Rhubarb, Rhubarb ...

New Stuff to Download!

2012-02-24T05:48:00.001-08:00

I have just put a load of 'stuff' on the website for you to download. To get to the download page click here. What I have put on the website is really, really useful:

HDR and whole day attendance sheet - compulsory for ARCP panels - less than 14 weeks away now!
Whole day training programmes for Group A and Group B hospital trainees
HDR training programme for trainees in GP1
Resources used in a recent Prospective Trainers Workshop - PowerPoint's, CBD documents, and MRCGP Competency Framework document
AND
Feedback and evaluation forms for Thursday whole days and the HDR sessions at Drighlington and Normanton - remember Moira's job depends on this ...

Well, to be truthful it is not really that excited, but at last it is one click from everything you need to know!

Making it easy ...

2012-02-09T02:21:00.000-08:00

I have just updated the website. You will have seen lots of posts from Terry and me about links to our online evaluation pages for the Thursday Whole Day sessions for hospital trainees and the Tuesday HDR sessions for GP ST3 trainees at Normanton and Drighlington.

Well I have made it so easy for you now. I have added a link to both Evaluation Forms from the 'Download' page on our website.

To get to the Evaluation Forms click here - it is so easy....

Hands-Only CPR

2012-01-15T04:57:00.000-08:00

The British Heart Foundation has started promoting 'Hands-only CPR' for people who have not been trained in Basic Life Support. We looked at the You Tube videos at our Whole Day Training Session on Thursday and I thought they were worth sharing. The BHF has been running a TV advert campaign staring Vinnie Jones - the advert is really funny. To watch just the advert on You Tube click here.

For more information about this then click here for the British Heart Foundation website.

New Year Resolutions!

2012-01-03T05:49:00.000-08:00

I hope several of you have made New Year resolutions to keep up to date with your ePortfolio and make lots and lots of entries and loads of WPBAs...! That is perhaps not a New Year resolution and more wishful thinking along the lines of 'if pigs could fly' ... But never mind there is always a time to start and the time to start is now. So the next milestone is meeting your Educational Supervisor to sign off your current post before you finish it. If you have not arranged a meeting then do it now so everything is on track for the last six months.

Happy New Year

Merry Christmas

2011-12-20T03:05:00.000-08:00

Just a quick message to wish all our trainees, trainers, admin staff and other' list-lurkers' a Merry Christmas and Happy New Year.

There are no teaching sessions next week, but Tuesday small group teaching sessions for trainees in general practice starts again on Tuesday 3rd January and the whole day teaching sessions for our hospital trainees start on Thursday 12th January.

I wish you all the best for the festive season.

Feedback about hospital posts

2011-12-12T06:34:00.000-08:00

At the end of each six months rotation I try and get feedback from trainees about their experiences at our whole day training session, our help in preparing you for MRCGP and of course some feedback about your hospital posts. This time round feedback was generally very good about most of the hospital posts and there were no major issues about workload. Most of you are getting to the whole day training sessions and attendance is nearly 70% on average.

Of course, things can always be improved and there were some specific issues about speciality training in A&E and Medicine and increased workload at DDH when Pinderfields is on GP Divert to DDH. I hope to raise these issues with the relevant people at Mid Yorks but if you have any more issues you think need raising please let me know. Click here to send me an email directly.

What a difference three years make!

2011-12-02T07:01:00.000-08:00

The Deanery have recently been looking at attendance at our small group training sessions. They last looked at attendance in 2008 when GP HDR attendance rate was 73%, A&E 12 %, Paeds 40%, O&G 20%, Psychiatry 72% and Medicine 35%.

This time they have looked at 3 months attendance, May to July, 2011 and for hospital specialities the rates have massively increased. In GP HDR rate was 67% but in A&E it ws 60%, Paeds 66%, O&G 65%, Psychiatry 71%, Medicine 71% and Palliative Care 114%.

The target to attend small group teaching sessions is 70% and I think that we are almost hitting that target now.

It is a huge change in attendance for our hospital trainees since 2008, so obviously a whole day works!

Modular posts

2011-11-18T08:09:00.000-08:00

We have had a few queries recently about whether doctors can undertake modular posts. Being able to do a modular post is a 'privilege' and not a 'right'. They can be undertaken in the second post of ST3 IF:

You have successfully passed AKT
Taken CSA
Your trainer, educational supervisor and TPD have no concerns about your progress

No concerns about your progress means precisely that; you are up to date with your ePortfolio and not been to panel or have had comments made about your progress. You will not have had got your CSA result before you start your modular post but we would expect you to pass. If you fail it then you need to leave the modular post and start doing full time general practice again.

Its easy - modular posts are for high flyer's who are at the top of the game!

Ponte A&E to close at 10 pm and then permanently ....?

2011-11-07T08:02:00.000-08:00

Mid Yorks Hospital Trust, which is the organisation that runs our local hospitals has recently announced that Pontefract Accident and Emergency Unit is to temporarily close overnight from 10 pm. To read the full story click here. But essentially it is because there are not enough junior doctors to work in all three Accident and Emergency Departments to maintain a safe level of service to patients. The Trust denies that it is accelerating the closure of Pontefract A&E.

But a week later at the Trusts Public Board meeting it announced that it is considering proposals to change the way it provides services to patients in Dewsbury, Wakefield and Pontefract. To read the full briefing paper click here. In order to become a Foundation Trust, Mid Yorks needs to demonstrate that its services are financially and clinically viable. In a nutshell that means that it can live within its financial means (ie save £30 million a year) and make sure that its clinical services are safe and effective. The current configuration of services does not allow it to do this.

The Trust has produced five proposals that will reconfigure services. All of the proposals have Pontefract A&E becoming a Minor Injury Unit only and In-Patient Paediatrics being centralised at Pinderfields. Three of the options have the Consultant Obstetric Unit being centralised as well. To make room for all these services the options have various surgical units moving to Dewsbury and Pontefract. The Trust is currently consulting with staff and GPs to produce one preferred option that it will take to public consultation next year.

So, .... watch this space (again!).

DWP Vacancies in 2012

2011-10-25T04:25:00.000-07:00

In 2012 the GP Training School in Yorkshire and Humber will be offering 309 vacancies (compared with 255 eventually filled in 2011). Of these DWP has been asked to provide 35 rotations beginning in August 2012 and a further 4 beginning in February 2012. I have put the rotations together and you can view more details about our posts by clicking here

The rotations all have 18 months in hospital and 18 months in general practice. The last 12 months of the rotations are in one general practice training post. If you are interested in applying the deadline for applications is noon on Friday 9th December. If you would like anymore information about any of the posts then contact me by clicking here.

And of course DWP is a great scheme to apply to for many reasons - one of the best being that we have never had a single trainee fail because they failed CSA!

Smug eh!

2011-10-10T06:38:00.000-07:00

Congratulations to all our trainees who have recently successfully passed CSA. We still have got a 100% pass rate with CSA (eventually ...). Or to put it a different way all of our trainees have eventually passed CSA and no one has failed to get a CCT because they have not passed CSA. A huge well done to our trainers, trainers and of course the TPDs who have been drilling our ST3 trainees in how to pass CSA.

Today I got some national CSA results sorted according to each Deanery. The mean pass mark was 55.2% - this is quite a bit lower than those in February or May - mainly because the September cohort is usually full of trainees who are resitting and the pass rate with CSA does not increase the more times you take it. But in this mean there were huge variations. For example in Oxford the pass rate was only 12.5% whereas in Yorkshire and Humber the pass rate was 64.7%.

One of my colleagues said today that all schemes should adopt our system. Train you like dogs and get you all to successfully jump through the hoops! But the real take home message to a wider audience is that if you are thinking of joining a GP Training Scheme then come to DWP because you will pass CSA. And that is a guarantee ...!

PSQ Fraud

2011-10-05T02:30:00.000-07:00

Just a quick reminder that PSQs need to be completed solely by patients and then every one that is completed needs to be entered onto your ePortfolio by an independent person ie not you.

Just for complete clarity it is fradulent to (1) help patients complete them (2) complete any yourselves (3) get a member of staff to complete them. These actions will get found out and will then inevitably lead to a referral to the GMC and some disciplinary action.

This should not need to be said but I thought I needed to make the above patently clear so that there is no doubt about this matter.

Oh dear, oh dear ....

2011-09-21T06:26:00.000-07:00

The overall pass rate for CSA in Yorkshire and Humber Deanery in 2010 was 84.5% according to the RCGP MRCGP Annual Report - click here to read the report in full. In the past no one on the scheme has failed CSA - but they may have had to take it several times to eventually pass it. The Training Programme Directors advise you to take the CSA at a stage in your training when you are able to have two attempts before the end of your scheme. This means that if you are finishing in July you should take it in February so that if you are not successful first time you have a second chance in May.

This will maximise your chances of passing it first time because you will have had more than six months in ST3 in preparation for CSA. I have heard of trainees who are in ST3 and have applied to do it in September or November. I wish you the best of luck but this is an expensive and high risk strategy. Remember you are only allowed four attempts so you could theoretically use all your attempts up in ST3 and have none in reserve.

I have in ST1 and ST2 tried to play down trainees anxieties about CSA but I think I may have been too laid back. Nearly one in eight trainees won't pass it without an extension of training so you need to treat the exam with respect and take it when you can maximise your chances.

Remember your TPD's know best!

Small Group Sessions on the website

2011-09-12T12:10:00.001-07:00

The programmes for the Thursday Whole Day Teaching sessions for hospital trainees and also the Tuesday afternoon Teaching session for trainees in their first GP training post are now up on the scheme website. To access the programmes click here for our download page and choose the one you are interested in.

I have got it!

2011-09-07T00:22:00.000-07:00

In the practice we have a 'Wednesday file' where we put random stuff that comes in the mail and once in a while we go through it at our Wednesday meeting - hence the name! Last week we were going through it and I came across a leaflet from Sheffield about how to obtain the Diploma of the Faculty of Sexual and Reproductive Healthcare. This explained very clearly the steps you need to take. My five point check list is:

Register to do the DFRSH - click here for link - £60 registration fee
Successfully complete e-learning course e-SRH - free
Successfully complete 'Course of 5' seminars - typically £350
Complete clinical part of training - typically four sessions at £50 per session

You need to do them in the correct order and pass each component to get to the end and your DHSRH - easy peasy ...!

Or you could click here for more information from Sheffield Contraception and Sexual Health Services website.

New to scheme - you should have registered by now!

2011-08-30T02:17:00.000-07:00

Just a quick reminder that if you are new to the scheme you should have registered with the RCGP by now. You need to be registered to get and ePortfolio and start completing WPBA. If you have overlooked this then click here and register NOW!!!

The admin staff will shortly be chasing up new doctors who not registered, it will save us time and effort if you do it. You know it makes sense!

Educational Supervision

2011-08-16T04:00:00.000-07:00

All trainees are allocated an educational supervisor. Click here to go to our downloads page to obtain the list of supervisors and their supervisees. If you are new to the scheme you should contact your supervisor so that you can arrange a face to face meeting with them before the end of September. Click here to get to the GP Posts page on the website to find their contact details. If you are not sure where they are then the Google search button works on the website for trainers names.

You need to register with the RCGP NOW and once you have registered it takes a few days for the Deanery to up date your ePortfolio so that your educational supervisor can see your ePortfolio. If you have not yet registered with the RCGP then click here to get registered that you are undertaking GP training.

Warm welcome

2011-08-07T06:27:00.001-07:00

A very warm welcome to all new doctors to our scheme. I hope everyone is settling into their new posts. Just a quick reminder about when our small group training starts.

If you are in your first GP post then the first Tuesday HDR meeting is on Tuesday 9th August at Pinderfields Medical Education Centre. The session starts at 2.00 pm sharp.

If you are in ST3 then the first Tuesday HDR meeting is on Tuesday 9th August. We have split you into two groups - Group A meets at Kings Medical Centre, Normanton and Group B at Adwalton Surgery Drighlington. For directions or to check which group you are in click here. The groups have been chosen with care and no swaps between groups are allowed.

If you are in a hospital post the first whole day meeting is on Thursday 18th August at Kings Medical Centre, Normanton for trainees in Group A. For directions and to check which group you are in click here. Tea and coffee are available from 8.30 and the whole day training starts at 9.00 am sharp.

We look forwards to working with you and a very warm welcome to all new doctors to our programme.

Problems admitting patients

2011-08-01T01:59:00.000-07:00

Paul Carrotte and I have both had letters published in the BMA News Review this week. Click here to read the letters. The week before a junior surgical doctor had written complaining about GPs sending patients to hospital without first contacting the admitting doctor. Both Paul and I described our experience about how difficult it can be to get patients admitted. This will of course not be news to anyone who practices in our area but it is interesting that of the three letters published two were about the difficulties getting patients admitted to Mid Yorks.

Nuff said?

SJT scores, CSA preparation and targetted help!

2011-07-18T01:44:00.000-07:00

As you all may know I love TLAs (three letter acronyms) and this week I have found a new one. SJT (Situational Judgement Test) has been buzzing around the Programme Directors discussion groups like a bee around a honey pot. The Deanery is planning to use trainees SJT score to target resources for CSA preparation.

You won't know your SJT score but it comes from Stage 2 of the recruitment process. The National Recruitment Office has evidence that there is good correlation between trainees SJT score and their score at CSA. The Deanery wants to use this to target resources for CSA preparation. Currently the Deanery runs CSA Preparation courses open to everyone, but from August it is going to use SJT scores to plan capacity and ensure that those whose SJT scores are in the lowest 20-25% are the only ones who are invited to these course.

This is all new to us and of course there have been some issues. We have SJT scores for new trainees starting in August but these are not the trainees who need CSA preparation course - uhh! We are not sure how DWP should use this new information and we have not seen any published evidence about the correlation. Indeed we only had one doctor fail CSA last year so I am not sure what this can add.

But SJT scores are on their way - so this is a heads up!

Feedback from local ARCP panel

2011-07-08T04:49:00.000-07:00

At the Pontefract Trainers Workshop this week Jaz Walsh fed back about any issues arising from the recent local ARCP panels and this is a summary of what she said. Generally the evidence presented by trainees was a lot better in terms of doing more than the minimum and also the quality of the evidence. The only deficit was in the quality of some trainees PDP entries.

An ongoing issue is about who validates trainees professional competencies. On the Pontefract side of the patch we think that Educational Supervisors should read and validate competencies when trainees are in hospital posts but that Clinical Supervisors should do this for their own trainees. This is not happening at Wakefield and Dewsbury and the TPDs will be seeking some consensus from trainers in Wakefield and Dewsbury about what we should do in the future.

Overall feedback about trainees ePortfolios was that the were better, but remember the bar is always being raised!

Pause, reflect - now what!

2011-06-30T04:30:00.000-07:00

I went to a really interesting working group meeting yesterday discussing the future of GP Training in Yorkshire and Humber. I hope I added my tuppenneth but the really interesting news was where we are now after the pause and reflect time on the NHS changes.

Skills Networks have gone and the new kid on the block is the Local NHS Education and Training Board - forever known as LETB. In Yorkshire and Humber their will be one LETB with 3 hubs for West Yorkshire, South Yorkshire and North East Yorkshire and Lincolnshire (sound familiar ...!).

The LETB will have a programme board and on the board will be nine chief executives (or their deputies) from acute trusts - three per hub, but the acute teaching trusts will not necessarily have a seat on the board, and three primary care board members - one from each locality. The Deanery will be split into schools and each school is likely to be hosted by another NHS organisation.

It is unclear where the GP School will be hosted and it maybe an acute trust. The hosting trust would employ all trainees on training programmes and trainees would have a single contract with the hosting employer. This will make things a lot better for GP practices.

Things are certainly clearer for me now than they were yesterday - LET it Be!

Future of GP Training?

2011-06-22T11:37:00.000-07:00

In the recent paper produced by the DoH in response to the NHS Future Forum report there is more detail about what will happen to Deaneries. To read the full report click here and chapter 6 is concerned with Workforce Development and Training.

But the response comments that further work is needed to develop plans about how the workforce will develop to meet the needs of patients and communities, more clarify is needed about where accountability will lie and more detail about provider-led networks.

My reading of the response paper is that it highlights all of our concerns, sets out an agenda for what needs to be done but gives no clear guide about what will happen. Apart from the bland reassurance that Deaneries will remain within the NHS family.

So much more work to be done!

AKT feedback

2011-06-01T01:45:00.000-07:00

The RCGP has published feedback on the May 2011 AKT. It is a really useful document because it tells you what the examiners are thinking when they come to set the next lot of AKT questions. Briefly they listed the areas that candidates did poorly as: management of basic medical emergencies, treating symptoms which may affect terminally ill patients and eye emergencies. Undoubtedly these will all be tested in future exams - because that is what they do!

To read the full feedback click here.

NOE - all you need to know!

2011-05-23T06:23:00.000-07:00

Its only three weeks before the ARCP panel. You should ALL have organised an ES review. This is just a quick reminder about NOE. This is compulsory and although it does not appear on the ePortfolio you will need to complete all the elements of NOE for satisfactory completion and transition to either CCT or the next year of training. Click here to read the NOE regulations on the Yorkshire and Humber Deanery website, but in summary you need to:

Three Significant Event Analysis per 6 months post filed under Significant Event Analysis in your ePortfolio
One Reflection on key learning from each post for each post. File under Courses/Certificates
One Audit or Reflection on QOF during your (preferably) first GP attachment. File under Audit/Project
One Case Study or Presentation per each six month post. File under Lecture/Seminar
Six OOH sessions per six months of General Practice. File under OOH.
Leave and complaints. File under Professional Conversations.

Easy really - just six steps to (ARCP) heaven!

Dr Liz Moulton resigns

2011-05-16T02:08:00.000-07:00

The Training Programme Directors received an email from Liz last week saying that she had resigned from her post as Deputy Director of Postgraduate GP Education with effect from 31 July 2011. This was quite a shock. From her email Liz has resigned because of unsustainable workload with the amount of Deanery work not fitting into the available sessions. She also said that 'at times it has been difficulty to carry responsibility without ... power.'

I think Liz has done a really good job - she has led on increasing our training capacity, increasing the standard of training and of trainees appointed to the scheme and dealt robustly with under performing trainees. I have always felt that Liz has been 'one of us' and has protected schemes from NHS bureaucracy and perhaps even some of its madness at times. We will miss her at the Deanery.

I was interviewing with Liz on Tuesday and was a bit disappointed that she had not told me first because it would have made a really good scoop for the blog!

New aTPD wanted!

2011-05-08T07:22:00.000-07:00

Rhiannon is leaving her current post as aTPD and will finish at the end of July. Rhiannon has been a very valued and skill member of the TPD team and I will miss her help, skill and new thinking in the way we have planned and delivered training.

The teams loss though means we have a vacancy. Rhiannon has worked with me facilitating the small group sessions for our hospital trainees on a Thursday. Its fun, the trainees do most of the work and it is enjoyable and satisfying. Hopefully the Deanery will be advertising soon for a two session TPD to help facilitate these sessions.

If you would like me information and details then email me off the list - click here to email me.

First slash from NHS cuts

2011-05-02T11:36:00.001-07:00

We have had our first taste of NHS cuts on GP training this week. We have five vacancies to start GP training in August 2011 but in order to balance the Deaneries budgets these will not now be filled. The posts that will not be filled in August are one in A&E at Pinderfields, one in respiratory medicine at DDH, one in Elderly Medicine at Pinderfields , one in Paediatrics at DDH and one in general practice.

The short term result will be that these posts will either not be filled or filled with locums (that will clearly be more expensive to the NHS) and this will destabilize these posts and make it more difficult for our trainees to be released for whole days and other training. The long term result is that in July 2014 we will produce five less qualified GPs.

When the NHS is becoming GP led this is totally bonkers!

Eight weeks and counting ...!

2011-04-18T05:22:00.000-07:00

The local ARCP panel is on Tuesday 14th June and that is only eight weeks away now. Nearly all our trainees will have their ePortfolio reviewed at this panel meeting and you need to have completed all the mandatory WPBA stuff by then. That means to have done all the necessary CBDs, miniCEXs, COTs, MSF, PSQs and got an up to date CSR and had a meeting with your educational supervisor.

If you have not already done it, now is the time to book an appointment with your educational supervisor. This wants doing the 3rd or 4th week of May by which time you will have completed everything and you will have no missing bits in your ePortfolio. Before your meeting with your educational supervisor you need to have completed the self rating competency scales - if you can't because you don't have a review date set then email your educational supervisor to set it up.

If you have not done it then your educational supervisor will not be able to complete his report and you will face the wrath of panel and a potential long, long walk to a Deanery panel in Leeds ....

DAAG Newsletter - highlights

2011-04-11T02:28:00.000-07:00

We have all been circulated the latest DAAG Newsletter. Click here if you have not got it. The DAAG is the Deanery Assessment Advisory Group and advises the Deanery in agreement with the RCGP external assessors about best practice in assessment.

Highlights for me include:

DOPS should not be carried out be peers - needs to be trained nurse or doctor
Helpful suggestions to trainers about helping trainees pass AKT: start early, remember 50 mock questions on RCGP website, do Pearson Vue orientation first, you only have 54 seconds per question (!), do once and move on, remember DVLA, BNF tables etc etc and lots more
Look at Bradford website for advice about finding ePortfolio evidence about competencies
Use the ePortfolio as evidence of progress - harness it and protect yourself!

The latest DAAG newsletter demonstrates good practice in assessment that has been agreed between the Deanery and external advisers from the RCGP and contrary to widespread belief it has not just made up on the whim!

Proposed changes to Medical Education and Training - they are daft!

2011-04-04T01:37:00.000-07:00

Alongside the large changes in NHS commission and the end of PCTs and SHAs you might not have noticed that Deaneries are also planned to be scrapped. The government has published a white paper 'Liberating the NHS:Developing the Healthcare Workforce' where it talks about setting up local skills networks which will commission and provide education and training.

Their proposals however are very unclear. What is so bad about the current system? What will be the size of these skills networks? What is the evidence that replacing a large system that attempts to deal with workforce planning issues be improved by replacing them with smaller networks? What is to reduce the threat that large foundation trusts will dominate these networks and use their power to create training jobs to staff EWTD rotas rather than meet and increasing need for GPs in a 'GP led NHS'?

The RCGP has published its response to the consultation - click here to download the pdf of what they have send to the Department of Health.

It is impossible to find an answer to my questions in the document and the proposals are unjustified, unclear and if carried out will seriously damage Medical Education and Training!

CSA results - well done!

2011-03-28T06:16:00.000-07:00

The latest CSA results came out last week and DWP has done spectacularly well (again !!!) Of the nineteen trainees currently in ST3 sixteen have now passed CSA - this is a pass rate of 85% - which is pretty damn good, in my opinion.

Commiserations to those who did not pass it this time, but DWP has a 100% pass rate of trainees taking CSA. Everyone who is coached, mentored (and even bullied) by the 'dream team' - Richard, Rosemarie and Jaz will eventually pass.

So well done to all those who have passed and good luck next time to those who did not.

The topic tutorial is dead ....

2011-03-18T06:30:00.000-07:00

We had a very interesting Joint Trainers Workshop yesterday which was titled 'Helping Trainees with Difficulties'. I had invited Nick Whelan, the Deanery Performance Tutor, to come along and talk/be an expert resource. Nick meets all doctors who have failed one of the components of MRCGP and had some very helpful and useful insights in how to help trainees who are having difficulties.

There were actually two different agendas. Trainers and Educational Supervisors were interested in what to do with their trainees and supervisees who they thought were running into difficulties, whereas Nick was very keen to get trainers to do more consultation skills training. We spent some time looking at how we could do this.

One of the issues that arose was that trainers maybe spending more time on observing consultations for COTs and less on teaching consultation skills. There, of course, is a tension between assessment and teaching but it is clearly possible to teach consultation skills and do a COT with the same material. But the only way that we (as trainers) will have enough time to do this is to let some things go. One of the things we can let go of is the 'Topic Tutorial'.

The 'Topic Tutorial' is dead, long live 'Consultation Teaching'. Hip, hip, hurrah...

Recruitment update

2011-03-14T03:11:00.000-07:00

Recruitment has now finished. At the final assessment centres 241 candidates were found to have achieved the competencies to be appointed and offers are in the process of being sent out to them. There were 300 vacancies so that leads about 60 rotations that have not been filled.

Last week we had an email from the Deanery asking us to suggest rotations that could be culled from our list of rotations because the Deanery has not got next years budget and is not sure whether their will be enough funding for a second round selection process.

This is nonsense - vacancies in hospital rotations will destabilise hospital departments, it risks demotivating GP trainers who have worked hard to create the extra capacity requested by the Deanery and we are moving to a NHS that is GP led so we should training more GPs, not less.

The GP part of the Deanery knows it makes sense to have a second round to fill our rotations - but if you have any influence you now know what to say!

Look after your bag, prescription pad and video ...

2011-03-07T01:34:00.000-08:00

I have blogged about this before (click here for a previous blog about video security) but we have had another significant event where a trainees car was broken into and their medical bag and video camera were stolen from the boot of the car.

This exposes the trainee, trainer and practice to all kinds of unwanted attention.

The theft of prescription pads has to be reported to the PCT as Serious Untoward Incident
The theft of a video camera has to be reported to the PCT who then reported it to the Strategic Health Authority. Loss of tapes or cards with patient consultations on is another SUI
There are issues about who is responsible for the loss of trainee medical bags.

So ....

Be very careful where you store cameras, bags and prescription pads, because if anything happens you are responsible for keeping them safe.

AKT MUST be taken before ST3

2011-02-28T05:09:00.000-08:00

The TPDs have been banging on, for nearly ever it seems, that trainees need to have taken AKT before they enter their last year of GP training. But I am not sure the message is getting through. At the last two introductory sessions there were still trainees who were under the impression that it is OK to do the AKT in ST3

It is not.

Waiting till ST3 to do the AKT puts loads and loads of pressure on you to pass AKT and CSA in the same year. You will be much more successful if you have already taken it (and hopefully passed) before you enter ST3.

So you have been told, again ......

Recruitment 2011

2011-02-21T05:55:00.001-08:00

The assessment centres for recruiting doctors to join our scheme in August 2011 start this week. At the assessment centres candidates will be asked to rank the rotations they want. With rotations for DWP it is very important that you rank the rotations you want because if you are successful in being appointed to DWP and accept a rotation WE CANNOT CHANGE IT - what you are offered is what you will get ...

Just to be clear, if you don't want to do A&E again, then don't choose a rotation that has A&E in it. At DWP more than half our rotations don't have A&E so you still have plenty of choice.

Not wishing to sound harsh, but you have been told ......

Anyway, good luck with your application

17 weeks to ARCP panel

2011-02-14T02:55:00.000-08:00

Have been looking at the teaching timetable for hospital trainees and do you know it is only SEVENTEEN weeks till ARCP panel. We are holding a local ARCP panel on Tuesday 14th June. By that date your ePortfolio needs to be fully up to date - all WPBA done, all NOE done, both your Clinical Supervisors and Educational Supervisors report completed AND we want your entries to be reflective and demonstrate that you have completed learning cycles.

Easy .....

Small group training

2011-02-08T00:10:00.000-08:00

Just a quick reminder that if you are in your first GP post then your Tuesday small group session is in the new Medical Education Centre at Pinderfields - it starts at 2 pm, but you will need to get there early to be able to park!

If you are in ST3 then the small group sessions have moved to Drighlington - food from 1 pm.

And if you are in a hospital post the whole day teaching sessions start on Thursday 10th February at 9 am sharp at Kings Medical Centre - remember to bring £2.60 to park in the 'Pay and Display' car park opposite. Trainees in Group A meet for the first time on Thursday 10th Feb, those in Group B on Thursday 17th Feb.

Joyce and Questa banned from Wakefield Resturant

2011-01-31T01:54:00.000-08:00

Shock. Horror. Joyce and Questa have been banned from eating in the Bollywood Lounge. This would be awful if it was because of Joyce and Questas' drunkenness andwoofing but it was not. It was for something much, much worse.

The management banned them on 'hygiene grounds'.

This of course is completely illegal and is breaking the law. I am sure that all of you, as I am are shocked and perturbed by this. Joyce and Questa (very nice picture I must say) have been in the Wakefield Express with this (on page 19 but it was the first page of Wakefield Centre News) and have made quite a fuss over it.

So, I think we should boycott Bollywood and go to the Mumbai on Westgate where Joyce, Questa and twenty others were welcomed with open arms!

Good News - CSA pass rate up

2011-01-25T05:16:00.000-08:00

The RCGP has published a summary of the November to December CSA results. Four hundred and ninety four candidates undertook the exam and the overall the pass rate was 63%. For trainees taking it for the first time the pass rate was 77%. Of the 181 candidates taking for the second or more time the pass rate was 38%. Of course the RCGP give the usual cautions that cohorts of candidates vary considerably but it is good news that 77% of candidates taking if for the first time passed.

Hospital posts move to Pinderfields - but not yet ...

2011-01-18T01:56:00.000-08:00

It will be no surprise to anyone working at Pinderfields and Pontefract to know that the moving date has been postponed. It was supposed to be this month but this has now been postponed. I had a tour of the New Pinderfields last week with a group of GPs. It was very impressive and easy to see how the hospital will become more efficient. Everything is close together and there is much more clinical space in A&E - I especially liked the way that adult and paediatric assessment areas were seamlessly linked to A&E.

However, the big but is that there are less beds and it seems to me a huge leap of faith that the new hospitals will be able to deliver a service with just over 150 less beds. Its OK getting patients in but there does not seem to be any urgency from social services to get people home!

The other big question is when will the move happen. We were shown around by the Gordon Walker, the Trusts Equipment and Comissioning Manager - and he was confident that the move would take place before Easter - watch this space ...!

Learning consultation skills - what works?

2011-01-10T01:48:00.000-08:00

The Training Programme Directors are going to a Deanery Training Seminar next week and we (or rather Shelagh - 'cos she has volunteered) have to produce a poster on how the scheme helps trainees to learn and develop consultation skills. I am interested to know what you thinks works well, what does not work well and if you have any ideas about how we should move forwards in the future.

If you are happy to the whole world to know your thoughts then just click 'reply to', if you would like to keep your email private then click here to email me directly.

Thank you in anticipation.

Happy New Year ...

2010-12-31T06:11:00.000-08:00

Just a quick message to wish all our trainees and blog readers a Happy, Healthy and Successful New Year.

Our small group training sessions start again for trainees in general practice on Tuesday 4th January and the whole day sessions start again on Thursday 6th January at Drighlington.

Best wishes to everyone.

AKT feedback

2010-12-20T00:55:00.000-08:00

After each exam round the RCGP publishes feedback about how candidates have done in the exam and gives advice about the broad issues where candidates have done not so well. They have recently published feedback for the October AKT. Click here to go to the RCGP website to read the whole document - its only two pages long and very interesting.

But if you want a brief summary then they gave advice about five specific items.

(1) Answer all the questions. They comment 'that candidates who answered all items performed considerably better than those who did not'. The RCGP says it does not want to encourage guessing in clinical practice but it is a valid examination technique to guess when you are not sure of the answer - you have nothing to lose.

(2) Candidates did not do well on ECG interpretation

(3) Candidates are still unfamiliar with normal childhood development and UK vaccination schedules.

(4) Candidates should revise the diagnostic criteria for diabetes.

(5) Candidates should revise about the safe prescribing of particularly dangerous drugs in practice e.g. methotrexate.

This advice is really good because in the past, issues that candidates have performed poorly on in one AKT get re tested in further AKTs - so this a heads up about what to revise.

Dr Richard Adams FRCGP ...

2010-12-06T06:29:00.000-08:00

Congratulations to Richard Adams who has recently been appointed a Fellow of the Royal College of General Practitioners because of his services to education. Above is a picture of Richard in his glad rags (note the tie ...) when he recently received his award.

Congratulations and well done.

ES confusion - for trainers and trainees

2010-11-29T06:15:00.000-08:00

We have just done mock ARCP panels with our hospital based trainees. Quite a few are struggling because their educational supervisor has not created a review or signed off their declarations.

WAKE UP TRAINERS - you need to create an ES review date and sign off their declarations for all your supervisees at the start of each 6 month, so if you have not done it yet DO IT NOW!

AND FOR TRAINEES - when you come to have your ES meeting you need to have completed all the self rating scales. In the past it did not matter but now your ES will not be able to complete the review until this is done.

I don't know why I am shouting this as I have just done an ES review and it took me and my supervisee ages to sort out all the stuff to allow us to complete it.

Actually I do know why I am shouting about it - everything with the ePortfolio seems to change every six months (I should not really be surprised with this because it has always been so) and it is so FRUSTRATING!!!

Tick, tock, tick, tock .... boom!

2010-11-22T01:47:00.000-08:00

I was an assessor at the ST3 mock CSA we had a Normanton on Tuesday. The case I was assessing was easy and staightforwards. It was a 35 year old taking microgynon who had had it stopped by the practice nurse because she was a smoker. She came to discuss alternatives.

However, of the eight doctors we assessed only three reached the end of the consultation and one of the doctors who gave her a prescription gave her the wrong advice about how to take it.

The main issue was TIME. Most doctors were very thorough but they simply spent too long on the consultation and never concluded it. They would have failed because they did not reach the management stage of the consultation.

The take home message I have is that you only have 10 minutes, you need to be consulting at 10 minutes and you need to have some impetus to get to the end! To pass CSA you need to be patient centred, with evidence based options and do it in 10 minutes - easy !!!!

Video security

2010-11-13T00:41:00.000-08:00

At the Primary Care Educators seminar last week, one of the Training Programme Directors reported an incident where a video camera and tape of consultations was stolen from a practice. This was reported to the practices local Primary Care Trust and a full Significant Untoward Incident Report was completed. This was a major loss of significant material of a confidential nature and exposed the practice, trainer and trainee to allegations of non compliance with Data Protection regulations and possible reporting to the GMC for loss of significant data.

This is really, really serious ...

So, it got me thinking. What should we be doing to protect against this sort of thing. At the Pontefract Trainers Workshop this week we discussed this incident and came up with a list of suggestions:

Keep your consulting room door locked when you leave the room if the video is set up
Lock the camera and tapes securely away when not in use
Wipe all tapes at the end of each attachment
Trainers should add a bit to trainees contracts and induction pack about keeping camera and tapes secure

Helpfull our take home message was that we should inform trainees that if anything is stolen it is YOUR FAULT....

Management savings getting close to home ...

2010-11-05T03:10:00.000-07:00

I was away at the West Yorkshire Locality Primary Care Educators seminar at Harrogate yesterday. This is a meeting of local training programme directors. In the past these events have lasted two days with an overnight stay, but they are now reduced to just one day - alas the 'proper English breakfast' has gone, but that is probably good for my waistline anyway!

At our meeting yesterday a constant theme through all of our discussions was how tight money is for training, there is none for expansion and management costs are expected to be drastically reduced. So, as well as me missing my proper cooked breakfast one of the things current trainees will notice is some tightening up on the rules for travel and accommodation claims. It was agreed yesterday that the Deanery will no longer reimburse travel and accommodation for attendance at exams - so from now on you will have to pay your own way to get to Croydon for the CSA!

How is the CSA marked?

2010-10-29T05:48:00.000-07:00

In the past to pass CSA you needed to get 8 clear or marginal passes out of 12 cases. The marking schedule has now changed. For each case you are given a mark between one and four on the three exam domains (data gathering, clinical management and interpersonal skills) and then an overall mark. One = clear fail, two = borderline fail, three = borderline pass and four = clear pass. The marks are then added up and you get a percentage score for the CSA exam.

The pass mark is set by averaging the score of candidates that CSA examiners have said are borderline. The RCGP then applies some magic number mystery stuff (borderline group method) to these average pass marks and a pass mark for the exam on that day is produced (this is what Richard Adams says if we have got it right!!)

In the past you could pass the CSA with 8 borderline passes and doing badly in the other cases. For example if you got 8 borderline passes, three borderline fails and two clear fails under the old system you would pass. Under the new system you would score 57% and fail. Richard Adams, our local tame CSA examiner, says that the pass rate is 60 - 70% (although the score to pass in the September CSA was 76%).

For each case you can get 16 points ( 1-4 per three domains, and 1-4 on the overall score). In order to pass, if the pass mark is 70%, you need to get on average 12 per case = 3 per domain overall.

So, in order to pass you need to do reasonably well in all the cases - if you do poorly in a few and get some ones and twos, you will fail. Which maybe one of the reasons why it is more difficult to pass.

Not wishing to panic you, but to prepare you need to do COTs and COTs and COTS, and be the doctor at HDR!

Autumn CSA results .....

2010-10-22T05:17:00.000-07:00

Not sure whether you have seen it or not but in Yorkshire only 10 out of 20 candidates who took the CSA this time passed. In DWP our pass rate was higher than this with three out of four candidates passing. This pass rate is a lot lower than in previous sittings of the CSA. The RCGP was reported as saying that this was because the quality of candidates was lower than in previous sittings - the doctors sitting it are more likely to have failed CSA before and undertaking remedial training and we know that the more times you take it the more likely you are to fail ....

Marking of the CSA has changed this time; all the cases count, an overall mark is given and the 'the borderline group method' of marking is now used. I have read the RCGPs explanation of how the marking scheme works click here for a link to the RCGP website but I would not like to have to explain how it works to anybody ....!!

So ... in order to make sure you pass first time do lots of COTs, volunteer to play the doctor in the CSA cases at ST3 HDR and click here to download what the RCGP says about what you should do to avoid failing.

Learning Log Entries - how many?

2010-10-15T06:27:00.000-07:00

At the Pontefract Trainers Workshop yesterday we discussed the issue of trainees who have not started to engage with the ePortfolio. This mainly concerned new doctors to the scheme who are in ST1. What the trainers meant by 'not engaging' is not making regular entries on their ePortfolio or have only made a small number.

Of course there is no dictate from on high about the number or frequency of entries you should make. The only advice is that your ePortfolio should show a progression in your learning over the entirety of your training programme. Not very helpful if you are after advice about a specific number of entries or advice about how frequently you should make these entries. From my perspective the time to start doing something about inadequate ePortfolio entries is NOW rather than new May, just before an ARCP panel.

So ... how many and how often. I would expect a minimum of two entries per week, every week. So that means that we would expect you to have made twenty entries in your ePortfolio by now. If you haven't then the time to start is NOW rather than in May when if your ePortfolio entries are inadequate you face the long, long walk up the hill to an ARCP panel meeting in Leeds ... And we know you don't want to do that!

No free lunch ....

2010-10-05T05:30:00.000-07:00

At the hospital trainees whole day teaching sessions we have had an interesting debate on whether doctors should accept gifts from the pharmaceutical industry - post it notes, pens and lunchtime sandwiches etc etc. In the group I facilitated I was really surprised how much support there was for accepting these promotional gifts as most of the doctors in my group thought it did not affect them and that they could clearly distinguish between marketing and education.

The debate has resurfaced with some discussion on the Google group about drug company sponsored educational meetings. The meeting was about neuropathic pain and was sponsored by Pfizer. Pfizer of course make Lyrica - which has global sales of $2.8 billion dollars in 2009 - click here for Pfizers 2009 Financial report. In 2009 sales increased by 10% compared with 2008.

If you look at comparative costs a 28 day course of Lyrica (pregabalin) 50mg costs the NHS £96.60 compared to £4.99 for an equivalent dose of gabapentin (300mg). The increase in Lyrica sales have happened despite authorative advice that 'in patients with neuropathic pain, there is no statistically significant difference in clinical response rates between TCA, anticonvlusants and SNRIs' - click here for the link to MeReC Rapid Review published by the National Prescribing Centre.

The reason why Pfizer have been so successful is because of their effective marketing campaign. It is estimated that in the UK there are 8,000 pharmaceutical representatives to promote their products to 60,000 NHS doctors - not a bad ratio, and that big pharma spends £10,000 per doctor on promotional activities. To read more click here for a link to No Free Lunch - which is a website that aims to expose the activities of Big Pharma in the NHS.

So next time you accept a drug rep sandwich please remember there is no such thing as a free lunch!

Rotations for 2011!

2010-09-20T01:56:00.000-07:00

As the nights draw in and the leaves start turning yellow it comes to that time of year when I start thinking about vacancies in August 2011 ... again! Applications to start GP training in August 2011 open on Monday 22nd November 2010. Further details can be found at the National GP Recruitment Website click here.

So - I have started looking at what rotations we will have and where we will have vacant slots. We are not able to swap any of our current trainees hospital posts but we maybe able to swap GP posts (as long as it will not upset the rota). If you would like me to consider a swap then click here and tell me what you would like to do. I cannot promise I will be able to do it but I will consider it.

Remember, its only nine weeks till the recruitment process for 2011 starts!

Deanery Quality Monitoring Visit

2010-09-13T04:32:00.000-07:00

The Deanery is inspecting our training posts at Mid Yorks NHS Trust next week. This is part of the Deaneries planned Quality Monitoring of all training posts in the region. We are particularly interested in trainees good and bad experiences about their hospital training posts. The things we are particularly interested in are:

Ability to get to whole day training
Clinical supervision
Organisation of post
Any areas of concern that you feel the Deanery should know about

If you would like me to feedback some comment to the Deanery inspection team then click here and I will annonymously feedback your comments.

Preparing for AKT

2010-09-07T05:40:00.000-07:00

If you are thinking of doing the AKT this time then you can now book your place via the RCGP website now. The Training Programme Directors advice that you should take the AKT exam in ST2 as soon as you have done some general practice. If you have done a general practice post in ST1 then you should be doing it now. The next AKT exam is 27th October and you can apply between 7th - 24th September via the RCGP website or 9th to 27th September via the Pearson Vue website.

The Yorkshire and Humber Deanery has produce a helpful guide about how to think about your preparation for the exam. Click here to download the Word document.

Another resource that trainees who have passed AKT have found helpful is Pass Medicine - click here to go to their website.

Good luck!

Leave

2010-08-31T02:02:00.000-07:00

There has been a lot of discussion (and hot air) about leave on the Google discussion group over the last few days. Below I have clarified what the position is:

Annual leave

The annual leave entitlement is 25 days for GP ST1/2 and 3. If you have trained in a different speciality first and are at Point 3 of the speciality payscale (this is NOT the same as ST3) then the leave entitlement increases to 30 days.

Study leave

The annual study leave entitlement is 30 days per year. This includes half day release, but you cannot increase your study leave by adding half day release sessions you have missed due to annual leave, sickness etc. To apply for study leave you need to first discuss your plans with your GP trainer (when in general practice) or your clinical supervisor (when in hospital posts).

I think that is all perfectly clear now?

Whole day evaluation forms

2010-08-23T05:55:00.000-07:00

We evaluate our teaching sessions in a couple of ways. Firstly we would like immediate feedback to the facilitators about how the session has gone; what was good, what could have been done differently and any other comments. These are read by the facilitators and often help decide what and how we will plan future sessions.

The other way we use evaluation forms is to fullfil our requirement to feedback to the Deanery about how the sessions we have run have been evaluated by our trainees. In order to do this Moira needs copies of your feedback forms and we have agreed that the easiest way to do this is for our trainees to email feedback forms to Moira at the Medical Education Centre.

Click here for Moira email address.

Click here to get an electronic copy of the Evaluation form

Current teaching programmes

2010-08-13T06:15:00.000-07:00

The new teaching programme for all three of our small teaching groups are now on the website.

Click here for the programme for trainees in GP1 - those in their first GP teaching post and going to Pinderfields on a Tuesday afternoon.

Click here for the programme for trainees in ST3 and click here for the group list - those in their last year of training and going to Drighlington on a Tuesday afternoon.

Click here for the programme dates for trainees who are in hospital posts and click here for the list of doctors in Group A and here for the list of doctors in Group B - as it says on the tin, these dates are for trainees who are doing a hospital post and go to Kings Medical Centre, Normanton for a whole day on a Thursday.

Easy ...

Educational Supervisors

2010-08-09T05:45:00.000-07:00

All trainees are allocated an educational supervisor. Click here to download the list of supervisors and their supervisees. If you are new to the scheme you should contact your supervisor so that you can arrange a face to face meeting with them before the end of September. Click here to get to the GP Posts page on the website. If you are not sure where they are then the Google search button works on the website for trainers names.

You need to register with the RCGP NOW and once you have registered it takes a few days for the Deanery to up date your ePortfolio so that your educational supervisor can see your ePortfolio. If you have not yet registered with the RCGP then click here to get registered that you are undertaking GP training.

Welcome!

2010-08-03T03:56:00.000-07:00

A very warm welcome to all our new trainees to the scheme.

If you are in a hospital post we have divided you into two groups. Click on the links to check which group you are in:

For hospital trainees in group A the Induction and Introductory Meeting will be on Thursday, 12th August. For trainees in group B Induction and Introductory Meeting will be on Thursday, 19th August. The Induction will be held at Kings Medical Centre, Normanton, WF6 2AZ. Click here for instructions.

For trainees who are in their first GP post, the first Small Group Teaching session will be held on Tuesday 10th August at Pinderfields Medical Education Centre starting at 2 pm.

For trainees who are in GP training posts in ST3, the first Small Group Teaching session will be held on Tuesday 10th August at Adwalton Surgery, Drighlington. Click here for instructions.

We look forwards to seeing you at these Induction and Introductory sessions but just to remind you that attendance at these sessions is compulsory and that we chase up non attenders!

See you there!

MRCGP - some rule changes

2010-07-31T00:10:00.000-07:00

Sue Rendel, the MRCGP chief examiner has just announced some MRCGP rule changes about how long a pass at AKT and CSA is valid for, the number of attempts you can make and when you can take AKT or CSA.

AKT and CSA passes will now be valid until you get your CCT (certificate of completion of training) - in the past they only lasted for three years.
For new trainees you will only be allowed four attempts at both the AKT and CSA. For existing trainees you can make unlimited attempts as long as you still have a valid training number.
And finally AKT can only be taken during ST2 and CSA only in ST3.

I think that the biggest impact these changes will have is for doctors taking maternity leave and coming back part time. In the past if you did AKT in ST2, then took maternity leave and came back part time, you could easily find that your AKT pass had expired before you finished your training.

Now it will not!

Swapping posts!!!

2010-07-28T03:01:00.000-07:00

I had an email from a new doctor to the scheme who starts in August asking if he could swap his rotation. The answer is a categorical NO!!!

The Deanery say we can't, we don't have the capacity to arrange swaps, personnel and practices have already been informed about the doctors that are coming so I am afraid that the answer is NO SWAPS!

Well, to be honest we do occasionally arrange swaps under limited circumstances. We maybe able to swap GP posts (as long as it does not upset the rota etc etc), we occasionally make mistakes in our rota planning (ie put two doctors into one post, miss doctors off the rota) and if we have made a mistake will ask doctors to swap inorder to rectify our mistakes and we have also arranged swaps inorder to make room for doctors requiring remedial or extra training. But that is it - the usual answer to requests to swap is NO.

New practice - have you been in contact?

2010-07-22T02:30:00.000-07:00

If you are starting in a new GP training practice in August then you need to get in contact with the practice and bring them the documentation that they will need to see before you start in your post. You need to complete some WYCSA forms and will required to show your original GMC certificate and birth certificate or passport. You need to ensure that your Medical Defence insurance is up to date and will cover you whilst working in general practice. You get reimbursed the cost of this insurance but you need to organise it first. You will also need to bring a P45 form from your last employer and finally make sure that your car insurance will cover you for using your car whilst driving.

It all seems a bit complicated but unless it is all done you won't get paid!

Why blog?

2010-07-15T00:28:00.000-07:00

This is the first blog on the new Dewsbury, Wakefield and Pontefract GP Training blog site. As per normal convention the first blog is about why write a blog? The main reason is that I am about to revamp our website, move it to a new domain name and I want to link the blog to the first page in order to keep it up to date and fresh. Rhubarb, Rhubarb .... (the best GP Training Newsletter in the world!) is about to end and I want the blog to replace it. My thinking is that small amounts of news will update the website and be easier to maintain. I intend to send the blog text round our Google group to keep subscribers up to date.

The Dewsbury, Wakefield and Pontefract GP training scheme provides GP training for doctors who want to become GPs in hospitals and GP training practices across Dewsbury, Wakefield and Pontefract - bit like what it says on the tin! I am starting this now so that I will have some content when we update the website. This blog and any comments is open to everyone on the www - so our current trainees should use moderation in commenting about any posts, please.

You do not know who might be reading it!