We (the TPDs) attended a meeting hosted by the Deanery regarding the topic of leadership as part of the GP training.  A number of questions were raised: what is leadership, why should we be looking at leadership and how are we/could we incorporate leadership into our training programmes?  The deanery has been looking at leadership in detail over recent months and now have webpage with useful tips and links.  There was a general concensus that we do not always recognise that what we are teaching on the half day release is indeed related to leadership.  It was also apparent, after listening to the First5 GPs who spoke at the meeting, that very few of us think that we are “leaders” – even though as part of our day to day job as GPs we need numerous leadership skills in order to function effectively.


There is no way of doing justice to the topic of leadership in such a short post, however, if you are interested and wanted to find out more there a number of websites which are worth checking out such as the NHS Leadership Academy, the RCGP and the London Leadership Academy toolkit.



Prescription and Over the Counter Medication Addiction

Addiction to prescription medication and over the counter medicines has a significant effect on patients’ lives and can present a challenging clinical scenario for GPs.  Although it is not always as obvious as other forms of addiction, for example, to illegal drugs such as heroin or cocaine, it probably affects much larger numbers of patients.  There are two links to Radio 4 programmes which are both very interesting.


The first programme focuses on the role of the GP – I will leave it to you decide whether or not it accurately reflects what we as GPs are really thinking and doing.  The second programme looks at how over the counter medications can lead to very severe addiction problems.  If you are looking for practical, hands-on clinical advice the RCGP have a section on their website dedicated to the above problems – see the factsheets at the bottom of the page.




It has been a busy week with the publication, by NHS England, of the Urgent and Emergency Care Review and also the GP Contract for 2014/15.  The role of GPs in providing prompt same day access was highlighted in both reports, forming part of a plan to ease some of the pressure currently faced by emergency departments and also addressing the desire to reduced unplanned admissions.


The GP contract included some significant changes including the removal of a number of QOF points and areas.  The “headline” change would seem to be the enhanced service to reduce unplanned admissions and to provide proactive case management for patients identified by risk profiling.  Specific ways to support this would be direct telephone access to a patient’s GP for Emergency Departments and Paramedics and improving same day access.  In addition, all patients aged 75 years of age or older will have a named accountable GP who will co-ordinate their care and Practice boundaries will be removed.  NHS England will co-ordinate urgent same day care for those patients registered away from their home.  The push to harness the power of the internet continues and patients should have online access to their summary care record and be able to book online appointments and request medication (see the RGCP document Patient Online: The Road Map).


It is important to note that money is being recycled to enable these changes rather than new funding being directed to General Practice.  Perhaps with this in mind, the RCGP have started a campaign “Put Patients First: Back General Practice” to campaign for additional resources.  There is a lot interesting information in the campaign brief and you can sign receive updates either through Twitter or Facebook.


There will be a lot of changes in General Practice over the coming months, some of which will be very challenging.  I think that as GP trainees it is important you consider how you would approach these challenges and what the pros and cons may be.


The RCGP annual conference took place this week in Harrogate against the backdrop of increasing media attention on seven day opening of GP surgeries.  Earlier in the week the Prime Minister shared his vision for patients to have the “chance to visit a GP in the evening or at weekends”Concerns have been raised about how the current GP workforce would be able to meet this demand when we are struggling to cope with the current workload.  I wonder how, as GP trainees, you feel about the prospect of working significantly different hours to those you “signed up for” when you accepted your place on the GP training scheme?


Another controversial idea was that floated by Dr Clare Gerada with regards the independent contractor status of GPs.  Dr Gerada has suggested that GPs should be “salaried to the NHS”.  An interesting summary of the pros and cons can be found in a document Dr Gerada published in 2009 for the RCGP.  I suspect this will continue to be a contentious topic of debate that, if it comes to pass, may have a bearing on your own professional plans as a GP trainee.  What would you choose?


If you would like to see more then check out the videos of Jeremy Hunt and Dr Clare Gerada delivering their speeches at the conference.


Away from the conference, NICE have released “Diagnostic guidance” on the use of Faecal calprotectin.  This is a test used to help differentiate between patients with irritable bowel syndrome and those with inflammatory bowel disease (Crohn’s disease and Ulcerative Colitis).  On the surface of it this would seem to be a useful test for GPs who frequently see patients with bowel symptoms. I would recommend having a look at the guideline – even though I am not entirely certain if the test is available in Barnsley yet.


Results of the CSA review

The independent review of the Clinical Skills Assessment (CSA) has now been published. The General Medical Council (GMC) commissioned the review amidst growing concerns from groups such as the British Association of Physicians of Indian Origin (BAPIO) about the failure rate for International Medical Graduates (IMGs) taking part in the CSA.  Further details of the review can be found at bmj.com.


Despite the conclusion suggesting that “it is the preparedness of UK graduates that may be an explanation for the differences between these two groups” and observing that the “CSA is not a culturally neutral examination” the author of the report, Prof Aneez Esmail, has allegedly accused the GMC and RCGP of “mis-representing” his report.


In 2010 the Yorkshire and Humber Deanery published a report looking at the experience of IMGs.  The results of this report seem to support some of the conclusions from the CSA review and may be useful for trainees and their trainers to take into account. Our hope is that all trainees on the Barnsley VTS get a better understanding of the culture of the local communities within which they work.