July 2014General Practitioners Committee

GP Trainees Subcommittee

GP TRAINEES Summer Newsletter

Dear trainees,

The academic year is coming to an end to most of you.Finishing exams, getting all the assessments done and all therelevant paperwork completed in an extremely short periodof time is not the easiest thing to do. There is much paperworkto complete and please don’t fall foul of it. For those of youcompleting training and embarking life as a qualified GP,please do make sure you use the resources available for BMAmembers to prepare for your future employment.

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In this newsletter:Contract Renegotiation 2

Out of Hours Care and the GP Curriculum 3

Know your Payslip! 5

LMC Conference 2014 7

Keeping Active During Training! 8

Post Qualification 9

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Contract RenegotiationThe contract negotiations with NHS employers are ongoing. This process is going to take a significantamount of time and you can follow the progress of these negotiations here:

http://bma.org.uk/working-for-change/negotiating-for-the-profession/junior-doctors-committee/contract

RCGP ePortfolioWe wrote to the RCGP expressing our ongoing concern with the new ePortfolio and have been assuredthat the minor bugs are being fixed. With every update the ePortfolio is becoming a more stableplatform, however the recent outage has caused some concern and we have raised this with thecollege for immediate action. If there are ongoing problems, please do get in touch with the ePortfoliohelp desk.

BMA CommunitiesThe association has launched this new facility to engage members and non-members alike to sharethoughts and engage in debate online. This serves as a forum for all of us to share our views andcontribute to shaping policy and most importantly, holding us to account! There is a GP Trainee specificsection as well as the broader medical topics. You can find out more at:

https://communities.bma.org.uk/

GP Trainees Subcommittee regional elections 2014 – 2015The GP Trainees subcommittee are holding elections for 11 regional constituencies this summer:

• East Midlands• Kent, Surrey and Sussex• London, North Central & East• London, South• Lancashire (North West Deanery region of North West LETB)• Scotland, West • Scotland, South East / East• Severn • Thames Valley• Wales • Yorkshire

If you would like to get involved in the work of the subcommittee, and really make a difference to thelives of your fellow GP trainees, please consider standing for election. Candidates do not have to beBMA members.

Anyone can stand who is either:

a) on a GP training programme that will not finish before 24 September 2014; or

b) starting a training programme between 27 June 2014 and 26 June 2015.

Successful candidates will be elected to serve for two full sessions; 2014/15 and 2015/16 unless therepresentative is set to qualify as a GP during the first session, in which case they will only serve for onesession

Full details of the election and nomination forms can be found on the BMA website:

http://bma.org.uk/working-for-change/negotiating-for-the-profession/bma-general-practitioners-committee/committee/gp-trainees-subcommittee/regional-elections-2014-2016

Nominations close at 5pm, Friday 18 July 2014.

If you have any concerns about your training or employment, please do contact the BMA helpdesk.You can also find me on twitter as @Dr_Kasaraneni if you prefer to have a more informal chat aboutissues affecting GP training and trainees.

- Dr Krishna Kasaraneni, Chair GP Trainees Subcommittee

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Nominations close at 5pm, Friday 18 July 2014.

Dr Krishna Kasaraneni

Chair GP Trainees Subcommittee

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GP Trainees Subcommittee

3

Out of Hours Care and the GP CurriculumOut of hours (OOH) care is integral to the GP curriculum. It is important you as a trainee to understandwhat is expected of you and also what you should expect from the OOH provider.

Below is a summary of the guidelines to OOH training outlined by the Committee of GP EducationDirectors (COGPED). If you find there is a great deal of variability in your deanery or if you have anyconcerns please email Christopher Scott at c.scott@bma.org.uk

OOH is defined as work undertaken between 18.30-08.00 and all day at weekends and on publicholidays. Current guidance suggests a minimum of 4-6 hours of OOH care should be completed permonth when working in a GP post. This is the same regardless of the year of training. Most deanerieshave selected the higher figure of 6 hours per month (there may be local variation, please refer to yourdeanery website for further guidance on this). For example, an ST1 doing a 4 month GP post wouldneed to complete at least 24 hours of OOH work and a full time ST3 72 hours. An Integrated post (ITP)is classified as a GP post therefore the OOH requirement is the same as a full time GP post. Thoseworking part-time are required to do a pro-rata amount.

4 month Post 6 month Post 12 month Post

(GP/ITP) (GP/ITP) (GP)

No. of hours/month 4-6 4-6 4-6

No. of sessions/month 1 1 1

Total No. of sessions 4 6 12

If you are unable to complete the minimum number of hours during a rotation in your ST1/ST2 year,then extra sessions can be done in ST3.

You are expected to demonstrate competencies in six areas of the GP curriculum related to the ‘care ofacutely ill people’ which are:

1. Ability to manage common medical, surgical and psychiatric emergencies in the out of hourssetting

2. Understanding the organisational aspects of NHS out of hours care3. Ability to make appropriate referrals to hospitals and other professionals in the out of hours setting4. Demonstration of communication skills required for out of hours care5. Personal time and stress management6. Maintenance of personal security, and awareness and management of security risks to others

Historically OOH services were provided by GPs, over time this service has now evolved to a network ofproviders which vary across the country. The provider must not only deliver high quality care but willneed to have the capacity and capability to deliver the required training for you.

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A small number of practices still take responsibility for OOH services, in this situation OOH training foryou remains within that Practice. Otherwise clinical supervision is arranged by the OOH ServiceProviders.

There are a number of organisations available to you that are involved in the delivery of OOH care,including GP co-operatives, commercial services, NHS 24, nurse triage, urgent walk-in-centres,ambulance services and GPs embedded within A&E departments.

You should keep a record of all OOH sessions by completing an OOH record form (see resources below)with the clinical supervisor. This is for you to record your feedback from each session. You should laterlog an e-Portfolio entry reflecting on the experience and the competencies you have achieved. Ideallythe OOH record form should be scanned and attached to the log entry.

Your Educational Supervisor (trainer) takes overall responsibility for signing off your OOH experienceand competence.

What should you expect from the OOH Service Provider?OOH providers should offer you appropriate induction to the service, including the use of the computersystems and any specific in-house protocols. The time you have spent on training during your inductioncan contribute to your OOH work.

Clinical Supervisors receive appropriate training commissioned or provided by the PostgraduateDeaneries. They are trained to look at your level of experience, competence and confidence; they arethere to provide you with an appropriate level of supervision. OOH providers should ensure that yourClinical Supervisor has adequate time to debrief and sign off each session.

The number of hours worked in any week should comply with the Working Time Regulation whichstates that the maximum length of work (currently 13 hours) and minimum rest periods (currently 11hours).

Resourceshttp://www.rcgp.org.uk/gp-training-and-exams/gp-certification-overview/~/media/Files/GP-training-and-exams/Certification%20files/Out-of-Hours-OOH-Training-for.ashx COGPED, Out of Hours (OOH) Training for GP Specialty Registrars, Revised Position Paper 2010

http://www.rcgp.org.uk/policy/rcgp-policy-areas/~/media/Files/Policy/A-Z-policy/RCGP-OOH-Training-Review-report-2011.ashx

Royal College of General Practitioners Review of Out-of-Hours (OOH) Training for GP Specialty Trainees,Executive Summary, revised report September 2011

http://www.rcgp.org.uk/gp-training-and-exams/gp-certification-overview/~/media/Files/GP-training-and-exams/Certification%20files/Record-of-out-of-hours-session.ashxOut of Hours Record Form

- Dr Bhavagaya Bakshi, London North West Representative

Dr Bhavagaya Bakshi

London North West Representative

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Know your Payslip!It may seem obvious but it is well worth paying attention to your payslip. Here are the key numbers tocheck to ensure you get what you’ve earned.

Salary ScaleThis is the scale on which your basic salary is based. This should be the GP or Speciality Registrarscheme.

Pay scales for doctors in training in England 2014:http://bma.org.uk/practical-support-at-work/pay-fees-allowances/pay-scales/juniors-englandPay scales for doctors in training in Scotland 2014:http://bma.org.uk/practical-support-at-work/pay-fees-allowances/pay-scales/juniors-scotland

IncrementCurrently, with each year of training you will gain another increment or level. You will start at theminimum point of the Registrar scheme if coming straight from Foundation Training.

If you have previous relevant service (such as previous training in another speciality) you should beappointed to an equal or higher increment level according to how many years. You should never dropan increment level. It doesn’t necessarily have to be time in training or even in the UK to be consideredto count – if in doubt it is worth approaching your human resources or payroll department to discussany period of service which might be considered.

The incremental dateThis is the date your increment is due to step to the next level, normally as you step-up training grade.Make sure this is correct to ensure your pay increases correctly.

Pay Banding Your secondary care rotation is banded according to what hours you are required to work.You should certainly check what Pay-Band your rotation is on and ensure you are getting paid this. Thisis where completing hours monitoring accurately is vital. In GP posts there is not a banding but asupplement of 45%.

It is also worth checking that the rotation is correctly banded according to how many hours you actuallywork. For more advice, including what to do if you think your rotation is incorrectly banded, see theBMA’s pay-banding guidance:http://bma.org.uk/practical-support-at-work/pay-fees-allowances/pay-banding

Tax Code and TaxIssued by HMRC, your tax code defines how much income tax you pay monthly – deducted directlyfrom your salary. Various factors may affect this including if you’ve reclaimed tax from approved work-related expenses. Make sure your tax code is correct, particularly as you move employer to ensure yourtax is paid evenly throughout the year – and to avoid any nasty surprises! You’ll find it on previouspayslips or tax statements.

Contact the HMRC if you have any queries regarding your tax code.

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National Insurance and NI NumberThis is a further deduction from your salary, to build up an entitlement to certain state benefits. Yourcontributions will depend on how much you earn. You will keep your National Insurance Numberthroughout your working life.

Other things to check:

NHS Pension SchemeUnless you’ve opted out, you will contribute towards your NHS Pension, based on your basic salary.

Student LoanYou will automatically contribute to repaying your student loan if you have one. It is worth ensuring thishappens to ensure you repay this.

Mess FeesSome employers will deduct a fee for a Doctors’ Mess, usually this is optional.

Mileage and other expensesIf you reclaim travel expenses this may be returned to you via your payslip – worth making sure thistallies with what you expected!

Changing EmployerTry to provide your new employer with a copy of your most recent payslip and any further forms (like aP46) as soon as you can to ensure you are given the correct salary scale, increment, date and banding.

If you’ve realised you’ve been paid incorrectly, raise this with your payroll department, with as muchdetail as you can provide.

If you’re still concerned or for more advice, call a BMA adviser: 0300 123 1233.

- Dr Nick Jestico, Severn Representative

Dr Nick Jestico,

Severn Representative

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LMC Conference 2014I am on my return train journey heading home from the annual local medical committee (LMC)conference 2014 which has been held in York over the last two days. This offers a great opportunity forme to gather my thoughts (and dare I use the term ‘reflect’ on the experience- I am a GP trainee afterall!). It has been a very busy motion-debating filled two days but one which has been hugely interestingand enjoyable. The conference is the opportunity for the regional LMCs and the national GeneralPractitioners Committee (GPC) to debate and vote on proposed motions which if passed will become‘policy’ which will act as the backbone of the work that the GPC will work on, on our behalf, over thecoming year. As a representative from the GP Trainees’ Subcommittee we are there to act asrepresentatives for you – our GP trainee colleagues.

The conference got off to a flying start with the annual report being given by Dr Chaand Nagpaul, theChairman of GPC. This was a very honest report talking about the immense pressures that the currentgeneral practice workforce and in particular GPs are facing. He talked about the threats to the healthand welfare of GPs currently working in an overstretched system and the challenges that we face dailyin an environment with an ageing population with more complex health needs and the difficulties offitting this into the 10 minute consultation. Dr Nagpaul ended on a rousing note clearly stating hispassion to the conference hall and setting out his vision about leading the GPC over the coming year toensure fairness and equality in the workplace for GPs but also to ensure that our patients receive thesafe and top quality care which they deserve.

The debating of motions then got underway. During the two days almost eighty motions weredebated; some serious and challenging to current thinking and practice and some more light-hearted – delivered via means such as poetry, comedy or song! The motions debated covered ahuge range of topics including the regulation of general practice by bodies such as the CQC,current workforce challenges, GP contract negotiations and the role of the CCGs to other topicswhich included the funding for appropriate premises for our practices, pensions, pay and evenpatient respect towards healthcare providers. In the middle of day one everyone was treated to theopportunity to feel warm and cuddly inside when a debate was had about whether consultationrooms must be conducive to a therapeutic environment and whether they should be allowed tohave carpets and have soft furnishings!

During both days the GP trainee representatives, led by Dr Krishna Kasaraneni, proposed our ownmotions and spoke both for and against other motions, including a motion calling on Health EducationEngland to fully fund the costs associated with the increasing numbers of GP training posts andenhanced GP training.

The Conference dinner at the end of the first day was an opportunity for all of the delegates to notonly wander around and peer through the windows of all sorts of trains – old and new (as it washeld in the National Railway Museum) but also offered a well needed opportunity for relaxationafter a hard days debating and an opportunity to meet and mingle with conference attendees fromdifferent regions.

The highlight of a huge number of motions and speeches over the two days of conference for mecame in the very last hour of the final day when a motion was raised regarding the HPV vaccinecurrently only offered to females in the UK. The proposer gave a truly moving and heart-felt speechabout the importance of the vaccine and called upon the DoH to change their current policy and offerthe vaccination to boys as well. His personal experience of the tragedy and pain that this disease canhave made everyone in the room sit up and take notice. It was testament to the speaker’s bravery tostand up and tell an important story close to his heart that led to the motion being carried unanimouslyand the speaker getting a standing ovation as he left the platform. This to me really showed whatconference is about- it’s about grass root doctors having the ability through their local committees andrepresentatives to have a voice to speak up about things that they feel passionate about: whether thisis recognition of good practice or raising current concerns about issues affecting them; their colleaguesand most importantly our patients.

This was my first LMC conference and it was fascinating, tiring and great fun all rolled into two (not sosunny) days in York. I look forward to returning to conference next year to do it all again!

- Dr Laura Dunn, Peninsula Representative

This was my first LMC conferenceand it was fascinating, tiring andgreat fun all rolled into two (not so sunny) days in York.

Dr Laura Dunn

Peninsula Representative

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Keeping Active During Training!All through winter, as I trudged along in the darkness and in the rain with my faint head torch, I lookedforward to the lighter days to arrive so I could see the mountains and lochs that surrounded me. As Icarefully planned another season of training with the motivation that the start of the New Year brings; Icounted the weeks, chose my races and thought about how I was going to fit in a run on the few longshifts or night shifts that overlapped with my training days.

However, just as the winter started to fade and my motivation peaked, I got a running injury. Ireluctantly came to the realisation that it was going to take several weeks, if not months, until I couldreturn to my previous mileage and I would have to think of other ways to keep active in the meantime.

I started to explore mountain biking, swimming, hiking and yoga. Each sport had its own challengesand benefits. Some were indoors others were outdoors. Some could be done quickly, others I couldenjoy for hours on end. Some were sociable, others involved concentration. But all of them wereenjoyable and gave me a chance to relax and re-centre.

I have found motivation from many of the people around me. I have worked with two consultant tri-athletes, a nurse who is a world-class mountain-biker and colleagues that are fantastic cyclists, skiers,climbers and runners. Whether it’s cycling to work everyday or swimming before your morning surgerywe can all benefit from integrating sports into our lives.

I am often surprised when talking to medical students to find what a talented bunch young medicsare. Yet too often the pressures of our medical training mean our interests and hobbies areneglected. From as far back as I can remember I have always been exercising, and for me its alwaysbeen about having fun.

There are not many sports I haven’t tried: in school I took part in a variety of team sports, I joinednumerous sporting societies at university and I relied exclusively on my bike for transport until I had tobuy a car for GP training!

My plans for this year are to attempt sea kayaking, canoe the Great Glen and practice yoga most days.I’m considering the Baxter’s Loch Ness Marathon in September, but my ultimate running goal is theAthens Marathon in November that happens to coincide with my birthday!

There has been a lot said recently about the mental and physical benefits of exercising and we allhave the added pressure of leading by example, however, the most important focus is to makeexercising enjoyable. If we succeed with this all the other benefits will come. There is an endlessnumber of ways in which we could be more active. Try and find a sport you enjoy and set the timeaside to do it. Don’t get too upset if things don’t always go according to plan, see it as anopportunity to try something different. Persevere and you’ll find that keeping active is a valuableway of coping with the demands of medicine.

- Dr Roberta Lindemann, Scotland, North Representative

...the most important focus is tomake exercising enjoyable.

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Post QualificationFirstly, hearty congratulations for those achieving CCT; well done for getting through the exams, WPBAand the ePortfolio! Cherish your success, obtaining MRCGP is no mean feat! You will soon learn, as Ihave recently, finishing training is just beginning of your career in GP. There will be many questions thatcross your mind and I hope that this article answers many of your questions.

Registering for Performer’s List:This is vital initial step, as you will not be able to work as a GP without doing this. Usually the LocalArea Team (LAT, which is new name for PCT) which you have registered with as a trainee, can registeryou as GP. Performer’s lists in England have now merged and registering on one area’s register wouldsuffice. They will ask to see your Original CCT certificate or a copy authorised by your trainer or practicemanager. Get details as soon as possible and start the process in good time. You’ll also need evidencethat you have medical indemnity before you get registered and it’s best to get quotes from individualorganisations. Most will have a basic package per annum and sign up for it, as you may not know forsure how many sessions you will need covered, until you start working, these often work out the bestoption initially. You can always change the policy and some organisations take the average at the endof a year.

EquipmentYou also need to start looking to buy necessary equipment whilst waiting for registration onperformers’ list. BMA members do get discount and please seehttp://www.bmamedicalsuppliesdirect.co.uk/ . You can also use other websites like Amazon andyou can claim these whilst submitting your tax returns.

Which working pattern will suit you?Everyone of us would have pondered this, but what is right choice? You can choose to take up apartnership job, be a salaried GP, locum or do a combination of these! You might’ve had a fewdiscussions and received advice from your peers, supervisors and senior colleagues. Every path has itspros and cons and it also heavily depends on your personal circumstances i.e. marriage, spouse’s job,family, child care etc. All of us would’ve gone through the same confusion and rest assured, it’s entirelyappropriate to feel perplexed about your choice. You are not the only one! Talk options through withyour friends or mentors can be really useful. My personal advice is to keep doing some locums if youdon’t know which way to go. Doing locums allows you to understand how each practice works, tokeep you going and also to make new contacts whilst aiding you to consolidate your clinicalexperience.

Networking and CVMake sure you’ve given some thought into writing CV before applying (see CV writing tips boxbelow). It is important to write a cover letter for each position and to take time to read the personspecification to highlight aspects in your CV which match this. Make sure you receive informationabout all available opportunities by circulating your email address amongst local faculty or VTSmanagers. LMC websites and bulletins usually have advertisements and other websites like BMJ careers, www.jobs.nhs.uk are also useful. RCGP first 5 group, local faculty first 5 and newGPs’ groups are very useful in networking. Monthly PCT / CCG wide teaching sessions are also goodsource of getting to know people or making contacts with other colleagues. Some CCGs havemonthly sessions and some may have more infrequently. You can also email your CV to the PracticeManager (PM), where you’ve last worked and request them to circulate it to other PMs in CCG area.

Congratulations forthose achievingCCT; well done forgetting throughthe exams.

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Dr Kalindi Tumurugoti

East Midlands Representative

Attending LMC open meetings also gives opportunity to network as well as keeps you abreast ofrecent developments and changes in Primary Care.

CV Writing Tips1) Keep it simple – i.e. demographics on page 1 (no need to mention gender or date of birth,

if you don’t want to) with qualifications and special interests, experience on page 2 withpersonal statement, referees on page 3. Ideal length of CV is 3-4 pages.

2) First page is very important and short listing people take 20 seconds to scan through firstpage. So please use it for important things like additional qualifications / interests

3) You don’t need to delineate each and every post you’ve done in the past – be concise

4) Write a brief personal statement tailored to that post.

5) You don’t need to give full details of referees – you can give their name, designation and placeand then use sentence like “details on request”.

Salaried GPThere are plenty of salaried vacancies available! GMS practices will provide you a BMA model contractand there is no such requirement for a PMS practice. Please click http://bma.org.uk/practical-support-at-work/contracts/sessional-gps. Salary varies and is usually mentioned as full timeequivalent. Working 9 sessions per week is considered as full time in most of the surgeries and domake sure that you run it past BMA should you have any questions. BMA runs a free contract checkingservice for members. http://bma.org.uk/practical-support-at-work/contracts/contract-checking-service. You can negotiate medical indemnity fees on top of your salary and of course pensioncontributions are paid for employees.

PartnershipThis is again, is a huge decision and will need careful consideration into all aspects including clinicalcommitments, business and premises. Lot of information available on GPC websitehttp://bma.org.uk/practical-support-at-work/contracts/independent-contractors.http://bma.org.uk/working-for-change/negotiating-for-the-profession/bma-general-practitioners-committee/committee

Locum JobsYou can register with a locum agency or make arrangements directly with surgeries- you are your ownboss! Locuming needs meticulous organisation as you need to send in invoices, fill paper work forpensions and make sure you get to the right place at the right time! You need to consult anaccountant, who can give an insight into how things work from tax point of view. It’s always prudent toagree on a contract if you’re doing a longer term locum. However, even for short term locum jobs youmay want to prepare a document outlining your terms and conditions.

Revalidation and ePortfolioYou will receive a letter from GMC confirming your revalidation and you need to update youremployer/CCG / LAT details on the ‘my GMC’ website after receiving it. Once, you’ve updated it, thenyou will receive a letter in about 4-6 weeks’ time confirming your assessor details and next appraisaldate. It’s important that you check this date and make sure it is approximately within 11-12 months ofyour last appraisal i.e. last ESR. Please ring appropriate personnel, if it is too soon or too late. The teamlooking after revalidation in your local area will change dates on your ePortfolio and will also attach it toyour assessor. Onus lies on you to inform them as to which platform you’re using i.e. RCGP ePortfolioor something else. Keep looking out for CPD sessions (free or paid) and faculty led new GPs meetingsas well as study days for sessional GPs, are very useful resource. Please take some time to look atRCGP’s guidance on this. www.keynoteconferences.com is a very good resource for CPD.

HMRC (The Taxman!)Last, but not the least, HMRC! Things are straight forward if you’re taking up a salaried post as tax isdeducted at source. You need to ensure that your tax code is correct and you’re pension details are upto date. If you are doing locum work you will need to ring HMRC and register as self employed. You’llpay class 2 NI contributions at £2.75 per week if your earnings are above £5885 per annum. You’lldefinitely need an accountant if you are doing locum work or taking up a partnership. Every practicehas their own accountant and you may choose to continue with them, if you’re joining as partner. Formore information, please see advice available on HMRC, BMA and RCGP websites.

Enjoy your new role and don’t hesitate to seek help if you’re in doubt. All the very best!

- Dr Kalindi Tumurugoti, East Midlands Representative

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GP Trainees Subcommittee membership 2013-2014

ChairKrishna Kasaraneni

Executive Group: Terms andConditions of Service Lead(UK) Eastern Donna Tooth

East MidlandsKalindi Tumurugoti

Deputy Chair, Kent, Surrey & SussexSangeetha Sornalingam

Lancashire (North WestDeanery region of North West LETB) Benjamin Brown

London North Central & East Dami Adedayo

London North WestBhavagaya Bakshi

London SouthBrendan O’Brien

Mersey (Mersey Deaneryregion of North West LETB)Nicola Pierce

North EastTom Gorman

Executive Group: NorthernIreland. Northern IrelandPatrick Stirling

Peninsula (Peninsula Deaneryregion of South West LETB)Laura Dunn

Scotland, NorthRoberta Lindemann

Executive Group: Educationand Training Lead (UK).Scotland, South East/EastSarah Mills

Executive Group: Scotland.Scotland, WestJohn Kyle

SevernNick Jestico

Thames ValleyRichard Wood

Executive Group: WalesWalesKashif Samin

WessexSarah Kay

West MidlandsPooja Arora

YorkshireDariush Saeedi

There will be elections for some subcommittee seats this summer.

If you are interested in getting involved in the subcommittee,

please email kjose@bma.org.uk or visit the subcommittee’s web page for more information.