Your GP Post
guidance on starting a GP post
path: GP POST INDUCTION FILES
- *** broad things to achieve if this is your 1st gp post.docx
- *** five tasks before you start with us.docx
- *** INDUCTION WORKBOOK -- gp post.docx
- *** practice manager checklist BEFORE trainee joins.doc
- *** practice manager checklist DURING induction.doc
- *** registering with the RCGP as an AiT .docx
- community placements.docx
- developing a fit for purpose practice induction.ppt
- foundation year trainees -- induction to GP.doc
- glossary for gp training.doc
- INDUCTION WORKBOOK -- gp post -- generic.docx
I'm due to be starting a GP post. What will happen?
Hopefully, the scheme should have told you by now which GP practice you are going to. If this isn’t the case, get in touch with either the GP administrator for your scheme or one of the Training Programme Directors (which are called TPDs for short).
Then, someone from the GP practice will make contact with you (the Practice Manager, the GP trainer, or both). Again, if you haven’t heart anything from them, go to the practice’s website -- and either ring or email the Practice Manager. Write a little paragraph introducing yourself and then ask them if you need to do anything further.
The GP practice is likely to send you an induction pack, a timetable and some preparatory homework to do before starting your first day. This preparatory material will help the practice and your trainer to determine how to settle you in nicely as well as some educational stuff like identifying your educational need
For those of you who are part-time or coming back from sick or extended leave, PLEASE make contact with your training practice EARLY (at least 6 weeks before) to make sure any special arrangements required are all in place, and if not -- gives them time to fix. Ask to see the timetable.
Understanding General Practice in the UK
You may have seen these video clips on our other web page for new trainees. We provide them here again in case you missed looking at them. Like we said before, most GP trainees (including those born in the UK) don’t truly understand how the NHS and General Practice work in the UK. The first video helps you understand how the NHS works. And the second, more specifically about General Practice.
How's the working different from in hospitals
Lot’s of ways!
- GP practices often offer a more friendly environment than hospital departments. However, because you may be the only GP trainee in the practice, you might feel quite isolated compared to the camaraderie that goes on in hospital posts. If you are in a multiple trainee practice -- please link up with them and form your own network. If you’re in a single GP trainee practice, find out which training practices are near and hook up with neighbouring GP trainees during lunch and breaks. And of course, please make close networks with the other GPs in the practice, the nurses and reception staff. Doing so will mean you make new friends and that in itself will rid the feeling of being isolated and alone. If you’re feeling isolated and alone -- that’s because you are not connecting! Sometimes, you have to be courageous and take the first step.
- The other difference is that in hospitals you handover patients to the next person. But in GP posts, you have to follow through patients yourself. This means that you need a good personal organisations system on keeping an eye on patients you want to follow. But don’t worry for now -- discuss it with your GP trainee. TO start off with, a little notebook will suffice.
- In hospital, you are scheduled when you work and when you finish. The same is the case with GP training practices. You will roughly work 40 hours per week. However, do remember that sometimes it’s important to hang on and go the extra mile for patients who are acutely unwell or in serious need. You cannot just discharge your responsibilities just because your working time is up.
- In hospitals, you don’t do home visits, but in GP you do! Again, don’t worry about this. You will follow a few doctors doing visits in the surgery first before you will end up doing your own.
- In hospitals you will do on-call as per the specialty department’s rota. In General Practice, you do Out of Hours. The on-call is lots easier and less tiring than that of hospital specialty departments. You will do roughly 1 on-call session per month. Each session lasts 4-6 hours. And often, it’s not as busy. Please remember to write about your OOH sessions in your ePortfolio to provide evidence for the OOH capabilties.
5 things to do when you start a GP post
Registration is online with an initial registration fee which is confirmed by email. The ePortfolio will be activated between 24 and 48 hours after registration with a welcome pack sent approximately 10 days after. Once registered, you are then called an “Associate in Training” (AiT).
- To register online, go to: https://www.rcgp.org.uk/about-us/membership/become-a-member/ait-trainee-gps.aspx
- There is an enquiry line for AiTs (email [email protected] or telephone 020 7344 3078) for any registration queries
Before you start, make contact with either the Practice Manager or the GP Trainer (or both) at the GP practice you are going to. They are likely to get in touch with you first but if they don’t, then it is down to you. Like we said earlier -- if you are part-time or coming back from sick or extended leave, PLEASE make contact with your training practice EARLY (at least 6 weeks before) to make sure any special arrangements required are all in place, and if not -- gives them time to fix.
Other than introducing yourself, ask to see the induction timetable and the regular timetable that you will be following thereafter. Double check to make sure it fits in with what you thought you would be doing (especially if you are part-time). Let the practice know EARLY if you need any time off at the start of your post. And finally, check to make sure you’re not working over the 40h limit.
A supplementary list is a list of doctors in the local area that are allowed to practice in that area). Failure to do so may mean you can’t start work when expected and that can have huge ramifications (you may end up with an extension to training etc.). So get it sorted now. Ask the Practice Manager for your GP post or alternatively the GP scheme administrator/TPDs will know.
In GP and Hospital posts, you are to some extent covered by the Indemnity offered by the NHS. However, you may end up doing (without realising it) other professional activities which may not be covered by the NHS Indemnity. So, if you want peace of mind, you must maintain membership of a recognised medical defence organisation or insurer for these purposes. Nearly all GP Training Schemes strongly recommend all GP trainees to contact a defence organisation -- like the MPS or MDU -- and take additional personal cover. Belonging to a defence organisation like the MPS or MDU will give you that extra support you will need if you become the subject of an investigation. Organisations like the MPS and MDU provide invaluable personal support. You will regret it if you don’t. For the small extra cost, is it really worth taking the risk of not having it?
And join the BMA. Employment issues – holidays, maternity pay etc – can be a minefield so worth having proper representation
There are two inductions you will have at the start of your training.
- The first is an induction to your post -- either a GP post based induction or a hospital specialty based induction. These will help you settle into your new specific ST1 post.
- The second induction will be that organised by your GP TRAINING SCHEME. The aim of this induction is to provide a sort of orientation session where you understand THE WHOLE of your GP training pathway and journey (and all the requirements, including exams).
You must attend both. If you don’t know when your GP scheme’s induction is -- email your GP scheme administrator. When you have got your dates for your GP TRAINING SCHEME’S induction, don’t forget to book that time as study leave with your first post. PLEASE TELL THEM AND BOOK IT IN AS SOON AS POSSIBLE -- they will not automatically know.
Make a good first impression & be flexible
It’s worth trying to make the best impression you can in the first few days of the post. Be friendly and show genuine interest in the job and all your colleagues at every level. Show a willingness to work hard, a willingness to listen to instructions and advice. If you do this, people around you will find it a pleasure to want to help you.
It would be tactless and inappropriate for us to quote examples, but some trainees have found themselves pigeon-holed either negatively (e.g. as slack, unconscientious or uncooperative) or positively (e.g. helpful, hardworking or conscientious) on very little evidence. Later, when their behaviour has changed, their reputation hasn’t -- reputation sticks!
That’s why we say a little extra effort in the first few days is likely to pay immense dividends in the end. Of course, this doesn’t mean that you can be good, hard working and conscientious in the beginning and slack off towards the end. Individuals who go the extra mile are ALWAYS admired, respected and generally liked. Others, in return, will often go the extra mile for you!
And be flexible! GP practices are often more flexible than hospital departments in terms of catering for your needs. In return, please be flexible back -- and go the extra mile -- for instance when the practice is busy and needs extra help. Be conscientious and helpful.
What equipment do I need and what will the practice provide?
Just bring your stethoscope. The GP training practice will provide you with a doctor’s bag which will include a minimum of
- BP machine
- Sats monitor
- Thermometer (digital)
- Peak Flow Meter
- Tendon Hammer
- Tape measure
- an Emergency Drugs box (check that that items are still in date). Includes things like adrenaline, benzylpenicillin, aspirin, an inhaler and GTN spray.
Do I get my own consulting room?
Most GP training practices have dedicated rooms for trainees. But in some practices, where space is (understandably limited), you may be sharing a room with someone else (especially if you are part-time). What should not be happening is that you being put in a different room in each different surgery. Like the other GPs in the practice, you need a room which is constant -- where you can keep things and organise yourself. So, if you are being moved around left, right and centre, please discuss with both your Practice Manager and GP Trainer.
Now remember this -- you are going to spend at least the next 6 months in the consulting room you are given. Most of your time in the surgery will be spent there. So, why not “own” it and make it your own. Take off old posters and things. Add your own pictures if you want. If you like things neat and tidy, then tidy the place. Make this space YOURS -- you OWN it. In that way, you’ll come to love your consulting room. Imaging seeing patients in a room you despise -- what effect do you think that has on you as a doctor and perhaps on the doctor-patient relationship? Make your room your own!
How will my timetable look? I'm a bit scared about appointments & seeing patients.
- You won’t be thrown in at the deep end – there will be an induction period, so don’t worry too much.
- Appointment intervals are long at the start. You’ll probably start at 30 minute appointments with each patient, gradually going down to 20, then 15 and finally 10. If you are an ST1, it’s likely you will start on 30 and eventually end up on 15 minute appointments. If you’re an ST3, because of your additional experience, you’ll probably start at 20, eventually moving towards 10 minute appointment.
- You will be debriefed after every surgery to start off with. Debriefing is where the a qualified GP goes through your patients with you to ensure you have done the right thing. In doing so, you learn things. So, please be honest about things during debriefs and don’t be defensive. Accept what the GP educator has to tell you. Otherwise you will never learn.
- Timetable: is 40 hours a week for a GP Trainee. In comparison, a full-time GP works 45-50 hours per week. A full time GP trainee will work 10 sessions. A session is defined as a morning or afternoon (4 hours). You will have…
- 7 clinical sessions per week
- 1 x tutorial with trainer (some practices like to split it into two half sessions per week)
- 1 x HDR session run by your TPDs (usually at the local hospital’s Post Graduate Centre).
- 1 x study day session
- The total number of hours you will work in a week is 40 hours.
- Your 1 x study day is for study and getting your administrative GP work done. It should not be seen as “half a day off”.
- If you have any concerns voice them with your Practice Manager and GP Trainer early.
Tell me more about debriefs
When you start doing surgeries – you will recieve debriefs from one of the qualified doctors at the surgery to double check that what you have done is okay and that the patient has received good appropriate clinical care and that the consultation has not left them vulnerable or unsafe. This is the primary purpose of debriefs. The great thing about debriefs is that often, the person debriefing you will also teaching you things along the way. If you want to get the most out of debriefs, you need to be open and honest and not cover up things you failed to do.
In your first GP post (in ST1 or ST2) – you should be debriefed after EVERY SINGLE SURGERY. Further more, EVERY SINGLE PATIENT should be reviewed (not just the difficult ones). If this is not happening, please raise it with both your GP trainer and your Practice Manager because it is unsafe and puts both you and the practice at medico-legal risk! It’s not fair on the patient either.
In your final GP post (in ST3), you will still receive debriefs after EVERY SINGLE SURGERY until you finish. However, the difference is that not every single patient will be reviewed. Initially, they will be but as you become more ready for independent practice, the doctor will end up selecting a few random patients to review to ensure all is okay. Again, make sure your debriefs are happening and if they are not – raise your concern with the Practice Manager AND your GP Trainer.
A note about Out of Hours
In General Practice, you will need to engage in Urgent, Unscheduled and Emergency Care (UUSEC). This includes being the on-call duty doctor for the surgery (during in hours service) or with a local Out of Hourse service provide (out of hours). In ST1/2 – if you are in a GP post, you wont be doing much of these. Instead, you’ll probably be sitting in and observing or seeing the odd patient under direct supervision. However, in ST3, you’ll be doing lots more, initially supervised and later more independently.
Don’t forget, if you do any shifts at a local Out of Hours centre – this needs to come off the 40 hours maximum working time per week. Your practice will not know when you are doing Out of Hours. So, when you have your dates, please tell your Practice Manager early so that he or she can tweak your rota to ensure your average week working time remains 40 hours and no more.
What sort of teaching will I get from my GP post?
First of all, as mentioned, the first type of teaching you will get is during debriefs. Debriefs occur after every surgery you do at the practice. It’s primary purpose is to make sure you have done the right thing by the patient (i.e. patient safety). However, there is much secondary teaching during these sessions. Some debriefs will be done by your trainer and others by other qualified GPs in the practice.
Then there is the tutorial. In some practices you get a 3 hour tutorial once a week. Others will split it and provide two lots of 1.5h. During these sessions there will be teaching on a wide variety of things like…
- communication skills
- clinical topics
- patient discussions, significant events & problem solving
- QIA projects, audits and things
- doing WPBA -- like CBDs (Case Based Discussions) and COTs (Consultation Observation Tool) -- whilst these are formal assessments, they too provide a rich platform for learning.
- your other learning needs
Tutorials will mostly be done by your GP trainer but sometimes by other practice members too. You will always recieve a weekly tutorial even when your GP trainer is away. It is your practice’s responsibility to allocate another teacher for your weekly tutorial when your trainer is away.
Is there anything else expected of me?
- It is hoped that GP trainees have a driving licence so they can do the home visits that are an expected part of their duties. If you don’t have a car or licence, then you are still expected to do home visits and you will have to arrange transport yourself (taxis, public transport, get a bike, a moped etc).
- You are also expected to attend educational sessions outside of the practice like Half Day Release and anything else the scheme has arranged for you.
- You need to do roughly one OOH session per month -- and again, this is your responsibility to devise. Your GP trainer will NOT keep an eye on whether you are doing this or not because it is your responsibility. It is a mandatory requirement from you. If you don’t know how to book onto these sessions, talk to your scheme administrator first and failing that, the TPDs.
- A special note about moonlighting. Moonlighting is when somebody has already got a job but decides to do another job too, often because they want to earn extra money. For example, a trainee who is on a GP post but who does locums for say A&E too in the evening. Moonlight is NOT ENCOURAGED if you belong to a GP training scheme. The reason we don’t encourage it is because there is simply a lot of things you have to do whilst doing GP training. GP training is NOT EASY. And doing another job on top will make it more difficult and very stressful for you. You may end up failing a year and having to repeat it. However, if you are full-time we can’t stop you from moonlighting -- and if you decide to do this, PLEASE GET EXPLICIT AGREEMENT from your trainer. If you are part-time, then you are not permitted to moonlight because the very reason of allowing you to go part time in the first place was because there was a pressing health, family or life need.
My friend's GP trainee post is much easier than mine! It's not fair, all GP trainee jobs should be standardised!
All GP practices are different. There are no two practices that are the same. The differ in so many ways, for example one may be urban, the other semi-rural or even rural. The types of patients (what we call the patient demography) and the patient list size will differ. Some will provide different extra services as different GPs will have different special interests. . IT systems may be different as may the ethos, principles and management style.
So, it is unsurprising that when comparing notes, two practices may well differ and that includes the experience and training you receive compared to others. The core GP training things are standardised between practices, but other things can’t be (like differing numbers of home visits or the way on-calls are done). But this should not matter because we are preparing you for the real world. When you qualify, and you are looking for a job, no two practices will be the same anyway. All GP training posts are preparing their trainees to become independent self-regulating GPs who can work in whatever type of practice they end up in.
Therefore, embrace the fact that your collegues are in different GP posts to yours -- some which will be harder and others easier than yours. Embrace the fact that total standardisation is not a good thing in this context because you are being prepared for independent practice in whatever type of practice you eventually end up joining. All GP training schemes want you to succeed and to have a variety of abilities to be able to deal with the varying nature of different practices. Oh, and remember…. your friend who has an easier time than you -- don’t fret -- because you’ll end up being more skilled and you’ll be able to deal with a wider type of general practice.
I feel my GP Trainer is harder and more critical than my friend's GP Trainer...
If you feel that your and your trainer have a personality clash and that you’re both not getting along, please talk to them or the Practice Manager about it if you can. We know this can be a hard thing to do and if that feels too uncomfortable for you, then talk to one of your TPDs.
But if your only complaint with your GP trainer is that you think they are too educationally hard on you then pause for a moment and mull over these things…
- Actually what you may be complaining about is the fact that you have a very good and through trainer who wants you to be the best you can be. All they may be trying to do is to help you with reaching your full potential.
- You’re friend who has the easier trainer may actually have a trainer that has a teaching deficiency or may not understand the GP assessment process as well as yours.
- The one thing we can say is with certainty is that your GP trainer has gone through rigorous training to become a GP teacher. So, even if you perceive one as being tougher than another, please remember the quality and level of teaching you will be receiving is high. All GP trainers are reapproved every 5 years and for that, did you know that they have to attend courses and show videos and things of them teaching and how good they are? It’s not based on number of years of experience like the old days. It’s tougher than that. So, get into the mindset of embracing differences and the possibility that if you feel your trainer is a bit harder than most, you might actually be getting a higher level of teaching experience.
- If you really feel that your trainer is too hard, it may be because you feel you need some balanced feedback in terms of receiving positive comments too. If that’s the case and the criticalness of the trainer is getting you down, gently talk to them about it. You’ll find them responsive, caring and even sorry for making you feel this way. Be open, honest, kind and gentle. Remember, your GP trainer has feelings too and really wants to help you -- otherwise they wouldn’t be in training.
Some tips from trainees
- 80% of your first GP rotation should be learning/developing your own consultation model. If you nail this early you will fly through ST3 assessments and the CSA. The remaining 20% should be learning the day to day GP jobs, practice structure, OOH service, build up on some foundation knowledge and making full use of the e-portfolio
- Don’t put too much pressure on yourself in terms of AKT; you need a good chunk of time in GP before sitting this. Some trainees get pushed into sitting the exam in ST2 before they are ready and the results are often not very good! You should do your AKT in your first post of ST3. Don’t do it any earlier.
- Try and get the Quality Improvement Activity project out of the way in your first GP post. Seriously, do not leave this until ST3 because you will otherwise be overwhelmed with the amount of stuff you’ve got to do.
- Getting on well with your trainer is key and makes everything easier
- Try and choose a few hospital clinics to sit in (good ones are memory clinic, syncope clinic, ENT etc.) – easy to get time off to do and don’t have to pay like you do for courses. You have to organise this yourself and then talk to your Practice Manager to seek permission to release you to attend.
- Keep a list of your referrals and then check back to read clinic letters to learn from them