Trainee assessments and safeguarding at-risk patients

22 May 2020

I was nervous as I zipped up my jacket and fastened my helmet. Although the peak of the pandemic has passed, I fervently hoped that some semblance of an orthopaedic service had resumed.

My focus was unwavering though; I had to see it.

Coping with lockdown

As I mentioned before, I have been struggling with lockdown.

A good dose of plantar fasciitis in my right foot has reduced my running and walking ability and I am missing the best two months of the year – May and June.

They are the months when our countryside is at its best and to me signifies The Balmoral Show, swallows chattering, swifts screaming down Markethill Main Street, and swimming in Camlough Lake.

Late night walks on beaches around Dunfanaghy including my favourite: Tramore Strand on Horn Head. Eating outdoors, fell running with skylarks singing invisible above my head. Malfy Lemon Gin and the sweet scent of honeysuckle in the hedges. All these pleasures are dimmed by COVID-19.

Determined to take back control, I took the risk, and early Sunday morning I left the house on my bike, early to try and spot the most beautiful bird in Ireland – the kingfisher.

Consequences

We are all familiar with the therapeutic risk-to-benefit ratio debate.

Whether we prescribe aspirin to prevent cardiovascular disease, or chemotherapy for patients with cancer, there is a trade-off between the benefits of our well-intentioned interventions and the potential harms they can do.

There are no treatments for COVID-19 and our intervention of social distancing has benefitted the population by reducing its spread, but the unintended consequences have yet to be fully analysed.

It was these nuances that I conveyed when I appeared on The Nolan Show last Thursday morning.

Domestic violence

When I speak to colleagues, they are all telling me the increase in mental health incidents is frightening.

The Police Service of Northern Ireland has also reported increased calls for domestic violence and child protection incidents.

Alcohol sales in supermarkets alone in the UK rose by 22% in March 2020.

Be mindful of our vulnerable children at this time, and as the article in BJGP Life highlighted last week, also be mindful that others may be listening to your telephone or online consultations.

The College has a host of resources on this topic. In Northern Ireland, Women's Aid also provides excellent resources.

As GPs, we have a statutory duty to recognise that children are victims of domestic violence, even if they do not directly witness it, so please report any experiences via Understanding the Needs of Children in Northern Ireland (UNICINI) or through your local gateway team. 

Multi-disciplinary teams

As we move to recovery, it is vital we have the tools and capacity to meet these challenges.

The multi-disciplinary teams (MDT) model has the potential to meet some of these challenges, with mental health practitioners (MHP) and social workers (SWs) embedded in our surgeries to meet the needs of our patients and our staff.

Although most of us understand the MDT model, what many of us forget is that MDTs have increased numbers of district nursing and health visiting staff.

The high rates of COVID-19 infection in our care homes have highlighted the importance of our district nursing colleagues.

Do you have any views on this or do you feel a different model would suit our patients’ needs better?

Please contact me if you have issues you feel we should raise, because this is your College and it is vital your concerns are heard.

New developments to trainee assessments

I was delighted to appear in webinars with Dr Michele Stone, our Director of Postgraduate General Practice Education at the Northern Ireland Medical & Dental Training Agency (NIMDTA) to help address the concerns of our ST1, 2 and 3 doctors.

The changes to our membership exam have been stressful for everyone and it was good to be able to reach out to our colleagues of the future.

The highlight of our College calendar is our October new members ceremony, which has been held in the Titanic Hotel for the past two years.

Unfortunately, we have had to take the decision to postpone this year’s event until February 2021, but I can assure our fantastic ST3 doctors that we will still have a massive party, which will be even more special with your families and friends there to celebrate your achievement.

Our ST3 doctors will have to perform an alternative to the Clinical Skills Assessment (CSA) exam this year, the Recorded Consultation Assessment (RCA), but I have no doubt that with the increase in remote working and excellent supervision from their tutors, our ST3 doctors will be prepared for the assessment.

Reinforcing support

Some of our sessional GPs are finding the pandemic very challenging, and I would be most grateful if you could continue to be mindful of them during this time.

We are all operating financially secure businesses, but we will need the support of our sessional colleagues in the future to allow us to take holidays and so on, so please support them.

The best businesses are those based on relationships, so please keep these relationships strong.

BJGP Life

laurence dorman and roger neighbour

I continue to enjoy the BJGP Life website and encourage you to check it out.

There are two excellent articles about video consultations and their implications this week with one highlighting practical advice and their implications for non-verbal communications.

It is worth reading these articles and revisiting Dr Roger Neighbour’s insightful work The Inner Consultation with information about “eye movement accessing clues” (pp126, second edition).

In it he talks about how patients glance upwards when remembering a visual image, to the side when remembering sounds or words and downwards when experiencing or remembering a feeling.

The BJGP Life article raises very interesting aspects of our face to face consultations which we probably take for granted.

It will be of particular interest to our ST3 colleagues, who are going to submit video analysis as part of their RCA soon. The attached infographic is excellent and worth reading.

Eye Movement Desensitisation and Reprocessing

How our brains recollect or remember information or experiences and translate these into eye movements is fascinating and can be used to treat people with psychological trauma.

Eye Movement Desensitisation and Reprocessing (EMDR) therapy is an interactive psychotherapy technique used to relieve psychological stress.

A new research project with the Trauma Response Network Ireland is seeking to recruit frontline healthcare workers who have experienced psychological trauma during the pandemic using early EMDR techniques.

Learn more about the study by accessing the introductory video or by emailing trnireland@gmail.com.

GPNI

The GPNI website continues to go from strength to strength and its webinars have been remarkable.

On Wednesday night, I appeared with doctors Margaret O’Brien and Alan Stout, and our Chief Nursing Officer Charlotte McArdle, for a GPNI webinar, Primary Care Update – What’s Next.

It was a great discussion and I was humbled that almost 400 GPs and primary care colleagues gave up their time to log in on a Wednesday evening.

There were almost 500 questions submitted so it was difficult to address everyone’s concerns but issues such as PPE, COVID-19 centres and new ways of working were all discussed.

I was delighted to hear Charlotte McArdle our Chief Nursing Officer highlight how valued primary care is by the Department of Health and how many opportunities we will have to work with our nursing colleagues in the future.

Back to my bike!

Between Hilltown and Rathfriland on the right-hand side is the Mill Road. It follows the beautiful River Bann, lined with bluebells and ends with a bridge at the Lisnamulligan Road.

Steps beside the bridge provided the perfect spot, and after 15 minutes a small black dot started to fly towards me.

Under the bridge it whizzed and right past, his course unstoppable, impervious to my gaze. His gas blue flame body was slightly darker than others I have seen, but his chest and throat were a beautiful bright dark burnt orange.

I laughed and smiled. Retinal champagne for my soul. Summer restored. 

I hope you see a kingfisher this summer. If you do, there’s no need to tell me – I’ll know when I meet you by your smile.

Email: ChairNI@rcgp.org.uk
Twitter: @laurence903


Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful 'Dear Colleague' initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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