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Road testing Revalidation: GPs pilot College proposals Hundreds of GPs across the country are taking part in several different pilots being run by the RCGP to ‘road test’ the College’s proposed requirements for Revalidation. Sessional Doctors Pilot Sessional GPs make up a third of the general practitioner workforce and face unique issues. They have been identified as a specific group who may have difficulty in meeting the currently proposed requirements for Revalidation. In particular, undertaking multi-source feedback has been identified as a challenge if GP colleagues are not sufficiently familiar with the sessional or locum doctor’s method of working to be able to comment appropriately. Patient surveys and the collection of information for audits may also be an issue for locum GPs and those in small and remote practices. In order to best assess the needs of this very important group of doctors, the College is in the process of initiating a pilot focussing soley on Sessional Doctors. This pilot project will work with recruits currently involved in annual appraisals and assess their readiness to collect the range of evidence required by the RCGP. The study will use regular focus groups to work through issues and any other concerns that might arise..

Overarching Revalidation Pilots A large Revalidation pilot led by the University of Warwick has recruited GPs from Heart of Birmingham PCT, Solihull PCT and Vale of Glamorgan Local Health Board (Wales) to take part. This pilot is focused on the collection and assessment of evidence and any supplementary information for a Revalidation portfolio. Further north, RCGP Scotland and National Education Scotland are leading a joint project with GPs involved. In addition to collecting and assessing evidence, they will be assessing GP experiences and piloting the use of an open book knowledge test (nPEP). Both these projects will report back in April 2010.

RCGP Chairman Professor Steve Field said: “Piloting will be a crucial aspect of how we plan for Revalidation. The College cannot postulate about how we think things should work – we need ‘real world’ doctors to help us develop our proposals and demonstrate what is and isn’t viable. “I am really pleased with the numbers – and willingness – of GPs coming forward to participate in our pilots. It demonstrates a real commitment to making sure that the profession gets this right. “I would urge all our Members and Fellows not to sit on the sidelines as this work develops – particularly if you have issues or concerns. If the College is made aware of these issues, we can take action to address them. “It’s important to remember that Revalidation is not meant to be a punitive process. It’s about professional development and improving patient care – and the profession must lead and take control.” ■ If you want to know more about these pilots, the RCGP’s current plans for Revalidation or wish to comment or contribute, please go to

Revalidation Version 2 is launched The latest Guide to Revalidation – Version 2 is now available on the RCGP website.

Yes, Minister Government support for GPs on health and work

Ready for Revalidation? GMC Chairman answers your questions

Standard Bearers

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Tackling the Silent Killer RCGP lends support to Ovarian Cancer Campaign

Detecting Psychosis How early intervention can change lives

Championing Diabetes

● More information on the resources needed for Revalidation and where they can be drawn from ● More details for sessional doctors, particularly peripatetic locums, and GPs in small or remote practices. ● An update to educational credits, with hours taken for education being moderated by the impact of that education. ● New developments on Remediation and support for doctors in difficulty.

New RCGP Clinical Lead on why his role is so crucial

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Better Leaders, Better Doctors Sign up now for next RCGP Leadership Programme


■ Version 2 of the Guide is available at ■ A compilation of Frequently Asked Questions is also available at _revalidation/revalidation _documents/ revalidation_faqs.aspx Steve Field: The present system is failing patients

Healthtalkonline is Grant assisted Out of hours care: RCGP calls for urgent review

RCGP Chairman Professor Steve Field has urged the Government to launch a comprehensive review of out of hours and weekend care.

Hierarchical Doctors

Sign up for the one-day conference for all UK GP appraisers in Glasgow on November 4 prior to the RCGP Annual Conference. See the ad on page 7.

Inside this issue...

New developments since the launch of Version 1, in April 2009, include:

An additional pilot is investigating whether or not Prescribing Indicators can be used to evaluate aspects of a GP’s performance. The work involves studying examples from around the world and developing a set of indicators for use by GPs in the UK which will then be assessed by a consensus panel of GPs. A preliminary set of Indicators has already been prepared by a team from the University of Nottingham, led by Professor Tony Avery, who is working with the British National Formulary to build an evidence base for each indicator.

■ Are you Revalidation Ready?


GPs set new protocols for shared records

Prescribing indicators

Meanwhile, a Hierarchical Doctors Pilot will focus on the particular needs of those GPs working in the Defence Medical Service and the Foreign Commonwealth Office; assessing their ability to meet the proposed requirements for Revalidation.


RCGP Fellow Dr Ann McPherson shared the BBC Breakfast sofa with actor Hugh Grant to promote – the patient experience website. Healthtalkonline was created by Dr McPherson and her colleagues at Oxford University. It aims to help people make informed decisions about their care, by featuring videos of real-life patients and their relatives relating their experiences. Information on over 40 conditions is now available on the site. Hugh Grant agreed to promote the site following the death of his mother from cancer. “I wish I’d known about healthtalkonline when my Mum was dying, especially during those particularly sleepless nights,” he told BBC Breakfast. Healthtalkonline is currently looking for volunteers to be inter viewed on Jewish health issues and men with breast cancer. Its sister site is also looking for young people aged 12-20 to talk about their experiences and views of a range of issues relating to weight and health.

Professor Field is calling for a ban on doctors flying to the UK to provide out-of-hours cover for GPs unless they have had an induction to British general practice work, including on-call services. His comments come after a 70-year-old man was accidentally killed by an overdose of painkillers delivered by a GP from Germany on his first shift in the UK. Professor Field said: “This is a poor system and patients deserve better. It is the responsibility of primary care trusts to ensure that patients have good quality care by commissioning services appropriately, both in hours and out of hours. This is obviously not working and something needs to be done. “I believe a radical review of out of hours and weekend care is needed. I know that care in many parts of the country is excellent but patients deserve high quality care, wherever they live in the UK. I’m more than happy to lead such a review, if the Government so wishes. “European doctors should have to meet the same rigorous standards as doctors working in the UK. We shouldn’t be appointing doctors just to fill in rotas – they must be competent and systems must be safe.”


Minister backs GPs on health and work Work and Pensions Minister Lord McKenzie heard at first hand how a £1 million contract from his Department is supporting GPs in managing patients with work and health issues. The funding from the Department of Work and Pensions is being used to roll out a National Education Programme of half-day workshops for GPs around the country. During his visit to Princes Gate, Lord McKenzie met RCGP Chairman Professor Steve and Dr Debbie Cohen who developed the content of the workshops with colleague Professor Sayeed Khan. The Minister heard that the workshops were being well attended by RCGP Members and Fellows and that the feedback had been very positive. The interactive sessions are designed to help GPs increase their knowledge, skills and confidence in dealing with clinical issues relating to health and work, providing skills and strategies for managing difficult consultations. Around 150 workshops will be delivered over a two-year period with the aim of providing training and support for 3,000 – 4,500 GPs. Professor Field said: “Helping patients return to work can put GPs in a difficult and stressful situation and many GPs worry about consulta-

tions on this issue. It’s extremely heartening that the DWP has recognised our concerns and the fact that Lord McKenzie is taking such a personal interest shows their level of commitment to working with and supporting GPs in finding a solution. GPs who have attended the workshops are already using what they have learned in their daily consultations and I urge as many GPs as possible to sign up for this vital support.”

Forthcoming workshops INVERNESS Tuesday 8 September CARDIFF Wednesday 9 September LEICESTER Tuesday 15 September CHELMSFORD Wednesday 16 September LEEDS Wednesday 23 September DUNDEE Tuesday 29 September OXFORD Tuesday 29 September BOURNEMOUTH Tuesday 6 October EXETER Tuesday 6 October NAIRN Thursday 8 October COVENTRY Tuesday 13 October MANCHESTER Wednesday 14 October CROYDON Wednesday 14 October NORWICH Thursday 15 October All the workshops run from noon to 4pm

■ Visit to download a booking form.

Essential Knowledge Updates

Health and work experience: Lord McKenzie (centre) with Dr Bill Gunnyeon, Director of Health Work and Wellbeing and Chief Medical Adviser at DWP, Dr Debbie Cohen and Professor Steve Field

More e-learning sessions go online The introductory session on Safeguarding Children is pitched at ‘Level One’ training and is suitable for all NHS staff who provide care for children and young people. Developed by the RCGP in collaboration with a specialist at the Royal College of Paediatrics and Child Health, it explains how to recognise the signs of abuse, what to do if you are concerned and the steps you should take to protect children from further harm. Three further sessions pitched at ‘Level Two’ training will follow to cover more specific aspects of safeguarding children.

Improving Access to Psychological Therapies is designed to help primary care practitioners improve services and care for patients who present with mental health problems in the community. Developed in partnership with the national IAPT team, the content is divided into two key subject areas: Improving Access to Psychological Therapies, based on the stepped care model, and Worklessness and Mental Health. It consists of approximately two hours of content and concludes with a short online selfassessment. The course covers core knowledge and provides engaging scenario-based learning tools to help GPs apply their learning to everyday practice. Completing the IAPT programme will provide evidence of continuing professional development to support the appraisal process.

■ Find out more at

■ Find out more at

Two new e-learning courses are now live on the e-GP online resource – Safeguarding Children and Young People and Improving Access to Psychological Therapies.

• Provides GPs with a six-monthly focussed update on new and changing knowledge central to everyday practice. • Updates on key clinical areas of national significance (including newly published NICE / SIGN guidelines and Gold Standards, new relevant legislation). • T a ake the subsequent Essential Knowledge Take Challenge to test your knowledge of the Update - scores in excess of 70% eligible for a certificate to use towards CPD and revalidation. • Stay updated - enhance your skills and improve the quality of patient care.

Free to RCGP Members / non-members can purchase an annual subscription for £79. RCGP News invites your comments or letters... Please write to: The Editor, RCGP News Royal College of General Practitioners 14 Princes Gate, Hyde Park London SW7 1PU email:


ISSN 1755-7720 © Royal College of General Practitioners. All rights reserved. Published monthly by the Royal College of General Practitioners 14 Princes Gate, London SW7 1PU email: website:

Bowled over: Joshua Rubinstein receives the engraved silver rose bowl prize from RCGP President David Haslam and Master of the Apothecaries of London Nicholas Wood

Prize-winning essay highlights GPs’ struggle to be accepted by peers The battle fought by General Practitioners to get the profession accepted by peers as an equal specialty has scooped this year’s Rose Prize, jointly awarded by the RCGP and the Worshipful Society of Apothecaries of London. Award winner Joshua Rubenstein, from Enfield, North East London, wrote the essay as part of his dissertation at Cambridge University. He said: “I’m really pleased about winning

the prize. It’s encouraged me to try to keep up academic work alongside the practical, clinical side of medicine that I’m now learning about. It’s also another reason that I’m glad I did my intercalated degree in History of Medicine – which I’d recommend to any medical student.” The RCGP offers the award biennially in association with the Worshipful Society of Apothecaries of London. The Award is open to all who are, or who have been, involved in primary healthcare but are not professional historians. The work must have been specifically written for the Rose Prize and co-authored entries will be considered. Work should focus on general practice within the UK.





In the hot seat continue to provide a locum service, they will need to participate in revalidation like any other licensed doctor. However, our aim is that the system will be flexible enough to enable retired GPs to demonstrate that they are up to date to do the job they are currently doing. One of the pilots currently underway is considering the implications of revalidation for locum doctors, particularly those working in many different organisations during the annual appraisal cycle.

When RCGP Chairman Steve Field invited Members and Fellows to submit questions for his interview with General Medical Council Chairman Peter Rubin, he received over 400 responses. Despite the volume, the same themes kept cropping up... Who will be revalidated first? How will sessional doctors be revalidated? How much will it cost? What format? What is the future for GPs working overseas? Here, Professor Rubin – who previously chaired the Postgraduate Medical and Training Board – outlines the rationale for revalidation and answers your questions.

Trainees are struggling with the costs of GMC fees, AiT/ePortfolio fees, professional indemnity insurance, examination and course fees. One of their concerns is the cost of implementing revalidation. Will they have to pay through increasing GMC fees or will there be a separate charge? Revalidation will largely be built on existing or enhanced local systems of appraisal and clinical governance so virtually all the associated costs will be linked to the strengthening of these local systems. This is a matter for the Department of Health (England) and the devolved administrations rather than the GMC. The Department is now working with others on the development of a full regulatory impact assessment including a costs and benefits analysis.

What prompted the DH to suggest revalidation? The GMC recommended that doctors undergo revalidation during the enquiry into children’s heart surgery at the Bristol Royal Infirmary. The GMC began to consider revalidating doctors once it became clear that certain doctors were working outside their field of expertise and competence.

What format will be proposed for Multi Source Feedback and what measures will be taken to avoid damage being caused to the recipient if there is negative feedback? Multi-source feedback from patients and colleagues is already widely used in medical practice and it will also contribute to the revalidation process. We are currently developing some principles and criteria for the use of MSF tools for revalidation and will consult on them early next year. We agree that feedback, while valuable, must be communicated in a way that promotes improvement.

As many GPs are locums or have portfolio careers encompassing a variety of clinical roles, what processes are in place to ensure that revalidation is sensitive to and understanding of those doctors who do not match the standard template? Revalidation is about demonstrating that you are practising in accordance with the current standards for whatever it is you now do. We know that one size doesn’t fit all, so we’re working with the Royal Colleges, the four departments of health in the UK and the NHS Revalidation Support Team in England to ensure the system on which revalidation is based enables doctors in all forms of medical practice to be able to revalidate – so it shouldn’t matter what sort of practice you undertake. The Department of Health (England) will shortly be consulting on guidance for Responsible Officers, who will be the ones who make a revalidation recommendation to the GMC in the light of information about doctors’ practice as a whole – we need to ensure we get the detail around this right.

What will be the minimum number of sessions of clinical work per annum and how will the GMC ensure standardisation? Our current thinking is that revalidation will not require doctors to undertake a minimum number of hours or sessions. Instead, doctors will need to provide information about the full range of their practice, covering the four domains in the GMC’s framework for appraisal and assessment: knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust. For example, I now do only one clinical session each week – a hypertension clinic – and I’ll need to show that I’m up to date in that area. The RCGP has been exploring how the framework should apply to GPs. We will be consulting on that, as part of a much wider consultation on how revalidation will work, in the early part of next year.*

What steps will the GMC be taking to ensure that doctors understand how to record their evidence for revalidation in the four domains? A key aim has been to minimise additional burdens, with the intention that revalidation be built, as far as practicable, on local systems already in place or being developed primarily to meet the needs of the NHS and other healthcare providers. Revalidation should be a by-product

are working to ensure that doctors and employers are supported with the ❛ We appropriate tools and guidance... It is part of our job to ensure that doctors have clear information to revalidate with minimal difficulty and bureaucracy ❜ of those systems. Much of the information that doctors will bring to revalidation will already be generated by these local systems. We and others are working to ensure that doctors and employers are supported with the appropriate tools and guidance. We recently published a FAQ document for doctors about revalidation. We will update and refine this as plans develop. We regard it as part of our job to ensure that doctors have helpful, clear information to enable them to revalidate with minimal difficulty and bureaucracy, and we will ensure that detailed information is available well before any doctor has to revalidate.

Can you say more about the Responsible Officer role and the RO recruitment process? The four Departments of Health are leading this work and producing the necessary legislation and guidance. The consultation which is underway is an opportunity for the profession to shape the detail of the Responsible Officer role, which, while it will not be a GMC appointment, will play an important part in revalidation.

How will revalidation work for GP academics undertaking limited clinical work? Many doctors have portfolio careers and it is important that revalidation covers the full spectrum of the work that they do and that will include any academic work undertaken as well as clinical work. The Department of Health (England) has previously issued guidance about whole practice appraisal, which includes guidance related to those involved in academic work. We have produced a Good Medical Practice template for appraisal and assessment, which ac-


knowledges the variety of doctors’ work and how they will be able to gather information to support their work. ( licensing/docs/Framework_4_3.pdf ) Your College will work with the Academy of Medical Royal Colleges on the development of guidance on supporting information that GP academics will need to bring to appraisal. This will need to be agreed by the GMC and consulted on widely thereafter so all GPs will have an opportunity to comment.

Can you give us any more information on the starting date for Revalidation and who will be revalidated first? The four UK Departments of Health have told us that parts of their systems will be ready to be used as a basis to support revalidation by 2011, with the first doctors being revalidated at a point thereafter. We will be taking a phased approach to the implementation of revalidation – local systems have got to be robust enough to support doctors thorough the process. The UK Revalidation Programme Board will continue to work on plans for readiness with other organisations to ensure a managed and targeted roll-out, and this will be among the issues for consultation early next year.

Newly retired doctors have always provided a useful locum service but some doctors might feel less inclined to keep up their licences under Revalidation. What will be done to prevent us losing this important part of the workforce? I hope we can reassure such doctors that there is no need for this to happen as a result of revalidation. It’s very important that all doctors are up to date in their area of practice. If GPs wish to

How will the system work for GPs who are not working in the UK but might want to return to UK general practice, or for GPs working overseas in the long term? How can they stay updated and would we need to be revalidated before taking up a clinical position? Unless an overseas employer requires it, there should be no need for you to maintain a licence to practise if you are not practising in the UK. You can voluntarily relinquish your licence and apply for it to be restored when you return to the UK, at no cost. Restoring your licence and your entry in the GP register will be straightforward, although if you have been away for more than two years we may require you to work initially in a GMC approved practice setting. Your College and any PCT or Health Board might also require you to undertake some form of re-entry training. Our aim is to make it easy for doctors who are taking career breaks or moving overseas for a short period to re-enter the workforce once they are ready to resume medical practice in the UK. Once you return and take a licence to practise, you will become subject to revalidation in the same way as all other licensed doctors. We will, however, reserve the option to require someone to revalidate at the point of restoring their licence if it has become clear that they are repeatedly relinquishing and then restoring their licence in order to avoid undergoing revalidation. * Editor’s


The RCGP current proposals do include a minimum number of sessions before a revalidation portfolio can be considered. Our current thinking would mean that the RCGP would not consider a portfolio if the GP had not undertaken the minimum number of sessions – 200 in the five-year period – and such a doctor would need to apply directly to the GMC to be revalidated. However, the RCGP proposals will need to be in line with those from other Colleges and will require the approval/sign-off from the GMC.



Remember the symptoms Patient Participation Groups to help beat ‘silent killer’ get new financial support A new £20,000 fund has been launched by the Growing Patient Participation campaign, supported by the RCGP, to establish or maintain initiatives undertaken by Patient Participation Groups (PPGs).

Peter Reynolds Chief Executive, Ovarian Cancer Action

The UK’s leading ovarian cancer charity, Ovarian Cancer Action, has won the backing of the RCGP for its national awareness campaign. The campaign, called Remember the symptoms, is based on key messages that were agreed through the National Awareness and Early Diagnosis Initiative (NAEDI) on ovarian cancer in autumn 2008. The initiative was led by the Department of Health in consultation with leading clinicians, scientists and women with an interest in ovarian cancer – including Ovarian Cancer Action – and has resulted in the disease no longer being considered to be a silent or symptom-less disease. In the absence of a national screening programme for ovarian cancer, being aware of the symptoms of ovarian cancer currently provides women and healthcare professionals with the best chance of detecting the disease. The advertising campaign features actress Emilia Fox sharing the common symptoms with women and clearly identifies the most common symptoms of ovarian cancer. In addition to identifying these, the Department of Health also identified other less common symptoms: urinary symptoms, changes in bowel habit, extreme fatigue and back pain. The key messages clearly state that, while ovarian cancer is not one of the most common cancers, these symptoms may be present in some women with the disease – so it is important that ovarian cancer is considered as early diagnosis may save lives. Ovarian cancer can be difficult to diagnose as the presentation may be vague, non-specific abdominal symptoms. The key messages on ovarian cancer aim to provide helpful guidance to healthcare professionals with a view to improving detection of the disease, as there is accumulating evidence that women with ovarian cancer experience specific symptoms more frequently, more severely and more persistently than women who were found not to have the disease. The guidance recommends that healthcare professionals should be particularly aware of the possibility of ovarian cancer in patients presenting with any unexplained abdominal or urinary symptoms and that GPs should be concerned about women over the age of 50 presenting with new onset of IBS-like symptoms.

Peter Reynolds: The campaign stresses how early consideration of ovarian cancer can save lives Abdominal palpation should be carried out if women are reporting persistent symptoms and, if there is a significant concern, a pelvic examination should be considered if appropriate and acceptable to the patient. If the symptoms are persistent, continuous and worsening, it is important to consider ovarian cancer and request a CA125 assay and a pelvic ultrasound scan. If caught early when the disease is still contained in the ovary (stage 1), women have up to 90% chance of survival. Ovarian Cancer Action is delighted to have received the backing of the Royal College of GPs for the campaign. For a number of years, the charity has worked closely with GPs to improve women’s chances of surviving the disease by receiving a prompt diagnosis and we look forward to continuing to work together to enhance women’s chances of surviving ovarian cancer. Ovarian Cancer Action has devised a symptoms diary to help women diarise the persistency and severity of common symptoms to help their GP get a clearer idea of whether further tests for ovarian cancer are required and to differentiate for less serious conditions such as IBS. The Remember the symptoms campaign will continue to evolve until Ovarian Cancer Awareness Month in March 2010. ■ For more information about the symptoms of ovarian cancer, visit or call 020 8238 7605.

Plan for the future with free ‘clinics’ Get free advice on Wills, Inheritance Tax, Pensions, Personal and Partnership Succession Planning at the RCGP in London and nationwide. The free clinics are presented by David Ainslie and colleagues from the prestigious City law firm, Stone King Sewell, with expert guest speakers. They will include brief presentations on the main issues followed by ample opportunity for attendees to discuss them in detail. Due to an interactive format, the number of places is limited, so please register as soon as possible.

Wills and Personal Succession Planning BIRMINGHAM Medical Institute EXETER Jurys Inn CARDIFF Marriott Hotel CAMBRIDGE Crowne Plaza 6.30pm start

Tues 6 Oct Tues 13 Oct Tues 27 Oct Tues 10 Nov

Pensions Planning and Partnership LONDON RCGP Princes Gate CROYDON RCGP

Wed 21 Oct Mon 14 Dec

5.30pm start

Topics addressed will be: ● What are the choices? ● How do the NHS Scheme and Private Pensions interact? ● What are the investment choices? ● What can/should be done with existing pension plans from past employment? ● What happens if I die before retirement? ● How can pension and/or death benefits be sheltered from unnecessary tax? ● How does pension planning integrate generally with other personal investment planning, or wills and succession planning

Topics covered include: ● Wills v Intestacy (UK and ‘Non-Dom’) ● Inheritance Tax – Basics ● Inheritance Tax – Business Property Partnership Issues ● Charitable Legacies ● Joining a Partnership for the first time – ● ‘Keep it simple’ v Trusts in Wills points to consider ● Partnership Protection ● Protecting the Partnership ● Life policy & pension death benefits ● The Formal Partnership Agreement ● Beneficiary of last resort – HMG or RCGP? ● Family issues – care of the elderly More dates and venues will be released soon. ■ Please contact for further information.

The Making a Difference fund is being made available as part of the campaign, to offer PPGs a chance to bid for financial support to help run local initiatives. PPGs can bid for up to £4,000 of the £20,000 available, to fund a new initiative or support the continuation of valuable existing activities. All types and sizes of initiative will be considered, as long as the bids demonstrate that they are achievable, responsive to local patient needs and will have a real impact on the health and wellbeing of the local population. Awards will be made in two rounds. The deadline for application for the first round is 23 November 2009. Awards will be made to successful bidders in December. The deadline for applications for the second round is 12 January 2010 and awards will be made in February. PPGs can apply by email or in writing. Application packs can be downloaded from The Growing Patient Participation campaign was launched in June as a joint initiative between the RCGP, the BMA, the NHS Alliance and the National Association for Patient Participation. Supported by the Department of Health, it aims to raise awareness of the good work being done, to encourage more widespread involvement and to support the creation of PPGs in more practices.

Dr Graham Box, Chief Executive of the National Association for Patient Participation (NAPP) said: “Currently 41 per cent of general practices in England have a PPG, and evidence shows that they help to improve services, promote health and allow better communication between the practice and its patients. From a patient dealing with reception staff and ease of booking an appointment to their experience in the waiting room and the level of choice on offer, PPGs can be effective in ensuring the patient experience is as smooth and pleasant as possible. “NAPP and the Growing Patient Participation campaign partners are delighted by the launch of this award, which will support PPGs in making a real difference to their practices and their communities. More than that, it will highlight the excellent, often undervalued work that is undertaken by PPGs.” ■ For more information on PPGs and the national Growing Patient Participation campaign, and to sign up for campaign updates, visit

Could you be an External Advisor? The RCGP is looking to appoint additional External Advisors to its panel which provides external scrutiny and feedback of Deanery Annual Review of Competence Progression (ARCP) panel processes throughout the UK. The panel also quality manages ARCP panel outcomes and Educational Supervisors’ Reports (ESRs) in the ePortfolio. External Advisors must be available to visit Deanery panels at least twice per year (usually December/January and June/July); attend RCGP External Advisor training/calibration sessions at least once per year; review in detail a sample of ePortfolios (either remotely or at a College forum); and must stay abreast of any changes or developments in GP specialty training. External Advisors should be able to commit to a minimum of ten sessions per year. Applicants should be currently active in clinical general practice (minimum two sessions per week of patient contact). They should have experience of using the ePortfolio and be familiar with the principles of education in general practice. They should have – or be able to quickly ac-

quire – a sound knowledge of the regulatory framework governing postgraduate medical education, the certification process for doctors completing GP specialist training, and the nMRCGP WPBA assessment processes. Experience of the management of training for general practice would also be desirable. Per diem payment is at the standard RCGP rate of £389 (amount reviewed annually). Expenses will be reimbursed in accordance with the College Guidance. Applications are particularly welcome from applicants in Northern England, South West England, Northern Ireland and Scotland as the Panel is currently under-represented in those areas. A role description is available from Hannah Petra, QA Administrator, Royal College of General Practitioners, 14 Princes Gate, London, SW7 1PU or ■ To apply, please provide a CV, personal statement, and a reference from a Director of Postgraduate General Practice Education, or Associate Dean/Director, or Training Programme Director who can testify to your commitment to education and continuing professional development. The closing date for applications is Friday 25 September 2009. Interviews will be held on 14 October 2009 and 10 November 2009.

Tee off for the first RCGP Golf Day You are invited to take part in the RCGP’s first ever Golf Day, raising money for your College. As only 40 per cent of our income comes from membership subscriptions we depend on raising funds from other sources to enable us to promote excellence in family medicine worldwide. Join your colleagues and peers at the picturesque Hampton Court Palace Golf Club in Sur-


Existing examples of good practice by PPGs include: ● Advising the practice on the patient perspective ● Organising health promotion events ● Communicating with the wider patient body ● Running volunteer services and support groups to meet local needs ● Carrying out research into the views of those who use the practice (and their carers) ● Fundraising to improve the services provided by the practice

rey on Thursday 8 October 2009 for this fantastic golfing experience. Enter as a team of four (bring family and friends) or as an individual (we can allocate you a team on the day). Prizes will be awarded, including ‘nearest the pin’ and ‘longest drive’. For £75 you get a great day out – breakfast, 18 holes of golf at this must-play course and a three-course dinner (including a silent auction). ■ Details: /020 7344 3167



GPs set new standards for sharing care records New guidance to support GPs and health professionals in using the shared electronic patient record has been produced by the RCGP. THE COLLEGE’S Health Informatics Group won a competitive tender to carry out the work on behalf of NHS Connecting for Health. The purpose of the Shared Record Professional Guidance (SRPG) project was to develop a set of professionally led guidelines that would consider the governance, medico-legal and patient safety consequences of Shared Electronic Patient Record (SEPR) systems in primary care. The key questions for the project were: ● What are the purposes of shared detailed care records? ● How can these requirements be delivered safely? ● What are the principles and practice that ensure clarity, safety and continuity? ● At what level does responsibility for shared detailed care record governance lie? The end result is a framework within which Shared Electronic Patient Records should operate, alongside the principles for using such systems. Guidelines to inform and support doctors and other health professionals working with shared records have also been developed. RCGP Fellow Dr Alan Hassey, who led the project, said: “We were pleased to have had the opportunity to lead this important project. Appropriate information sharing is essential if we are to provide safe and effective care for our patients and we are confident that by implementing the principles and guidance in this report, we will increase public and professional trust in such systems.

Out with the old: The SRPG project will help improve the ability to deliver safer, more effective care “Computerisation of health records enables us to rapidly share data and information in ways that are not possible with paper records. This brings obvious benefits for patients, not just in safety terms but in increasing the efficiency and flexibility of the healthcare and services we can provide. “Understandably, there have been concerns about what information is shared – and the mechanisms for sharing it. “The need for a shared detailed care record is compelling and we now believe there are enough checks and balances to make it a signif-

icant move forward in patient safety and clinical care. The outcomes from this project will produce faster access to up-to-date information about patients and improve the ability of healthcare professionals to deliver safer, more effective care, wherever the patient chooses to access that care.” Dr Hassey added that the enthusiasm, interest and involvement from professional and patient stakeholders had been “quite exceptional”, demonstrating the commitment to having a unified, multi-professional approach to record keeping and quality care.

Towards consensus for best practice: Use of patient records for research in general practice The RCGP has endorsed guidelines for best practice in the use of patient records for research purposes. The guidance was developed during a national consensus meeting held at the Wellcome Trust in 2008 with GPs, researchers and patient groups. Nicola Perrin, Senior Policy Adviser at the Wellcome Trust, explains. Research is a core part of the NHS. Evidence is needed to improve patient care, advance understanding of disease, and evaluate interventions. The foundation for much of this research is information contained in patient records. But patient information is both sensitive and private. The general public and patients must have confidence that the security of personal information is protected, and that procedures are in place to safeguard data. Although some GP surgeries already participate in research activities, there is a lack of consistency as to how records can be accessed and used. The best practice guidance is intended as the first step in a process to ensure that patients and GPs have confidence in the processes used to access patient information.

Background: using patient information for research Patient records in general practice surgeries are a unique resource for research. The increasing use of electronic records offers new possibilities to analyse large volumes of data. Information from patient records may be used for research in two ways:


● Anonymised or coded information from records may be used without patient involvement: for example, for epidemiological research, to monitor trends in infectious diseases, or for pharmacovigilance ● Patient records may be used as a starting point to identify participants for research. Potential recruits are then contacted to seek consent to participate. General practice records are particularly useful to identify groups of patients with a particular disease. Some research can be conducted with anonymous information; in other cases, researchers need access to information from which it may be possible directly, or indirectly, to identify a patient. Researchers do not usually need to know an individual’s identity but may want data at a person level. Very few data are truly ‘anonymous’; all clinical data may potentially be sensitive to a patient.

Overarching principles The best practice guidance is based on three overarching principles which emerged from the 2008 consensus meeting: ● Patient confidentiality and

privacy must be safeguarded The over-riding priority must be to safeguard patient confidentiality at all times. There is a real need to clearly define the processes and procedures for the use of data. The best available technologies should be used to improve security and enhance privacy, wherever possible. Where researchers are to have access to identifiable patient information, there must be mechanisms of accreditation and accountability. A formal process of accreditation should be in-

troduced that places researchers under the same duty of confidentiality as a health professional. This should also define appropriate and substantive sanctions so that researchers may be held to account should there be any breaches of confidence. This guidance is consistent with the Data Sharing Review, co-chaired by the Information Commissioner Richard Thomas and Sir Mark Walport, Director of the Wellcome Trust, in 2008. The Government has since responded to the report, committing to introduce a mechanism to ensure that only accredited researchers have access to identifiable information. The Research Capability Programme of Connecting for Health is currently defining how a safe haven service might be delivered across England. ● GPs and healthcare professionals

should take on the role of the patient’s advocate The first priority of GPs must always be to deliver high-quality healthcare, but the GP must also protect patients if patient records are to be used in research. GPs and their practices must retain ultimate responsibility for ensuring appropriate access to data. The GP should also be in a position to provide advice to patients about taking part in a trial, not least because it is recognised that where a GP endorses a study, this increases patient trust in that study. Additional training, support and resources may be needed to ensure that GPs are able to fulfil the role of ‘patient’s advocate’ and to ensure that the practice can support research. ● Public awareness and understanding

of the use of patient records in research should be improved Members of the public are generally supportive of research: two-thirds of people are likely or

“The publication of these SRPG principles, underpinned by sound research, is likely to guide and accelerate the processes of information sharing that are crucial for improving care. We hope the report will prove immediately useful to a wide range of professional groups, and that the principles established are worthy of wider consideration throughout the NHS,” he said. In a joint statement, Professor Michael Thick, Chief Clinical Officer, and Ros Moore, National Director of Nursing at NHS Connecting for Health, said: “This report will provide key points of reference as we move into a ‘new world’ of patient centred records, structured and governed to enhance quality and preserve meaning in a multi-disciplinary context. “It also serves to highlight the continuing challenges presented by the quality of existing evidence about current and future models for improving clinical communication, and the level of understanding and consent by clinicians and patients to ‘record sharing’. “This work continues the collaboration between NHS Connecting for Health, professional organisations, clinicians and patients to develop and refine clinical record keeping standards that are appropriate for shared electronic records. It provides a significant opportunity for individual professional groups to revise and align existing guidance in the light of endorsed and shared principles. “We thank the Royal College of General Practitioners for co-ordinating the involvement of other professional and patient stakeholder groups in order to achieve a wide agreement on principles.” ■ Details from news_and_events/news_room/news_2009/ rcgp_shared_record_professiona.aspx

certain to allow their ‘personal health information’ to be shared for research. However, there is little understanding of what this means in practice. It is essential to improve engagement and awareness. We recommend that information should be provided through two routes: a national awareness-raising programme highlighting the importance of using patient records to inform research; and the provision of information locally through individual general practices, for example as patients register at a practice. Transparency is essential: the information should make it clear that patients can opt-out of the use of their data in research if they wish.

Best practice guidance The report includes guidelines on the use of anonymised, coded and identifiable data from patient records, and the use of patient records as the starting point to identify potential participants to take part in a research study. There is also information about the steps a practice should take before the start of a research study, the process of informed consent and feedback of research findings. The guidance is primarily intended for GPs and responsible healthcare professionals, but will also be useful to researchers, patient groups, health informatics professionals and advisory bodies. In addition to the RCGP, the guidance has already been endorsed by the British Medical Association, the HODS group (heads of departments of general practice and primary care in the UK and Ireland), the Health Improvement Network (THIN), QResearch, the Research Capability Programme in NHS Connecting for Health/National Institute for Health Research, the Society for Academic Primary Care, and the Wellcome Trust. The best practice guidance is a first step in a process to ensure that patients and GPs have confidence in the processes used to access patient information, and to enable everyone to benefit from the significant research potential of patient records. ■ For more information and to download the report free of charge, visit





Early intervention in psychosis is everyone’s business Professor Helen Lester Professor of Primary Care NPCRDC

Table 2: Detecting psychosis

Dr David Shiers National Mental Health Development Unit

If you suspect a developing psychosis ask about changes in:

Professor Steve Field Chairman RCGP

● Social functioning, e.g. problems in

THOUGH GPs see only one or two new people with a first episode of psychosis each year, they are key players in detection/referral (about 65 per cent of cases in West Midlands audits)[1]. This affects young people (75 per cent men and 66 per cent women have their first episode by age 35 years, mostly in their late teens and twenties)[2] at a critical time in their intellectual, social and physical development with potentially devastating and long-lasting consequences. (See Table 1 below.)

● Cognition, e.g. poor concentration

Early Detection of Psychosis

● Drug misuse

Psychosis usually emerges from some months of prodromal disturbances consisting of intensifying psychological distress and social difficulties, perhaps poor personal hygiene, delusional or bewildered mood, abstract or vague speech and unexplained outbursts of anger or irritation. Clear-cut psychotic symptoms are rarely volunteered and an ‘active watching brief’ may be needed to discover psychotic symptoms; heed parental fears and intuition; appreciate suicidal ideation; regard non-attendance as a signal of deterioration rather than symptom resolution. Importantly GPs should be sensitive to and act on concerns from the family. In West Midlands audits, between 59 – 80 per cent of family members initiated help-seeking, the majority through their GP[1]. Furthermore GPs play a pivotal role in supporting families once a diagnosis is made by providing information, practical assistance and emotional support. Traditional outpatient/inpatient routes are not popular for these young people and families, highlighting the need for more flexible and accessible pathways. GPs need both a lower threshold for seeking help and advice, and a more responsive specialist service – key attributes of an effective Early Intervention in Psychosis (EIP) service. Such services are accessible in most parts of England, but less so elsewhere in the UK. However a range of measures could be usefully agreed locally with or without access to EIP provision. For example: ● GP concerns discussed at an early stage with a nominated local mental health team

● Suicidal ideas

Table 1: Premature mortality ● Recent studies now estimate a 25-

year reduction in life expectancy. [3] ● One-third of these premature deaths

are from suicide ● 10 per cent life-time risk ● 66 per cent of suicides occur in the first five years [4]. ● Two-thirds of premature deaths

are due to treatable cardiovascular, pulmonary and infectious diseases [5]. ● For example, those aged 24-44 years have 6.6x rate of CVS death than their age matched peers, and the gap is widening [6].

relationships with friends and family and memory ● Mood, e.g. feeling depressed,

anxious or irritable ● Thought content, e.g. preoccupation

with strange thoughts or ideas (ideas of reference, delusions of harm, persecution or grandeur, auditory hallucinations)

● Outpatients as a setting for specialist assessment avoided in favour of primary care settings, community youth facilities or the patient’s home. ● Shared primary care/specialist educational meetings about care pathways and cases of mutual concern.

Early Intervention in Psychosis: a paradigm for body and mind Psychosis is bad for your physical health (see Table 1). Moreover, because adverse physical risks operate in those with early psychosis, there is an opportunity for GPs to extend the early intervention paradigm to preventing future pathways to physical health inequality. A diagnosis of psychosis is as much a marker of risk as diabetes. It should invoke a similar intensity of concern, investigation and management. What is perhaps lacking is a more general recognition that primary care can define a group of many thousands of young people in their twenties and thirties at high risk of dying young, who would not normally be considered for active primary or secondary cardiovascular prevention.

of my life I have lived with people with mental illness. When ❛ All my son started to hear voices and hallucinate I thought that – like my father and two brothers – his life was over and he would never take an active part in society. Then we were introduced to the early intervention team and all of our lives changed for the better. E is a very much active member of society and has passed his GCSEs and now has a GVNQ in horticulture. He was horticulture student of the year and is now at college continuing his studies. I feel that a chain was broken in our family that had gone on for many years and, without early intervention, we would still be living under that black cloud. Jill Hewett 2009

These is an opportunity to modify at a much earlier stage key risk factors such as smoking, physical inactivity and poor diet, all more prevalent in this young patient group. Furthermore taking anti-psychotic medicines amplifies these risks by causing weight gain and diabetes[7]. Like diabetes, most morbidity occurs in the larger group at medium risk – there are adverse effects on HbA1c regardless of whether they cross thresholds – similarly for cholesterol etc. The key message is that all the risk parameters – lipids, glycaemic control, BP, adipose – are knocked in the wrong direction by psychosis. However despite higher GP consultation rates (13–14 per year compared with three per year for the general population), data recording for a range of health promotion areas, particularly of cardiovascular risk, appears significantly less likely to be recorded or acted upon[8]. Thus people with psychosis require particularly good primary care, yet paradoxically may not always receive it. It is also important to recognise that the impact on people with psychosis of physical health issues is more than just morbidity and premature death. (See Table 3 on the right.)

Future possibilities Steps towards effective prevention of psychosis As the markers for those at highest risk become more refined, there is hope that very early detection and intervention could reduce the progression to psychosis. Two trials have already reported promising results. The PACE study in Melbourne demonstrated reductions in transition rate for a defined group of people at ultra high risk of psychosis from 35 per cent to 10 per cent using low-dose atypical anti-psychotics and CBT, but the benefits disappeared once treatment stopped [9]. A study from Salford revealed similar reductions to 12 per cent using CBT alone [10]. However, these were relatively small, selected groups at high risk of psychosis and willing to seek help in a research setting. It remains to be seen if these benefits are translatable into routine practice. Nevertheless, for primary care, the implications of these studies are considerable. They could shift the focus towards GP recognition

References [1] Shiers & Lester (2008) Chapter 6 in Delivering Mental Health in Primary Care pp138-142. RCGP Publications. ISBN: 978-0-85084-314-9 [2] Kirkbride JB, Fearon P, Morgan C et al. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry 2006; 63(3): 250–258. [3] Parks J, Svendsen D, Singer P, Forti ME (2006) Morbidity and Mortality in People with Serious Mental Illness, National Association of State Mental Health Programme Directors, 13th technical report. [4] Wiersma D, Nienhuis FJ, Sloof CJ and Giel R. Natural course of schizophrenic disorders: a 15-year follow up of a Danish incidence cohort. Schizophrenia Bulletin, 24, 1, 75-85 [5] Brown S (1997) Excess mortality of schizophrenia. Br J Psychiatr;171: 502-508. [6] Saha S, Chant D, McGrath JA (2007) Systematic Review of Mortality in Schizophrenia: Is the Differential Mortality Gap Worsening Over Time? Arch Gen Psychiatry; 64: 1123-1131 [7] Newcomer JW (2005) Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs; 19(suppl 1):1-93 [8] Kendrick T (1996) Cardiovascular and respiratory risk factors and symptoms among general practice patients with long-term mental illness British Journal of Psychiatry;169:733–9. [9] Patrick D, McGorry P, Yung AR, Phillips LJ, Yuen HP et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms Archives of General Psychiatry 2002; 59: 921–8. [10]Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomized controlled trial British Journal of Psychiatry 2004; 185: 291–7.

Table 3: Other risk factors The effect of risk factors such as obesity beyond premature mortality ● Increased levels of stigma

and discrimination ● Medication ‘non-compliance’

due to weight gain ● Negative psychosocial impacts such

as lower self-esteem and poorer social and interpersonal relationships ● Increased medical costs ● Negative effects on psychopathology

(e.g. medical problems increase risk of suicide, and associations between medical co-morbidity greater psychotic and depressive symptoms) ● Decreased quality of life ● Negative impacts on rehabilitation

and recovery rates

and flagging up of those with key ‘alert’ indicators and a different access route to a youth-orientated specialist assessment and psychological treatment service.

The potential for primary prevention of physical disorders Early Intervention in Psychosis offers a paradigm of care which can go beyond improving psychological health; it can also inspire a different mindset for approaching the adverse physical pathways described above. Can we aim for a situation where discussions over therapeutic decisions and screening and intervention for cardiovascular risk factors are standard, right from the start, for every young person with a psychosis?

Further reading/resources Primary Care Practitioner E-learning Resource Primhe and the West Midlands Regional Development Centre have developed this practical comprehensive collection of learning resources and materials to support professional development around EIP. earlyinterventiontraining/default.aspx

Forum for Mental Health in Primary Care (RCGP; RCPsych) offers learning resources for primary care practitioners mentalhealthinprimarycare.aspx Lester, H. (2001) 10-minute consultation: First episode psychosis. British Medical Journal, 323,1408. Shiers D, Jones P, Field S (2009) Early intervention in psychosis: keeping the body in mind. British Journal of General Practice, 59: 395-396

Updated National clinical guidelines for Schizophrenia (NICE CG 82)





Why diabetes care needs a ‘roll’ model Dr Brian Karet RCGP Clinical Lead for Diabetes Dr Brian Karet has been appointed as the RCGP Clinical Lead for Diabetes in a unique collaboration with Diabetes UK. He has been a GP for 20 years and for the last ten years has run primar y care Satellite Diabetes clinics in Bradford, looking after more complex type 1 and 2 diabetics with multidisciplinary team input. In 2005, the team won a Health Foundation award for integrated diabetes care with core patient involvement An executive member of the Primar y Care Diabetes Society, Dr Karet is a lecturer on the masters programme for GPSwSIs in diabetes at Bradford University and was involved in constructing the Diabetes Commissioning Toolkit. Recently, he was the lead clinician responsible for producing the Guidelines and Competencies for PwSIs in diabetes in conjunction with the RCGP and the Department of Health. Here, he explains why his new role is crucial to the future of primar y care. “IF IT’S that important, you need a snappy title or a memorable acronym,” said my 19-year-old son on hearing I had been appointed to my new grand-sounding post. I doubt any crossword buff could come up with an acronym out of this title but it is a really important job all the same. We know that 80 per cent – and in some places 90 per cent – of the care delivered to people with diabetes takes place in primary care settings. Most of this care is provided by dedicated teams of GPs and practice nurses supported by dieticians, podiatrists and diabetes specialist nurses. More specialist care like insulin initiation and maintenance and the management of complex diabetes related issues is increasingly happening in the community. The Quality and Outcomes Framework (QOF) is approaching its fifth birthday and has made aspects of measurable diabetes care the envy of the world. However, there are still problems to address. Effective seamless collaboration between hospital based teams and primary care isn’t happening everywhere and, eight years after the National Standards Framework (NSF), very few patients would say they are truly empowered and involved in their care, according to the National Diabetes Audit. And the cost is huge. The aggregate annual PCT spend on care for people with diabetes is approaching £1 billion and as that only accounts for less than half the total costs, we as a nation are spending nearly £10 million a day on diabetes. The problem is that much of this spend is not effective and there is massive duplication and waste, not least the waste on programmes which are inadequately evaluated and on medications that are not taken through lack of engagement or understanding of benefit. Most people working in primary care appreciate what some of the main issues are: ● Ineffective integration between primary and secondary care. ● IT systems which don’t allow data sharing between different users. ● Ineffective commissioning by PCTs and alliances. ● Lack of true patient engagement. Since the National Diabetes Audit disturbed the cosy feeling of achievement engendered by QOF improvements – noting, for example, that less than half of patients had been involved in planning their care – most organisations involved in planning diabetes care have taken a step back to look at some of the barriers to effective delivery of care. Pilots are emerging which look at integrated IT incorporating e-consultations and direct data

Generation excellence: Recent graduates from the RCGP Leadership Programme with TV presenter and Chancellor of Exeter University Floella Benjamin (centre), RCGP President Professor David Haslam (front, second right) and RCGP Honorary Secretary Dr Maureen Baker (front, right)

Stepping up to leadership The RCGP is recruiting its next generation of leaders – and you have until mid September to sign up. Brian Karet: Care quality information at all levels needs to be contructed and disseminated entry and access by patients. The Year of Care pilots are currently being evaluated using tools to engage patients in treatment decisions. These pilots have shown some major benefits, not least of which is the improved working environment for primary care teams looking after people with diabetes no matter what their skills level. The Diabetes Commissioning Toolkit is being relaunched with the aim of becoming much more practical to commissioners and providers of care. Groups of professionals and patients from across the hospital gate divide are looking to break down barriers to make integrated diabetes care a reality and move away from the inconsistencies evident around the country. One of the drivers to iron out inconsistencies in the way diabetes care is delivered is to construct and disseminate care quality information at practice, locality and PCT levels so informed proactive patients can influence both commissioning and delivery. Public Health Observatories, NHS Diabetes and the Diabetes UK Information Bank have gone some way to doing just this. Of course, there is a lot of information out there already. All GPs in the UK have taken part in the fantastically successful QOF which gives important practice-based information on, for example, what proportion of people in the practice have a HbA1c under 7.5 or a Cholesterol under 5. However, this system doesn’t tell patients whether they can see a team locally that knows about insulin management; how long they have to wait to see a podiatrist; how many dieticians there are; or whether they can contact a diabetes nurse at 10pm on a bank holiday. It also doesn’t tell you how well people like them are being looked after. Perhaps it should. Well organised patient-focused teams should be proud of the care they deliver and act as beacons for others. At the end of the summer it’s hard to think about snow but, like a snowball, initiatives that are evidenced and effective (and more importantly improve patient care) have a good chance of being adopted. So I’m helping to push the snowball – a roll model!

The RCGP Leadership Programme – Better Leaders, Better Doctors – is the only one of its kind specifically targeted at GPs and structured specifically around the changing landscape and challenges of primary care. It will help you to: ● Focus on issues that matter to you, your organisation and your community ● Discover your own leadership style and become more effective within your practice and PCT ● Lead locally and influence the agenda in your local care economy

● See the bigger picture and influence the national policy agenda The one-year programme – run by a consortium from the University of Exeter, the OD Partnerships Network and the Peninsula Medical School – comprises four residential weekends, five tutorial days and four to five hours of additional learning per week. Online coaching is also provided for confidential feedback and support. A ‘Blue Ribbon Panel’ provides the opportunity to interact with a group of nationally and internationally known figures, working mainly in health but also drawn from journalism and management to support the programme. Selection is by application form and an interview. A number of bursaries are available. ■ Email

■ For further information about the work of the RCGP Clinical Lead for Diabetes, please contact the RCGP Clinical Innovation and Research Centre /0203 170 8245 ■ CIRC is looking to recruit GPs with an expertise in all clinical, educational and research areas to act as an Expert Resource within the College. To register, please visit research/ circ/expert_resource.aspx or email for further information.



Annual National Primary Care Conference 2009

Excellence in Practice Winning ways for primary care

5-7 November  Scottish Exhibition & Conference Centre, Glasgow

y d a e r t e G


for ion! t a d i l a Rev

Don’t miss the opportunity to attend this year’s conference and learn more about the College’s role in Revalidation, the development and delivery of the system, as well as key timelines and requirements. The keynote address by RCGP Chairman, Professor Steve Field, 'Excellence through Revalidation' will highlight how Revalidation requires a commitment by all to improve the quality of care for our patients. Delegates will also learn about enhanced appraisal - what it means for GPs, what is required of GPs and support available from your PCT.

There are also over 50 different concurrent sessions to choose from, a host of workshops, courses and fringe meetings and of course a great social programme.

Don’t miss out on the event of the year! For further details or to register please visit or contact conference organisers, Profile Productions Ltd, on 020 8832 7311 or email: Principal sponsor

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