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.

The first thing to get to grips with is to understand how General Practice works in the UK.   Many trainees (both those that  graduate from the UK and those that graduate outside) have little knowledge of the Primary Care model used in the UK.  By the way,  for those of you from abroad, primary care is another word for general practice and secondary care refers to hospitals.   Here are two video clips that are worth while watching.   The first helps you understand how the NHS works.    And the second, more specifically about General Practice.

Video 1: UK General Practice by The Kings Fund

Video 2: BMJ on Primary Care

While you’re on the Bradford VTS YouTube channel, don’t forget to subscribe.

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.  

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!

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)
• Auroscope
• Ophthalmoscope
• Glucometer
• 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.
• Paper

If it things are missing or items are out of date – now is the time to bring them to the attention of your GP trainer.

• 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.

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.  

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.

In General Practice, you will need to engage in Urgent, Unscheduled Care (UUC). This includes

• being the on-call duty doctor for the surgery (during in hours service) or
• working in the local Out of Hours service provider (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 qualified GPs.  You may be asked to see a few patients under DIRECT and CLOSE 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.

It’s likely that you haven’t registered and therefore you have no National Training Number (NTN) which is necessary to create an e-portfolio. 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).   Register NOW.   Do NOT delay it.  

Simply dress smart.  You don’t have to wear a shirt and tie or an elegant dress.  Looking smart is the key.  Most hospitals ban ties – so please do make contact with your organisation if you have questions or anxieties.

• 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 to do your basic things like writing in your ePortfolio and getting assessments done.  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.