UK GP Training

layzeeboy

Hi all,

I've been reading this forum for a little while now. I just watched Monday's Frontline and the update on current shortage of GPs without a forseeable significant increase in GP training places and projected retirement of ~50% of GPs over next seven years.

I started my training as a GP in SE England last August and thought my experiences to date may be useful for some people considering training over here.

I studied in Trinity straight from school. I considered applying for GP training in Ireland immediately after internship but decided that I would give hospital medicine a go and thoroughly enjoyed it. I completed my 2 years basic medical training in SHO posts in various Irish hospitals. By that stage, I felt fairly knackered and decided to take some time out of regular hospital posts to recharge the batteries and consider my options. I did a mix of short-term locum work, volunteer work, travel, and spent 2months as an SHO in an acute medical unit in an NHS hospital to check out their system.

I considered the quality of life that I would likely have as a medical registrar in Ireland/UK, the further hoops I would need to jump through to get on an SpR scheme, and the limited long term prospects of getting a consultancy in Ireland even if I completed SpR training. During my 2 months in UK AMU, I worked alongside fully qualified GP colleagues seeing exactly the same unselected medical patients as I was. They had all the fun of acute medicine but worked 2 days/week in AMU, 2 days/week in GPland and never worked nights. Eureka!

I applied for GP training both in Ireland and UK via the appropriate online applications. Prior to my interview in Ireland, I went for an 'informal meeting' at one of the GP training days for the current trainees for the scheme as suggested. I met the heads of scheme and had a chat about my career to date etc. I was politely probed about my personal background and, literally, was asked if my father was Mr X who played sport with one of the trainers as a young lad (he wasn't)... I was shortlisted and attended interview, which was the standard panel of six interviewers asking questions across a table scenario.

In the UK, no 'informal meeting' is suggested prior to the selection process. Following online application, the next step was a computer-based MCQ assessment of intern-level broad medical knowledge and ethics. The last step was a selection day broken into 3 parts: a written task-prioritisation exercise, a short teamwork exercise with three other candidates observed by one examiner per person and lastly a roleplay with an actor in a healthcare setting lasting 20-25mins, which was also supervised by an examiner in the background. I understand that the application system has changed a little since I did it but I don't think it's an awful lot different.

At the end of the day, I was offered a place on my preferred UK scheme but was not offered a place on the Irish scheme. Decision made for me.

A few compare and contrast points:

UK training 36 months, Ireland 48 months
UK scheme didn't make me duplicate experience of jobs I had already done, no guarantee of that in Ireland
UK application process felt suitably anonymous and it's difficult to see how any charge of appointment to training scheme due to personal contacts etc could be levelled against it. I'm sure that such shenanigans don't happen in Ireland but the process does not appear to be as transparent.
48hr EWTD compliant hospital posts in UK, not a hope in Ireland (!); means I work up to 30hrs less/week
There's still hospital management/politics nonsense but not as painful
The ratio of applicants to places in UK is way lower
Not too sure on salary comparison in current Irish climate but my take home is about UK£2300/month at the moment; a bit of a hit from what I was earning before with overtime but enjoying much better quality of life
My (non-medical) girlfriend also found work over here, which made the move a lot easier
It's a pain not being able to meet friends/family at a moment's notice but I found that equally difficult when I was working 70hrs/week in Ireland anyway...
Seven flights/day from Gatwick to Dublin

My scheme is broken down as follows:
Year 1: 4 months GP registrar, 4 months A&E, 4months O&G
Year 2: 4 months GP registrar, 4 months Ortho, 4months Paeds
Year 3: 12 months GP registrar

Target time here for qualified GPs is to see one patient every ten minutes, which is tight. I was seeing a patient every 15mins at the end of my first four months.

Plenty of supervision is available, at least in my experience, but can't vouch for this elsewhere

The NHS Free at Point of Care mantra makes some aspects easier, others harder e.g. don't have to ask people for e50 for consultation versus people coming in with a sore finger for the past few hours for which they haven't tried a couple of paracetamol.

Working as a GP over here seems to be more flexible with plenty of people enjoying a 'portfolio' career; plenty of GPs work part time in hospitals/hospices/occupational health companies/other setting. That said, in the greater scheme of things, we hope to move back to Ireland in due course. There's no difficulty working in Ireland with MRCGP, on paper at least; I'm not too sure if the lack of local contacts will make it difficult getting a first substantive post, maybe someone can comment on that? There's always locum work to get your face known, I suppose.

In summary, it felt like the UK process was more transparent, it's easier to get a training place here, you work less, you get an equivalent qualification BUT you're not in Ireland near your family and friends.

Sorry for the essay, I hope it will help somebody.

Conor


http://www.gprecruitment.org.uk/

UK applicant to place competition ratios http://www.gprecruitment.org.uk/ratios.htm

tightropetom

How many years experience had you before starting your scheme?
What are you doing at the moment?

£2300 a month? Is that in your GP posts, or in the hospital posts? I'm getting more than that at the moment in my hospital rotation, but am heading to GP land in August. Am I going to end up taking a hit to my wages? (To give perspective - I worked for 8 years prior to starting my GP training in the UK, 3 years as a Registrar in Ireland. I applied 5 times to the Irish GP scheme but no joy. Perhaps they've credited hospital experience . I'm currently approaching the end of year 1 on my scheme).

The following video may explain my feelings as of March 2010:
http://www.facebook.com/video/video.php?v=379112194441

layzeeboy

Hi Tom,

Hope you're enjoying your training.

Working O&G at the moment; the rota is very EWTD compliant so lower antisocial hours pay banding. I'd worked three years in Ireland (internship, SHOx2) then locumed/short term NHS/other for another year; total ~4year postgrad experience. The health authority where I'm working won't recognise my 3 years in Ireland for pay-banding although I've heard this varies from region to region. Was all your previous experience in Ireland?

Pay has been between 2300ish and 2500ish/month depending on whether GP, A&E or O&G so far this year - no variable overtime pay, as I'm sure you're aware. GP 2400, A&E 2500. Goes up a couple hundred in August when I'm 2nd year trainee.

Good job on the video! No mountains in SE England, should have added that on the things I miss list.

Conor

tightropetom

Ah, I see. I'm on EWTD compliant rota alrite in A&E but it must be that they've credited my previous 8 years a bit, hence I'm getting a bit more. I guess I'll find out in August how the pay'll change. I'm not too bothered though, the quality of life will be awesome

Cumbria's a great spot indeed for the outdoor stuff

sam34

i noticed there's no psych rotation- do you get to choose between psych and another specialty or is it random allocation?

its a big omission IMO , as a lot of psych stuff is managed in primary care.

Traumadoc

Yea I am suprised that there is ortho, but no psych.

tightropetom

Well I got no Obs&Gynae on my rotation. Probably because there were too many docs for the limited number of 'service job's available. Consequently some people have ended up with double stints in A&E or doing Elderly Care followed by 'Stroke' Medicine in our area. I'm doing Psych as an 'innovative post' while in GP land next August (half and half)

RobFowl

I believe UK training involves 1 year of "general" ie medicine/AE/Gen surgery etc and 1 year combining paeds/obs & Gynae and psych (or 2 of those 3).

Devils advocate Sam and Trauma doc but I strongly feel AE and Psych training should include a rotation through General practice ...

sam34

RobFowl wrote: »

Devils advocate Sam and Trauma doc but I strongly feel AE and Psych training should include a rotation through General practice ...

why do you think that? (for psych, rather than A&E)

i think its far more important that GPs have psych training rather than psychs having GP training. so much psych stuff is managed in primary care, it seems bizarre to me that a vocationally trained GP wouldnt have psych experience.


wrt psychs havng GP training - tbh, i dont really see the value of this but i'd be interested to hear your opinion of why it should happen. what do you think we could/should be doing that we're not doing at the moment? plus, theres the issue of keeping up to date - i mean, i did a stint as an intern in plastics and i can remember very little of what i learned, as i no longer use it and its not relevant. if i did a GP rotation and eg learned current guidelines on management of asthma, i'd use it so infrequently that it would soon be forgotten and out-of-date, whereas GPs see so much psych that they would be familiar with management of depression, anxiety etc.

my 2cents

RobFowl

sam34 wrote: »

why do you think that? (for psych, rather than A&E)

i think its far more important that GPs have psych training rather than psychs having GP training. so much psych stuff is managed in primary care, it seems bizarre to me that a vocationally trained GP wouldnt have psych experience.


wrt psychs havng GP training - tbh, i dont really see the value of this but i'd be interested to hear your opinion of why it should happen. what do you think we could/should be doing that we're not doing at the moment? plus, theres the issue of keeping up to date - i mean, i did a stint as an intern in plastics and i can remember very little of what i learned, as i no longer use it and its not relevant. if i did a GP rotation and eg learned current guidelines on management of asthma, i'd use it so infrequently that it would soon be forgotten and out-of-date, whereas GPs see so much psych that they would be familiar with management of depression, anxiety etc.

my 2cents

I think Psych tends to operate a little in its own bubble with little interaction with primary care (certainly locally). 90% of Psych issues are seen and dealt with in primary care as well. The importance of communication, access to services an generally a holistic view of the patients and family's needs rather than a problem orientated approach would I believe benefit all.
I think at the very least a psych trainee should have some experience of trying to get some one admitted, especially a formal admission when the receiving doctor seems to be inventing obstacles willy nilly would be an interesting exercise to say the least.
As both specialities are now more community based it would help if there was greater understanding of how these services are accessed, are available and how they work.
It would also help GP's by getting feedback on how referrals are viewed and what is deemed appropriate or now and also getting a consensus view on where "inappropriate" referrals should actually be going.
Locally we have terrible problems with lack of communication, little if any access to non pharmacological treatments and an appalling over use of benzo's by the local psych services.

Traumadoc

No Rob, I would say any training program should have some primary care element.

I believe understanding the roles and difficulties faced by GPs would be of huge benefit to hospital based doctors as well as GPs.

sam34

RobFowl wrote: »

90% of Psych issues are seen and dealt with in primary care

which is exactly why i think a psych rotation is so important for GPs. it's a bit baffling to me that someone can be a vocationally trained GP and not have psych, given that 90% of psych stuff is dealt with by the GP and 1 in 4 people coming in will have a psych problem, albeit not necessarily the reason for the consultation.

RobFowl wrote: »

The importance of communication, access to services an generally a holistic view of the patients and family's needs rather than a problem orientated approach would I believe benefit all

to be fair, of all specialties, i dont think psych could be accused of having just a problem solving approach and not taking the wider picture into account.

RobFowl wrote: »

I think at the very least a psych trainee should have some experience of trying to get some one admitted, especially a formal admission when the receiving doctor seems to be inventing obstacles willy nilly would be an interesting exercise to say the least

what sort of obstacles do they invent?

where i work, we have a policy that we only accept patients for assessment, not admission. it's more than semantics. the reason for it is that we have a finite number of beds, and we do not have the "luxury" of A&E trollies, the A&E dept refuse to have psych patients wait there for a bed (a whole other political debate). so, we dont accept admissions over the phone, as we have so many to deal with and we need to prioritise based on clinical need, not whichever GP phoned first.

re involunatry assessments, these cant be refused once an application and recommendation have been made. however, the recommendation is for a consultant assessment only, not necessarily an admission.

i know it sometimes annoys GPs when we ask them about the forms and the accuracy of the dating/timing etc, but it is incredible frustating (and sometimes dangerous) when a patient arrives "on forms" and then you find you cannot legally keep them because of a cock-up on the form. we now ask that they fax us the forms so we can have a look at them prior to sending up the patient, but that seems to have insulted/affronted some - of course, inevitably these are the GPs who end up sending in incorrectly filled forms and then ringing to complain that we didnt detain the patient.

RobFowl wrote: »

It would also help GP's by getting feedback on how referrals are viewed and what is deemed appropriate or now and also getting a consensus view on where "inappropriate" referrals should actually be going

again, shouldnt GPs learn that during their psych rotation?
i dont see why you would need a psych trainee to do a 6 month stint to teach GPs this.

common sense should apply too - (i presume) GPS wouldnt send a referral to a cardiologist for simple uncomplicated hypertension that they havent attempted to treat themselves, yet some will send us referrals on uncomplicated mild depression.

i meet the GPs in my sector every 6 months - i do a talk (on various topics) at one of their CPD meetings and its a useful opprtunity to give the above feedback informally.

RobFowl wrote: »

Locally we have terrible problems with lack of communication, little if any access to non pharmacological treatments and an appalling over use of benzo's by the local psych services.

RobFowl wrote: »

I think Psych tends to operate a little in its own bubble with little interaction with primary care (certainly locally)

tbh, the above seems to be a problem with some psych services, not a blanket problem. i certainly feel my servoce has very good communication with the GPs (bar a few who are just awkward :pac:)

RobFowl

sam34 wrote: »

which is exactly why i think a psych rotation is so important for GPs. it's a bit baffling to me that someone can be a vocationally trained GP and not have psych, given that 90% of psych stuff is dealt with by the GP and 1 in 4 people coming in will have a psych problem, albeit not necessarily the reason for the consultation.

Any speciality whose training excludes 90% of the pathology relevant to that speciality needs to ask serious questions about the quality of it's training.

sam34 wrote: »

what sort of obstacles do they invent?

Have they had alcohol in the 48 hours previously?
That sounds like organic pathology needs to be excluded send them to casualty...
Send them to casualty first and if they paracetamol levels are negative we may accept them..
That sounds like it's outside my area..
Send them to the Clinic in the morning (clinic inevitably goes beserk when they show up)
We've no beds try (insert any other unit and see answer 4)
Believe me you have to hear it to believe it and almost always sho/junior regs

sam34 wrote: »

re involunatry assessments, these cant be refused once an application and recommendation have been made. however, the recommendation is for a consultant assessment only, not necessarily an admission.

i know it sometimes annoys GPs when we ask them about the forms and the accuracy of the dating/timing etc, but it is incredible frustating (and sometimes dangerous) when a patient arrives "on forms" and then you find you cannot legally keep them because of a cock-up on the form. we now ask that they fax us the forms so we can have a look at them prior to sending up the patient, but that seems to have insulted/affronted some - of course, inevitably these are the GPs who end up sending in incorrectly filled forms and then ringing to complain that we didnt detain the patient.

The average involuntary admission takes place out of hours by a GP not familiar with their full history and takes between 3-4 hours. (almost always a co-op car shift which is 4 hours long)

sam34 wrote: »

shouldnt GPs learn that during their psych rotation?
i dont see why you would need a psych trainee to do a 6 month stint to teach GPs this.

It's more about Psych trainee needing training then and being taught about what services are available, how they are accessed and why patients do not always present in the "ideal" form


PS Don't get me wrong once you get to access consultant level the standards of care are good (but very poor with non pharmacological interventions). The standard of Sho/Reg level care is frighteningly bad. (One example I send in a patient for formal admission (under the old system) left my mobile , hone and partners number as the person had threatened to kill their ex partner and if it was not psych we were going to get the police involved to arrest them, Pat discharged at 10pm with no notification whatsoever) , That particular doc was a locum consultant.......

MrCreosote

The type of psych problems that GPs see is completely different to the severity of problems people see in secondary care. For the most part it's going to be mild depression/anxiety/adjustment problems rather than psychotic illnesses.
You do get training in this- it's the GP registrar block of the training that allows you to gain experience with 'GP' problems, including the psych ones. You could make the argument that time spent in almost any speciality will help a GP's practise but the line must be drawn somewhere.

My own opinion- the only two specialties that all GPs should do are Emergency Medicine and Paediatrics. Pick and choose from the rest.

sam34

RobFowl wrote: »

Any speciality whose training excludes 90% of the pathology relevant to that speciality needs to ask serious questions about the quality of it's training

thats not a fair statement, tbh. its not like psych training doesnt incorporate the milder end of the spectrum of illness.

RobFowl wrote: »

Have they had alcohol in the 48 hours previously?

:eek: do people really try that? thats ridiculous. if someone is intoxicated currently then fair enough, you cant do a reliable MSE, but 48 hrs? thats taking the piss.

RobFowl wrote: »

That sounds like organic pathology needs to be excluded send them to casualty...
Send them to casualty first and if they paracetamol levels are negative we may accept them

i know this pisses people off, but sometimes its necessary. without wanting to start anecdote-tennis, i got a call one night from a GP wanting to certify a guy who had sustained a head injury and was now agitated and confused. I refused to accept him, and was called lazy and incompetent by the GP, who then rang teh consultant on call, who also refused to accept him. (btw, i was an SpR at teh time, not junior). anyway, the patient went to the general hospital, and died later that night of his head injury. imahine teh scenario had he been admitted involuntarily under psych - the medics and surgeons are very slow to attend for consults at teh best of times, telling them its an involuntary patient worsens that... nightmare.

also, i've often seen attempts to certify someone who's delerious. they need A&E assessment.

RobFowl wrote: »

That sounds like it's outside my area

tbf, if it is out of sector then they are right to tell you, as they wont be able to admit the patient. so isnt it better that they redirect you to the appropriate service, rather than accept the patient, assess them and then try transfer them to another unit where the patient will have to wait agian, be assessed again etc.

RobFowl wrote: »

Send them to the Clinic in the morning (clinic inevitably goes beserk when they show up)

laziness, and inexcusable, imo.

RobFowl wrote: »

We've no beds try (insert any other unit and see answer 4)

doesnt make sense to advise this, given sectorisation. in any event, lack of beds is not your problem and you can always insist on assessment, even just so they'll go on the waiting list.

RobFowl wrote: »

Believe me you have to hear it to believe it and almost always sho/junior regs

i think in psych we can be unfortunate with the quality of trainees. because its not a popular specialty there are always vacancies, and we tend to get people who couldnt get other jobs and/or who want what they perceive to be an easy job. the 'real' psych trainees are streets ahead of these yahoos and are unlikely to be unhelpful/obstructive.

RobFowl wrote: »

The average involuntary admission takes place out of hours by a GP not familiar with their full history and takes between 3-4 hours. (almost always a co-op car shift which is 4 hours long)

even if thats the case, its not an excuse for incorrectly filling out forms. if you're concerned enough to fill out the forms in the first place, you should do it properly so that the patient can be assessed. nothing more frustrating than having a sick pateint land on the unit but not being able to detain them because someone messed up the forms (or sent in the old pink form, as happened me one memorable night...). its akin to a surgical reg consenting someone for a lap chole, even tho' they're having a splenectomy and thinking "ah sure they'll sort it out in theatre".

RobFowl wrote: »

PS Don't get me wrong once you get to access consultant level the standards of care are good (but very poor with non pharmacological interventions). The standard of Sho/Reg level care is frighteningly bad. (One example I send in a patient for formal admission (under the old system) left my mobile , hone and partners number as the person had threatened to kill their ex partner and if it was not psych we were going to get the police involved to arrest them, Pat discharged at 10pm with no notification whatsoever) , That particular doc was a locum consultant

that's disgraceful.

see my point above re some regs/SHOs.

re non-pharmacological intervention - i protect my access to this very tightly, as the resources just arent there. for my sector population, i should have 3 times the access to psychology that i have, 2 times the OT and SW input and another CPN. oh, and a day hospital. (i live in hope :pac:).
for that reason, we dont take direct GP referrals to allied health professionals as we have to prioritise what little we have.

i dont want to come across as desperately territorial or defensive (bit late for that:pac:), but just putting the psych perspective out there.

gaffer91

Hi guys, this might merit its own thread but I said I'd ask here as I don't have a clue-how many places are available on GP training schemes in Ireland and how many people (on average) apply for them every year?

RobFowl

gaffer91 wrote: »

Hi guys, this might merit its own thread but I said I'd ask here as I don't have a clue-how many places are available on GP training schemes in Ireland and how many people (on average) apply for them every year?

There 150 places ths year (up from 127 last).
They are oversubscribed by between 2 and 3 to 1

jimmydec

as a reply to all the psychs , have a positive note to add i have been working as a gp for over 30 years and the adult psych service in my town/rural area is fantastic:)-- excellent liason,interact with them several times weekly,CPNS and consultant/reg totally accessible-- have absolutely no problem making sure the forms are ok--will check with them to see all ok-still absolutely dread!!! like any gp the urgent psych involuntary admission cycle, but they do the best they can to facilitate. Dont hear the same story from colleagues in other parts of the country, and the child adolescent service is scarily under-resourced :mad:.Also NO service officially for psychogeriatrics or intellectual disabilty-- so we are all on the frontline just about managing outside our expertise with this type of pt:eek:

ergo

MrCreosote wrote: »

The type of psych problems that GPs see is completely different to the severity of problems people see in secondary care. For the most part it's going to be mild depression/anxiety/adjustment problems rather than psychotic illnesses.
You do get training in this- it's the GP registrar block of the training that allows you to gain experience with 'GP' problems, including the psych ones. You could make the argument that time spent in almost any speciality will help a GP's practise but the line must be drawn somewhere.

My own opinion- the only two specialties that all GPs should do are Emergency Medicine and Paediatrics. Pick and choose from the rest.

I would agree with this point of view

conflict of interest: I have my MRCGP qualification but haven't done a psych rotation

thanks to OP for posting this, I , like many Irish docs, did a self structured scheme when it was possible, whereby I did my hospital jobs ad hoc in Ireland and went straight into 3rd year in UK as GP registrar - this, after multiple narrowly failed attempts to get on Irish schemes (this is no longer possible and now you have to do the full 3 years in the UK)

as OP mentioned, the selection process is much fairer and more anonymous in UK. In Ireland after I got shortlisted for a highly competitive GP training scheme a previously successful candiadate advised me to canvas the head of the scheme in person, said he had done that himself (this was between shortlisting and interview)...I did ask somebody else's opinion and they advised strongly against canvassing..I didn't in the end, didn't get the place...but my interview wasn't as good as it could have been...and I could argue that I didn't have the family connections....in the end it worked out well for me, but I wasn't too happy at being effectively forced to emigrate for my training

regarding the UK schemes there is a big variety of hospital jobs that can be done so you won't duplicate experience eg Ortho etc. There are some schemes in the UK with no Paeds on them which I think is essential however...working Paeds A+E was by far the most useful hospital experience for my subsequent GP work..... I know of people that have gone through Irish schemes without doing any Psych or any Obs/Gynae and it hasn't done them any harm

be warned, I believe there are some (maybe just a tiny fraction, but some) purely service hospital jobs in the UK where you may not learn a whole lot and just work very hard doing the very mundane tasks - OBGYN used to be notorious for this in Ireland - I'm not sure if it has changed much) - so it's not necessarily all a bed of roses in UK --- but that could be because the English (in my opinion and experience!) tend to give out so much about their system and possibly their jobs...any that have been exposed to the Irish system usually say they will never give out about the NHS again!

also, it's so much cheaper in the UK (outside London)

and re coming back to Ireland - in summer time there's plenty of locum work out there so you can get yoursef known on the GP scene for work purposes..it can be challenging seeing private patients initially after the NHS experience but you get used to it..or you could work in a place that sees all or mostly GMS patients...and soon it'll be universal "free" healthcare for all so will be even more similar to NHS

Amnesiac_ie

Enough with the positivity GPs; you are seriously going to tempt a lot of us off our HSE "training" schemes.

We're most used to bowing down to our seniors; being told how awful our job prospects are and fighting to be paid for the illegal hours we work.

fkm

Good post, just wondering if you have to have completed the two SHO years in order to be eligible to apply for the UK GP scheme? I am a first year SHO and am looking to apply to the Irish GP scheme but would like to maximise my chances by also applying to the UK as well.

Thanks in advance if anyone knows this!

chanste

fkm wrote: »

Good post, just wondering if you have to have completed the two SHO years in order to be eligible to apply for the UK GP scheme? I am a first year SHO and am looking to apply to the Irish GP scheme but would like to maximise my chances by also applying to the UK as well.

Thanks in advance if anyone knows this!

The following link might help:

http://www.gprecruitment.org.uk/applicantsguide.html#id5

You will be asked to confirm that you have...
12 months satisfactory completion of either a pre-registration, internship* or FY1 post AND 12 months full time satisfactory completion in posts approved for the purposes of medical education by the relevant authority.

OR 12 months satisfactory completion of either a pre-registration, , internship* or FY1 post AND 12 months full time experience at a publicly funded hospital in at least two specialties with acute medical responsibilities as shown in List “A” of the List of Specialties (see below).

OR 12 months satisfactory completion of either a pre-registration, internship* or FY1 post AND a 12 month full time FY2 post.