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South East Scotland GPR Curriculum

Principles

·           Course Organisers should, throughout the year, keep the Trainer informed not only about the content of the half day release course, but of any concerns about the progress of any individual GP Registrar

·           The Trainer should feel free to inform the Course Organiser of any concerns about a GP Registrar at an early stage

·           Trainers should be encouraged, where practical, to contribute to half day release course activities and half day release Course Organisers should identify within the training cohort, Trainers with particular skills or attributes for use during the half day release teaching

·           Ultimate responsibility for learning during the year rests with the GP Registrar. Both the training practice and the half day release course are in effect resources that the GP Registrar should make maximum use of to develop their learning

·           The outcome of the year should be to produce a GP Registrar who is fit for purpose, which is one who can work independently in Primary Care in a variety of settings. The GP Registrar should also have acquired sufficient insight into his/ her strengths and areas that require development and be comfortable with the concept of self-development and lifelong learning.

Half Day Release Course

The Course Organisers will ensure that the following occur during the GP Registrar year:

·           Half day induction to the half day release course and to the GP Registrar year

·           The first half day release course group will be a whole day session

·           There will be three terms during the half day release course. The first two terms will run from the period beginning September to beginning of April. The third term will be more self-led and there will be a series of independent modules developed that will prepare GP Registrars for working in Primary Care

·           Each half day release group will have a residential two days which will occur between September and April of each academic year

·           The half day release courses will occur on Wednesdays

·           Each Course Organiser will have responsibility for appraising each GPR in their group at the end of term one.

·           There will be a structured questionnaire developed at the end of the first year to allow feedback from both GP Registrars and GP Trainers on the modified curriculum.

GPR Curriculum

The curriculum described below is developed under the headings of Good Medical Practice for General Practice. There are inevitable overlaps between the various components but the outline offers guidance to specific responsibilities for the half day release course and GP Trainers. For the purposes of the curriculum, the headings are similar to those chapter headings in Good Medical Practice in General Practice.

Good Clinical Care

Clinical Care

This is a fundamental area of GP Registrar training and ensuring that the Registrar is fit for clinical practice is the main responsibility of the GP Trainer and GP training practice. The half day release group will support the GP Registrar’s development and in this area, will offer peer group support and will seek to challenge, in a safe environment, the GP Registrar’s views and opinions. In developing the skills necessary for good clinical care, it is important that GP Registrars have adequate clinical experience, time to reflect on that experience and an opportunity to discuss the experience both with the GP Trainer and their peers in their half day release group.

Responsibilities of the Half Day Release Group in this area may include:

·           Providing a forum for GP Registrar’s to bring clinical issues for discussion and clarification by their peers

·           Ensuring that problems that are brought by GP Registrars are looked at and discussed in a structured way and that feedback to GP Registrars is positive and developmental

·           Providing GP Registrars with models and templates to use in thinking about managing difficult clinical situations

·           Encouraging an evidence-based approach to clinical practice, challenging GP Registrar’s on their clinical basis and evidence for decision making and seeking to identify areas where there is good clinical evidence for patient management

·           Providing GP Registrar’s with a structure for looking at significant event analysis and ensuring that they understand the importance of a significant event analysis and professional development

·           Providing GP Registrar’s with an insight into the value of clinical audit as a measure of good clinical care

·           The individual Course Organiser will develop a series of clinical scenarios that will act as a trigger for discussion about issues relating to clinical management and clinical effectiveness

·           GP Registrars will be provided with a structured approach to communication skills and a method of analysing and discussing consultation techniques.

Responsibilities of the GP Trainer in this area may include:

·           Providing a structured induction period for the GP Registrar and including within this, an assessment of the GP Registrar’s learning needs, clinical strengths and areas that require development

·           The GP Trainer will be responsible for ensuring that the GP Registrar has a clear understanding of the principals and practice of prescribing, investigation and referral

·           The GP Trainer will work with the GP Registrar to identify throughout the year, the areas of their personal clinical strengths and areas of clinical need

·           The GP Trainers will make themselves available, as required, to discuss with the GP Registrar clinical issues. This need for informal clinical based discussion will be particularly important in the early stages of the GP Registrar year. The GP Trainer will undertake a formal needs assessment of the GP Registrar and following regular discussion and appraisal, guide and develop their learning throughout the year.

·           The GP Trainer will tailor their teaching to the identified needs of the GP Registrar and will offer a flexible enough training programme to accommodate GP Registrar needs

·           The GP Trainer will encourage and develop an evidence-based approach to clinical practice. This will involve introducing the Registrar to the concepts of evidence-based practice, critically appraising literature, clinical guidelines and clinical audit

·           Ensuring that the GP Registrar has sufficient clinical experience in managing chronic disease and that they have exposure to other members of the primary health care team and can identify their role in providing clinical care

·           Supporting the GP Registrar in developing a suitable audit project

·           Providing good quality video equipment and encouraging early and regular videoing of the GP Registrar’s consultation and providing an opportunity to give the Registrar formative feedback on their performance

·           Ensuring that the GP Registrar is clear about the requirements for the Summative Assessment and MRCGP video assessment

·           Providing protected learning time for the Registrar. This may involve structured tutorial time for random case or problem-based case analysis or a period of time, when the Registrar can reflect on their clinical practice and any issues that have occurred during the course of their working week

·           Ensuring that the Registrar has sufficient exposure to out of hours work and emergency care in General Practice, to allow the Trainer to be certain that the Registrar has sufficient skills for independent clinical practice

·           Using the Trainer’s Report as a template for monitoring and managing progress of the GP Registrar during the year and to share the content of this with the GP Registrar at appraisal sessions

·           To conduct a minimum of two formal appraisals for the GP Registrar during the GP Registrar year with a focus on the GP Registrar’s clinical and professional skills and attributes

Keeping records, writing reports and keeping your colleagues informed

This is an area that has largely been neglected during the course of the GP Registrar year with no formal guidance given on the content or structure of note keeping. With extended practice teams, it is proving increasingly important that Registrars are instructed in proper record keeping.

Responsibilities of the Half Day Release Group in this area may include:

·           Raising general issues relating to good record keeping and the failure to comply with acceptable standards of professional record keeping

·           The importance of maintaining confidentiality in clinical record keeping

·           Discussing in peer groups, dilemmas that arise about providing reports, information or statements based upon information recorded in GP clinical records

·           Using an ethical template to aid discussion of the above points

Responsibilities of the GP Trainer in this area may include:

·           Ensuring that the GP Registrar understands the importance and nature of good clinical record keeping in General Practice. Monitoring through tutorial work and particularly through random-case analysis and problem-case analysis that the GP Registrar can maintain good quality records and that they have an understanding of both the importance of maintaining, where necessary, paper and electronic records

·           Reviewing with the GP Registrar, the content and instruction of referral letters to hospital and communication with other professional colleagues and advising the GP Registrar about how to construct written reports in General Practice for third parties

·           The standards of record keeping that the GP Registrar should aspire to, are those that are detailed by the General Medical Council

Access, availability and providing care out of hours

Responsibilities of the Half Day Release Group in this area may include:

·           Discussing issues such as continuity of care and accessibility of care. Raising awareness of Registrars of the organisational issues relating to primary care and the importance of access for patients. Debating such issues as clinical triage, NHS 24 and out of hours provision

·           Reviewing with the Registrars, telephone communication skills

·           Raising awareness amongst GP Registrars of the political issues involved in continuity and accessibility and of the potential and likely changes to occur in the development and structure of primary care as a result of these

·           Developing an evidence-based approach to accessibility and out of hours provision

Responsibilities of the GP Trainer in this area may include:

·           Ensuring that the GP Registrar has sufficient exposure to out of hours work to allow the GP Trainer to make an informed judgement about their capability, ensuring that the GP Registrar understands how the out of hours system for the practice operates

·           Ensuring that the GP Registrar understands the importance of accessibility and availability in primary care and how the practice system is both organised and audited

·           Involving GP Registrar’s in meetings within the practice which discuss access and availability. Ensuring that each GP Registrar undertakes a patient satisfaction survey during the course of the year and that the results of this are fed back to them

·           Ensuring that GP Registrars are involved in triage work and providing emergency day time cover for the practice.

Treatment in emergencies

Many of the issues identified in this area are covered in the out of hours component of training.

Responsibilities of the Half Day Release Group in this area may include:

·           Encouraging discussion and sharing of issues and problems identified during emergency care. For example, uncertainty in managing out of hours care and emergency care in general practice

·           Providing time for peer reflection of discussion in cases that the Registrar did not think went too well or there were difficulties with.

Responsibilities of the GP Trainer in this area may include:

·           To ensure that they identify early in the year, areas that the Registrar has clinical uncertainty in relation to emergency care and to ensure that these are adequately covered during the practice.

·           To ensure that the GP Registrar is fully capable of undertaking CPR.

·           To ensure that the GPR is fit to cope with emergency care in the General Practice setting including an understanding of the use of emergency services, Mental Health Act and liaising with other services in any other area

·           Ensuring that the GPR has access to the necessary equipment and drugs required for providing the emergency care

Making effective use of resources

Responsibilities of the Half Day Release Group in this area may include:

·           Introducing the Registrar to the concept of resource management and the principals underlying this including rationing and individual patient need, review the evidence base for the effective use of resources to ensure that Registrars are using resources effectively

·           To provide information to Registrars about how resources are allocated and designated within the NHS

Responsibilities of the GP Trainer in this area may include:

·           As part of tutorial time, to ensure that there is time spent discussing the day to day work of the Registrar and looking particularly at the Registrar’s use of investigation, prescribing, referral and other data that is available and to ensure that the Registrar understands the need to maximise their effectiveness in the use of resources

·           To ensure that Registrar understands the importance of time as a resource in General Practice and to ensure that the Registrar has a sufficient understanding of how to use time therapeutically.

Maintaining good medical practice

Keeping up to date and maintaining clinical performance

Responsibilities of the Half Day Release Group in this area may include:

·           To ensure that each Registrar has a clear understanding of GP appraisal and revalidation including an outline of the history and reasons relating to this and the evidence for each component

·           To critically look at sources of information and knowledge available to General Practitioners, including the use of journals, practice-based meetings, clinical meetings and the role of the pharmaceutical industry

·           To look at methods of maintaining performance through critical event analysis, reflective diaries etc and to attempt to ensure that each Registrar has an understanding of the method they will employ for future practice

·           To ensure that the Registrars are fully conversant with the contents of Good Medical Practice and the importance of using this as a guide to future clinical activities and professional performance

Responsibilities of the GP Trainer in this area may include:

·           Setting a clear example to GP Registrars through partnership activities of how partners maintain personal development and plan for continuing professional development

·           Fully involve the GP Registrar in practice audits and significant event analysis and to demonstrate how these are used in initiating change within the practice

·           To involve the GP Registrar in discussions about GP appraisal and revalidation at practice level. To ensure that the GP Registrar understands the type of information that needs to be collected into the appraisal documentation and to ensure that they understand the process whereby appraisal information feeds into revalidation

·           Using the appraisal process to familiarise with the GP Registrar with the importance of peer appraisal, and the acceptability of the this as a method of identifying personal development needs

·           To ensure that the GP Registrar has an understanding of their responsibilities as an employer

Relationships with Patients and Health and the performance of other doctors

Relationships with patients and maintaining trust
Avoiding discrimination and prejudice against patients
If things go wrong
Protecting patients when your own health, or the health, conduct or performance of another doctor puts patients at risk

This is a key area in General Practice training and there are responsibilities in both the half day release course and the training practice to ensure that GP Registrars have a clear understanding of their responsibilities towards patients as outlined in Good Medical Practice.

Responsibilities of the Half Day Release Group in this area may include:

·           Highlighting and informing GP Registrars of the importance of professional values when working with patients and providing a framework (Good Medical Practice) of ensuring that GP Registrars will converse with these

·           Using a structured, ethical approach and developing dilemmas to highlight the difficulties that can arise for GP Registrars in clinical practice

·           Looking at the processes within the NHS for patient complaints and working with the Registrars identifying how complaints should be handled and dealt with in practice

·           Raising awareness of the issues of under-performance in General Practice and the processes and procedures available in Scotland for managing under-performance

·           Ensuring that the Registrar understands how to manage their own health, what to do if they feel their health is compromising patient care and to ensure that they understand what to do if they feel the health of a colleague is compromising patient care

Responsibilities of the GP Trainer in this area may include:

·           The Trainer and the practice team have a responsibility to provide a clear role model in this area

·           The Trainer needs to monitor the GP Registrar’s development in this area through random-case analysis, significant event and video of consultations

·           The GP Trainer should work to support a GP Registrar who develops or is having any performance difficulties during the year and should, if they have any concerns, discuss these with the Registrar and alert the Director of Postgraduate GP Education

·           Ensuring that GP Registrars have an understanding of what is meant by patient-centred care and why this is important

·           Raising awareness within Registrars of their own communication skills with patients and ensuring that they are capable and, if possible, exposed to dealing with people with different values and belief systems

·           Creating in the practice, an open and honest environment where clinical and professional work is audited and feedback is received and given in a constructive manner

·           Ensuring that the Registrar has a clear understanding of how complaints are managed in the practice and how these are dealt with. Ensuring that the Registrar has a clear understanding of the need to deal with complaints appropriately and professionally

·           Using the Trainer’s Report as a template for documenting Registrar progress

Working with Colleagues

Working with Colleagues and in Teams

This is another critical area in the GP Registrar year and both half day release and Trainers have responsibilities to ensure that Registrars have an understanding of the importance of this and can demonstrate the appropriate competencies.

Responsibilities of the Half Day Release Group in this area may include:

·           Recognising that the half day release group is a team and the Course Organiser will be looking at how individuals work within the group and whether they demonstrate respect for other members of the group. The group will be used as a model for individual Registrars to look at how they function in a team and how they influence and affect team functioning

·           Looking at issues which are critical to team working, including managing meetings, leadership, negotiation skills, delegation, agenda setting and managing conflict within teams

·           Reviewing how individual members relate to the team and how they value or otherwise, team functioning

·           The evidence base for successful team functioning and development of models of team working that Registrars can apply in practice

·           Providing challenging scenarios to GP Registrars to develop their thinking of the different roles required of a GP in primary care in the future in relation to team working.

Responsibilities of the GP Trainer in this area may include:

·           Ensuring that the GP Registrar is exposed to team working in the practice and is able to understand and articulate the value of team working in primary care

·           Ensuring that the Registrar has an understanding of the broad boundaries of teams within primary care and how the different compositions of teams, i.e. different employee employer relationships, can affect team working and team structure

·           Encouraging the Registrar to be aware of good employment practice and how this can impact upon staff working and staff functioning

·           To conduct a 360o appraisal of the Registrar at some point during the year to provide them with feedback on their own team performance

Referring Patients

Responsibilities of the Half Day Release Group in this area may include:

·           Discussion around the evidence base for referrals in practice, i.e. what do referral rates tell us about an individual doctor’s performance

·           Discussions around how to manage clinical uncertainty in practice and when appropriately to use referral

·           Looking at referral out with the NHS for example, complimentary care, secondary opinions

·           Dealing with difficult situations posed by referral. For example, a patient’s refusal to accept a referral or passing on sensitive or other information to third parties during the referral process.

Responsibilities of the GP Trainer in this area may include:

Similar areas to those identified by the half day release course but, in particular:

·           Monitoring the referral activity of the GP Registrar and providing feedback and advice about the appropriateness or otherwise of referrals, about the nature of the referrals and the content of the letters, about resource management and about the disclosure of information

·           An audit of GP Registrar referral activity during the year should be undertaken to provide feedback to the GP Registrar on the outcome of a series of their referrals.

Teaching and Training, appraising and assessing and Probity

Teaching and training, appraising and assessing
Research

Responsibilities of the Half Day Release Group in this area may include:

·           Raising awareness and the importance of research in general practice

·           Identifying instances where research has informed the practice

·           Critically reviewing research papers to ensure that GP Registrars have an understanding of the construct of a research paper and how it can be applied in a GP setting

·           Providing GP Registrars with the opportunity of being involved in teaching where appropriate, either through group-based activities or teaching their peers.

Responsibilities of the GP Trainer in this area may include:

·           Being aware of the benefits of General Practice research and being encouraging in supporting the GP Registrar in developing any research interests

·           Encouraging within the Registrar and enquiring attitude and questioning attitude to the use of evidence-based practice

·           Ensuring that the Registrar has a clear understanding of what constitutes effective research in clinical practice and how this can be applied in the general practice setting

·           Having examples of where research has influenced practice.

Financial and Commercial Dealings

Responsibilities of the Half Day Release Group in this area may include:

·           Detailing information to GP Registrars about how the financial arrangements of General Practice are arranged

·           Ensuring that the GP Registrar is conversant with the new GP contract

·           Ensuring that GP Registrars understand the importance of good ethics in financial management

·           Ensuring that GP Registrars understand the responsibilities of an employer.

Responsibilities of the GP Trainer in this area may include:

·           Ensuring that GP Registrars have the opportunity to observe the practice at work and have an understanding of how the practice finances are constructed and managed

·           Ensuring that the GP Registrars have an understanding of how practices earn money and the income sources of the practice, both NHS and non-NHS

·           Ensuring that GP Registrars have a clear understanding of the importance of good practice management and financial management in the management of General Practice as a business.

 
Source: Course Organisers of South East Scotland region

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