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Reflecting on progress for future success

General Practice Training Wales // Strategic Overview 2011-2014

The Wales Deanery


Strategic Overview 2011-2014 // Contents

Mission Preface Introduction Structure of GP Training Wales Our Major Workstreams GP Specialty Training: Overview GP Specialty Training: Recruitment GP Specialty Training: Innovations GP Specialty Training: Trainers GP Specialty Training: Academic Development GP Specialty Training: Quality & Governance

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Early 1970s

Early 1980s

1996

2002

2003

2004

2004

2005

2005

2006

2007

2007

Formal training for General Practice first piloted

Formal training for General Practice becomes compulsory

Summative Assessment introduced as the beginning of mandatory exit assessment for GP Training

11 Regional Programmes, 273 GP Trainees & 188 GP Trainers in Wales

Initial development of the Further Training Practice Network (FTPN) in Wales to retrain GPs in difficulty

FTPN Wales role extended to include systematic assessment and induction for UK and EEA qualified GPs

Early adoption of competencybased recruitment and selection system for GP Trainees in Wales

Wales introduces use of a machinemarked clinical knowledge test as a shortlisting method for GP Trainee selection

Postgraduate Medical Education Training Board (PMETB) replaces Joint Committee on Postgraduate Training for General Practice (JCPTGP) as the regulatory body for postgraduate medical training

Competencybased system model for GP Specialty Training recruitment is adopted UK wide

New MRCGP single training and assessment system replaces previous UK Summative Assessment

Introduction of the Gold Guide for Specialty Training in August 2007

2007

2008

2008

2008

2009

2009

2009

2009

2010

2010

2010

2010

54 GP Trainers recruited to take on the role of Educational Supervisor of GP Trainees whilst in hospital posts following the introduction of the nMRCGP

18 month placements split between hospital posts, and General Practice replace the original 24/12 month training model

Introduction of all Wales online endof-placement evaluation feedback (EPEF) for GP trainees in hospital posts

First GP Annual Review of Competency Progression Panels (ARCP) held in June 2008

Introduction of a Continuous Quality Improvement (CQI) strategy

A new online system of accreditation of GP Trainers introduced to monitor GP training standards

Five GP Specialty Trainee representatives appointed in Wales

Initiation of sub-regional meetings for district Scheme Administrators

General Medical Council (GMC) replaces PMETB as the regulatory body for postgraduate medical training in April 2010

Appointment of a new Associate Dean with responsibility for Curriculum Delivery Coordination in Wales

Appointment of a GP Research Lead to manage a new Academic General Practice Training programme scheme in Wales

12 Regional Programmes, 408 GP Trainees & 230 GP Trainers in Wales

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GP Further Training: Overview GP Further Training: Returners & Inductees GP Further Training: GPs in Difficulty

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Organisational Capability: Overview Organisational Capability: Human Resources Organisational Capability: Communications Organisational Capability: Trainee Reps Organisational Capability: Future Capacity

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Meet the Team Academic Publications

Timeline of Major Developments in GP Training in Wales and the UK

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26 27 28 29 30 32


General Practice Training Wales // Mission

We aim to significantly contribute to the health and well-being of the people of Wales by continually improving the provision of GP training.


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Strategic Overview 2011-2014 // Preface

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In the last five years there have been major changes in the organisation and regulation of medical education in the UK. I am delighted to congratulate Dr Phil Matthews and the GP Training Team in Wales on planning and successfully managing the introduction of so many positive innovations and procedural solutions.

Why high quality GP training and excellent General Practice are critical to an efficient and cost effective NHS in Wales:

From this firm base, we now need to look forward to ensure that we carry on effectively delivering what is required.

GPs refer patients to secondary care in only 4-5% of consultations, and the majority of these referrals are for planned surgical operations

The start of the millennium brings increasing financial as well as organisational challenges. The introduction of integrated Health Boards and a new plan for delivery of primary health care in Wales, coupled with transformations in General Practice commissioning and medical education structures in England, are major changes already in progress. This is therefore a particularly timely opportunity for The Wales Deanery to produce this excellent strategic overview of General Practice Training in Wales.

According to The Office for Health Statistics, there are around 260 million consultations between patients and GPs in the UK every year The government is currently pursuing an agenda of shifting care out of hospitals, reinforcing the need for appropriate workforce capacity in primary care

86% of all the health needs of the British population are managed in primary care GP care for a whole year costs less than a single day’s hospital admission 97% of respondents to the 2005 Healthcare Commission survey of primary care patients said they had confidence and trust in their GP

Strategic Overview 2011-2014 // Introduction

Thank you for taking the time to look at this strategic overview. It describes the work, achievements and plans of the many General Practitioners (GPs), administrative staff and aspiring GPs who contribute their energies and skills to the dynamic, supportive and forward looking culture that is General Practice Training Wales. In the pages that follow we outline and explore the progress we have made in a wide range of operational areas in recent years, and demonstrate our strategic plans for the next three years. In doing so we have not provided an exhaustive list of achievements and goals, but have instead highlighted those we consider most important. Our approach is always to anticipate potential change and plan well for it. We recognise that in the fast-paced environment of health care and medical education, some important new challenges inevitably arise unforeseen. When such challenges emerge we will continue to carefully analyse them, generate robust solutions and enthusiastically adjust our strategy accordingly. Our motivation in producing this visionary document is to:

A 2006 international survey of primary care physicians found that in the UK 76% of GPs felt they were well prepared to provide optimal care for patients with multiple chronic conditions – second only to Germany

— demonstrate our work and accomplishments

The Value of General Practice, RCGP Fact Sheet, November 2006

This in-depth overview complements the production of a broader strategic report on the work of the whole Wales Deanery.

— underline our ongoing contribution to NHS Wales — explain our commitment to perpetual improvement — outline how we will continue to play our part in delivering the mission of The Wales Deanery as a whole

We believe this document clearly demonstrates our on-going commitment to delivering a continually growing, significant and positive impact on the health and well-being of the people of Wales.

Professor Malcolm Lewis Sub Dean & Director of Postgraduate GP Education

Dr Phil Matthews Sub Dean, Head of General Practice Training Wales & Deputy Director of Postgraduate GP Education

General Practice Training Wales is responsible for managing: Training Programmes in Wales for doctors wishing to become GPs The re-training of qualified GPs in Wales, when this is required by The General Medical Council (GMC) or National Clinical Assessment Service (NCAS) Systematic assessment and managed refresher or induction training placements for UK and EEA qualified GPs based in Wales, who have not worked in UK General Practice for two or more years

GP Training in Wales was a great experience for me. My scheme was well run, with weekly access to protected teaching. Hospital jobs in appropriately chosen specialties were run by approachable clinical supervisors, with a strong commitment to learning. My local GP Programme Directors were friendly, always available, and focused on tailoring the programme to my individual needs at all times. I could not have wished for better from my Training Practice, which equipped me well in passing all components of the MRCGP. Overall, GP Training in Wales helped make the transition from Trainee, to locum GP, to GP Principal, as smooth as possible.

Dr Jamie Jones, GP Trainee (2006-2009)


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Strategic Overview 2011-2014 // GP Training Wales The Wales Deanery

Postgraduate Medical and Dental Education Wales (The Wales Deanery) is responsible for commissioning, overseeing and monitoring the provision of education and training for some 2,600 doctors and dentists in postgraduate training posts in the NHS throughout Wales. The Wales Deanery also helps to oversee the provision of Continuing Professional Development for General Medical and Dental Practitioners across Wales. At present, Professor Derek Gallen (Dean) and Professor Peter Donnelly (Deputy Dean) are further professionalising the organisation and structure of the Deanery.

Foundation School

Dental Practice Secttion

Managment Executive & Postgradute Board

Secondary Care Postgraduate Training Unit

Deanery Support Units

General Practice Section

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Wider Deanery Foci Deanery Executive Board Membership Medical Revalidation Foundation Training Working with Deanery Units

GP Support Wales GP Continuing Professional Development GP Appraisal

GP Training Wales GP Specialty Training GP Further Training

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General Practice Section The General Practice Section of the Wales Deanery contributes to the wider deanery activities, for example: as members of the Deanery Executive & Board; in Medical Revalidation; and in Foundation Training. 02

General Practice Training Wales Within the General Practice Section there are two units working closely in tandem: GP Appraisal and Continuing Professional Development Wales; and GP Training Wales. This Strategic Overview document concentrates on the work of GP Training Wales. The GP Appraisal and CPD Unit produces a separate periodic review of its work. The Welsh Assembly Government regards the development of primary care and General Practice as one of its top priorities and has funded numerous initiatives to support the training of both new and established General Practitioners in Wales. To deliver these programmes General Practice Training Wales has two functions: Specialty Training which delivers the training of new GPs; and Further Training which runs training for existing GPs.

GP Specialty Training

I started my GP Specialty Training in August 2006 and completed two years of hospital medicine, before entering my GP rotation in August 2008. The advice and information from the Wales Deanery meant that the whole process ran very smoothly and I’d definitely recommend training in Wales. I was well supported, all my questions were answered swiftly, and any training changes were effectively communicated through the e-portfolio. The move to e-portfolio and the nMRCGP was smooth and consistent, and did not negatively affect my training experience. Since completing my training, I am currently covering another GP’s maternity leave; and I have recently been offered a partnership which will begin in 2011.

408 future GPs are undertaking 3 or 4 year GP Specialty Training Programmes in 12 regional GP Specialty Training Schemes located across Wales

Dr Ian O’Sullivan GP Trainee (2006-2009)

21 GPs wishing to return to the workforce in Wales, after prolonged absence, have received refresher training since 2004

24 GP Programme Directors run these 12 GP Specialty Training Schemes Conventional 3 year programmes consist of 18 months in hospital and 18 months in GP placements Pilot 4 year programmes consist of 24 months in hospital and 24 months in GP placements 204 GP Specialty Training placements are based in 25 hospitals throughout Wales 204 GP Specialty Training placements are based in 130 approved GP Training Practices 230 GPs in these practices have been trained and accredited to train future GPs GP Further Training 12 GP Practices provide Further Training placements 12 GPs in difficulty have received retraining since 2003

8 European Economic Area (EEA) accredited GPs wishing to enter the workforce in Wales have received induction training since 2004


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Strategic Overview 2011-2014 // Our Major Workstreams

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As General Practice Training Wales has grown in recent years, we have organised our work into three distinct activity areas.

This has enabled us to develop an ethos of continual improvement, to compliment our primary role of providing an effective and accessible GP training service. Our three areas of focus are: Specialty Training Further Training Organisational Capability

Developing & Supporting New GPs ForThe People of Wales

We have identified a series of strategic goals for each of these activity areas to assist us in our aim of continual innovation and improvement.

Systematically Reviewing & Refining Strategy Organisation of GP Specialty Training (GP ST)

Researching & Evaluating

Improving Communication & Data Handling

Some of these goals are outlined throughout this document.

Improving our Organisational Capability

Work of General Practice Training Wales

Employing Continuous Quality Improvement

Developing & Supporting GP Specialty Trainers

Planning & Developing Human Resources Developing & Supporting Further Training Practice Network (FTPN)

Organisation of GP Further Training (GP FT)

Assessing & Inducting Foreign GPs & UK Returners

Retraining GPs with Performance difficulties

Leading & Managing GP ST

Leading & Managing GP FT

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The Wales Deanery is, in my opinion, a leading player nationally in a number of areas that are critical to the advancement of GP Specialty Training. The aim to bring in a centralised contract for the entirety of training, and the proposal to offer a four year Training Programme option, are reasons I wanted to get involved as a GP Specialty Training Representative. When these developments are established, it is my belief that this will further professionalise GP Training and make it an even more popular specialty career option than it already is.

�

Dr Simon Davies GP Trainee Representative


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GP Specialty Training // Overview

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GP Specialty Training is the predominant and longest established area of our work. Over 400 GP Trainees in hospital and General Practice placements throughout Wales are supported by 24 Programme Directors and more than 200 GP Educational Supervisors / Trainers. Our responsibilities in relation to GP Speciality Training are: —— Influencing (in liaison with other UK Deanery GP sections) and implementing UK regulatory policy.

Goals to be achieved by 2014 In Developing and Supporting New General Practitioners for the People of Wales we will: Produce an evaluation of a 4 year pilot Training Scheme Implement a single contract arrangement with a sole lead employer for all GP Trainees in Wales Extend the quality control role of GP Specialty Trainee Representatives to include District Scheme Reviews and Training Monitoring visits

—— Attracting and recruiting 136 doctors each year to the 12 GP Specialty Training Schemes in Wales.

Train and report on the effectiveness of a ‘bank’ of lay representatives involved in GP Training quality control activities

—— Ensuring GP Trainees have an appropriate mix of posts that comply with regulatory requirements.

From 2010 recruit and develop two GP Academic Trainees per year

—— Ensuring GP Trainees experience well organised and supportive learning environments and effective curriculum delivery.

Report on steps taken to further facilitate appropriate entry for less-than-full-time GP Specialty Training

—— Providing eligible Trainees with the opportunity to train part-time, or take time out of their programme.

In Developing and Supporting General Practice Specialty Trainers we will:

—— Supporting Trainees in difficulty and, if necessary, liaising with our Deanery Performance Unit.

Evaluate the new on-line training monitoring procedures and publish the findings

—— Management of the Annual Review of Competence Progression (ARCP) for all GP trainees in Wales. —— Management of GP Trainees’ annual appraisals.

Implement a new post-module assessment system for our Prospective Trainer Course (PTC) and publish an evaluation

—— Management and quality assurance of GP Programme half-day release training.

Introduce a system of annual individualised feedback for all GP educational supervisors

—— Management and support for the system of workplace-based assessments, which are part of the GP licensing assessment package that confers Membership of The Royal College of General Practitioners (MRCGP) and the award of a Certificate of Completion of Training (CCT) —— Recruitment, training and professional development of GP Educators, including GP Programme Directors, GP Educational Supervisors / GP Trainers

In Leading and Managing GP Specialty Training we will: Introduce a system to use End of Placement Evaluation Feedback (EPEF) data to improve all levels of curriculum delivery Review delivery of the new RCGP curriculum and report on the implementation and impact of agreed changes

GP Speciality Training // Regional Round-up

Aberystwyth The Aberystwyth scheme provides an English Language Development Course for all trainees who want to improve their English Language skills. Feedback has been very positive and Trainees state that it has improved their confidence when speaking to patients.

Dyffryn Clwyd Dyffryn Clwyd generates a close knit community of Trainees through joint meetings for all levels of Trainee with regular teambuilding. We are delivering a varied curriculum locally by cooperating with neighbouring schemes.

Bangor Bangor is a smaller scheme, based in and around the Snowdonia National Park. Since the advent of the nMRCGP we provide active support to Trainees at a scheme and practice level in preparation for their assessments. Trainers, both in General Practice and the hospital environment, are enthusiastic in their teaching and we are able to keep all GP years together for the half day release scheme.

Glamorgan Valleys We organise three or four informal CSA preparation sessions where Trainees take it in turn to be either the Trainee, patient or examiner. The feedback provides Trainees with an opportunity for reflection and helps them understand a patient’s perspective. At our General Practice Specialty Training Symposium a variety of speakers are invited to talk about different types of work GPs can do following qualification.

Bridgend A highlight of our programme is the annual Communication Skills Trainee Course run in conjunction with the Royal Welsh College of Music and Drama. This year our Postgraduate Centre at the Princess of Wales Hospital has been extended and renovated. The new Centre is providing an outstanding experience for Trainers and Trainees. Cardiff Our trainees have a high exam success rate promoted by lively and well attended Trainers’ Workshops. Recent changes to our administration structures have helped improve our overall scheme management. Carmarthen Trainees are encouraged by Consultants to attend all their half day release meetings if they are not on call or on leave. We find that the third years encourage the first years, creating a supportive group. One or two Trainees teach the others on diverse topics in the curriculum, and this helps cover the curriculum successfully, giving trainees confidence in public speaking and creating a supportive atmosphere.

Gwent and South Powys A current focus has been the e-portfolio with familiarity training sessions set up for Clinical Supervisors. Former Trainees speak to new Trainees at induction and this peer teaching has been well received. We have set up a ‘pass on pack’ system, with advice and tips on what to expect from particular posts. Neath Port Talbot We now have a successful Specialty Training scheme in areas of relatively high deprivation, such as Port Talbot and Glynneath. This has helped improve recruitment and morale of GPs in the area. Many Trainees have found local jobs on leaving the scheme. So far all Trainees have completed their training and qualified for a CCT or equivalent.

Pembrokeshire The rural nature of Pembrokeshire makes it a challenge to entice and retain GP Speciality Trainees. We now run combined group training sessions for first, second and third years, which has improved quality, flexibility and diversity. We have a very active e-group for all Trainees and Trainers which generates debate and provides peer-group support for many clinical and technological topics and issues. Swansea Bay We have an excellent record of high MRCGP pass rates, with 100% in 2010. In preparation for the Clinical Skills Assessment (CSA) we run a ‘mock exam’, utilising a local health centre and actors. This exposes the GP Trainees to near exam conditions, whilst providing feedback from GP Trainers, and highlighting how to improve patient management. We also provide targeted Curriculum Days to cover areas which GP Trainees find it hard to gain experience of, such as clinical genetics or learning disabilities. Wrexham and North Powys Our teamwork style of training starts with a popular two day ‘Introductory Residential’ meeting, usually in Snowdonia National Park. We benefit from an enthusiastic and talented group of Trainers, whose expertise allows the Trainees to explore medical ethics, rural medicine and art in medicine, along with the more conventional elements of the curriculum. We are fortunate to have superb support from our local Postgraduate Centre and from Wrexham Maelor, a local hospital.


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GP Specialty Training // Recruitment & Training

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With over 130 trainee GPs entering training in Wales every year, continually improving the way we co-ordinate recruitment for GP Specialty Training is a core focus. Since 2006 recruitment to GP Training has followed a competency based system used throughout the UK. Wales along with several other Deaneries, has been heavily involved in the development of this UK wide system. We were instrumental in piloting and promoting the use of a machine marked clinical knowledge test to assess candidates. Candidates doing well in the knowledge test are next invited to attend for a further three hours in a selection centre. Successful candidates specify their preferred training locations in Wales; and these preferences are taken into account when allocating placements.

We have introduced new systems to help us develop the performance of the assessors who run our intensive selection processes. New assessors receive a dedicated training day several weeks before the selection centre is held. Additionally, we hold a further training half-day for new and existing assessors, just prior to our selection centre. We also provide performance feedback to the assessors to help us optimise the reliability of the recruitment and selection process.

Pioneering GP Trainee Appraisal Annual appraisal of all doctors, including Trainees, is a GMC obligation and will become an important part of revalidation and re-licensing. It is also an essential part of the ARCP process. In Wales, the GP Section has pioneered the development of a robust on-line appraisal system for established GPs which will soon be used for GP Trainee appraisal as well.

The recruitment and selection process in Wales is extremely well organised and run. Communication from the GP Training Wales Office is first class and successful candidates are notified quickly. The fact that prior experience and personal preferences are taken into account when creating a personalised three year rotation was appreciated by all of us.

Dr Anna Gaskell GP Trainee Representative

We work closely with our hospital consultant colleagues, who provide clinical supervision for our Trainees, during the early hospital based element of their GP Training. This helps to ensure that the support they receive in secondary care placements is optimised. In addition, when GP Trainees encounter significant training difficulties we are able to liaise with the Deanery Performance and Careers Units to organise help and support. They can organise a wide range of assistance from Occupational Health assessment and careers advice, through to psychological support and behavioural coaching.

Qualifying as a GP takes a minimum of 10 years from medical school entry

A minimum of three hours protected teaching time in General Practice placements, as well as weekly self-directed learning sessions

A typical three year GP Specialty Training programme will include:

Between two and four hours protected teaching time in hospital posts, depending on departmental arrangements in each hospital

Support and regular contact from named GP Educational Supervisors throughout the duration of training

30 days annual study-leave, including half-day release study sessions

Two 6 month hospital posts in the first year of training (ST1) 6 months in another hospital post and 6 months in a General Practice post during the second year of training (ST2) 12 months in another General Practice post (ST3) Half-day release teaching sessions overseen by regional GP Programme Directors; these emphasise both personal and professional development, as well as comprehensive MRCGP exam preparation

Out-of-hours training Local support via GP Programme Directors and Trainers (Educational Supervisors) Regular assessment of progress at an Annual Review of Competence Progression (ARCP) Panel Annual appraisal Achievement of a Certificate of Completion of Training (CCT) once all assessments are passed

Dr Shallini Subbu GP Programme Director, Neath

Dr Gareth Parry Jones GP Associate Dean

Qualifying as a GP takes a minimum of 10 years from Medical School Entry GP Specialty Training

Before entering Specialty Training >> 5 or 6 years undergraduate medical training

2 years as Foundation Doctor

GP Specialty Training selection processes

18 or 24 months in hospital-based GP training posts

>> 18 or 24 months in GP-based training posts

Final exams & Certification of Completion of Training (CCT)


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GP Specialty Training // Innovations

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Over the past few years we have developed a number of innovations as part of our ethos to continually improve how GP Specialty Training is organised and delivered in Wales. A few are highlighted here. Lead Employer and Single Contract Historically, many Trainees constructed their own training schemes, applying for hospital posts independently, and frequently only joining a formal GP Training Scheme for the General Practice element of their scheme. Under these arrangements Trainees were given an employment contract for the duration of each successive training placement but were afforded employment protection by the NHS, acting as their legally overarching employer. Any cases of employment injustice were not common enough to lead to a change in the multiple contract arrangements. However, in recent years all new GP Training Programme appointments are for three years (or longer, due to maternity leave and less-than-full-time training, extensions for exam-retakes etc). This change brought problematic employment arrangements into much sharper focus. The introduction of a more formalised annual review of individual Trainee progress in 2007, in the form of the ARCP panel process, further exposed these issues. A positive response from the Welsh Assembly Government to our lobbying has led to the commitment to implement a single lead employer contract for GP Trainees for the duration of their training. We have had preparatory talks with one of the new Local Health Boards in Wales, who will become a single lead employer, holding a full training and employment contract for all GP Trainees in Wales. New Associate Dean for Curriculum Delivery The curriculum for GP Specialty Training is extensive and is now systematically reviewed and refined at a UK level, as the discipline evolves. In July 2010, we appointed Dr Colette McNally as the new Associate Dean for Curriculum Delivery co-ordination in Wales. The role involves co-ordinating a three yearly curriculum delivery review and improvement cycle. ”The challenge of this exciting new role is to help ensure that all GP Trainees under our care in Wales have the opportunity to cover the breadth and complexity of the curriculum in an effective and well-supported manner.” Dr Colette McNally Associate Dean

Aberystwyth English Language Project Aberystwyth is one of the smaller, rural GP Training Schemes in Wales and in recent years has had many overseas trained doctors amongst its GP Trainees. An English language training course was set up with the International English Centre at Aberystwyth University, following concerns from Trainees that they were struggling with some aspects of language in their training experience. RCGP Clinical Skills Assessment exam statistics confirm that pass rates are lower for international medical graduates. On the Aberystwyth Scheme, individual Trainees volunteered for language assessment and took part in an eight week programme of group and individual teaching.

The course dealt with specific cultural communication practices, such as how to structure interviews, deal with sensitive issues, break bad news, give results, and deal with challenging patients, using appropriate and clear diction and language. The improvement in levels of confidence and use of language has been considerable for the doctors who took part.

Dr Karen Penry and Dr Roddy Evans GP Programme Directors

There is a clear need to extend training to cope with the expanding GP curriculum driven by: expansion in medical knowledge; increasing patient expectations; the call for GPs to be formally taught leadership expertise; and the managerial, organisational, medico-legal, ethical, surgical, negotiating, commissioning, computing and people skills required of modern GPs. The timescale for GP Training should be extended in Wales, to reflect the intellectual challenge of this highly complex occupation.

Dr Phil Matthews Sub Dean, Head of General Practice Training Wales & Deputy Director of Postgraduate GP Education

Pioneering a new Four Year GP Training Scheme Initiative: Four Year Training Scheme We have, along with a few other Deaneries, been at the forefront of a move to introduce a pilot scheme offering all GP Trainees in Wales an optional further year of General Practice Training. Situation Analysis: The RCGP curriculum is designed to be delivered over a five year training programme By delivering it in just three years, some GPs emerge from training with knowledge and skills inappropriate to delivering the new Governmental vision of primary care Specific Issues for Wales: A further side effect of this initiative is to enable more training posts to be filled over the next few years, and, in doing so to ameliorate a temporary but significant deficit in junior doctor staffing levels in Welsh hospitals. Pilot Scheme: In late March 2010, with the agreement of the Welsh Assembly Government, we emailed incumbent and recently recruited GP Specialty Trainees in Wales, inviting volunteers for an extended four year scheme. The new scheme includes two years of hospital based posts and two years of practice based posts. Success: This great opportunity has been welcomed by many newly recruited and existing GP Specialty Trainees in Wales Over 50 trainees have converted to the four year programme, starting in August 2010 In order to optimise the value of this initiative we plan to introduce innovative modular training in management, leadership and teaching skills


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GP Specialty Training // Trainers

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General Practice Training Wales is responsible for the recruitment, training and management of 230 GP Trainers, based in 130 approved Training Practices throughout Wales. 24 GP Training Programme Directors oversee our network of GP Trainers. Prospective Trainers undertake a course of three modules (each of two days duration) over one year and practices who have no history of training also attend a New Training Practice Day prior to the modules. This preparatory day provides basic information about GP Training and allows a practice to make an informed decision about whether to pursue the route to GP Trainer accreditation. Demand for the Prospective Trainers Course remains high - approximately 20 doctors are currently waiting to commence the course and we actively manage the waiting list so that trainer supply is matched to those areas with greatest need in different parts of Wales. Trainer practice performance is reviewed annually and in addition each practice is visited periodically. The requirement to attend 75% of local Trainers’ Workshops throughout the year is one parameter we examine. We also provide a variety of educational activities for GP Trainers, including regular sub-regional GP Specialty Training Days, which are organised and run by our GP Associate Deans.

Redesign of Delivery and Assessment of Prospective Trainers Course in Wales Two members of our Associate Dean Team, Dr Mair Hopkin and Dr Gordon Lewis, are leading the development of a new structure and a new assessment process for the Prospective Trainers Course, which will be implemented from October 2010 onwards. Plans for the assessment procedure include the creation of post module online knowledge tests for modules 1 and 2, and an Objective Structured Educational Assessment (OSEA), upon completion of the final module.

GP Specialty Training // Trainers

Training and Supporting the Trainers

Rolling out the new MRCGP Exam in Wales

—— 230 GP Trainers supported in Wales. Monitoring of standards involves an online review and periodic practice visits

When the nMRCGP and e-portfolio were introduced in August 2007, 54 GP Trainers were recruited to take on the role of Educational Supervisor of Trainees during their hospital posts.

—— Support and advice from local Programme Directors and local Associate Dean —— 2 one-day courses run every year for prospective Training Practices —— 2 three-module Prospective Trainers Courses run per year —— Regular Trainers’ Workshops supported via central funding fed into 12 GP Training Schemes —— 3 sub-regional GP Specialty Training Days per year —— More than 200 GP Trainer CPD grants administered every year

Our new assessment procedures will lead to a more rigorous, professional accreditation process, which in turn will help continuous improvement of Trainee supervision in Wales.

Dr Gordon Lewis GP Associate Dean

As this was a completely new role, using new assessment methods and technology (the RCGP e-portfolio), we held an All Wales Educational Supervisor Training day, covering the requirements of the Gold Guide, the role of the Educational Supervisor and the e-portfolio. Three sub-regional Trainer Update courses were run in 2008 and 2009 covering: the updated functions of the e-portfolio; written reviews; content for learning logs and ARCP Panels’ expectations. Feedback from ARCP external assessors has been positive, and we are very pleased with the hard work and commitment demonstrated by our Trainers.

Dr Alan Rogers GP Associate Dean

Training the Trainer Journey Before becoming a Trainer >> Fully qualified GP working regularly in General Practice

One year period of teacher training > GPs wishing to become postgraduate Trainers apply to attend a Welsh Prospective Trainers Course

Preparatory Training Practice Day for practices with no history of training

Module 1: Pre module reading and post module online assessment

Module 2 Pre module reading and post module online assessment

Accreditation and monitoring of Trainer performance Module 3 Pre module reading; preparatory work

Post module OSEA leading to approval and a practice visit if the practice is not already an established Training Practice

Accredited practising Trainer Annual review of approval status including attendance at regular Local Trainer Workshops

I started the GP Trainers Course in February 2007 and completed it later that year. Like many others, I have found the nMRCGP website daunting. I gained most information about it by sitting on the ARCP panels.

Dr Nicholas Prigg GP Trainer Wrexham


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GP Specialty Training // Academic Development

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Research and evaluation of our work is critical in stimulating improvement and innovation. Over the last five years, we have had various papers published in peer-reviewed journals and members of GP Training Wales have presented posters and workshops at many national and international conferences. 2010 sees further advances in our academic work, with the introduction of two GP Specialty Academic Trainee (GPSAT) posts and the appointment of Dr Melody Rhydderch as GP Training Wales Research Lead. This new post will act as a focus and catalyst for driving forward our research and evaluation agenda.

This is a very exciting new development. As well as overseeing the GP Academic Trainees, it is an opportunity to conduct more in-depth academic projects thereby creating a stream of research to simultaneously build on our academic reputation and feed into our ongoing improvement process. It is also, however, an opportunity to empower all staff to embrace evaluation and research as a part of their role.

Dr Melody Rhydderch GP Research Lead

Our research evaluation strategy includes: Leading the GP Training section research agenda Applying research to support evidence-based policy and programme decisions Building capacity to access, use and conduct research and evaluation Fostering research collaboration through networking and partnerships Communicating research through academic journals but also to a wider public Contributing to national and international bodies of research knowledge

I applied to be a GP Specialty Academic Trainee because I wanted to get involved in research; as an early part of my academic programme I have received funding from GP Training Wales to undertake a postgraduate diploma in statistics and epidemiology. I am hoping to get a good grounding in conducting and publishing research, as well as gaining skills and experience in teaching medical students.

GP Specialty Academic Training After their first year of training, all GP Specialty Trainee recruits in Wales will be able to competitively apply to extend their training

Dr Harry Ahmed GP Specialty Academic Trainee

Academic Training Rationale The purpose of the new General Practice Academic Programme is: A route into an academic GP career, starting in General Practice Specialty Training The development of academic skills early in a GP career To undertake training and research in the GP Section of the Postgraduate Medical & Dental Deanery as well as in the GP Section of the Undergraduate Medical School, in tandem with the final part of their clinical GP training Preparation to begin a PhD if subsequently recruited to a GP Academic Fellowship programme

Structure of General Practice Specialty Academic Training Programme First year and Second Year >

Third year and Fourth year >

At Certificate of Completion of Training (CCT)

Clinical training – 18 months in hospital posts and 6 months in a General Practice post.

Clinical training - 2.5 days a week

Opportunity to apply for General Practice Academic Fellowship Programme

Opportunity to apply for Academic Programme during second year.

Academic training - 2.5 days a week


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GP Specialty Training // Quality & Governance

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Over the last few years we have introduced a number of initiatives to further improve our approach to evaluating training experiences and outcomes as well as improving the managerial and support activities which underpin them. Specialty Training Quality Control (QC) and Quality Assurance (QA) Our quality control system routinely utilises evidence from multiple sources including Trainees, Trainers and Programme Directors to gain an accurate picture of the quality of the GP Trainee experience. We make improvements and where necessary liaise with the Deanery QA Unit. This regular dialogue promotes solutions which work with the over-arching Deanery QA Framework.

End of Placement Evaluation Feedback Every six months each GP Trainee in hospital or General Practice posts completes an End of Placement Evaluation Feedback (EPEF) questionnaire. These allow Trainees to highlight good practice and potential issues with the training posts or Schemes. The questions are mapped to the training standards set by the GMC for all postgraduate Specialty Training in the UK. The results are used for a variety of purposes, including: the annual Trainer monitoring process, providing the QA Unit with additional information that assists in triangulating feedback from the annual GMC Trainee survey; and in informing discussion and providing feedback during District Scheme review visits.

Regular Evaluation of Local GP Speciality Training Schemes Each district Training Scheme is visited every two years (Scheme Review Visit) and collated elements of EPEF information are discussed with local GP Programme Directors. The visiting team also meets local Trainee and Trainer groups, providing an excellent forum for feedback. The Scheme visits conclude with a verbal summary of recommendations given by the visiting team to the Programme Directors. A more detailed written report is then produced and shared with the District Scheme and the QA Unit.

The EPEF results are analysed and fed back to GP Programme Directors and assist us in our bi-annual Scheme and individual post review visits. The information we obtain from EPEF and other QA activities is extremely valuable in giving us a balanced perspective and true picture of the activity taking place ‘on the ground’ at both scheme and post level.

Dr Mair Hopkin GP Associate Dean

GP Specialty Training // Quality & Governance

01

02

Senior team members take part in several UK level committees including: National Recruitment Steering Group (Head of School); RCGP Assessment Committee (Dr Gareth Parry Jones, GP Associate Dean); the RCGP Quality Management & Training Standards Committee (Dr Gordon Lewis, GP Associate Dean); and the Deanery Assessment Leads Group (Dr Alan Rogers, GP Associate Dean).

01 GMC / PMETB

03

02 The Wales Deanery QA Committee

03 GP Specialty School Board (SSB)

04 Specialty Training Executive Group (STEG)

04

05

05 Monitoring of Training Environments

The 230 GP Trainers who deliver GP Specialty Training are subject to an annual Trainer Re-accreditation process, and regular workshops. The 400 GP Specialty Trainees all undertake six month electronic end-of-placement feedback (EPEF). An annual ACRP panel must also be passed.

Following the merger of the Postgraduate Medical Education and Training Board (PMETB) with the General Medical Council (GMC) on 1 April 2010, the GMC is responsible for regulating all stages of medical education in the UK. The Wales Deanery Quality Assurance Committee reviews consolidated feedback from the GP Trainees’ EPEF reviews; it also logs and monitors any issues identified in hospital and GP Scheme Visit reviews. Professor Malcolm Lewis Chairs the GP Specialty School Board (SSB). Prescribed by the GMC, it scrutinises the work of GP Specialty Training and includes representatives from The British Medical Association’s GP Committee (GPC Wales), The Royal College of GPs (RCGP Wales), Welsh Local Health Boards, The Welsh Assembly Government, as well as a GP Trainee, GP Trainer, GP Programme Director and hospital consultant representatives. Dr Phil Matthews chairs the Specialty Training Executive Group (STEG), which includes seven GP Associate Deans and the GP Training Wales Organisational Lead. This includes monitoring procedures at scheme and post level.


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GP Further Training // Overview

21

The Further Training function of GP Training Wales manages the assessment, placement and learning experience of existing GPs, based in Wales, who are required to undertake a period of re-training for a variety of reasons. These often challenging assignments are undertaken by a highly skilled network of Trainers who have been selected, trained and developed over the last eight years. This work is highly valuable to Health Boards who are responsible for ensuring GPs on their Medical Performers List (MPL) are fit to practice independently. The Need For GP Further Training In certain circumstances, GPs are required to undertake additional training in order to enter or continue to work in NHS General Practice. This includes: —— UK trained GPs wishing to return to NHS General Practice after an absence of two or more years (known as Returners) —— Overseas trained GPs wishing to work in NHS General Practice for the first time (known as Inductees) —— GPs in difficulty, who have undergone an assessment by The National Clinical Assessment Service (NCAS) or General Medical Council (GMC) and are required to undergo a period of re-training Demand for GP Further Training has grown considerably in the UK over the last 20 years due to: —— More reliable assessments and procedures to help recognise and support GPs whose performance has been questioned —— The need to reduce underperformance by assessing and inducting GPs whose performance in current UK General Practice is untested —— Greater numbers of European Economic Area (EEA) qualified GPs wishing to work in the UK —— The need to encourage and support GPs returning to the workforce following prolonged career breaks

The Further Training Practice Network in Wales

Goals to be achieved by 2014 In Assessing and Inducting Overseas GPs and UK Returners Entering the GP Workforce we will: Report on the re-establishment and effectiveness of regular communication and feedback mechanisms with the reorganised Local Health Boards in Wales.

Pioneering: In 2003, General Practice Training Wales began to develop a Further Training Practice Network (FTPN), supported by a strong central management team. The structure and success of the Welsh model has helped other Deaneries in designing their own support networks.

In Retraining GPs in Difficulty we will: Report on the re-establishment and effectiveness of regular communication and feedback mechanisms with the reorganised Local Health Boards in Wales. In Developing and Supporting the Further Training Practice Network we will: Report on geographically comprehensive Further Training Practice coverage for the whole of Wales, resolving the current shortfall in North West Wales

All Wales: Llandudno

Supervising Doctors: Each Training Practice has two nominated Trainers, who are involved in intensive supervision of referred GPs.

Bangor Caenarfon

Evaluate the skill sets acquired by trainers in the FPTN Publish the findings of these two evaluation processes in a peer-reviewed journal

I have been involved in the Further Training Practice Network (FTPN) for a few years and have been consistently impressed by the detailed, dedicated and skillful work that my colleagues put in to supporting and re-training the doctors involved. I mentored a returning doctor in 2008 and from the outset found that she was highly motivated to learn, but acutely aware that her therapeutic knowledge was out of date. Continued feedback from myself, patients, and allied staff, combined with working in our busy urban practice, as well as tutorials and self-directed study, meant that she slowly but surely developed a natural consulting style, an excellent knowledge base and passed her assessments. When I think about that doctor now, what I remember most is the catchphrase we designed to boost her confidence – ‘best job in the world’!

Wrexham

Dyffryn Clwyd Llangollen

In Leading and Managing GP Further Training we will: Evaluate the progress and longer term outcomes for GPs who have undertaken any form of mandatory further training in Wales from the inception of the network until 2010

The FTPN has grown to become a pool of expert trainers, in 12 Practices spread throughout Wales.

Dr Sue Williams GP Trainer Cardiff, Further Training Practice Network

Training: Support: We recognise that induction and remedial training is complex and extremely demanding. Colleagues delivering the programmes through the FTPN are supported through regular group meetings, educational opportunities and a well organised, supportive and available central management team.

Twice-yearly residential meetings of the network are held, providing opportunities to discuss casework, share problems and solutions, and invite input from experts in fields such as medical regulation, educational assessment, linguistics, neurological science, occupational psychology and behavioural change techniques.

Aberystwyth

Glamorgan Valleys Pembrokeshire

Carmarthen

Neath Gwent

Swansea Port Talbot Bridgend

Cardiff

“I am now four months into my year of training as a GP Returner, working part-time. The two aspects of practice that I found most difficult were tackling the therapeutics and the computer system. Therapeutics has changed tremendously over the thirteen years that I have not been practising. There are whole new classes of drugs to learn about and some familiar drugs have fallen out of favour. Overall, I have really enjoyed my return to practice and have been amazed how quickly I have settled back into the routine. I am extremely grateful to have been given this opportunity and support by the Wales Deanery.” Dr Debbie Monk GP Returner, Newport


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GP Further Training // Returners & Inductees

23

Preview Session UK trained potential GP Returners and overseas trained potential GP Inductees may have little concept of what modern UK General Practice is like and so we offer a pre-assessment, preview session, held in a conveniently located FTPN practice. Needs Assessment Potential Inductees and Returners, wishing to progress to a placement, must first have a needs assessment, organised by GP Training Wales. This consists of a: —— Clinical knowledge test —— Simulated consultation —— Written problem solving test —— Needs assessment interview Assessment Report The needs assessment results are communicated to the applicant’s chosen Local Health Board (LHB) and we offer our opinion as to the likelihood of the applicant achieving safe, independent practice after a six month induction placement. Supervised Placement Returner and induction placements are usually offered as six months full-time or 12 months half-time. Training techniques include regular tutorials, hot reviews, video-taped consultation analysis, audits and focused reading. Trainers provide regular reports on progress based on each GP’s individualised development plan and feedback is sought from patients and staff at the practice.

Assessment of Polish GPs for Neath Port Talbot Local Health Board In January 2006 Neath Port Talbot LHB was seeking to shortlist and interview a group of GPs from Poland, with a view to appointing one salaried doctor in a hard to recruit area. We offered to provide additional assessment methods, alongside the planned conventional interview, explaining that this could provide a better understanding of the candidates’ abilities and learning needs. We also recommended that the successful candidate would benefit from a six month induction placement in one of our Further Training Practices. The LHB welcomed our suggestions and a mini-assessment centre was set up consisting of a clinical knowledge test, a simulated patient consultation, a written problem solving / prioritization exercise, as well as the previously planned interviews.

We were surprised to find that our preferred candidate from the interview process actually scored lowest in the other assessments conducted by GP Training Wales. We therefore readily accepted the logic of offering the induction placement to another of the candidates. The doctor received a successful induction from GP Training Wales and, five years on, is in a salaried post providing a first class service to a Valleys community in South Wales. We are delighted with the results of the help and guidance we received.

Outcome At the end of the placement the Returner / Inductee sits the RCGP Applied Knowledge Test (AKT). A Trainer from another FTPN Practice also assesses and reports on a video sample of six of the GP’s patient consultations and the host Trainer compiles a final report on the individual’s progress. These assessments assist the LHB to decide whether the doctor should receive unconditional inclusion on the MPL.

Debra Davies Abertawe Bro Morgannwg University Health Board (now incorporating the former Neath Port Talbot Local Health Board)

GP Further Training // GPs in Difficulty

The Further Training Practice Network also provides retraining for GPs who are required to undertake a period of re-training, having undergone a professional performance assessment by The National Clinical Assessment Service (NCAS) or the General Medical Council (GMC). Wales was an early leader in developing a comprehensive, structured system for this retraining. Placements are usually six months long, with the GP in difficulty typically being based in the Further Training Practice for six sessions per week. The extensive assessment undertaken by NCAS, or the GMC, prior to the placement, provides an indication of the individual’s learning and development needs and these are used as a starting point to build a bespoke training programme.

We play a key role in these placements, acting as the ‘hub’ for all communication between the Health Board, the Further Training Practice and NCAS or GMC. Six weekly reports from the Trainer outline the GP in difficulty’s progress against identified learning needs. A series of external assessments, including videos of consultations and Applied Knowledge Tests, help to triangulate the findings of the Trainer to ensure the GP can hopefully demonstrate sufficient progress to be successfully re-integrated into General Practice in Wales. Equally, if adequate progress is not demonstrated, LHBs can take this, and other information they have available, into account when making any subsequent Medical Performers List (MPL) decisions.

Dr Martin Sullivan GP Associate Dean

NCAS in Wales has, since its inception, worked closely with GP Training Wales through the implementation and development of action plans following performance assessments. This has involved arranging placements in further training practices in several locations throughout Wales. In the majority of cases, these placements have been successful and have resulted in practitioners returning to unrestricted practice following intensive programmes of remediation. The link between GP Training Wales and NCAS has developed in a very positive manner over the past few years and we look forward to continuing to work closely in the future.

Mr Paul Hutchings NCAS


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Organisational Capability // Overview

25

In the Spring of 2009 we embarked on the development and implementation of a number of initiatives to improve our organisational capability. We identified five areas of focus which are: reviewing and refining our strategy; developing our research and evaluation processes; improving our communication and data handling processes; progressing our Continuous Quality Improvement (CQI) Strategy; and continuing to develop our human resources.

Goals to be achieved by 2014 In Systematically Reviewing and Refining our Strategy we will: Report on how the attainment of aims and goals stated in this document has contributed towards the wider Deanery mission

Organisational Capability // Overview

Using LEAN Processes as Part of Continuous Quality Improvement

Our objectives in adopting a continuous quality improvement strategy are: —— To restate and maintain a focus on clear long term aims —— To consistently set and achieve valuable goals —— To help us introduce a systematic process to routinely review and make improvements to the way we deliver our work

01

05

In Developing our Research & Evaluation Processes we will:

An Annual Strategic Review for the GP Training Unit will be held every autumn.

Report on the implementation and impact of a comprehensive evaluation strategy for GP Training Wales

05 Systematically review changes made and introduce further improvement

In October 2009, and March 2010 two 2-day workshops were held with all administrative staff, Associate Deans and ‘customer’ representatives such as Programme Directors, Trainers and Practice Managers.

Whilst improvement has always been part of our culture, embedding a formal CQI strategy is an aspiration we have had for several years. With a full complement of administrative staff in place in the Spring of 2009, we had capacity to begin this important strategic development. We have worked closely with the Lean Unit of Cardiff University and they have been extremely helpful in providing us with a framework for improving our systems and processes in a methodical way.

Ms Mary Beech Organisational Lead, GP Training Wales

01

04

Work with the Deanery Quality Assurance Unit to implement an All Wales Training Concerns Policy reflecting recent regulatory changes

Systematically review induction programmes for all staff Maintain staff quota at current levels and fill vacant posts Support administrative and educator staff to undertake continuing professional development

Improving communication protocols following GP Trainee recruitment and selection

Introduction of assessment of course participants’ learning into each module of the Prospective Trainers Course

GP Training Wales

04

02

Three of the managers in the GP Training Unit have been trained in Lean skills techniques and a Continuous Quality Improvement Board has been set up to oversee the progress of the improvement projects.

We have now mapped the major activities and component processes we undertake in GP Specialty and Further Training.

03

02

Identify areas of wasted effort and inefficiencies.

Map the activity currently delivered by GP Training Wales

Implement and report on a Continuous Quality Improvement Strategy for GP Training Wales In Planning and Developing our Human Resources we will:

Improving GP involvement in Trust Commissioning Visits

Improving security and efficiency of online payments for GP Educator activity

Identify users of GP Training and find out what they want

Remove inefficiencies and introduce improved processes

Implement a pro-active GP Training Communications strategy, in liaison with a new Deanery-wide Communications Lead

In Progressing our Quality Improvement Initiative we will:

Review of procedures for monitoring sick leave for Trainees

Developing an online demonstration video to help Trainers and Trainees navigate the e-portfolio

Review all GP training protocols using the newly developed checklist system and put in place a mechanism for routinely reviewing the system

Report on a fully implemented and robust online data management system

Electronic Induction Pack for Trainees Review of intra-Deanery transfer procedures

In Improving our Communication and Data Handling Processes we will: Introduction

Examples of some projects being taken forward at the time of writing:

03 Small project teams have been formed to start work on process improvement assignments, ranging from small scale ‘quick fix’ projects, to large scale strategic changes, such as driving the introduction of a single lead employer for all GP Trainees in Wales.


26

Organisational Capability // Human Resources

27

We value all the individuals who work together to improve GP Training throughout Wales, whether they are GP educators or administrative staff. Planning and developing our human resource is a crucial element of our continuous improvement programme.

230 GP Trainers including 28 Further Training GP Trainers

Head of GP Training Wales (Deputy Director of Postgraduate Education for General Practice)

7 GP Associate Deans Academic Lead

Organisational Lead GP Training Wales (based in Cardiff)

9 Administrative Staff (based in Cardiff)

24 GP Programme Directors

Over the past few years we are proud to have developed an ethos of excellence in staff recruitment and development across the whole GP Training Wales team. All staff have annual appraisals and are regularly supported to undertake University accredited and other courses. Ensuring staffing levels are maintained in order to support the growing business need is also fundamentally important to continually improve the service we provide to NHS Wales. Management and support of diverse and geographically dispersed teams is carefully orchestrated. Our Executive Group has formal monthly meetings, and we also run two All Wales GP Programme Director Meetings per year, which include a mixture of educational sessions, sharing good practice and discussing latest developments and issues. Even though local GP Scheme Administrators in Welsh Postgraduate Centres are not employed by the Deanery, we recognise the significant contribution they make and in 2009 we initiated a series of three sub-regional meetings for these administrators providing an important networking and best practice sharing opportunity.

Organisational Capability // Communications

A number of communications project areas have been identified to ensure that the administration and infrastructure supporting GP Training becomes increasingly efficient and effective, and that information is appropriately disseminated.

05

01

This document is a first stage in systematically reviewing and refining our strategic direction and communicating that direction. The work has included the consolidation of our mission and vision, and the articulation of action plans for all areas of our business.

Creating a paperless office via an intranet database is a core part of our vision to improve our communications and data management processes. Building the efficacy of our web and office-based information handling systems is crucial to the realisation of this vision and a project is being set up to improve our web-based interface.

01 Data Management Processes

05

02

Refining and Communicating

Database Functionality

Communications Initiatives

02

04 A major project identified as part of the CQI initiative was the development of a coherent long-term communication and PR strategy that links in with a wider Deanery strategy to ensure we are attracting the right number and level of Trainees and Trainers and that the availability of GP Further Training is well publicised.

04

03

Long Term Communications and PR

GP Specialty and Further Training Website

03 In 2009 we started to revise the Wales Deanery web pages and allocated responsibility for individual web pages to ensure that the information is updated continuously. A major development for 2010 is the introduction of an electronic information pack for Trainees, based on these pages, building on the existing website which has hosted training materials for many years.

An extensive database underpins the knowledge management and information retrieval aspects of our work . It holds details of Trainee rotations, Training history, Training Practices and Trainer accreditation history. It automatically generates assessment questionnaires and links to the GP Appraisal database, providing a seamless transition into the Welsh GP Appraisal system, enabling us to provide data instantly as required by Business Service Centres, the PMETB, the GMC and RCGP.


28

Organisational Capability // GP Specialty Trainee Representatives

29

GP Training Wales appointed five GP Specialty Trainee Representatives in January 2010 from current GP Trainees in Wales. The role of the GP Specialty Trainee Representatives is to represent the views and interests of GP Trainees, whilst also providing a feed of information from the Deanery to Trainees. Through organised consultative meetings and ad-hoc feedback they play an important role in the development of existing and emerging policies on all aspects of GP Training in Wales. This covers all aspects of the GP Trainee experience, from recruitment through to the support processes that eventually lead to attainment of the Certificate of Completion of Training (CCT). The GP Specialty Trainee Representatives keep abreast of changes in postgraduate education as they happen, and pass relevant information to their peers through regular newsletters and, with the assistance of our administrative team, a web page. They attend Specialty School Board meetings, the Selection Centre for recruiting new trainees and National Conferences such as the ‘British Medical Association’s Skills for New GPs Conference.

I believe being a GP Specialty Training representative is a fantastic opportunity to act as an essential link between Trainees and the Deanery. On a personal level, juggling a family and a career has made me understand the differing needs of Trainees. I hope that bringing my life experience from outside medicine and my previous training within the evolving NHS in Wales to my role as a GP Trainee Representative, I can act as an effective advocate for all GP Trainees in Wales.

Dr Isolde Shore-Nye GP Specialty Training Representative

Organisational Capability // Future Capacity

There is a well recognised strategic imperative to train more GP Trainees and other practitioners in the General Practice setting. The aging population; medical school expansion; the Tooke Report proposal to lengthen GP Training; and an annual increase of 800 entrants into GP Training, have all led to a massive investment in educational capacity within GP premises in England. If we are to provide for the multiplicity of trainees needing education in the GP setting in Wales, we need to understand the extent of premises development required to meet that demand. In spring 2009, practice managers for all 493 General Practices in Wales were e-mailed requesting a response to a number of questions relating to the infrastructure required to deliver future GP training needs. Key findings included: —— Over 70 per cent of General Practices in Wales responded

We are delighted to have the involvement of the Representatives and look forward to working with them as they progress through their training and assist us in appointing future Trainee Representatives. In the future, we aim to extend their involvement, building upon the inclusive nature of training that we have created in Wales.

Dr Peter Saul GP Associate Dean

—— 245 out of 337 responding practices already contribute to organised medical and/or nurse training —— Of 209 practices who were keen to provide more training, only 34 are not already making a contribution —— 93 practices wished to train more medical students —— 100 practices wished to train more GP Speciality Trainees —— 59 practices stated that no building work was needed to deliver the extra training they aspire to deliver —— 25 practices would need structural modification —— 56 practices would need an extension to an existing surgery building —— 69 practices would need a new surgery to be able to deliver extra training

Considerations for the Future General Practice based educators currently make a far-reaching contribution to NHS staff development in Wales Given adequate resources, so that clinical care provision is not compromised, GPs in identified practices throughout Wales are keen to train even more doctors and other health care professionals Whilst 59 practices are able to provide more training from existing accommodation, a further 150 will need premises development, ranging from modest internal modification to complete new builds Targeted investment would unlock the even greater contribution General Practice needs to make in order to meet the increasing need for medical and nurse training in Wales


30

31

Strategic Overview 2011-2014 // Meet the Team

GP Training Programme Directors (left to right, top row first) Dr Roddy Evans, Aberystwyth Dr Roger Ramsay, Bangor Dr Stephen Hailey, Swansea Bay Dr Andrew Cooper, Cardiff Dr Bob Tanner, Wrexham Dr Alistair Bennett, Neath Port Talbot Dr Steve Jerrett, Glamorgan Valleys Dr John Rees, Camarthen Dr Shallini Subbu, Neath Port Talbot Dr Carmen Munteanu, Bangor

Dr Roger Burns, Pembrokeshire

Not in Photo

Dr Ffion Williams, Dyffryn Clwyd

Dr Richard Griffiths, Bridgend

Dr Sasha Robinson, Gwent

Dr Eilir Jones, Dyffryn Clwyd

Dr Esther Lomas, Glamorgan Valleys Dr Robert Davies, Pembrokeshire

Dr Suchitra Vijayanarasimhan, Pembrokeshire

Dr Ruth Williams, Camarthen

Dr Ian Happs, Wrexham

Executive Group and Office Managers

GPÂ Training Central Administration Staff

Dr Gareth Parry Jones

Miss Nicki Elliott GP Training Manager, Trainee Support and Development

Miss Sian Davies GP Training Manager Faculty Support and Development

Mr Miguel Cossio GP Training Web Programmer

Ms Mary Beech Organisational Lead, GP Training Wales

Miss Rebecca Gardener GP Training Officer

Mr Sajan Miah GP Training Web Development Officer

Mr Steffan Biggs GP Training Officer

Miss Gemma Jones GP Training Administrator

Miss Eleanor Morrey GP Training Officer

Miss Lisa Hooper GP Training Administrator

Miss Nicki Elliott Dr Phil Matthews Miss Sian Davies

Dr Karen Penry, Aberystwyth

Dr Gordon Lewis

Dr Roo Kabeer, Cardiff

Dr Martin Sullivan

Dr Kirstie Truman, Swansea Bay

Ms Mary Beech

Dr Julie Keeley, Gwent

Dr Mair Hopkin

Dr Peter Harrop, Bridgend

Dr Alan Rogers Dr Colette McNally (not in photograph) Dr Peter Saul (not in photograph)


32

Strategic Overview 2011-2014 // Academic Publications

Publications & Conference Presentations: Beech, M. & Lewis, G. (2009) Development of a Revised GP Training Practice Re-approval Process in Wales, Poster Presentation, AMEE Malaga Beech, M. (2006) Early Experience of Needs Assessment of EU GPs Wishing to Work in the UK, Poster Presentation, AMEE Genoa Beech, M. (2008) A System of Assessment and Induction for GPs Who Have Not Worked in UK General Practice for Three Years or More, Poster Presentation, AMEE Prague 2008 Beech, M. (2010) Increasing Lay Involvement in GP Specialty Training Activity – Opportunities and Challenges, AMEE Glasgow Elliott, N. & Davies, S. (2010), E-Induction for GP Specialty Trainees – Improving Communication Flow to Trainees, AMEE Glasgow Hopkin, M. (2002) Identifying the Learning Needs of GP Registrars Using a Critical Incident Technique, World WONCA, London Hopkin, M. (2004) The use of Humour in Medical Education, World WONCA, Orlando Hopkin, M. (2006) Appraisal for General Practice Registrars, AMEE Genoa Hopkin, M. (2008) Identifying and Helping Doctors at Risk of Unsatisfactory Outcome at ARCP, AMEE Prague Hopkin, M. Rhydderch, M., Sullivan, M. & Lewis G. (2010) Exploring the Perceptions of Less Than Full Time Training in Wales, World WONCA, Mexico Lewis, G. (2009) Exploring the Perceptions of OOH Training for GP Registrars in Wales, Education for Primary Care, 20: 3 152-159 Lewis, G. (2009) Quality Assurance of GP Training Practices – a New Model, AMEE Malaga Lewis, G. (2010) Reducing the ‘Exercise Effect’ at a Selection Centre for GP Trainees in Wales, World WONCA, Mexico

Matthews, P. & Bett, M. (2005) Provision of GP Further Training in the Wales Deanery: The development of activity of the Advanced Training Practice Network (ATPN) in Wales, AMEE Amsterdam Matthews, P. (1998) How Should General Practices That Provide Vocational Training Be Compared? A Delphi Survey Of Trainers: Masters in Medical Education, University of Wales Matthews, P. (2006) Application of the “Bookmark” standard setting method, so that a test can be used to predict the extent of GPs’ knowledge learning needs, AMEE Genoa Matthews, P. (2008) A Delphi Survey exploring Annual Review of Competency Progression (ARCP) scenarios and issues in GP Specialty Training, AMEE Prague

Ongoing research projects in 2010 Evaluating the Experience of Returners to General Practice – Dr Vicki Lewis, GP Academic Trainee How Does Exposure to a Specific Medical Specialty at Foundation Level One or Two Influence a Decision to Undertake Specialty Training in that Discipline? - Dr Harry Ahmed, GP Academic Trainee The Advanced Training Practice Network: An outcome evaluation study, 2002-2010, P Matthews, M Rhydderch, M Beech, N Marfell Do measures of cognitive ability and personality have anything to offer the selection process for general practice training? P Matthews, M Rhydderch, M Beech Planned Projects for 2010-2011

Matthews, P. (2009) Ensuring Capacity for Future Medical and Nurse Training within General Practices in Wales, AMEE Malaga

Extended training: What Value Does it add for Trainees, Patients and General Practice? P Matthews, M Rhydderch, M Beech,

Matthews, P. et al (2005) The case for general practice vocational training extension schemes and for the GP Clinical Fellowship Scheme: Education for Primary Care, 16: 517-525. Radcliffe Publications

Acknowledgements

Matthews, P. et al (2007) A New Model of Educational Provision for GPs Directed to Undertake Further Training in Wales: Education for Primary Care, 18: 3 316-327. Radcliffe Publications Matthews, P., Beech, M., & Rhydderch, M. (2010) A Continuous Quality Improvement Strategy for General Practice Training Wales: Start of a Journey, AMEE Glasgow Rhydderch, M., Beech, M. & Matthews, P., (2010) The Influence of Personality on Performance at GP Selection, AMEE Glasgow Rhydderch, M., Matthews, P., & Beech, M. (2007) The Advanced Training Practice Network: providing Prescribed Further Training for General Practitioners in Wales, Education for Primary Care, 18, 572-581, Radcliffe Publications

It is important to acknowledge the contribution of Wales’ previous directors of GP education - Dr Derek Llewellyn, Dr Terry Reilly and Professor Simon Smail in helping to shape the organisation. Former associate deans Dr Keith Richards and Dr David Wood progressed a number of important strategic initiatives; and Dr Bob Mortimer was instrumental in instigating our leading website functionality.


General Practice Training Wales // Strategic Overview 2011-2014

General Practice Training Wales gptrainingwales@cardiff.ac.uk 02920 687508 GP Training Wales Wales Deanery 8th Floor, Neuadd Meirionnydd Cardiff University Heath Park Cardiff CF14 4YS www.cardiff.ac.uk/pgmde

General Practice in Wales  

Strategic Overview 2011-2014. The Wales Deanery

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