SCOPME Report into the educational needs of GP non-principals

As mentioned in our last Newsletter, the Standing Committee for Postgraduate Medical Education has come up with some findings and recommendations that were reported to the Secretary of State. It recognises non-principals as an educationally disadvantaged and vulnerable group, and goes on to make 13 recommendations which include:

• inducting all non-principals to their relevant practices
• "Educational contracts" to be provided for non-principals to specify time available for education within contracted hours.
• career counselling
• inclusion in mentoring schemes
• inclusion in initiatives to draw up personal educational development plans.
• non-principals should be routinely notified of local educational activities.
• all GP non-principals should be provided with written information about their eligibility for educational funding.
• mechanisms need to be devised so that non-principals have appropriate access to support to meet their educational needs.
• non-principals should be included on mailing lists for important publications.

Further details are at http://www.scopme.org.uk.

Chief Medical Officers Report of CPD

Published four months after the SCOPME report, this review by Sir Kenneth Calman recommends a sweeping change to the provision and delivery of education for primary care. Its core recommendation is for the implementation of Practice Professional Development Plans (PPDPs), whereby education is organised at a practice level and will include education for assistants, retainers and long-term locums. However, the only mention in the report of short-term locums is as a possible means of allowing GP principals to undertake education. The report suggests that PPDP's are initially run in parallel with the PGEA system, with the funding still being made to GP principals only. This is potentially a great improvement on the present system of PGEA, with group-based learning central to education. However, the PPDP is the only means of education suggested and excludes most locums.

Calman pays no attention to the existence of over 60 non-principal groups in the UK, which would have been the one additional means of providing education for GP locums. Nor does he pay any heed to the recommendations made by SCOPME into non-principal education. Clearly this could have grave consequences for locum education, and is a step backwards (and a slap in the face) for these GPs.

The NASGP has made its feelings known to the relevant authorities, and will strengthen its campaign to bring equal education to all GPs.

A full text of the report can be found at http://www.open.gov.uk/doh/cmo/cmoh.htm.

Editorial - Workforce planning

We've all heard about the GP recruitment crisis and the problems persuading new principals to join practices. Few would question that the ultimate aim of any planned recruitment drive for general practice should be to ensure effective delivery of medical care to our patients.

If there is a shortage of GPs, why aren't our patients up in arms? Someone somewhere must be looking after them. The equation doesn't seem to add up. Has anyone shown that patients are not being adequately treated because of this low recruitment into principal posts? No. And why? Because non-principals are out there, taking the strain.

The common mistake when looking at recruitment issues is that “GP” is widely assumed to mean “GP principal”. With around 7,500 non-principals (representing anything up to 20% of all GPs), working an average of six sessions per week, this could amount to an incredible 1 in 5 of all GP consultations.

So before implementing spectacularly expensive ways of recruiting more students into medical school, more doctors in to general practice and more GPs into principal posts, it makes sense to first make the most of the GPs that we already have. And, yes, that means non-principals.

Educate us equally, employ us efficiently and treat us with the respect and status we deserve and, as sure as night follows day, doctors will be queuing up again once to become GPs.

Guest Editorial

GP tutors are appointed by Regional Directors of Post Graduate GP education and have responsibilities and duties towards both principals and non-principals within their areas (See article GP tutors - who are they and what do they do?).

However, only GP principals can apply to become GP tutors. A non-principal GP could do all the tasks required of a GP tutor, and it seems unfair that they are excluded from these posts by virtue of their employment status.

Since the publication of the Standing Committee on Post Graduate Medical Education (SCOPME) report on the educational needs of GP non-principals, Regional Directors of GP Post Graduate Education should be aware of the neglected educational needs of many non-principals. Some Regional Directors have appointed tutors with a specific remit to seek out and offer a variety of educational opportunities to GP non-principals. This type of GP tutor is still a fairly rare breed, but we do a lot to highlight the educational needs of non-principals and the deficiencies of the PGEA system for doctors who choose a different career path within general practice. In regions where no tutor or course organiser has been appointed, local non-principals should ask their Regional Director to appoint someone in line with SCOPME recommendations. Regional Directors are having to make budget cuts of 5% this year, which makes the creation of new posts more difficult for them. They nevertheless have a responsibility to ensure that the educational provision for all practitioners in their regions are comprehensive and inclusive of both non-principals and principals.

GP tutors can offer a variety of methods to GPs to identify their educational needs and a host of suggestions as to how to meet those needs. The recent Chief Medical Officer’s review of Continuing Professional Development (CPD) in Practice suggests that in the future practices teams will use these methods to formulate Practice Professional Development Plans (PPDPs) annually. PGEA is likely to be abandoned and replaced by a budget for CPD to be held by GP principals. Where non-principals working as locums in several different practices would fit in to such practice learning plans, remains unclear. These doctors clearly need to formulate their own personal learning plans with the help of their GP tutor. They must then have adequate financial support and protected time to achieve their learning goals. They will also need to be aware of the priority areas that a Primary Care Group (PCG) is tackling in its Clinical Governance and Health Improvement programmes, and should be included in the consultation process required of PCGs with their stakeholders. The Department of Health must take this in to consideration when developing the new arrangements for PCGs and CPD within primary care.

Bitty Muller, Educational Facilitator for Non-Principals in the West Midlands Region.

GP tutors - who are they and what do they do?

I was appointed as Educational Facilitator for Non-Principals in the West Midlands Region in September 1996, and discovered I was a member of the GP Tutor Group in the West Midlands. At present only principals can apply for a GP tutor post in West Midlands.

There are 2937 GPs in the West Midlands region, we have 450 Non-Principals on our regional register and there are 22 GP tutors. Each tutor has a base at a local Post Graduate Medical Centre where secretarial support is available. Additionally, Regional Directors of GP Post Graduate Education throughout the country, are becoming aware of the neglected educational needs of Non-Principals and are appointing Tutors with a specific remit to seek out and offer a variety of educational opportunities to GP Non-Principals.

GP tutors have duties, which fall in to 3 main areas:

• Identification of educational needs
• Provision and facilitation of activity to meet the identified need
• Evaluating educational activity.
• liaison with Health Authorities, the local MAAG, Course Organisers, the hospital clinical tutor, LMCs and their Regional Director.

These duties are generally performed by providing a basic ongoing series of meetings at Postgraduate Centres, though some tutors also offer an annual 3 or 5 day update course. They also approve all PGEA applications for courses, meetings and individual GPs.

In post graduate medical education there is a growing awareness that adults learn best when they are “self-directed” - they assess their own knowledge gaps and decide how they want to fill those gaps for themselves. In addition to lectures, there are lots of ways for practitioners to keep up to date. GP tutors have a responsibility for offering a full range of educational methodology to their “flock” of doctors. This range includes Personal Learning Plans (PLPs), Self-Directed Learning (SDL) groups, practice-based learning and practice learning plans, mentoring, co-tutoring/”buddying” and information about higher degrees and distance learning.

GP tutors are increasingly offering individual sessions to GPs in their areas, assessing the individual doctor’s learning needs and help them to formulate a PLP. Such plans can comprise spending time in the library reading up about a subject, or sitting in with a consultant colleague or attending a course at the local college. A written record of their learning achievements is kept, and this can be presented to the GP tutor as their portfolio at the end of the time period that they have set for their PLP to run. In the future practices teams will use similar methods to formulate practice learning plans annually.

In our region GP tutors also attend 4 study days annually to share ideas and update on educational theory and techniques. Because of all these duties, tutors do tend to be energetic activists, and are a good source of information about local practices, courses and initiatives. They know their locality and might be able to put doctors who want to meet regularly in touch with a colleague to formulate and discuss their learning or personal and professional development.

Non Principals in the West Midlands region can link into their local Postgraduate Centre, and generally attendance’s at short meetings are free for Non-Principals. Additionally, in our region all GP tutors now have a responsibility to meet with retainer scheme doctors on their patch annually, to look at their career plans and educational needs - this is proving very popular. We offer 2 regional study days for retainer scheme doctors (a mixture of lectures and workshops) which are paid for out of Section 63 money. Additionally we have 5 active self directed learning groups for Non-Principals throughout the region, where doctors who are working as locums, assistants and retainers can get together and discuss problems or review their learning needs with others in the same situation. We have also managed to secure funding for a “Return to General Practice” Course for doctors who have had a career break and who are thinking of increasing their time commitment to GP. So when a person is appointed to a tutor post with specific responsibility for Non-Principals, a lot can happen. It all needs funding, however, and as we all know, there isn’t much money around!

The local postgraduate education centre can tell you who your local GP tutor is and your Regional Director of GP Post Graduate Education (DPGPE). Their office can then tell you if they have anyone in post with a specific responsibility for non-principals. Get in touch. We want to hear from you and are trying to offer appropriate educational initiatives for Non-Principals.

Bitty Muller, Educational Facilitator for Non-Principals in the West Midlands Region.

Non-Principal GP Tutor - A Valid Job Title at Your Local Post-graduate Centre

I would like to see a network health authority funded non-principal GP tutors. These tutors could be the "focal point" for non-principals in their area, working closely with existing non-principal groups and existing GP tutors. They would be responsible for identifying and keeping in contact with all non-principals in their area, co-ordinating support, mentoring, disseminating information and constructing educational events. The tutor would need to be aware of sources of finance for educational events for those not eligible for PGEA. Like most non-principals, I believe I have a fair idea of what education I want or need and possibly even the organising skills to make it happen. What I do not have is the paid time to go to the events I would like to, nor to consult with the non-principals in this area to produce a programme that would answer our particular needs.I believe that a non-principal should definitely hold the post of GP non-principal tutor. Conflicts of interest could arise if principals are appointed to this position. In the future GPs may move more readily in and out of principal posts and may require specific advice on this, which could be made available through the non-principal tutor, supported by interested principals if necessary.With a non-principal tutor at the centre of non-principal groups, I believe non-principals' interests will be better served. This must ultimately help the whole of general practice, which relies on quality locums, assistants and retainers for its present and for its future.

Eva Kalmus

Non-Principal GP Tutors

The NASGP is aware of a growing band of GP tutors and other educational facilitators who are keen to help local non-principals. These GPs have an educational interest or background, and may have some form of budget or contractual remit for this purpose, or simply seeing the education of non-principals as a logical extension of their current job description. This is different from our working definition of current non-principal group co-ordinators, as these tend to be actively working non-principals with no such other formal educational remit. We have compiled the following list, and would like to add to this in further editions of the Newsletter. Please let us know if you or a colleague would like to be added to this list.

Area: Ealing, Hammersmith and Hounslow
Job Title: Post VTS Course Organiser
Contact: Carolyn Lynch. Telephone: 0181 894 6588, Fax: 0181 894 6668

Area: South Thames (West)
Job Title: Adviser for Non-Principal GPs, South Thames West
Contact: Anne Hastie. Telephone: 0181 669 3232, Fax: 0181 661 9804

Area: NE Thames NP GP Tutor/Course Organiser
Job Title: NP GP Tutor
Contact: Rebecca Viney. Telephone: 0171 278 3487, Fax: 0171 278 0772

Area: Merseyside
Job Title: NP GP Tutor
Contact: Jenny Fox. Telephone: 01704 569 181, Fax: 01704 550 616

Area: West Midlands
Job Title: Educational Facilitator for Non-Principals: West Midlands
Contact: Bitty Muller. Telephone: 01543 414311, Fax: 01283 792379

Area: Dorset
Job Title: GP Course Organiser
Contact: Mark Taylor. Telephone: 01202 841288, Fax: 01202 840877

Area: Manchester
Job Title: Fellow for the Retainer Scheme
Contact: Jan Webb. Telephone: 0161 972 9999, Fax: 0161 972 9995

Area: County Durham
Job Title: GP Career Start
Contact: Jamie Harrison. Telephone: 0191 333 2807, Fax: 0191 386 5934

Area: Cumbria
Job Title: Associate Director of GP PG Education
Contact: Rod Jones. Fax: 01697 332834

Area: South Devon
Job Title: GP Tutor
Contact: Nick Cooper. Telephone: 01803 654707, Fax: 01803 616395

Area: Bexley & Greenwich
Job Title: GP Tutor
Contact: Sarah Divall. Telephone: 0181 319 9864, Fax: 0181 319 9868

Nomination of members to serve on NASGP Council 1998-1999

The NASGP was formed in January 1997 by a group of enthusiastic GPs to serve and represent GP non-principals. As with any such organisation, we have striven to represent our members as best we can. In order to continue in this tradition, we must do this democratically and will therefore hold an election for our new council later this year.

Council members are required to attend up to 5 two-day weekend meetings per year, and are expected to contribute to the general running of the association.

11 members need to be elected to sit on the NASGP council from 1998 to 1999. Any full (non-principal) member of the NASGP may propose another full member for election to one of the 11 seats. A postal ballot will take place in August if the number of nominations exceeds the number of seats. A single transferable vote system will be used for the election. The result will be declared at the national conference and in the non-principal newsletter.

Nomination forms and further details may be obtained by application to the Returning Officer at the NASGP, PO Box 188, Chichester, West Sussex, PO19 2YP. The closing date for applications for nomination is July 30th 1998.

Local Group News

All it needs to start up a non-principal group is for one individual to act as a co-ordinator. Collect a small list of names and think of somewhere to meet up - perhaps a pub, bar or restaurant. When the first person arrives, get them to buy the drinks and suggest they help you organise the meetings! Group dynamics will take over from there. As you'll see on the back page, we produce a list of all our contacts. If you'd like to be added to this list, either speak to Alyson Lee on 01865 779583 or write to us at the address at the end of this newsletter.

Lothian Association of Non-Principals

After just one year the LANP goes from strength to strength. We now have 70 members & meet on the 1st Wednesday of each month. At each meeting we have a PGEA approved education talk, a short business meeting & either a buffet or meal, usually followed by a trip to the pub.

We have recently made some progress on the education front, with Lothian considering a 25% reduction on the cost of attending courses for non-principals, and are looking at allocating 10% of all course places to non-principals, either at a reduced rate or even free! Our next big event should be an introductory week end for new members in September, when we hope to cover essential topics such as tax self-assessment, medico-legal matters etc.

Allison Holloway

West Surrey Non-Principal Group

We meet on the first Monday of the month (except bank holidays - then second Monday) at Woking Community Hospital, from 7.45pm-9.30pm. We normally have a speaker, usually a local consultant, who does an informal discussion/question and answer session on a relevant GP topic that our group has requested. The meeting is sponsored by a drug rep who provides a buffet supper first and gives us time to discuss problems. We have also received PGEA accreditation at our members' request for those going on to partnerships. As equally important are the occasional social meals out to get all those tensions off our chests.

We have a locum availability list that is circulated to local practices quarterly for a £10 yearly administration fee, along with our terms and conditions of work, including our set rates of pay which are the top end of the BMA suggested scale. All our members now receive BNFs and a copy of the local GP guidelines.

I have a non-voting seat on the West Surrey LMC, and have been involved with the setting up of the salaried doctors scheme. We have managed to secure £20,000 for the education of non-principals in West Surrey, although I am still negotiating how this will be distributed. Our Health Authority has also funded a personal computer to help us run the group - all we need to do now is work out how to use it! We have developed strong links with the NASGP, and most of our group are members.

We also have good links with the GP Tutors at the two local hospitals, and by attending GP luncheon meetings each week, we recruit new non-principals and get to hear about maternity locums, partnerships etc. that I can pass on to members. We actively encourage members to attend these meetings as it helps prevent isolation. As we all sit together, it makes the principals realise we are worth reckoning with (as well as the important educational aspect of course!)

Nicki Mantel

North Thames

Keep an eye on North East London to find out what could happen for non-principals everywhere. Rebecca Viney - see the section on GP tutors for contact details - has lined up a host of interactive courses, self directed learning groups and comprehensive information on all things non-principal. All these are free for non-principals, with PGEA certificates thrown in! And check out their new website at www.nthames-health.tpmde.ac.uk online soon - you'll need your NASGP number to access some of the contents.

Enfranchising non-principals

A National register of non-principals is being developed in Wales as part of a GP educational initiative funded by the Welsh Office. An up-to-date, accurate and accessible register has many implications for the NHS and could enfranchise non-principals in Wales.

Until the NASGP emerged, most arguments made against the inclusion of non-principals in the structures and processes of the NHS were based on the assumptions that non-principals are an ill-defined and transient group. The register also challenges this position.

Non-principals must be encouraged to enlist. One proposal is to create regional ‘quality registers' in each Health Authority area using data from the national register. Inclusion criteria could be set to ensure quality and each registered non-principal would be eligible to an educational allowance. Continuing medical education would be a major criterion for inclusion onto the register. All parties commissioning non-principal services would be recommended to use the register.

The non-principal registers thus formed would define non-principals as a quality assured group and clarify their relationship with Local Health Groups and LMCs. Non-principals could contract with Health Authorities in a similar way to principals and Trusts and GP practices could commission their medical services. A register would also enable dissemination of essential information and improve workforce planning.

Quality and consistency can only be achieved by providing the resources and opportunities for non-principals to participate in continuing medical education akin to that provided for principals. Involving non-principals in the structures and processes of the new NHS will ensure equitable distribution of resources. The non-principal register will play a crucial role if this is to be achieved.

Tony Downes

How the NASGP National non-principal database will help you

You may recall recently ticking a "data box" on your NASGP membership application form, allowing us to pass on your details to your local Director of Postgraduate Education, Health Authority and LMC. This is in an attempt by the NASGP to help these departments and organisations to keep up to date with their local non-principals and thus help target local resources more effectively. We have written to all these bodies asking them to register their interest, and we are delighted by the response so far. With the written assurance from the recipients that your data will not be passed on to any other organisation, we hope that by August 1998 we should be able to start circulating your details.

www.nasgp.org.uk

As if you didn't already know, our website is up and running. We've already welcomed over 500 visitors, and have been particularly encouraged by the use of our discussion forum. Members have been posting questions and comments from subjects relating to education, superannuation and the retainer scheme. If you have any queries, you may find this a useful way of sharing them.

DFFP - the Diploma of the Faculty of Family Planning and Reproductive Health Care

The deadline for applications for the DFFP, based on holding one of the JCC, FPA or a pre-1990 DRCOG certificate, has now been extended to 30th September 1998. If you have one of these and need a DFFP certificate, and feel you will be able to slip in before the deadline, get your skates on and call the faculty on 0171 923 7184.

NASGP National Conference, 24th and 25th October, Norwich

Plans for this year’s conference are now complete. Although priority will be given to those members who ticked the box on their membership renewal forms, there is still time to apply for your application pack if you have not already done so.

We have found room for an extra 50 delegates for the Saturday only, added to the 150 places for both days. The rate for the full weekend, including lunches, dinner and accommodation is £90 for members applying before August, which compares with £195 for non-members.

Features of the conference include

• Full crèche and childcare facilities
• Flexible accommodation options for accompanying families and additional stays (the following week is half-term)
• A 25-stand exhibition
• A choice of 11 workshops
• Keynote address by Mr Richard Armstrong, Head of primary care, NHSE
• After dinner speech by Dr. Phil Hammond
• Question time event with Dr. David Haslam (RCGP), Mr. Maurice Henchey (Chief executive Healthcall) , Prof. Ann-Louise Kinmonth,( Professor of GP Cambridge University), and Dr. Peter Holden (GMSC and Chair of Private Fees Committee)
• A soapbox event for members to have their say
• 4 hours’ PGEA and section 63 applied for.
• Results of the forthcoming elections to NASGP council

Book early to avoid disappointment! For an application pack write to the NASGP, PO Box 188, Chichester, West Sussex, PO19 2YP.

Pensions for locums

A landmark meeting took place at BMA house on 5th May between representatives from NASGP superannuation task group, BMA Private Fees Committee, BMA superannuation committee, BMA superannuation department, pensions department of NHSE, and Confederation of Health Authorities. The NHSE had already conceded to the NASGP that it accepted the principle of allowing locums into the scheme after we successfully lobbied the director of Primary Care in March. This latest meeting, based on the NASGP's and BMA's proposals successfully produced a consensus on how it could all be administered, and many of the NASGPs’ suggestions were adopted. We are waiting for a final answer from the NHSE and an implementation date.

The following is a brief summary of the proposals, which carry the full support of the NASGP.

• Any doctor legally eligible to practice as a GP would be eligible to contribute.
• An individual locum may voluntarily “opt in”, by registering with a Health Authority (probably the one in which he/she resides)
• Full scheme benefits (as well as pension) to apply from the date of initial registration.
• Locums will carry customised forms countersigned by employing principals, documenting their gross earnings per period of work, or be able to append countersigned invoices.
• Every quarter, Locums tot up their GMS earnings and multiply by 69.1%,(to turn gross pay into net pay) and then calculate 6% of this. They send their form and a cheque for this amount to the HA, which will pass it on to the Pensions HQ with another 4%. DoH officials will have the right to spot check the validity of these earnings, and their accuracy is the responsibility of the locum.
• Backdated pensionable earnings will be based on declared net income for the months from 1.9.97 to the date the scheme goes live (subject to statutory limits on allowable pension contributions), Locums will send a single payment cheque which will be backed by 4% direct from DoH
• Because some of the work we do is not superannuable , such as co-op duties, deputising and small amounts of private work, we won’t have to abandon any PPP's that we already have.

Peter Harvey

Fees

Members of the BMA/NASGP fees working group met in May, and have prepared a complete redrafting of the “BMA rates”. This needs to be approved by individual working group members, amended accordingly, and ratified by BMA Council. This means that we are on target for publication by the autumn. The draft proposals are “fair enough” in our opinion, and we are optimistic that we will be able to support the final draft. Members are thanked for their patience shown on this matter so far this year.

New Age Men

Ruth Pinder is a Research Fellow and Education Consultant at Brunel University. She has already performed an in-depth study of women GPs' experiences of flexible working and its impact on professional development. However, feedback suggests that male GPs would like their voice to be heard too, and has obtained a funded extension form the RCGP to provide just such a rounded picture.

She would therefore like to hear from any part-time male GP - of any age - preferably living in London or the Home Counties, who will be willing to speak to Ruth about their experiences. Please contact Ruth on 0181 867 9772. All calls will be treated in the strictest confidence.

CSN Research

Ever wanted to tell drug companies just what you think of their advertising? CSN Research are keen to find out what non-principals think of press adverts and information supplied by drug reps. By filling out the occasional simple form, you'll be helping the way we receive new drug information, as well as receiving a gift token for your efforts. Call 01202 670099 for more details.

Letters

Dear Editor,

I would like to thank the NASGP’s newsletter for putting in a notice on the new journal launched for women GPs. Unfortunately the first edition and plans for the journal were made by Macmillan publishing. The health care publishing element of Macmillan was taken over by Emap healthcare at the end of last year and after they had conducted some research they decided not to go ahead with publishing any more editions of ‘Women in General Practice.’

I got a fair number of phone calls from your newsletter, which shows it is well read and thanks again.

Jackie Cresswell

Dear Editor,

I was recently disturbed to learn that my registered address, which in the case of non-principals is most likely to be their home address, is available to any caller at the GMC without any attempt to find out the identity of the enquirer. Presumably, it is only after an assault on a doctor at their home as a consequence of obtaining this information has occurred, that this will be considered inappropriate. I hope we do not have to learn the hard way.

Name and address supplied

Following this enquiry, Shaun O'Connell has investigated the information that the GMC requires. We can now warn all our members that any doctor who gives the GMC their home address is unwittingly giving this information to anyone who wants it! The GMC is obliged under the Medical Act 1983 to publish doctors registered addresses and the GMC register is held in most public libraries. The GMC says that it draws this to the attention of applicants of full registration but the NASGP suspects that many doctors just don't notice this or forget it. Such availability of doctors private addresses could be a serious security risk, and we urge members to consider changing the details that they have given to the GMC.

The GMC does not require your home address, but non-principals who frequently change position may feel it is impractical to give any other address. It suggests using the address of a bank, solicitor or a PO Box number. The NASGP knows that using the latter option costs £110 per annum. First Direct (telephone) Bank told us they don’t offer such a service but one firm of solicitors thought the cost would be small. We would be interested to know whether any members have had any bad experiences as a result of not realising their address was public, and whether any members have any experience of using a reliable alternative address.

The NASGP is considering starting a service for its members to redirect such mail - once we’ve worked out how best to do it. Watch this space!

Editor,

Congratulations and well done on securing access to superannuation for GP locums! I have had correspondence with various people at the BMA over the last year about several issues relating to non-principal finance, and am glad headway is finally being made.

When you get round to it, don't forget to argue for a decent maternity package for non-principals - GP assistants are still not covered by Whitley Council agreements.

Keep up the good work.

Caroline Hoffbrand, part-time Principal and ex locum/assistant

Thanks for your support, and we're very grateful for your continued support as a principal. This great leap forward would not have been possible without the huge contribution from Peter Harvey, Chairman of the NASGP superannuation committee. I'm sure he's looking for another challenge, although his experience with the pitter-patter of little feet is more limited to the feline kind!

Non-principals working in the third-world

NASGP member Helen Corcoran describes her work as a Volunteer Missionary in Kenya

Not another Mango-related injury!

During my first morning surgery back in England I saw no one with malaria. It took several days to recover from that unsettling feeling that I had missed something. In reality I was missing Kenya and the very different style of medicine practised there. That was two years ago. I had just returned from working at Mutomo Hospital, Kenya, as a member of the Volunteer Missionary Movement (VMM). Mutomo is in a dry, remote part of south-east Kenya, 50 miles from a tarmac road, with occasional running water, electricity from a generator for 3 hours each evening and one wind-up telephone for the 150-bed hospital, which serves 100 000 people.

The day’s work would begin with minor procedures such as inspecting skin grafts and draining abscesses. Ward rounds came next, starting with the very sick children on blood transfusions and quinine for severe malaria. Over half the patients had malaria and other problems included pneumonia, gastroenteritis, TB, burns, fractures, snake bites, malnutrition and AIDS. During the mango season there would be an epidemic of supracondylar fractures in boys who had fallen out of mango trees. Most outpatients were treated by nurses, who referred anyone with complicated problems to one of the three doctors. Many people saw a witch doctor before or after attending hospital.

Basic drugs were available but laboratory facilities were limited. The lab could cross-match blood and screen it for HIV. Microscopy of blood (for malaria parasites), urine and CSF could be done. During my first year in Mutomo the need for blood transfusion was assessed by the colour of the patient’s conjunctivae. I was very relieved when the machine for measuring haematocrit was finally mended. Clinical skills are certainly sharpened by the lack of available investigations!

Most days included a summons to the labour ward for a breech, twin or Ventouse delivery. Eclampsia and uterine rupture were common, partly due to lack of transport.

GP training was ideal preparation for working in Africa. Experience of Paediatrics and Obstetrics was useful, and so was the experience of working in General Practice with limited access to investigations. It was educational to work with an essential drugs list and very limited resources. I also gained skills in minor surgery, Obstetrics and infectious diseases. It was encouraging to see the benefits of immunisation, oral rehydration therapy and, when necessary, interventions such as Caesarean section.

We are fortunate in the medical profession that many of our colleagues look favourably on overseas experience. If you have thought about working in a developing country and you are working as a non-principal at present, now may be the time to consider voluntary work overseas, before the potential ties of work or family commitments remove this option. The Volunteer Missionary Movement (VMM) recruits committed Christians willing to give two years. Other organisations have different remits and a few recruit for one year.

If you would like further information about VMM please contact Helen on 01844 292386.

Crisis in the Sudan

Humanitarian crises are fortunately not that common in general practice, but when they do occur GPs are in a strong position to do something about it. If you're not currently committed, consider giving one of these organisations a call to see how you could help.

Medicins Sans Frontiers tel. 0171 713 5600

British Red Cross tel. 0171 235 5454

International Health Exchange tel. 0171 836 5833

Medical Missionary Association tel. 0171 928 4694

Warning!! Service general practice can seriously damage your wealth

There is a worrying rumour flying around RAF medical centres these days. Despite all efforts, our intrepid mole has been unable to elicit an outright denial.

Last year, most RAF stations were instructed to de-register their families (dependants of serving airmen and officers). At the time, the powers that be insisted this would have no effect on general practice seniority. This looks set to change, as Commands are facing the prospect of a humiliating U-turn.

At present, the time any doctor (service or Civilian Medical Practitioner, CMP) works as a GP for the RAF on Station is a direct one-for-one swap with regards to seniority for an NHS pension. This will no longer apply at stations without dependants. Time on such stations will be ‘wasted’ years.

Why is this important? With recruitment at an all time low, the RAF relies on CMPs - even on flying stations. If seniority is lost, then even CMPs will think long and hard before signing up.

And the relevance to non-principals? CMPs are non-principals - make sure you get any seniority issue clarified in writing before ‘joining’.

Of course, GP locums with service experience (whom the seniority issue already excludes) may become highly sought after - possibly with a subsequent upwards pressure on rates.

Wessex GP Education

The Wessex GP Education Committee responded to an article in our last Newsletter by asking the NASGP to help locate a non-principal representative . Flavia Woodwark, GP Education Manager from the committee, said "we were delighted to receive two keen applicants for the post. We were aware of the need for a non-principal to join the committee, and so turned to the NASGP for help". They appointed Lorrie Symons from Bath. Lorrie said of the meeting, "Non-principal issues seem to be traditionally ignored, but there was a clear indication from this committee that they wanted to change all that and start addressing our educational dilemma. They were quite keen for me to remind them each time a non-principal issue was being overlooked! It's great that the post has been created, and I found the meeting very useful."

We are very interested to hear if you have had any similar experiences, or want help in finding a non-principal representative on your committee.

GMSC subcommittee elections

The deadline for nominations for this committee has now expired. If the GMSC didn't send you a nomination form, then they don't know about you! Give Mr Peter Corpe a call on 0171 3836617 or fax on 01713836406 in time for the voting deadline of June 23rd for your ballot paper.

GMSC secures new GP retainer scheme

The GMSC has been attempting to secure government agreement to improve and update the scheme for a considerable number of years. The previous scheme has long been criticised by GPs as being too inflexible, with too little educational content and with inadequate financial incentives for participating doctors.Dr Judy Gilley, the deputy chair of the GPs' committee said “the present government is to be congratulated for coming to the negotiating table and achieving with us an outcome which is a win-win situation for all concerned”-However, Judy is keen to emphasise “We will be keeping a very close eye on the implementation process to ensure that retainers receive the intended benefits of the system”.The main points are:

• The number of sessions which can be worked in an approved practice have been increased from 2 to 4 per week.
• All practices will be able to participate in the scheme if they can provide the correct working environment and educational support to retainers, subject to the approval of the Director of Postgraduate GP Education (DPGPE)
• The employing practice will receive an allowance for each session which the retainer worksPGEA sessions undertaken as a retainer will be counted towards the first PGEA payment for those GPs who become principals.
• The GMSC strongly urges that retainers should be paid a salary in accordance with the BMA's guidance on the half day locum sessional rate
• Retainers are eligible to join the NHS superannuation scheme
• Retainers will be allowed to undertake sessional non GMS work such as family planning with the support of their DPGPE

The GMSC hopes the scheme will encourage many doctors to play a valuable part as a member of a practice team whilst family and other commitments prevent them from taking on a heavier workload.

Non-Principal of the Year

Applications are now all in for the Doctor Awards 1998. The non-principal category is again sponsored by Healthcall, and Professor Ruth Chambers - one of the NASGP's founding members - will be judging the non-principals category. Three non-principals will be invited, along with their respective partners, to the Doctor Awards dinner at Grosvenor House, Park Lane, London on October 20th.

East Norfolk non-principals suffer education setbacks

Norfolk LMC, in agreement with East Norfolk HA, has opted to channel finances initially intended for “salaried doctors” schemes into non-principal education. However, East Norfolk HA has withdrawn support for the this unique educational initiative, as local principals have now applied for this funding to employ salaried GPs. Dominique Hubble, one of four NASGP representatives on the LMC and member of the working group aimed at implementing mentoring and personal development plans for non-principals said of the news, "Funding allocation should be aimed at gaining the maximum patient benefit for the money available. Funding salaried GPs is short-term crisis management of a workforce shortage, which will still be present next year and only benefit a limited number of patients for a short time. GP education, however, is a long-term investment and in this case would have benefited a far greater number of patients for a longer period."

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