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Lord Darzi calls on GPs to step up to leadership challenge GPs do not need to ask permission from anyone to lead. They are already clinical leaders but they should have the confidence to put themselves forward for top roles in the NHS locally, regionally and nationally in order to exert their influence and expertise far wider than the clinical arena, according to Health Minister Lord Darzi. Lord Darzi’s comments came as he joined RCGP Chairman Professor Steve Field and RCGP Members for a teleconference discussion on local implementation of his reforms for improving patient care. He heard how GP leadership and engagement with Primary Care Trusts and Strategic Health Authorities was already helping to redesign local services and deliver improvements. Dr Mike Bewick impressed the Minister with a good example of how his own PCT in Cumbria had created a new business model for commissioning – with quality and GP leadership at its core. “Fundamental change is needed and this requires continued leadership from GPs. We realised that we would have to become change merchants in order to achieve this and we are lucky that our Chief Executive is an exemplar of this attitude. Our GPs don’t just sit on committees to give medical advice, we are used wisely to give advice on how to refigure local services,” he said. Dr Kay Mohanna from West Midlands drew his attention to a successful local leadership programme set up by the RCGP with a grant from the SHA to develop leadership in Primary Care. “Sixty people from across the West Midlands were recruited and supported to carry out Practice Based Commissioning-led projects, which shows that we can engineer environments for success “ Lord Darzi was keen to hear from RCGP Members about particular challenges and barriers faced by GPs when considering leadership roles. Identifying the relatively small number of PCTs with a GP as Chief Executive, he asked how top jobs could be made more attractive to entrepreneurial GPs. Dr Howard Bloom, who works within South East Coast SHA, identified a lack of confidence and reluctance to compete against professional administrators and civil servants. Halifax GP Dr Peter Davies added: “As GPs are self employed, we can’t be seconded and it’s often a case of not wanting to leave our patients or colleagues in the lurch. Our practices are our medical home and there is a lot of insecurity about moving into a PCT.” Lord Darzi replied that as a clinician, he could understand those concerns. “I admit that I had sleepless nights about taking this job and moving to what some consider


JULY 2009

Inside this issue... Excellence in Practice – Winning Ways for Primary Care Book now for RCGP conference 2009 and claim your discount


Childrens’ Champion

Dr Sheila Shribman on the crucial role of GPs in caring for young people


Spotlight on swine flu

Health protection expert Professor Anthony Kessel answers GP queries


The Next Generation

‘Junior’ International Committee reports on first meeting

Respiratory Medicine Why it’s a Clinical Priority

5 6

Expertise required

Sign up your skills to new RCGP resource


Primary Care Pioneers Dialling in: Health Minister Lord Darzi (right) joins RCGP Chairman Professor Steve Field for the teleconference with Members to be the ‘dark side’. But I took the plunge and now I’m here it’s much warmer than expected!. However changing our mindset is one of the biggest challenges we have.” RCGP Chairman Professor Steve Field said that PCTs needed to be more active in encouraging GPs to come forward for leadership roles – but that GPs had to be more confident about putting themselves in the frame for top jobs. “The Medical Director role in a PCT is a massive opportunity for GPs and we need to look at ways of encouraging more GPs to take on this role and then supporting them once they get there. But GPs also have to have confidence in their ability outside the clinical environment and stand up as leaders rather than managers.” He added that the College’s own Leadership Programme was already making excellent progress in successfully addressing this issue. During the teleconference, RCGP members also raised issues about commissioning and the location of GP-led health centres in some areas. Dr Kathryn Oliver reported that there had been a lot of interaction with local GPs by one Primary Care Trust in her area – but very little in the neighbouring PCT where the establishment of a ‘Darzi centre’ had created a lot of negativity. While London GP Tony Burch said his own bid to set up a GP-led health centre had failed – for no obvious reason. Lord Darzi replied that such decisions had not been predetermined and were not weighted against GPs. “No-one in the Department of Health is saying where these centres should be or who should run them. Even if we wanted to, it would be impossible. This has to be a local issue engaging service users and deliverers. “You need to look locally to those who led and made these decisions, to discuss with them how GPs and other local stakeholders can more effectively engage in future decisions so as to have mutual trust in those decisions.” At the end of the teleconference, he said: “Thank you for the discussion and feedback, which I would very much like to do again. We’ve made some bold statements about the role of GP leadership in driving up quality and I will do everything I can to ensure this happens. It will be the biggest disappointment if we look back in ten years and we’ve missed this opportunity.” Professor Field said that the RCGP was com-

mitted to providing solutions. “Last year you asked me to find constructive GPs to stand up and provide leadership,” he said. “Well, here they are today.” ■ Lord Darzi was speaking to the College’s ‘Darzi leads’ – a network of ten doctors established in September 2007 following the announcement of the Next Stage Review of the NHS. The Group meets virtually every month and is an opportunity for RCGP Chairman Professor Steve Field to update members on national activity and for GPs to share their experiences of how they are engaging with their SHAs on local implementation.

How GPs are positioning primary care at the core of mental health services


Current RCGP ‘Darzi leads’ Steve Field Chairman of RCGP (Chair) Andrew Spooner North West SHA Dinah Roy North East SHA Howard Bloom South East Coast SHA Kathryn Oliver East Midlands SHA Kay Mohanna West Midlands SHA Peter Davies Yorkshire & The Humber SHA Sati Aryanagram East of England SHA Steve Holmes South West SHA Tina Kenny South Central SHA Tony Burch London SHA

Appraisers – are you ready for revalidation? The RCGP is to hold a major conference for UK GP appraisers and Medical Directors in Primary Care Organisations immediately before the Annual National Primary Care Conference in November. Revalidation Ready? will take place on Wednesday 4 November at the Scottish Exhibition and Conference Centre, Glasgow, as a precursor to the main RCGP event. The College is keen to keep costs to a minimum to maximise attendance, so is charging a flat registration fee of only £49 – refundable if you also attend the full RCGP conference which runs from 5 -7 November. Chaired by Professor Martin Marshall, the programme will include: ● RCGP Scotland Chair Dr Ken Lawton on revalidation pilots ● Multi-source feedback and patient surveys led by RCGP Chair Steve Field ● Latest developments on CPD with Professor Nigel Sparrow and Terry John from the GPC ● Revalidation for ‘non standard’ general practitioners (sessional, academic and armed forces) led by Professor Mike Pringle and Dr Richard Withnall The conference will cover all the latest pro-

posals for appraisal, Continuing Professional Development and the roles of Responsible Officer and GMC Affiliate. Delegates will have the chance to have their questions answered by a range of experts from the RCGP and the other main organisations involved in Revalidation. RCGP Chairman Professor Steve Field said: “This conference should be an unmissable event. The College has identified a gap in the market and there is no other learning event like this currently available that is targeted specifically at GP Appraisers and Medical Directors of PCTs. It is a one-off opportunity for you to find out everything you will need to know about revalidation under one roof – and we hope that as many delegates as possible will stay on for the main conference.” Professor Jenny Simpson, Chief Executive of the British Association of Medical Managers, said: “This event is a ‘must-attend’ for every primary care doctor with a role in the revalidation process. The time to learn about the new processes and the real opportunities they bring to all those involved with service improvement and medical management is now. “Never before has there been such a chance to put the systems in place that we need to run things as we'd like – join us at this crucial event to hear the latest on timescales and key milestones.” ■ For more details, see the ad on page 2.


Book now for primary care’s event of the year Dr Clare Gerada RCGP Vice-Chair

The RCGP Annual National Primary Care Conference is now in its third year – and this year’s event at Glasgow’s SECC from 5-7 November promises to be bigger and better than ever! Now firmly established as the MUST ATTEND event for GPs and practice team colleagues, the central theme for 2009 will be: GP revalidation and the challenges facing the College and individual GPs. It will showcase the latest clinical and policy developments across the UK and bring together an impressive range of national and international speakers and politicians. The Conference offers a fantastic opportunity to update yourself on the latest primary care developments and to meet, network and exchange ideas with over 1,000 primary care professionals. A packed programme has been developed by experts to ensure that there is something to suit everyone. Alongside the ever-popular clinical, policy, research and education streams, this year’s programme offers something for the whole primary care team, with specific streams for practice managers and practice nurses. We also look forward to welcoming a large number of Associates in Training to Conference. AiTs are crucial to the future of the general prac-

Clare Gerada: There will be something for everyone at the Conference tice and are an important part of the RCGP. The Associates in Training Committee have put together an excellent programme for AiTs which includes talks and workshops throughout the

On show: The exhibition will again offer the opportunity to explore and compare a vast array of primary care products and services conference as well as a dedicated low cost AiT night out in Glasgow. Various programme streams have been devised specifically for AiTs covering the GP curriculum and the new MRCGP assessments and AiTs may also find the educational streams of interest.

CPR TRAINING Five two-hour CPR and resuscitation certificated courses are being operated by St Andrew’s Ambulance Association throughout the Conference. This is a great opportunity to refresh your knowledge on CPR procedures. The course and subsequent certificate is worth £50, but is being offered free of charge to all delegates (on a firstcome first-served basis).

MEDIA TRAINING For delegates wishing to learn or improve media interview techniques, presentation skills and tocamera styles, medical journalist John Illman will be running eight 90-minute training sessions throughout the Conference.

MOBILE SKILLS UNIT A mobile skills unit will be present, enabling delegates to update or refresh their skill set on a variety of different procedures.

EXHIBITION The exhibition will again be an integral part of the Conference, providing delegates with the opportunity to explore and compare a vast array of products, services and suppliers from a wide

range of primary care products and services. RCGP departments, faculties and councils will once again be exhibiting in the ‘RCGP Village’, promoting the work of the College, its products and services. This will be a great opportunity to see at first-hand how the College is supporting GPs preparing for revalidation.

POSTER SUBMISSIONS There is still time for delegates to submit poster presentations. In addition to research and scientific posters, the RCGP welcomes posters that demonstrate good practice, education and any new or innovative projects in primary care. Posters will be accepted from a broad range of professionals including GPs, practice managers, nurses, students and other allied health professionals, agencies and organisations. The deadline for submission is 31 August 2009.

SOCIAL PROGRAMME An extensive social programme has been devised, ranging from welcome receptions for various groups of delegates to the Conference Dinner and Ceilidh on the Friday evening at the stunning Kelvingrove Museum. Back by popular demand, there will be a special AiT Curry and Karaoke night and also a GP Jammin’ Session for musically talented delegates. I’m particularly looking forward to the RCGP version of Desert Island Discs on Thursday at 1.25pm with Professor David Haslam marking his final weeks in office as RCGP President. RCGP Honorary Treasurer Colin Hunter will play the part of Kirsty Young while castaway David discusses his favourite pieces of music and the items he couldn’t live without.

THREE-LEGGED RACE To help raise money for vital cancer research and the RCGP, we have partnered with Cancer Research UK to host the world’s largest threelegged race (as judged by Guinness World Records) which will take place around the Glasgow Quayside during Conference, with proceeds being equally split between the RCGP and Cancer Research UK. Why not join in the fun, pair up and take on the 1km challenge? There will be prizes for highest fundraisers, fastest couple and more... To book your team’s place, please email ■ Don’t miss out on your opportunity to save, by registering your Conference place by 27 July to benefit from the early bird discounted registration rates. Discounts are available on a variety of different tickets.

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:

It’s your conference: Update yourself on new developments – and make your voice heard

This will be different from any other conference you attend this year. It’s YOUR conference – we look forward to seeing you there! See the ad on the back page of this issue for full details about the conference.



A warrior for children and young people Widely known as the ‘Children’s Tsar’, Dr Sheila Shribman is a powerful and determined advocate for children, young people and families in the UK

r Shribman’s role as National Clinical Director for Children, Young People and Maternity Services stretches across a variety of different government departments. In total, her work encompasses nearly a quarter of the UK population. “To be flippant, I provide a dating service and translation agency,” says Dr Shribman. “I connect people who need to work together for children and who might be unaware of each other. I’m also fluent in clinical terminology, the professional world and NHS management talk. “I guess I’m more of an advisor than a traditional public servant. I work with senior figures in the NHS and Department of Health, and I get to travel around and see good practice in action – as well as hearing about problems.” Clearly she is undaunted by the enormous scope of her role. “I love my job – it’s extremely hard work and challenging but very enjoyable. It provides an opportunity to influence policy in a way which is very satisfying.”


The role of the GP There is no shortage of big issues to tackle, particularly in the light of the Baby Peter case and Lord Laming’s subsequent report. Dr Shribman says she is deeply aware of the role primary care has to play in promoting health and the provision of healthcare for children and young people – not least because her husband is a practising GP. “It’s fair to say I’m delighted the RCGP has chosen to focus on children and young people as a top priority,” she says. “I’ve always believed general practice is a central part of delivering good healthcare for children and young people, in both promoting and delivering it.” Dr Shribman believes health outcomes for children and young people have improved in some areas, but new challenges have arisen. “There is better awareness and recognition of conditions such as autism and ADHD, and infant mortality is falling, but it’s still not as good as it should be compared with our European peers. “Diabetes and obesity are major new public health challenges, and there is more to do for sick children in the light of new approaches to care.” There is room for improvement when it

comes to the diagnosis, treatment and support of children with long term health issues, she believes. “As one example, we need to do more to improve the treatment of asthma because there is a big variation in hospital admission rates around the country. Our new guide to be released in autumn will help with this.” She is keen to see improved training for GPs in dealing with child mental health issues. “Up to ten per cent of young people have mental health problems, and we know that depression is under-diagnosed. GPs don’t always feel they have the skills to recognise and deal with behavioural, conduct and emotional problems.” Safeguarding is another major issue arising from the Baby P case. “GPs may be anxious about this, but it’s unavoidable in clinical practice. You can’t choose not to do it! If you fail to recognise serious problems and take action there may be serious consequences for the child and the GP. “GPs have a unique role in protecting children because they are aware of risk factors such as domestic violence, drug and alcohol abuse, and the mental health of the parents. The wider context is very important in families as well as just the child specific factors. “GPs are in an ideal position to take a holistic view and understand the needs of the whole family. The new Child Health Strategy published in February 2009 emphasises the role of GPs and the opportunities we can take to improve health and healthcare.”

Communicating with young people Dr Shribman is keen to promote the role of GPs in helping young people transition from child to adult services, and avoid “falling through the cracks”. She also challenges GPs, health providers and local authority colleagues to improve their communication. “To be frank, many young people don’t think much of the services we offer them. They think we don’t understand them, and we’re not always very good at taking into account children’s views. Sometimes it can be hard for GPs to shift their mindset when they are used to seeing the parent as the patient. “Children’s views are very important to elicit.



views are very important to elicit. It’s ❛ Children’s important they feel the GP is listening and talking to them, and taking their concerns seriously. Of course I’m aware there are excellent practices and I’m a big fan of GPs... but we have a way to go to be as children and young person friendly as we could be It’s important they feel the GP is listening and talking to them, and taking their concerns seriously. “Of course I’m aware there are excellent practices and I’m a big fan of GPs – I’m married to one, after all – but we have a way to go to be as children and young person friendly as we could be.” Greater use of modern technology such as email, text messaging and the internet could help improve communication, she believes. She also shares the concern of the RCGP that many GP trainees no longer spend time in paediatrics. “I am concerned, and I know your Chairman Steve Field agrees with me. GP trainees undertaking paediatric placements have declined from around 60 to 65 per cent to around 40 per cent. In the past it was thought you could learn enough about paediatrics in regular GP placements but I don’t believe that’s the case anymore.”

Raising standards of care Dr Shribman is enthusiastic about measures to improve standards of healthcare, such as provider accreditation. “It offers a real chance to celebrate good care for young people,” she says. “I’m very interested in this and I hope to see a significant amount relevant to children and young people. “There are plenty of generic statements on good practice, but they are not often perceived to be about children and young people. This is a unique opportunity to raise standards and celebrate the success of the focus on quality, such as the ‘You’re Welcome’ criteria.” The same applies to QOF: “In the past very few points have been attributed to activities ad-

dressing the needs of children and young people. That’s been disappointing to many people, although I understand the difficulties of measurement. I hope the RCGP puts forward more proposals as it’s revamped.”

A career based around children Dr Shribman’s role is the culmination of a varied career which began as a consultant paediatrician. She has held various posts in NHS management, including as medical director and chief executive of a large acute trust for 11 years – “unusual for a community paediatrician,” she says. She was also a senior officer at the Royal College of Paediatrics and Child Health and has held posts in continuing professional development, workforce planning, child protection and policy areas. “This is why I was chosen for the role – because I’ve been out there and done it. What I can bring is clinical experience and practical, real life experience of the NHS. “I never thought I’d progress to achieve such a post. I didn’t come from a medical family but I knew I wanted to be a paediatrician from the age of 13.” It is a profession she is still closely involved with, practising one day a week in Northamptonshire. Away from work Dr Shribman enjoys reading, cooking, relaxing and travel – when there’s a chance – “which isn’t as often as I’d like these days!” Of her three children in their 20s, one has chosen to follow her into medicine. As for drawbacks to the role, she admits only one: “I admit that media exposure is not my favourite part of the job!”




Questions – and answers – on swine flu With the UK experiencing its first pandemic in over 40 years and the H1N1 virus continuing to dominate the headlines, RCGP Honorary Secretary and emergency preparedness expert Dr Maureen Baker quizzes Professor Anthony Kessel (right), Director of Public Health Strategy at the Health Protection Agency, on the pressing issues for primary care.

The UK is said to be operating a strategy of containment at the moment. What does this mean exactly in terms of antiviral treatment and prophylaxis for confirmed and suspected cases? The UK’s current policy of containment has been primarily aimed at reducing or limiting the spread of swine flu in the population during the early stages of this epidemic. A fundamental part of this is giving prophylaxis, either widescale or more targeted, to contacts of confirmed cases, as well as treating cases and encouraging self-isolation. Clearly, when a disease has spread widely in the community, the approach of containment is less appropriate and at that point we talk about moving to mitigation, the primary goal of which is reducing the severity of the disease in those who have got it.

When will we move to mitigation? The situation is constantly evolving, so it is impossible to say at the moment when a strategy of mitigation will be adopted. There are ongoing discussions about moving to mitigation at around the same time as we may have sustained community transmission of the virus. Sustained community transmission is not the same as spread within the community, which we clearly have at the moment (evidenced by the outbreaks in schools). Sustained community transmission is further than that and is a situation whereby a significant number of cases in the community are sporadic cases – in other words, have no links to another case or to travel – and scientific evidence points towards ongoing spread of the virus. We’re not yet at that stage in the UK, but we are undoubtedly getting closer.

November launch for doctor licences The GMC has announced that from 16 November all doctors will need a licence to practise medicine in the UK. From 16 November, all doctors will need a licence in addition to their GMC registration in order to undertake any form of medical practice in the UK, including writing prescriptions, holding a post as a doctor in the NHS, and signing death and cremation certificates. Since 20 April 2009, the GMC has been contacting all doctors on its register to find out whether they wish to take a licence. Some doctors, such as academics or researchers, won’t need a licence to practise and are therefore choosing to hold registration without a licence. GMC Chair Professor Peter Rubin said: “We have received a good response to the licensing campaign, having asked 225,000 doctors whether they want a licence to practise. So far, almost 50 per cent of doctors have responded, with the vast majority choosing to take a licence.” ■ The GMC has produced a guide, Revalidation: Information for Doctors and Frequently Asked Questions, which guide can be accessed at

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Kessel: GPs should keep up to date by looking at the RCGP and HPA websites regularly

If we know that we are not likely to be able to eliminate swine flu by containment, is this not a waste of time and resources? I don’t believe so. The success of the UK’s containment policy at slowing down the spread of the disease has been shown by the gradual increase in the number of cases during the first four to five weeks of the outbreak. Only in the last week or two has the number of new cases escalated to around 50 or more per day. Without this strategy of containment, it is extremely likely that we would have seen more cases in earlier weeks. It’s becoming increasingly likely that we’re going to reach a point where the virus will spill out to the wider community, but our success at delaying the spread has given us time to develop the basis for a vaccine and to ensure that government preparedness plans are in place. I therefore believe that our policy of containment has been valuable to both the healthcare community and to the public by gathering vital virological, epidemiological and clinical data on the disease.

Other countries are just giving antivirals to high risk groups. Bearing in mind the fact that Tamiflu has known side effects and that swine flu has proved to be a mild illness in most cases so far, would it not be sensible to follow suit? It is known that antiviral medication can have

side effects – we have picked this up in surveys of children in schools and is recognised by manufacturers; and we also know that because of this there is not always concordance with our advice on prophylaxis. We have noted these facts and they are very important findings for us. However, during a period of containment, the primary public health objective is to limit the spread of a disease in the community – hence the widespread use of prophylaxis, especially in the context of whole schools, year groups or classes being given antivirals. This use of prophylaxis on a large number of contacts has really helped to limit the spread of the virus, particularly during the first four to five weeks of the outbreak, therefore we uphold our recommendations to schools and parents. It is also the case that at some point, as we move away from containment towards mitigation, we will move away from this widespread use of prophylaxis in schools. It has always been the plan to have a step-wise approach: starting with widespread prophylaxis and slowly grading down to providing antivirals as prophylaxis for household or high-risk group contacts only.

It is quite clear that we are not picking up all cases of swine flu in the community. Would you agree that there could be as many as twice the number of cases in the UK as the HPA’s current official figures? Whilst the number of laboratory confirmed cases in the UK currently stands at just over 1,300, it is likely that there are many more cases in the community: there are inevitably going to be people with mild symptoms who don’t go to their GP and there is no way of us tracking these cases. However, there is a comprehensive system of flu surveillance in the UK – praised as being one of the best in the world – and, from what this surveillance is picking up, I believe that it is very unlikely that there are tens of thousands of cases in the community – a figure which has been mentioned by some scientists.

What surveillance measures has the HPA put in place to pick up cases of community transmission? The Health Protection Agency has enhanced its seasonal flu surveillance systems and put in place new measures to pick up cases of transmission within the community. In particular, we have enhanced lab reporting – for example, for the last few weeks, our network of RCGP sentinel practices has been testing anyone with influenza-like illness for swine flu. This has been

New awards celebrate the best of General Practice in Scotland RCGP Scotland has created a new national award for ‘GP of the Year’, the first of its kind in Scotland. Patients and the public will be able to nominate and vote for their chosen GP online and through the local and national media to recognise the huge contribution Scotland’s general practice makes to healthcare. Chair of RCGP Scotland Dr Ken Lawton has created the award scheme in order to highlight the excellent quality of care in General Practice across Scotland. He said: “Quality of patient care is a priority for GPs in Scotland and it is important to recognise the success stories of General Practice at its best. Creating the opportunity for patients to nominate their GP for an award gives us an important insight to the dedication of grassroots GPs who play a significant role, not only in the care and treatment of patients but as valuable members of the community.” A new Practice Team Award acknowledges the work and dedication of all members of the primary healthcare team, from administrative

staff to practice nurses. Practice teams are invited to put themselves forward and demonstrate how they have provided excellent quality of service for the patient community. The awards will be presented in December at a charity Awards Gala at the Braid Hills Hotel in Edinburgh. The patient who submits the winning entry for the GP of the Year will receive two tickets to the ceremony and be invited to present the award to their GP. All GPs in Scotland are eligible for the award and the winner will be chosen by a panel including members of the RCGP Scotland Patient group, P3. Patients wishing to nominate their GP can get more information by contacting RCGP Scotland or by visiting the website to download a nomination form. Closing date for entries for both awards is 14 August 2009. ■ Tickets for the Awards Gala are priced at £40, with discounts available for group bookings. To book please call the Executive team on 0131 260 6801 or email

complemented by a primary care testing scheme that is run by the HPA’s Regional Microbiology Network. Clinical surveillance has also been enhanced, by monitoring the number of consultations for flu like illness at GP Practices, and by monitoring NHS Direct consultations, to pick up increases in flu levels. For the last two to three weeks, hospital surveillance has also been in place: through a system that links in to microbiologists in hospitals around the country, we have been facilitating the testing of admitted patients who have acute respiratory, or other severe, illness. The HPA’s algorithms for swine flu testing are regularly updated and the most recent ones provide any clinician the opportunity to test patients who they believe might have swine flu – or to test simply for surveillance purposes.

Have these surveillance measures picked up more flu activity than would normally be expected for this time of year? What has been picked up doesn’t indicate that there are large numbers of people with swine flu. Cases have been picked up by our surveillance, but not enough to lead us to believe there could be tens of thousands of people infected in the UK.

What is your advice to GPs who are concerned about swine flu or unsure about their responsibilities? What is expected of them? The HPA has very close contacts with its GP colleagues. Since soon after the onset of swine flu, weekly meetings have been held between the HPA and key members of the RCGP and the primary care community, to help guide us on issues that doctors feel are pertinent to primary care and to those working in the field. This has been hugely valuable for us in terms of responding to concerns and issues raised. In terms of GPs who may be uncertain about what is expected of them, I would urge GPs to look at the excellent RCGP website and the guidance they have been issuing regularly to all their members. It is also important that primary care practitioners regularly look at the HPA website – and do note that our guidance, and especially our algorithms, have been, and will continue to be, updated regularly. This is very much a moving epidemic and we’re constantly changing our advice as we learn more about it. If a clinician is in any doubt, they can, as professionals, speak to a member of their local Health Protection Unit – contact details for which can be found on the HPA website. ■ Professor Kessel is also Honorary Professor at the London School of Hygiene & Tropical Medicine. He has a background in general practice and is a member of the RCGP.

Support for GPs to help patients into work The RCGP is running half-day workshops throughout July to support GPs managing patients with work and health issues. Delivered by a GP and specialist occupational health physician, the workshops aim to help GPs build their skills and confidence for dealing with clinical issues relating to work and health – including successful strategies for managing difficult consultations. The workshops are part of a £1million National Education Programme set up by the RCGP and the Department for Work and Pensions to drive up standards in the area of health and work. Over 100 workshops will be delivered over the next two years, to provide training and support for 3,000 to 4,500 GPs. The July schedule includes:

7 July 8 July 9 July 14 July 16 July

Luton Preston Birmingham Wrexham Guildford

12.30 – 4pm 12.30 – 4pm 12.30 – 4pm 12.30 – 4pm 12.30 – 4pm

■ For further information, see



A champion celebration for the Midlands Winning combinations in the Midlands... Top picture: RCGP President Professor David Haslam with Midland Faculty Board Members and award winners Below left: Michael Drury Award winner Beryl Smith with Dr David Rapley Below right: Midland Faculty Chair Kay Mohanna

Dr Ryan Prince RCGP Midland Faculty district representative and editor of Midland Faculty Newsletter FOR A NUMBER OF YEARS, the RCGP Midland Faculty has combined its annual general meeting with an event to recognise the local champions of general practice, GP education and GP administration within the region. This is a chance to acknowledge the unsung heroes who carry out the important day-to-day work that ultimately leads to improvements in patient care, as well as giving the leaders and innovators of our region the recognition they deserve. We were honoured to welcome both RCGP Chairman Professor Steve Field and RCGP President Professor David Haslam who had taken time yet again in their extremely busy schedules to join us for our special occasion. Professor Haslam was kind enough to congratulate the Faculty on our ongoing achievements and the fact that “we like to do things properly here”, probably alluding to the ceremonial order of events in the exquisite surroundings of Birmingham's Botanical Gardens! Following the annual general meeting there was a brief Faculty board meeting in which new officers and district representatives were elected and re-elected. During this short time, other award winners and their guests were able to enjoy a stroll round the venue’s various glasshouses and displays. Everybody then retired to the dining room and enjoyed an excellent dinner with exemplary service by the Botanical Gardens staff before Professor Haslam presented the awards. Events that celebrate the achievements of College members and staff, who keep primary care at the forefront of good medical practice, are a great morale booster in uncertain times. We look forward to next year and many thanks to all who made the evening possible.

Winners included: Associates in Training Dr Rachel Parry

for her article More than Words

Dr Peter Reeves

for his article Tears and Fears

Dr Adeela Bashir

for her project A Resource for Learning

Robin Steel Vocational Training Award Dr Mike Fisher, Midland Faculty Provost Michael Drury Award for Non-GP Contributor to General Practice Education Beryl Smith Quality Awards in GP Education Dr David Fuller Dr Andrew Bartlam Dr Sarah Shannon Dr Howard Skinner Dr Jag Dhaliwal Dr Paul Scott Dr Paul Middleton Dr Jag Sihota Dr Charanpal Sikka Claire Boothroyd Award Dr Kay Bridgeman

Setting up a ‘junior’ international committee Dr Luisa Pettigrew UK Vasco da Gama Movement Council Representative Dr Moontarin Ansar UK Vasco da Gama Movement Vice Council Representative Dr Soleman Begg AiT link to UK Vasco da Gama Movement ON A BEAUTIFUL SPRING DAY at the RCGP, an International Committee for aspiring and new GPs blossomed. With over 40 people attending, the largest room in the college was filled with a passion to share experiences and learn about General Practice across the world. We heard from Dr Iona Heath, Chair of the RCGP International Committee, and Dr Steve Mowle who encouraged the active involvement of young GPs in the College and at international level. We also heard from British trainees about their own international experiences and welcomed Dr Claire Taylor, Chair of the RCGP Associates in Training Committee. The day began with Dr Heath taking us on an inspirational voyage of her own career. She related numerous positive professional and personal experiences that she had gained from taking an active role in international activities. Consideration was given to which country the attending delegates would most like to visit and why. A cross-section of the world was mapped out by the replies! Discussion of health care systems in the various countries highlighted the enormous diversity of interest in international health. Yet the



recurring thought was: where are the opportunities? We heard reflections from two UK trainees who had seized the chance to make an international experience a reality for themselves. Dr Rowan Langton (ST3) from Sheffield enthused us by relating to her experience of attending the European WONCA conference in Istanbul last year. Attending a conference alongside more than 4,700 other European GPs, with a total of 189 sessions in 21 lecture halls, provided a truly unique learning opportunity. Dr Nicolle Green (ST1) from Manchester reflected on her experiences following an exchange to the Netherlands. During this exchange she had the opportunity to visit a Dutch GP practice, take part on a VTS study day and attend the Dutch GP trainee national conference meeting numerous doctors from across Europe in the process. Our guest speaker, Dr Chantal Emaus from the Netherlands, guided us through the ins and outs of setting up an international committee for young GPs and the huge benefits of doing so. In 2005 alongside other Dutch GP trainees she helped establish the Dutch European Working Party (‘WES’). This has grown from strength to strength, and now forms a very active part of General Practice training in the Netherlands. It enables over 50 Dutch trainees to attend the annual WONCA conference and regularly facilitates international clinical exchanges. By hosting foreign trainees at national conferences they have also ensured that not only those who travel abroad are exposed to international experiences.



Cross-country heat: Delegates at the first national meeting of the Junior International Committee Established at the European WONCA conference in 2004, the Vasco da Gama Movement is the European organisation for GP trainees and GPs within five years of CCT. It provides a forum for the exchange of ideas and experiences through clinical exchanges, research programs and educational sessions at international conferences. Brainstorming workshops made up the remainder of the afternoon, focusing on the key roles needed to form the committee and working on the five key areas of the Vasco da Gama Movement (Exchanges, Research, Education & Training, Image & Recruitment). The room buzzed with ideas and a working party was formed! There are many exciting projects planned over the coming year including setting up clinical exchanges, running a research questionnaire comparing vocational training across Europe, and for the first time hosting around 20 European trainees the RCGP annual conference in Glasgow in November 2009.

The day would not have been possible without the passion and enthusiasm of those who attended, nor without the support of many training deaneries and regional RCGP faculties who funded selected representatives. Many training deaneries and RCGP faculties have also agreed to fund representatives to attend the next European WONCA Europe 2009 conference in Basel, Switzerland. This will, without doubt, be an invaluable experience allowing doctors to share their learning both at home and abroad. We hope that this momentum continues and would encourage anyone who is tempted by what they have read to find out more. There are many wonderful international opportunities and with your participation we can make them happen! ■ To find out more please go to: ● – ‘Junior RCGP International Committee’ ● ● ●


CLINICAL UPDATE updated in 2008 with a further pharmacological update in process. So, what is the role of the College in all this ? The College, via Maureen Baker, has already played a major role in giving advice to government departments and health professionals regarding the current ‘swine flu’ outbreak. The launch of major asthma and COPD Guidelines gives a further opportunity for the College to be involved in their dissemination in primary care Other plans over the next three years include: q Further developing the respiratory expert resource within the College. w A joint initiative with the General Practice Airways Group (GPIAG) to improve quality standards in respiratory care in practices. e Practical respiratory workshops for GP trainees. If I could sum up why respiratory medicine should be a clinical priority, it is because primary care has a lot to offer people with respiratory disease. The life of the child (and his or her family) who is frequently being admitted to hospital with asthma can be transformed by effective prophylactic therapy. Good quality care can make all the difference to an elderly man with COPD from being depressed, housebound and fearful of breathlessness to living an active and fulfilled life. All of this can be achieved in general practice. Together, we can make a huge difference to a lot of peoples’ lives just by getting some of the basics right.

Why is Respiratory Medicine a Clinical Priority for the RCGP? Dr Kevin Gruffydd-Jones FRCGP RCGP Clinical Champion for Respiratory Disease and GP, Box, Wiltshire

Monday am Surgery 0830: JW (2 year old) with wheezy cough. “Is it asthma, doctor?” 0840: BH (65 year old) with Chronic Obstructive Pulmonary Disorder (COPD), coughing green sputum with streaks of blood. 0850: Phone call from a couple recently returned from Texas with flu-like symptoms. 0855: CL (45 year old) review of results of tests for breathlessness. 0905: HR (56 year old) complaining of falling asleep a lot in the day; wife can’t sleep at night due to his snoring. 0910: Asked by practice nurse to see a child with acute asthma.

So, why should Respiratory Disease be a priority for the College? Although the scenario on the left may be a little exaggerated, consultations for respiratory related problems are ‘bread and butter’ general practice. In 2004 one in five males and one in four females consulted a GP for a respiratory complaint. Respiratory conditions account for 24 million consultations every year, more than any other disease area. In the United Kingdom, one in five people die of respiratory disease per year: this is more than die from ischaemic heart disease. According to 2004 figures, the major killers in the UK are: ● Respiratory cancers (33,000) ● Pneumonia (34,000) ● COPD (27,000) Of course, the major concern is that many respiratory deaths are preventable (eg asthma) and are associated with social inequalities and inequalities in health provision (eg COPD). Statistics such as these have brought respiratory disease to the forefront of health planning. Inevitably, threats of a flu pandemic concentrate government minds but there is also an official report, highlighting inequalities of health provision for patients with COPD

Gruffydd-Jones: Getting some of the basics right can make a huge difference (Healthcare Commission, 2006), and that by the Chief Medical Officer in 2004 which have led to the development of a National Strategy for COPD which is due to be launched this year. In addition, the British Asthma Guidelines were

■ For further information about RCGP Clinical Priorities and the work of the Clinical Champions, please visit: circ/clinical_priorities_and_ccs.aspx Email: or call 0203 170 8245

Your College needs you – and your knowledge – for Expert Resource By Steve Holmes FRCGP RCGP Lead for Expert Resource Associate Dean, Severn General Practitioner Shepton Mallet THE GENERAL PRACTICE community can be rightly proud of the expertise and skills we have developed in family medicine, but many of us have great skills and expertise in more specialist clinical, managerial, educational and academic areas. One of the areas the RCGP is keen to develop is to be able to tap into the skills of its membership when RCGP, national or international policy decisions are being made. The Expert Resource initiative pilot began in April 2008 and was launched to help GPs actively contribute to the College’s clinical strategy, as well as support the RCGP’s responses to national consultation documents and work with the skills of its membership. The Expert Resource database is run from the RCGP Clinical Innovation and Research Centre (CIRC). It enables GPs to inform the College of their individual areas of expertise and then work with the College on relevant projects. Experts can register in three main areas divided into 78 specialties. The expert panel can provide a valuable resource, and an ability to understand both the dilemmas of family medicine and combine these with the evidence base and research into effective healthcare. The panel is commonly asked (depending on the topic area) to comment on strategic national documents – for example from the Department of Health, National Institute for Clinical Excellence (NICE), National Patient Safety Agency (NPSA), General Medical Council (GMC) and Royal College of Physicians – as well as RCGP documents that are being prepared. There are advantages for the general practitioner as they are privileged to gain access to central thinking at a high level and contribute to develop of these strategies and guidelines.

The expert panel is also used as a resource to locate general practice experts who are prepared to contribute to guidelines produced nationally as a general practitioner expert. From speaking to colleagues, this is again a great opportunity of working with a group of other experts from a variety of backgrounds, not only to steer care (along the evidence base) but to enjoy discussion of a topic from a variety of perspectives with passionate and committed professionals. The panel is also regularly contributing to the Essential Knowledge Updates, the GP core curriculum, the Map of Medicine and many of the other educational areas of development within the RCGP. At times, we are looking for general practitioners with ‘general expertise’ to perhaps comment on more expert advice or more general areas. We find at times that a GP with specialist interest sometimes knows just a little too much about their pet subject and forgets the generalist knowledge prevalent in most practices. Professor Nigel Sparrow, Chair of the RCGP Professional Development Board, said: “The CIRC Expert Register has made a valuable contribution to the work of the Professional Development Board, especially with respect to Continuing Professional Development and elearning initiatives. “GPs from the register have been directly involved with providing input into our e-learning packages, particularly Essential Knowledge Updates – our six-monthly synthesis of new and changing knowledge which was launched in May 2009 and will be a key element in the revalidation of GPs. “As we develop our e-learning strategy further, we will continue to need more help and we see the register as an excellent way of involving grassroots GPs, who are interested in contributing to the RCGP education and professional development initiatives in our work.” The initiative asks GPs to register their individual areas of interest and expertise through

an online form. Registration carries no obligations to the GP as they are contacted as and when appropriate, and they are free to accept any projects of interest if they have the availability and capacity. Commitment for the Expert Resource is not set and varies between different GPs. In the pilot phase, over 300 GPs registered as Experts in a number of categories. Most volunteered their expertise in an average of six areas. The Expert Resource areas are split into Clinical, Educational and Professional, with a number of subcategories for each area. So far we have managed to complete 48 different requests for involvement over a variety of projects and topic areas. After evaluation of the successful pilot phase, the College identified that the value of the Expert Resource initiative would be increased by having more members to work with. The infrastructure of the Expert Resource has been refined so it is now easier for GPs to register their interest and expertise. As the value of the Expert Resource has now been realised, there is an ever-increasing scope of projects for GPs to become involved with through this system. We are delighted that GPs who have been involved with the initiative to date have given positive feedback. Dr Sanjeev Maskara from Aberdeen said: “Expert Resource keeps me intellectually stimulated and updated with the latest developments and their contribution to the development of services that affect Primary Care. “It gives me an ample opportunity to get myself involved with the formulation and implementation of various stages in NICE guidelines groups, peer review and validate other clinical outputs essential for general practice.” Dr Joss Bray from Northumberland said: “Being an Expert Resource is certainly worthwhile from a personal and professional development point of view. As well as being able to inform national policy on important issues, it can


Holmes: A great opportunity to engage with GPs and benefit from their expertise involve working with people from widely diverse backgrounds. I would recommend it to anyone with a particular area of expertise coupled with a vision and passion to improve services to patients.” We appreciate every GP who has registered so far, but we are always looking for more to get involved so that we can meet the increasing volume of requests received by the RCGP from NICE and other organisations. The initiative is looking for more general practitioners to nominate themselves. We are looking for academics and generalists, we are looking for those with a strong clinical interest and/or strong evidence-based interest, but mostly we are looking for people who want to help improve the standard of care for our patients. ■ If you are interested, please register online at or email us for more info:

RCGP Chairman Professor Steve Field says: “It is more important than ever that GPs are actively involved with the work of the College, and the Expert Resource is one of the ways in which the members can use the College to make a difference.”





Pioneers in Primary Care: GPs lead the way in developing new mental health services Dr Ian Walton GP in Tipton, West Midlands Member of the RCGP/RCPsych Mental Health Forum and Chair of Primhe Lisa Hill Service Redesign Lead in Mental Health at Sandwell GP PRIMHE – THE UK CHARITY devoted to Primary Care Mental Health Education and Training – realised a few years ago that much was being talked about developing GPs with a special interest (GPwSIs) in mental health. But no-one really knew where to start or what to teach and, worse still, the money to finance GPwSIs had been devolved down to Primary Care Trusts, making it impossible to access. So we decided that we should give it a go. Recognising the opportunity, a number of universities were able to quickly set up GPwSIs courses in various medical and surgical sub-specialities. It proved relatively easy to develop successful courses to produce doctors doing clinical work above the general expertise of general practice but below that of a consultant - but not one university developed a course on mental health. Primhe could not see any advantage in producing sub-specialists in psychiatry, when the mental health we see in General Practice is very different from that seen in secondary care psychiatry. It is now generally accepted that in approximately 20 per cent of GP contacts, mental health will be the main reason for the consultation and that it will play a major part in up to 75 to 80 per cent. GPs are forced to deal with approximately 90 per cent of the mental health problems in the health service, and are the experts in common mental disorders such as anxiety, depression and psychosomatic illness. Yet most of us manage this majority of our mental health patients with little support, as we have no primary care mental health services to refer to or, if we do, they are sub-standard. Those with severe and enduring mental health problems tend to get referred to psychiatrists but Primhe is passionate about creating a primary care mental health service that meets the needs of the 90 per cent of patients who have less severe illness and who should be treated in the community. And who knows, if we had such a service, how

many of our patients could we prevent entering the secondary care psychiatry sector? We do a pretty good job already – one of the findings that has surprised the new IAPT (Improved Access to Psychiatric Care) services has been the severity of symptoms of many of the patients we do look after in our practices and in the community. When we did a needs assessment of potential GPwSIs in mental health we were therefore delighted that they too shared our dream of a comprehensive mental health service rooted in primary care and wanted both the skills to lead such developments and further knowledge of skills that they could introduce. It quickly became clear that if we wanted such a course we would have to set it up ourselves. So we designed a course that would start to meet the serious gap within primary care mental health services. Primhe is affiliated to the RCGP and we were delighted with their support. They worked with us to ensure that completion of the course would ensure that the

individual met all the competences to become a GP with special interest. Primhe approached a number of universities but only Stafford University would allow us to lead on the teaching of such a course and to define what needed to be taught. This was vital, as most universities we approached told us about the teaching packages already in their possession that they were prepared to teach. Our experience with the teaching of mental health to the workforce by universities is that students tend to get taught such packages, which are based on government policies and drivers, but that these fail to focus on local needs and what the individual requires for their work. We also designed our course to be primary care focused with the emphasis on delivering services to meet individual needs, as opposed to being purely categorised by disease. We developed eight modules, to be run over three years and the university rigorously ensures that we are reaching the required stan-

RCGP Vice Chair Clare Gerada says: It is gratifying to see general practitioners designing courses that truly meet the needs of GPs – rather than importing hospital-based training programmes and assuming these will do. Establishing a primary care curriculum for mental health had always been a tough and deceptively complex challenge. As the authors say, mental health in primary care is not the same as mental health presenting to psychiatrists. We know that our patients more often than not present with physical health problems, underplaying their true distress. GPs are more likely to deal with patients with a multiplicity of problems, having to interchange psychological support with dealing with housing benefits or their back pain. GPs need eclectic skills and to be able to assess and treat a range of problems, from anxiety to depression and substance misuse. It is tempting therefore when designing a curriculum to include everything and to risk replicating the MRCPsych. This course brings together the essential competences required for GPs leading special interest mental health services and equips these doctors with the necessary leadership as well as the clinical skills needed to perform. In 2000, the RCGP certificate in substance misuse was set up to help improve GPs’ response to the care of drug users and became the first of its kind to be accredited by the College. The certificate was designed by GPs, led by myself, and was set up to meet the needs of busy doctors. Nearly 10 years later, more than 4,000 GPs and other professionals have been through the training – which now involves a part one and part two element. The certificate is reviewed annually to make sure it remains up to date and fit for purpose. The success of the substance misuse certificate has shown that if careful thought is given to what GPs need to know and how they best learn, then the profession will participate in considerable numbers. Ultimately, better trained doctors provide better care for patients.

The fascinAiTing story of how the new College journal is motivAiTing and stimulAiTing the minds of GP trainees WITH THE INTRODUCTION in August 2007 of the RCGP Curriculum for General Practice Training and the new MRCGP assessment, all GPs in training (now known as Associates in Training or AiTs) became registered as Associate Members of the RCGP. To support the educational and learning needs of AiTs as they progressed through the period of specialty training leading to assessment, the RCGP, in partnership with Oxford Journals, launched InnovAiT in January 2008 with the objective that it would act rather like a rolling textbook covering the range of curriculum topics over a three-year period. Chantal Simon, an established author and editor of many leading books for GPs such as the Oxford General Practice Library and the Oxford Handbook of General Practice, accepted the position of Executive Editor of the fledgling journal, and tells her story of its development. “My first task was to find out what the trainees themselves wanted, so some focus groups with trainees were arranged. These were attended by a selection of trainees, at all

stages of their training, and our editorial team of two (Ben Riley and myself). They covered everything to do with the journal, from cover designs and colours, to page layout and content. “As a result of these focus groups, the journal with its distinctive lime green cover and unique format of easy-to-read articles collected into topics, linked directly to the requirements of the GP curriculum, was born. The trainees wanted the journal to be colourful, have a ‘hands-on’ feel and feature lots of photographs, tables, flow charts and figures. “It is not easy to ask people to write articles for a journal that had not yet come into existence, and the last three months of 2007 were a blur of activity – convincing established writers to write for us; developing a format for the articles that would ‘fit anything’; creating a reviewing system and developing authors’ instructions and editorial policy. However, by January 2008, the content for the first three issues of InnovAiT was complete and had gone to production. “A year on and InnovAiT has gone from strength to strength. It has been described in

terms as diverse as ‘the definitive information resource for GPs in training’ to ‘stonkingly brilliant’ – but thankfully all positive. Although originally aimed at AiTs and trainers, many qualified GPs also find the articles useful. Our board has expanded to 14 (including several AiT members), and our manuscript system has gone from a manual system on my own computer to a commercial automated manuscript management system (Manuscript Central). “The original format has proved very successful. InnovAiT covers two clinical topics and one non-clinical topic each month, featuring seven full length articles per issue. There is also a Crammer’s Corner section providing exam tips;

dard. We use a combination of local and national experts. Each module lasts two days and the course is residential in order to offer peer support to GPs and allow time to discuss and process the learning. The award is also open to commissioners and psychiatric nurses who help ensure a broader prospective. The seven compulsory modules are: ● Values ● Leadership ● Research ● Service redesign ● Common mental health disorders ● Ethics and law ● Service redesign The eighth module allows the student many options but the last cohort chose collectively to study NLP (Neuro-Linguistic Programming). We are running the ethics and law module now as a separate module, as completion qualifies one for Section 12 approval. The modules are studied at Masters level and include a dissertation, though this is not compulsory. Though most students find this extremely challenging, those who complete their assignments agree that the challenge is well worthwhile and the success of the course has been evidenced in the developing and championing of new initiatives across primary care, publishing of articles based on essays and also the current development of e-learning. By designing a course which has challenging learning outcomes, participants have addressed issues like stigma and social exclusion in their day-to-day practice, alongside leading on service redesign, commissioning and change management. The first students have now completed all eight modules and nearly all plan to go and do a Masters dissertation which will further research and develop mental health. It is hard to identify the real return of investment on individual PCTs but Primhe is proud of these pioneers in primary care and the beneficial outcomes for their patients is exceptional. The setting up of primary care services is in its infancy, though more developed areas have resulted in proved reductions in referrals to secondary care and the move to access care closer to home has been a key driver in the NHS. The evaluation has shown us that we have grown a number of GPs, all of whom have developed at both a personal and professional level; leaders who are challenging current services and developing a primary mental health workforce. Feedback from PCTs, in particular those in Manchester, Sandwell and Bradford, has been positive and supportive. ■ If you are interested in joining us on cohort three on September 17 and 18 or want to attend the legal and ethics module and gain Section 12 status on October 1 and 2, details are on the website at a News and Views section covering hot topics in primary care; and an Opinions section featuring articles not directly linked to the curriculum but which are of interest to GPs in training. “For each clinical topic there is a selection of Advanced Knowledge Test (AKT) questions in each print issue, with further questions available online. New features are constantly being introduced, such as book and course reviews, international perspectives and case studies. We hope that the new Snap shots will make the journal more exciting and stimulate visual learning, and that our new ‘buddying’ scheme, pairing novice writers with experienced authors, will provide AiTs with the support that they need to enable them to contribute to InnovAiT.” ■ If you would like to write or review for InnovAiT, please contact the editorial team at To read a free issue of the journal online, or to subscribe, go to www.rcgp-innovait., where you can also browse all the journal’s content.

Vacancy at InnovAiT We are looking for two people to join the InnovAiT team as Advanced Knowledge Test (AKT) editors. These posts would involve composing and peer reviewing the AKT questions for InnovAiT. If you are interested in joining the InnovAiT team and would like more information about these posts, please contact Chantal Simon at



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 Get for !


ion t a d i l Reva

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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