A year in the life of a GP Registrar
So, I’d finally made it!!! After three
years of hospital medicine, I was turning up to work at a GP
practice. Would it be what I expected or would I find that it
wasn’t what I wanted to do after all? As I walked in the
door, I was greeted by smiling receptionists and the smell of
coffee; a positive start…
One of the first differences between hospital
medicine and general practice was that I had a two week induction
period. I spent two weeks sitting in with different GPs, with
the practice nurses, learning how to use EMIS, accompanying my
trainer on home visits and generally settling in to my new
environment. If you haven’t heard of EMIS, it’s one of the
computer systems GPs use. Again, in contrast to hospital
medicine, GP practices are much more computerised. No more
searching for lost notes; all notes are on the system and letters
are scanned in. As someone who is a little computer phobic, I
was slightly sceptical at first, but with the help of my trainer
soon came to realise how invaluable the computer system is.
We were also blessed with an IT systems manager, so if ever the
computer was being unfriendly, I could simply phone him for
help!
Getting to grips
QOF (Quality and Outcomes Framework) was
another new concept to me. It is the system introduced in the
new GP contract, whereby practices are paid in part by achieving
certain targets, such as a certain number of patients with BP
<150/90 or regular documentation of patients’ smoking
habits. It means that when a patient walks in, as well as
discovering and dealing with their agenda, you also have your own
agenda. For example you may need to perform an asthma
review.
How on earth can this all be achieved in 10 or
15 minutes you may ask? Again, having come from a hospital
environment which is much less time prescriptive, the idea of
having to achieve anything in such a short time was daunting.
I did start off with longer appointments, and gradually reduced
down. I found that generally timings work out – for example
one patient may come in for a repeat pill prescription which takes
less than 10 minutes, while one may come in with a first
presentation of depression, which obviously requires more than 10
minutes. The unpredictability of general practice, and not
knowing who is going to walk through the door, or why, is endlessly
challenging and fascinating.
Support
The key part of the Registrar year is that you
have a trainer, a doctor who is there to supervise you and with
whom you have a weekly tutorial. I cannot stress enough how
important this relationship is; I soon discovered that while
there were many clinical aspects I needed guidance with, which had
passed me by in previous training (head lice, otitis externa,
“funny shaped heads” to name but a few), by far the most valuable
training was in consultation skills. It may be quite easy to
thrust some antibiotics at someone, but what is much harder, and
the true art of a GP, is building a rapport, picking up on subtle
cues and asking pertinent questions - taking the extra effort to
ask if everything is OK if a patient looks unhappy. It’s
amazing how important simply listening to someone is, and a real
privilege that they feel they want to share such personal
information. There is so much more for me to learn but my
trainer certainly helped put me on the right track.
A typical week
Anyway, down to the practicalities! What
is a typical week? As a full time Registrar I had seven
surgeries a week. Typically they started at 9 and finished at
1, or started at 3.30 and finished at 6.30. In the middle of
the day I went on home visits as needed, typically either one a day
or none. One half day session was the tutorial with my
trainer, and Wednesday afternoons were for joint VTS teaching –
attending teaching with other GP Registrars and SHOs on the VTS
training scheme. This was also invaluable, not only as an
educational forum and to compare experiences and socialise, but
also we often had Balint sessions which were very helpful.
This is where someone would present a patient who they felt uneasy
or uncertain about and the group would fantasise about the life of
this patient, hopefully arming the doctor with a new way of looking
at the consultation. We also went on two GP residentials
during the year – one in the UK, and one abroad (Barcelona this
year).
The final session of the week was for personal
development. Initially, I found myself using this for admin –
for example writing referral letters and sorting through the post I
had received. I must admit, as with several other of my colleagues,
there was a point in the first half of the year where this all
seemed a bit overwhelming. However, as time went on and I
managed my time better, it became less daunting. I started to
enjoy getting feedback from specialists on my referrals and really
started building up a picture of my patients, as the focal point
for correspondence from different consultants.
As with all of medicine, exams also played a
part in the year. Things have changed now, with the
introduction of the new
MRCGP. This will mean that if a GP Registrar passes the
year, they will also be a member of the Royal College.
Assessments
In my year the old system still existed.
This meant to pass the year I needed my trainer to judge me as
competent, to pass an MCQ, submit an audit and a two hour tape of
video consultations. Performing the audit was fascinating
and, again unlike previous hospital audits, because I was in the
same practice for a year I was able to complete the audit cycle;
re-auditing to see if changes I had implemented altered
performance. I would be lying if I didn’t say that the videos
were the bane of my life!! Nonetheless, however excruciating
it was watching endless footage of myself, it was very illuminating
and did help me improve my consultations. I also entered the
old MRCGP which meant an MCQ, written paper, a viva and (you’ve
guessed it!), videos. Another very rewarding part of the year
was being part of a study group with other Registrars to help share
revision. I must admit, we started it as we were told that
being part of a study group was the only evidence-based way of
improving our passing chances – and it certainly helped.
Development
Another invaluable part of the year was the
chance to go on various courses. I went on a very useful
consultation skills course, a CBT course and introduction to
teaching course among others. I would also recommend taking
the DFFP (diploma of family planning), but make sure you get on the
list for practical training as soon as possible, as it is a
long waiting list.
Out of hours training is also part of the
requirement for the year. I had to do twelve out-of-hours
sessions of six hours duration (much to the disgust of my hospital
peers!) during the year. These were a mixture of telephone
consultation sessions either giving phone advice or arranging
review, under the supervision of my trainer, or going out on home
visits. I particularly enjoyed the latter – you get your own
driver, and it really is a good chance to learn about a patient
group outside your practice area.
One more thing...
And that, I think, is all I have to tell
you. Perhaps one more thing – I’m writing this whilst
awaiting my CCT (completion of training certificate) which I need
to start work as a GP. If you wish to avoid a period of
enforced holiday, make sure you submit your forms a month or so
before you finish training. Having said that, I am looking
forward to a holiday!
In summary, the Registrar year has been very
enjoyable but hard work, though even a stressful day has not
compared to a stressful hospital on-call, with bleeps constantly
bleeping. I have felt very well supported and taught, and now
feel ready to enter the world as a qualified GP. Although
it’s early days, I thoroughly recommend becoming a GP. It is
a very rewarding and stimulating job, combining the science of
medicine with the art of humanity. Every patient has their
own fascinating story and I can’t think of a job I would prefer to
be doing.
Dr Mary Howman
East Anglia