checks and training before accessing the system – are being carefully monitored in order to evaluate their experience of using the system. Currently, a number of GPs are involved and have been working with other practitioners from across the region. Feedback has yet to be collected, but an example of how this may work
might involve school staff calling a GP about a child’s behaviour problem to see if there are any underlying health issues. This would lead to the GP checking the credentials of the school, finding out what they need to know and then – with the parents’ consent – discussing with the teacher or other professionals involved how issues such as, for example, Attention Deficit Hyperactivity Disorder (ADHD) can be addressed. The GP would have an integral role to play in helping develop a plan that addressed the child’s specific needs. While many practitioners might consider that it is the parents’ role to know which different people are working with a child, it can often be the case that contact details are lost or are not automatically updated. This becomes even more likely when we look at the experience of families that are most in need, who have perhaps moved several times and have complex requirements. In many cases, they are least able to provide the contact information required. This is where ContactPoint can help, and further underlines the importance of GPs knowing what ContactPoint is and how it works.
Security Multiple levels of security are in place to ensure that only authorised users have access to ContactPoint and that it is only used for authorised purposes. In addition to organisations meeting the accreditation criteria, all users must have security clearance including an enhanced Criminal Records Bureau (CRB) check. After training, which is mandatory for all users, they will receive a user name, a password, a PIN and a security token. All users will have to state clear reasons in order to gain access to a child’s record. Authorised users will be able to access ContactPoint through a secure weblink, or through another authorised user if they do not have access to a computer. In the future, access to ContactPoint for health practitioners will be available through a dedicated web application on the N3 Network. This will allow health practitioners who are authorised ContactPoint users to access the tool using their NHS smartcard and to find records using the NHS number.
Delivering ContactPoint ContactPoint will be made available to more practitioners across England in the coming months, starting with ContactPoint teams being
trained across England during the summer. It will be made available to health practitioners in a phased and managed process in conjunction with local authority partners. Over time, as the tool is introduced, GPs should find it increasingly simple to liaise with other professionals working with a child or young person to coordinate the support provided. This is a major step forward in helping GPs locate all the right practitioners needed to ensure their patients get the right support to achieve the best outcomes. There may continue to be conflicting views about the need for an online database such as ContactPoint, but it is clear that it can make it easier for GPs to know who to contact when they need to share information. While many will see ContactPoint as simply a reaction to high profile cases such as the death of Victoria Climbié, it is not just about avoiding tragedies. For every terrible case we read about in the national papers, there will be many thousands of children who just need joined-up support from GPs and other practitioners to help them overcome problems that if left unchecked could escalate to become major issues. ContactPoint is not the complete picture, but an important tool to help facilitate effective information sharing – something that all GPs need to consider in their work to ensure the best possible outcomes for the children they treat. And while patient confidentiality remains at the centre of a GP’s work, it need not hamper effective cross-sector working.
Reference points ■ GPs who are interested in finding out more about ContactPoint should contact their Local Authority ContactPoint team. Further information is also available on the DCSF website at: www.dcsf.gov.uk/ecm/contactpoint ■ For more on information sharing and to download or order Information Sharing: Guidance for practitioners and managers, go to www.dcsf.gov.uk/ecm/ informationsharing/ ■ For further information, please contact: Patrick Southwell, Red Consultancy T: 020 7025 6507 M: 07813 151994 E: patrick.southwell@redconsultancy.com
GP training: The case for five years The RCGP is continuing work on its review of GP specialty training. Following comments on our first draft in May, we are in the process of engaging a health economist to assist us with the final report. The intention is to produce a further draft in September. The original project specification agreed with the Department of Health in 2008 did not include a health economist. The Department continues to support this project and has recently extended Kenneth Allen’s secondment to lead this work for a further year. Here Nishma Manek – who has just started her fifth year at Imperial College, London – makes the case for extended training from the trainee perspective.
IN MAPPING OUT their future career paths, the specialty of general practice increasingly appears on the radar of medical students today as an attractive alternative to hospital medicine. The service need is such that half of all doctors in training will go on to become general practitioners. After their first glimpse of the frenetic activity of hospital life in the early days of their clinical experience, students have often re-evaluated general practice as an option; the opportunity that general practice provides for flexible working hours, together with recent changes, which increase prospects of specialisation and the shorter training requirements, have led to a change in the way general practice is perceived as a career amongst students. No longer is it considered an inferior second option, but is now being considered as an appealing path in its own right. This appears to be particularly true of female students who – wishing to combine their careers in medicine with starting a family – favour the current shorter time period to qualification of general practitioners compared with hospital doctors. Furthermore, with the impending European Working Time Directive coming into force this August raising concerns over the quality of working life of hospital doctors, such an exponential increase in interest in general practice is unlikely to cease in the near future. RCGP NEWS • AUGUST 2009
In the UK in January 2008, Sir John Tooke’s report on Modernising Medical Careers recommended that training for general practice should be extended from three to five years. Yet many medical students, both in the UK and abroad, remain unaware that such a dramatic proposal is being seriously considered by the Department of Health. Furthermore, the intended implementation date announced by DH is as soon as 2011, although it seems likely that consideration will be given to 2012 as the actual date. Implementation may also be staged over a number of years, so that it could be some time before threeand four-year schemes completely disappear. Thus, if the case for extending training is accepted, this would most likely affect the trainee intake in August of that year. The first ‘five year’ trainees would be those students currently in their final years at medical school, and they would therefore leave GP specialty training at the earliest in 2017. Clearly, with such a rapid timescale for implementation planned, there is an urgent need for students in all years – both in the UK and those considering entering the system from abroad – to understand the implications of such changes to their future career ambitions.
What happens now? Currently, upon completing their medical school training, students enter a two-year general FounRCGP NEWS • AUGUST 2009
Nishma Manek: Changing and increasing demands on the 21st century GP reinforce the need for a five-year training programme dation programme. Those wishing to embark on a path to general practice are then required by UK regulation to meet minimum European standards by undertaking three years of specific speciality training, leading to the award of a Certificate of Completion of Training (CCT). This entitles a doctor to be entered on the General Practitioner Register and therefore to practise independently as a GP in the NHS.
What are the proposed changes? The Tooke Report highlighted the disparity between the Government’s intentions to shift patient care away from hospitals and into the primary sector, and the current short period of training required to become a general practi-
New Rural Forum for RCGP The College’s Rural Practice Standing Group is to change its status and become a Forum for rural GPs. The Rural Practice Forum (RPF) will be launched at the RCGP annual national conference in Glasgow. It is open to any College member who has an interest in rural practice and will be piloted over two years, after which its achievements will be evaluated and its future determined by the College. Its main aims are to: ● Develop a forum that will represent rural and remote general practitioners in the RCGP with the potential to promote rural issues within and outside the College faculties and be the rural face of the College ● Encourage engagement with the College of Fellows/Members working in rural and rural practice ● Advance the College’s objectives in rural and remote practice ● Facilitate communication and networking between remote and rural doctors across the UK ● Support the professional development of remote and rural general practitioners, with particular reference to the required
knowledge, skills and attitudes of a GP to care for patients in a rural setting ● Promote remote and rural issues at the appropriate level, engaging with the profession, managers and informing political debate. Dr Malcolm Ward, Chair of the Rural Forum, said: “It is more important than ever that rural and remote practice is adequately represented within the RCGP and we hope that the Rural Practitioners’ Forum will attract a large membership of grass root rural practitioners throughout the UK. By ensuring an adequate voice for rural and remote practitioners within the College we will be able to co-ordinate and share innovation, feedback and support. “Response to this Forum will also determine whether further initiatives are necessary. The more members we have, the more influence the Forum can have in rural proofing future RCGP policy and initiatives. This is your opportunity to show support for the Rural Forum and help shape the future of rural primary care.” Allied to the Forum is a new Rural blog – www.ruralgp.org.uk – which has been set up by RCGP member David Hogg and is already proving to be a very useful resource for rural doctors and all those with an interest in rural medicine. Full details on how you can get involved in the RPF will be available shortly.
Put your best feet forward
POSTBOX
As only 40 per cent of our income comes from membership subscriptions, we depend greatly on raising funds from other sources to enable us to promote excellence in family medicine worldwide. I will be waking up early in the morning on 6 November to take part in the RCGP and Cancer Research UK’s Three-Legged Race. I have partnered with my colleague Clare Gerada, the Vice-Chair of the RCGP, hopefully to break the world record! This is a good opportunity to raise important funds for vital cancer research as well as our College that is working extremely hard to deliver excellence in general practice and patient care, in the UK and overseas. I have set myself a high fundraising target
and look forward to this hour of fun! Why don’t you pair up and join in the 1km challenge? There will be prizes for highest fundraisers, fastest couple and more… Places are limited, so please contact threelegged @rcgp.org.uk to ensure your place, T-shirt etc. I look forward to seeing you there! Dr Colin Hunter Honorar y Treasurer
tioner. At the moment, there is the possibility – which is a reality for many trainees – of GPs having spent as little as 12 months in general practice during their training under the current system. Tooke recommended the introduction of a new five-year training programme, to replace the current three years of specific speciality GP training and to increase both the professionalism and the confidence of newly qualified GPs.
role of general practitioners of the 21st century is set to change, with the shifting demographic of an ageing population leading to an increase in clinical complexity, co-morbidities and the need for professional and clinical leadership. The ‘Darzi reports’ point unambiguously to a greater role for the GP of the future: the question raised is whether the current training period is adequate for producing GPs sufficiently equipped to deal with the patients of tomorrow. The case for extending current GP training is not a new one but the increasing costs of hospital care and the inexorable increase in hospital acquired infections has resulted in a shift in the significance towards the role of the GPs in the patient’s journey of care.
Why are these changes proposed? The Royal College of General Practitioners has been commissioned by the Department of Health to prepare a business case on extending GP training. An information-gathering exercise conducted by the RCGP in late 2008 found that while today’s trainees are competent by the end of three years, they lack confidence in their professional and clinical abilities at the conclusion of their training. With little supervision after this time, and the increase in clinical governance resulting in today’s GPs being more accountable than ever for their decisions, emerging trainees often feel unsure of their abilities to deliver a satisfactory level of patient care confidently in their new roles. This lack of confidence can potentially lead to risk-averse behaviour, leading to overreferring and over-prescribing, and poorer health outcomes for patients. Secondly, with the implementation of the EWTD, in the current hospital training in the Foundation programme, trainees are no longer obtaining the same depth of experience or the same amount of patient contact, despite doing the same overall length of training, as their predecessors of ten years ago. Furthermore, the projected demands on the
How does this compare with other countries? Students from outside the UK looking to set out on the general practice career path outside their home country may wonder how these proposed changes compare to GP training systems elsewhere. However, with such a variation across Europe in the healthcare system that the GP works in, it is difficult to equate the training schemes in other countries with that of the UK. Very few countries have a list-based system like the UK, for example. The GP in other countries is usually neither the referral agent nor the gatekeeper, and there is often a cost attached to making a GP visit, which does change the patient case mix. It is worth noting, however, that Denmark, which has a health system that draws many parallels with that in the UK, extended GP postgraduate training from three-and-a-half to five years in 2005.
7
Annual National Primary Care Conference 2009
Excellence in Practice Winning ways for primary care
5-7 November Scottish Exhibition & Conference Centre, Glasgow
y d a e r Get for !
ARE YOU READY FOR REVALIDATION?
ion t a d i l Reva
Don’t miss the opportunity to attend this year’s conference and learn more about the College’s role in Revalidation, the development and delivery of the system, as well as key timelines and requirements. The keynote address by RCGP Chairman, Professor Steve Field, 'Excellence through Revalidation' will highlight how Revalidation requires a commitment by all to improve the quality of care for our patients. Delegates will also learn about enhanced appraisal - what it means for GPs, what is required of GPs and support available from your PCT.
There are also over 50 different concurrent sessions to choose from, a host of workshops, courses and fringe meetings and of course a great social programme.
Don’t miss out on the event of the year! For further details or to register please visit www.rcgpannualconference.org.uk or contact conference organisers, Profile Productions Ltd, on 020 8832 7311 or email: rcgp@profileproductions.co.uk Principal sponsor
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