Preparing for life as a South West Trainee

Foreword

Welcome to the South West!

Health Education England (HEE)  would like to extend a warm welcome to all trainees joining this region.

At HEE, we recognise that the transition to working and living in a new area, or even a new country can be a difficult one. In the hope of easing this change, we have created this resource pack to provide the relevant information required by registered doctors coming to train in the South West.

‘Preparing for life as South West trainee’ should provide you with the information and resources you might need to help you at the start of your journey through training, here in the wonderful South West.

We realise there is lots of information that would be useful for any trainee new to training or new to the South West, so whatever your situation we hope you’ll find useful information in here to help you prepare for life as a South West trainee.

Wishing you well on your training journey!

Bijal O’Gara
HEE DA Fellow
ST6 Anaesthetics Registrar

Kimberly Silochan
International Medical Graduate
ACCS CT 2 trainee

Shamilah Clement-Rahman
GP DA Scholar
GPST3 Trainee

Contents

Living in the South West - Introduction
Working in the South West
NHS Peninsula Trusts
Accommodation and Renting
Biometric Residential Permit
Opening a Bank Account
Shopping
International Groceries in the South West
Transport
Culture, Custom and Community
Local Culture and Common Local Phrases
Food and Drink
Queuing
Before Starting your Post
Online Learning Resources
During your Post
Education and Support
Your Clinical Supervisor
Your Educational Supervisor
Career Planning
Applying for a Training Post
References

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Living in the South West - Introduction

The South West is the largest of all regions in England. The region offers an enchanting mix of sandy beaches and surf ready waves in coastal regions such as Torquay and Cornwall to vibrant metropolitan cities such as Bristol, Plymouth and Exeter. There truly is something for everyone here. It is no wonder why the region is such a popular destination for tourists. The area is becoming more diverse and offers a wide variety of food, and outdoor activities. Living in the South West gives you the perfect chance to try something new and exciting from paddle boarding to glamping, the options are endless. Additionally, the South West is relatively well connected to the rest of the country and continental Europe having airports in Exeter, Bristol and Cornwall as well as rail and national bus services. This makes it easy for a long weekend trip abroad. Why not try a day trip to the Isles of Scilly or beautiful St. Ives. Whatever you decide on we do hope you enjoy your time here and embrace as much of what the region has to offer.

Did You Know?

• Devon’s coast enjoys more hours of sunshine than anywhere else on the British mainland, inspiring the nickname the ‘English Riviera’.
• The South West is famous for its Devon cream tea, Cornish pasties and cider!
• The county has two large national parks – Dartmoor and Exmoor which you can explore by foot, horseback or even by llama.

Working in the South West

The South West region is made up of the Severn and Peninsula deaneries. As such there are numerous local NHS service providers in the region as well various Higher education institutes. All of which can provide various opportunities for career progression and training. The training programmes offered by Severn and Peninsula deaneries have been generally highly rated in recent General Medical Council satisfaction surveys completed by staff. If it’s your first post in the region or you are thinking of settling down it’s highly likely you may work in one of the following NHS hospitals.

NHS Trusts

Taunton and Somerset NHS Foundation Trust, Taunton
Northern Devon Healthcare NHS Trust, Barnstaple
Royal Cornwall Hospitals NHS Trust, Truro
Plymouth Hospitals NHS Trust, Plymouth
South Devon Healthcare NHS Foundation Trust, Torbay
Royal Devon and Exeter NHS Foundation Trust, Exeter

Gloucestershire Hospitals NHS Foundation Trust 
Great Western Hospitals NHS Foundation Trust, Swindon
North Bristol NHS Trust, Bristol
Royal United Hospitals Bath NHS Foundation Trust, Bath
University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
Yeovil District Hospital NHS Foundation Trust

Accommodation and Renting

Finding suitable accommodation may at times prove to be challenging. However, many doctors choose to initially live-in hospital accommodation until they settle down and can find somewhere more long-term to call home. It is useful to get in contact with your hospital’s accommodation manager or Human resource department about any vacancies. There is also the option of living off site. You may also be able to find a suitable rental and arrange viewing through real estate agents.

There are also numerous websites where you can search for your perfect rental. The most popular sites include:

• Rightmove
• Zoopla
• On the market
• Spare Room
• Open Rent
• RoomGo
• Gumtree
• Nestoria

The Governments 'How to Rent - the checklist for renting in England' provides a comprehensive overview of renting in the UK. It would be useful to read through the information provided on the link below before agreeing to let a home.

Biometric Residence Permit

Your biometric residence permit (BRP) can be used to confirm your:

• identity
• right to study or work in the UK
• right to any public services or benefits you’re entitled to

You’ll usually get a BRP if you:

• apply to come to the UK for longer than 6 months
• extend your visa to longer than 6 months
• apply to settle in the UK
• transfer your visa to a new passport
• apply for certain Home Office travel documents

How you get your biometric residence permit (BRP) depends on where you made your visa or immigration application.

If you applied from inside the UK

Your BRP will be sent to you by courier, usually within 10 days.

If you applied from outside the UK

Collecting your BRP should be one of the first things you do once in the UK. You must usually do this before the vignette sticker in your travel document expires or within 10 days of arriving in the UK, whichever is later.

Your decision letter will tell you to collect your BRP from either:

• a named Post Office branch
• your sponsor, if you chose this option when you applied

What you’ll need

Bring your passport or travel document with your vignette sticker in when you collect your BRP. It is always useful to call the named Post Office branch to check if your BRP has arrived before making the journey.

If you are having difficulties with your BRP visit the GOV.UK website for more information.

Opening a Bank Account

You should also apply for a bank account as soon as possible. This is essential as you will need this to receive your monthly salary. Additionally, there will be the advantage of setting up direct debits (automatic monthly payments for utilities / instalments) for various fees and subscriptions (eg – GMC and Royal College memberships). Here are a few popular banks that international medical graduates often open their first bank account with. You can find more information on their online websites:

• Lloyds
• Barclays
• HSBC
• Santander
• Nationwide Building Society

In order to open your bank account, you will need the following documents:

• Employment Contract
• Original Passport/Photo ID
• Evidence of Address
• BRP

Shopping

Groceries

One of the major changes that you will experience when initially settling will be the different foods. There are a number of supermarket chains that you will find across the South West (Asda, Tesco, Lidl, Sainsburys, Waitrose, Aldi, Morrisons). It is important to also note that other general shops generally close earlier than what you may have been used to, typically around 5pm. Therefore, it is essential to plan and organise your shopping well ahead of time. That being said many stores have online shopping available which allows goods to be delivered to your door at a time convenient for you.

International Groceries in the South West

If you’ve had your fill of fish and chips and scones and are really missing some home cooked food. There lots of restaurants specialising in different styles of world cuisine. You can also try some of these international supermarkets where you may be able to find familiar ingredients and food items from home. This list is not exhaustive.

CITY	INTERNATIONAL GROCERY	LOCATION	TYPES OF FOOD
EXETER	Heera International Foods	EX4 6QR	Indian, Chinese, Thai, Korean, Japanese, Philippine, Turkish, African, Middle Eastern and Eastern European
	168 Oriental Supermarket	EX1 2AT	China, Thailand, Philippines, Malaysia, Korea, Japan and Singapore
	Continental Food Stores	EX4 6LD	Indian, Bangladeshi, Chinese, Thai, Filipino, Korean, Malay, Japanese, Iranian, Arabic, Turkish, African, Nigerian and Caribbean.
TORQUAY	Eastern Groceries and Butcher	TQ2 5NF	Polish, Bangladeshi, Thai, Halal food.
	Jaz Pinoy Supermarket	TQ1 3AF	Asian
	Torquay Asian Food Store	TQ3 2RB	Asian
PLYMOUTH	Costless Worldwide Food Store	PL1 1TQ	Asian, Oriental, Kurdish, Turkish, Arabic, Iranian, African, Caribbean, European.
	Maxim Supermarket	PL1 1TQ	Eastern European
	Worldwide Food Store	PL1 1NJ	International
CORNWALL	Big International Grocer and Butcher	TR1 2SF	Middle Eastern, Asian.
	International Mini Mart	TR14 8AF	Polish,Romanian, Lithuanian,Bulgarian
BRISTOL	Alfu international	BS16 3UH	International
	Bristol Sweet Mart	BS5 6JH	Asian
	Wai Yee Hong Chinese Supermarket	BS5 6XX	Asian
GLOUCESTER	Wisla Supermarket	GL1 4HY	Eastern European
	Yip Shing LTD	GL15RZ	Asian
CHELTENHAM	Oriental Food Store	GL50 3JF	Asian, International
	Orient-Asia Foods	GL50 3HQ	Asian, International
SWINDON	Masala Bazaar	SN1 2AF	Asian
	Neelam Grocery and Halal Meat	SN1 2DS	Halal meat, Asian
	Fantasia Supermarket	SN1 5PL	Eastern European, International
TAUNTON	Ruay Thai Supermarket	TA1 3HL	Thai, Asian
	Pearl Oriental Food Store	TA1 1NU	Asian, International

 

Transport

The easiest mode of transport in the South West, particularly the more rural areas would be by car. Taxis can sometimes be costly and it is recommended that you start the process of having your own or access to a vehicle. However, there are other modes of transport available in the region.

 

 

Culture Custom and Community

When at work there will be a dress code that you must familiarise yourself with and comply with. This includes maintaining appropriate standards of appearance, dress and personal hygiene.

Common themes around appropriate dress at work for doctors in training include:

• All clothes must be clean, presentable and consistent with presenting a professional image. Jeans are usually not permitted to be worn in the clinical environment.
• Hair and beards should be neat and clean; long hair should be tied up and off the shoulder securely.
• Staff must not wear jewellery except for a plain wedding ring and ear studs.
• No wrist watches should be worn in the clinical environment.
• Staff must not wear false nails and/or nail varnish as it discourages efficient hand washing and can be a source of contamination.
• Staff must keep fingernails clean and short.
• Visible tattoos where present should not be offensive or provocative to others.
• Staff should not socialise outside the workplace or undertake social activities while wearing an item of clothing that will identify them as NHS employees.
• All clinical staff must wear short sleeves or elbow –length in the workplace to enable effective hand washing techniques- this is referred to as being ‘bare below the elbows’.
• Footwear should be comfortable and practical for the role undertaken. Enclosed shoes (toes covered) must be worn by clinical staff as these offer protection against spillages and injuries.

Local Culture and Common Local Phrases

In the South West there are some distinct accents.

West Country English is a group of English language varieties and accents used by much of the native population of South West England, the area sometimes popularly known as the West Country.

Its origins can be traced back to various West-Saxon dialects, which eventually developed into Old English in the Middle Ages. Some academics even think that the accents of various Saxon tribes are still reflected in the slight differences amongst accents in the different towns within the West Country.

You may come across new colloquial expressions which you don’t know, and you won’t be alone. These expressions can vary hugely across the UK and can be difficult to understand It’s always best to ask patients or colleagues to clarify what they mean by these to avoid misunderstandings. Some are more common, for example – “I feel sick” generally means I feel unwell rather than nauseous, ‘I’m going to examine your ‘back passage’’ means that you are going to do a rectal examination on the patient and ‘down below’ means the genital or peri-anal area! We’ve listed a few West country phrases below. Many of them may not be commonly used nowadays, but older generations in particular may still use many of these.

This document has some useful information about terms which are commonly used in the
UK -  https://www.bradfordvts.co.uk/wp-content/onlineresources/teachinglearning/international-medicalgraduates/spend%20a%20penny%20and%20other%20things%20patients%20say%20-
%20by%20jill%20choudhury.pdf

If this is an area you feel you could benefit from extra support in you can connect the
Patient Support and Welfare Team - https://severndeanery.nhs.uk/about-us/professionalsupport-and-well-being-south-west/show/what-psw-offers-2#language

Peninsula deanery have also made a communication skills app which you might find useful -https://telmed.uk/pcs/

 

Local word or saying	Meaning
Alright my lover	Hello mate
Gurt Lush / Gurt	Very good / large
Ark at Ee	Listen to him
In any case	anyway
Skew-whiff	crooked
Where be to?	Where are you going?
Chucky pig	Woodlouse
Janner	Person from Devon, particularly Plymouth. Used proudly by Janners, derogatorily by people from Somerset, Dorset, posh Plymouth and the Royal Navy.
Where’s that to?	Simply ‘Where is it’?
Lush	Nice, wonderful.
That’s the badger	That’s the exact one / that’s exactly what I meant
Dimpsey/ tis getting dimpsey	Gradually getting dark, especially in summer. (Used In Plymouth & Somerset)
Babber	Baby /small child
Yertiz	Here it is
Betwaddled	confused
Keener	Someone who tries hard
Grockles	West country word for tourists
Butty / Mucker	Friend (Devon) / friend (Gloucestershire)
Mind	A word used to emphasise a point. 'Be careful, mind'.
Off-Key	Having a bad day
Grass	Snitch
Scrumpy	Cider
Mint	Really good

 

This is a useful link for familiarising yourself with the south west accent:

British Accents: West Country - Bing video

The doctor-patient relationship in the UK has changed a lot over the last 30 years and may
be quite different to your home country. Patients will increasingly expect to have things
explained to them in a way they can understand, and to be part of making a decision about
what options will be best for them, called ”shared decision making”.
There are now some fantastic resources on how to help doctors explain complicated topics
such as risk: patient decision aids often use pictures to bring statistics to life and are useful
for doctors too! This link explains more with some examples:

https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making

Food and Drink

As a result of the diverse and multicultural nature of the UK, the food and drink on offer is varied, with nearly every type of cuisine catered for. This variety can be found alongside traditional UK food and drink.

The evening meal in the UK is typically the main meal of the day and may be referred to as dinner, tea or supper! Other meals eaten during the day include breakfast, which is eaten in the morning and can consist of cereal and or toast; and lunch, eaten around midday and typically consists of a sandwich.

Other terms used for meal times includes brunch; eaten between breakfast and lunch; supper, which may be eaten just before bed. Pudding or dessert eaten after the main meal. However, even within the same region there is inconsistency in the word used to describe a particular meal. Therefore, if in doubt, ask!

When it comes to sitting down and having a meal with others, there are some informal rules to be aware of

• Guests usually wait until everyone at their table has been served before, they begin eating, unless invited by others at the table to start eating.
• Food is eaten with a knife and fork (with the fork in the left hand and knife in the right hand) or spoon.
• It is considered polite to keep your mouth closed whilst eating.
• Conversation is welcome at the dinner table, although it is considered polite not to talk with your mouth full or eat too loudly.
• It is important to inform the host or waiter/ waitress at the restaurant of any dietary requirements and/or food allergies so that they may accommodate your request.

Queuing

The British have a passion for queuing (or standing in a line) and will que everywhere and for everything! It is commonplace to queue when waiting for something, when waiting to be seen by someone, when paying for something and even when waiting to be seated in a restaurant. If someone decides not to wait in line or pushes in front of someone to get ahead in an already established queue, they are described as having ‘jumped the queue’. In the UK, ‘jumping the queue’ is considered rude. It is expected that a person joins the back of a line and waits their turn to be seated or seen.

Before Starting Your Post

Checklist

 Read this handbook

 Obtain your Biometric Residence Permit (BRP)

 Open a bank account

 Contact the Occupational Health Department within your organisation and schedule an appointment to complete your pre-employment checks. This may include a blood test and providing proof of vaccinations.

 Consider applying for additional medical indemnity with organisations such as MDU, MDDUS. Your employer will have a form of indemnity protection

 Think about joining the British Medical Association.

 Consider contacting your Trust’s Resuscitation Department to find out about the nearest dates for Basic Life Support and Advanced Life Support training

 Consider reading and completing some online learning modules pertaining to common topics within your speciality or department.

 Relax and go out and enjoy what the South West has to offer.

Online Learning Resources

Some useful online learning resources include:

• e-LfH: e-Learning for Health Website

We encourage you to complete the following modules:

Induction for International Doctors

• Introduction to Working in the NHS
• Social Aspects to UK Clinical Practice
• Ethical and Legal Aspects to UK Clinical Practice
• Patient Safety Aspects to UK Clinical Practice
• Professional Aspects to UK Clinical Practice

Doctors in Training Induction

• Safe Prescribing and VTE Scenario
• Blood Transfusion and Consent Scenario
• Mental Capacity Act and Death Certification Scenario

British Medical Journal e-Learning Online Courses for Healthcare Professionals

This is a useful online resource which will help you to refresh your knowledge and provide essential information to ease your transition into working in the NHS.

Royal College websites each have online learning material depending on your speciality.

Examples include – RCEM e-learning, frca.co.uk, RCPCH online learning.

Top tip – Create an online profile with these websites and link them to your e-portfolio, in most cases your completed e-learning gets automatically recorded and counts as CPD points.

During Your Post

Learning to Reflect

For some including myself this was an entirely new concept. However, reflection is a very important part of becoming the best doctors for our patients. It is an essential aspect in helping us to identify areas we can improve on. Reflection is a purposeful analysis of one’s own experiences and behaviours, practice, clinical skills and knowledge, and our interactions with colleagues and patients. Your WPBAs should include reflective analysis and your online portfolio should also include additional reflective entries for each post.

How to reflect in a nutshell.

An example of a reflective process is the Gibbs’ Reflective Cycle. It offers a framework for examining experiences. It covers 6 stages:

Description - What happened? › Feelings - What were you thinking and feeling? › Evaluation - What was good and bad about the experience? › Description - What sense can you make of the situation? › Conclusion - What else could you have done? › Action Plan - If it arose again, what would you do? 

Education and Support

As a doctor working in the UK, you are expected to record and maintain a portfolio of your clinical and educational competences. The system currently in use for Foundation Doctors and SHOs (FY2s) is called the “Horus ePortfolio”, and is available for free even if you are not in a training programme It is recommended to regularly perform workplace-based assessments (WPBA) and keep an updated portfolio even if you are not in a training post. If you wish to continue working in non-training posts but would like to have access to a speciality training ePortfolio, you may be able to purchase this from the relevant speciality Royal College website. Depending on your individual training needs and speciality, you may also need to use additional websites/apps in order to keep a logbook of cases (eg: surgical or anaesthetic specialities)
Workplace based assessments serve as evidence of your progression and experience. It becomes very important for ARCPS and when applying for training or non-training posts.
Some examples of WPBAs and what they entail are given below.

 

Your Clinical Supervisor

The GMC (General Medical Council)defines a clinical supervisor as a trainer who is selected and appropriately trained to be responsible for overseeing a specified trainee’s clinical work and supplying constructive feedback during a training placement. This will provide you with the opportunity to discuss individual cases in depth, reflect and review on your performance, and identify training and continuing development needs. They can serve as a mentor and help with any questions you may have regarding your post. Most importantly, once you have demonstrated the necessary competences (through Workplace Based Assessments), they will be able to sign off your CREST form, or provide evidence to your Educational Supervisor for the same. If you are unsure who your educational or clinical supervisor may be please contact your HR Department. It is important to document each meeting with your supervisor in your ePortfolio.

Top tip - You should contact your supervisor at the earliest to arrange an initial meeting once in your new post.

Your Educational Supervisor

The GMC defines an educational supervisor as a trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a specified trainee’s educational progress during a clinical placement or series of placements. The educational supervisor is responsible for the trainee’s Educational Agreement.

Your educational supervisors’ responsibilities include:

 Ensuring that your educational and clinical progression is in line with that required for your level of training, and according to your individual career needs
 Ensuring you are provided with ample training and educational opportunities.
 Acting as a first port-of-call for any concerns that you may want to raise about your training or workplace

You should be proactive and arrange educational meetings during your post.

 Initial meeting
 Midpoint meeting
 End of placement meeting

Career Planning

ARCPs, Revalidation and Appraisals

On a yearly basis there is an appraisal of your overall performance, where you can provide
supporting evidence to demonstrate that you are meeting the principles and values as set out by GMC’s Good Medical Practice.
ARCP (Annual Review of Competence Progression) is a similar process for doctors in training. The GMC requires doctors to undergo Revalidation at the end of each 5-year cycle of appraisals/ARCPs to maintain their registration and demonstrate fitness to practice.

It should be pointed out that these are not “pass or fail” exercises, but rather developmental. There is an outcome certificate that you will receive and should collect as part of evidence for your Revalidation. Within each yearly review period, you will also be expected to address previously identifies areas of development.

There are six types of supporting information that you must collect, reflect on and discuss at your appraisal:

1. Continuing professional development (this includes making sure have recorded sufficient clinical evidence and WPBAs to your portfolio, and are up-to-date with the latest guidelines)
2. Quality improvement activity
3. Significant events
4. Feedback from patients or to those to whom you provide medical services
5. Feedback from colleagues
6. Compliments and complaints

For doctors not in training:

Most Trusts will use their own appraisal software or system, which is different from the ePortfolio. Your Trust Revalidation Team will contact you and provide login details for this. You will have to provide evidence of your supporting information and complete all sections of the appraisal checklist. This can be a time-consuming process, so please plan for it in advance. Your appointed appraiser will be able to give you some guidance in completing this before the date of your appraisal. Please note that your appraiser is likely to be a consultant or educator from another department/speciality and you may not have any prior acquaintance.

Applying for a Training Post

The ultimate goal for most doctors in training is to enter a speciality-training programme and become a consultant in their chosen field.

In recent months, this has become even more accessible to IMGs through a relaxation in visa eligibility requirements for application to these posts. Applications for all training posts, irrespective of speciality or level of training, takes place through a central application system called Oriel. The system is currently undergoing some changes; more information can be found on the Oriel website.

You will need to register an account on this portal and prepare your profile to apply for a training post. The HEE speciality training website has a recruitment timeline available. The application for “round 1” is usually between the first and last weeks in November, therefore you should aim to keep your application ready by the end of October. There are also opportunities to find posts at other times through re-advertisement and “round 2”.

In reality, most IMG’s new to the UK at Foundation or SHO level may not be able to apply for training during their first year in the UK as they may not meet the eligibility criteria as set out in the Person Specification Guidelines for each speciality. Please refer to these documents relating to your area of interest and prepare your portfolio to satisfy these requirements. The diagram below gives a broad overview of medical training and career structure, with entry points for applicants detailed.

Medical Training and Career Structure

Support and Wellbeing Resources

Professional Support Unit
The Professional Support Unit offers assistance and support whether you encounter professional or personal difficulties during your training

The GP Health Service (PHP)
This is a free and confidential service available to GPs and GP trainees (all those on the National Performers List). They provide confidential advice and treatment for mental health and substance misuse problems. http://gphealth.nhs.uk

BMA Counselling
The BMA Counselling and Doctor Advisor Service runs 24 hours a day, seven days a week for BMA members. Call 0330 123 124 or see link for further details. https://www.bma.org.uk/advice/work-life-support/your-wellbeing/bma-counselling-anddoctor-advisor-service

Support4Doctors
Support4Doctors provides access to a wide range of specialist advice and support for doctors and their families. There are also links to organisations that can provide further help.
http://www.support4doctors.org

Doctor Support Service- Confidential, emotional support for doctors going through fitness to practice procedures with the GMC, or at risk of having their license withdrawn. https://www.bma.org.uk/advice-and-support/your-wellbeing/wellbeing-supportservices/gmc-investigation-support-doctor-support-service

Doctors' Support Network
A peer support group for UK doctors and medical students with mental health concerns, including stress, burnout, anxiety, depression, bipolar affective disorder, psychoses and eating disorders. DSN activities include an anonymous confidential online support forum, face to face meetings around the UK, newsletters and an annual AGM & conference (free for DSN members). Website : www.dsn.org.uk
Email : info@dsn.org.uk

The Sick Doctors' Trust
An early intervention program for addicted doctors - facilitates treatment in appropriate centres, arranges funding for inpatient treatment and provides advocacy and representation when required. Tel: 0370 444 5163 (24hr) http://sick-doctors-trust.co.uk/

British Doctors and Dentists Group - a service for recovering alcoholic and drug dependent doctors, dentists and students.Tel: 07825 107 970
Email: bddg@btinternet.com http://www.bddg.org/

Tea and Empathy (Facebook)
Online peer support network of >4,500 NHS staff (mainly doctors) - aiming to foster an atmosphere of compassion and support throughout the NHS. You can post anonymously or openly in the main public group, regional closed groups or secret groups for addictions, mistakes and LGBT staff.

Association of Medical Professionals with Hearing Loss (AMPHL) - provides information, promotes advocacy and mentorship, and creates a network for individuals with hearing loss interested in or working in health care fields.
https://amphl.org

Hope 4 Medics - a support group for doctors with disabilities. Email:
info@hope4medics.co.uk
http://www.hope4medics.co.uk/homepage.php

BMA Charities provides financial assistance for medical students, doctors and refugee doctors. It works independently of the British Medical Association https://bmacharities.org.uk/

The Cameron Fund - a charity for doctors who are, or have been, general practitioners, and for their dependents. It offers help in times of poverty, hardship or distress http://www.cameronfund.org.uk

Royal Medical Benevolent Fund (RMBF) - "RMBF can consider financial assistance to doctors, medical students and their families who are facing financial crisis." Tel: 020 8540 9194 Email: help@rmbf.org

Royal Medical Foundation - a medical benevolent charity which assists UK medical practitioners and their dependents who find themselves in financial hardship. Tel: 01372
821 011
http://www.royalmedicalfoundation.org/

Society for the Assistance of Medical Families -assisting doctors and the families of doctors in times of hardship https://www.samf.org.uk/

Gay and Lesbian association of Doctors and Dentists- GLADD is the UK's only organisation that unites and represents LGBTQ+ doctors, dentists, medical and dental students from all over the country. https://gladd.co.uk/

The Louise Tebboth Foundation. Supporting the mental wellbeing of medical practitioners and doctors’ families bereaved by suicide http://www.louisetebboth.org.uk/

Frontline19 offers free confidential+ psychological support to those working on the front line https://www.frontline19.com/#about

References

West Midlands handbook for IMG’s
London Deanery website for DA
Wessex Handbook for IMG’s

GP Training in the South West

By Sarah White GPST3 DA Scholar and Jasmin Krischer Bristol GP TPD

GP training is a 3-year programme consisting usually of at least 12 months spent in secondary care, 12 months spent in primary care and the remaining 12 months will usually be a combination of primary care/ community/ secondary care placements depending on local availability. At the end of this you CCT (get a certificate of completion of training) and then can work as a fully qualified General Practitioner.

Your training is documented on an on-line ‘e-portfolio’. This shows the jobs you will be doing, the timing of any changes and assessments and the names of your supervisors. It is also the place where you are asked to write down things you have learnt as you go . The requirements for this are quite tough in the UK compared to similar systems in other countries, but don’t worry, there is a lot of help. Many trainees, for example, struggle with the concept of writing ‘reflections’ on cases they have seen. We have some more e-portfolio guidance for you in a later section.

Training is broken down into 3 stages, each of which is a year long – GPST1, GPST2 and GPST3.

In ST1 and ST2 trainees will either be allocated 2 x 6 month placements or 3x 4 month placements. In the last couple of years there have been a new type of placement called integrated training posts which trainees may be allocated to. In this type of post, trainees spend 50% of their time in GP based in a training practice and 50% of their time based in a speciality.

Every GP trainee will have an Educational Supervisor (or ES) who is a GP who is also a trainer and is responsible for overseeing your progress through the entire training programme. They will supervise you directly in your GPST3 year, and you will have regular contact with them in GPST1 and 2 in the form of a 6 monthly Educational Supervisor Review (ESR). You will also arrange days when you visit their surgery in GPST1 and GPST2.

You will also have a Clinical Supervisor (CS) for your placements in GPST1 and GPST2. They oversee your work on that placement, and you should arrange an introductory meeting with them at the beginning of each placement and will do a Clinical Supervisors Report (CSR) at the end of your placement.

As the beginning of every placement, think about what your goals, or ‘personal development plan’ for the placement is. These points should be documented on the e-portfolio.

A standard working week is 40 hours long. It is possible to work less than full time (see less than full time section below), which extends the total duration of training.

You will be sent a ‘Work Schedule’ which describes your working hours for your rotation and your pay. You should get it 6 weeks before starting a placement. If you are unhappy with your Work Schedule you should discuss this with your educational supervisor.
This is an example of a normal working week in GP from a Work Schedule for someone working full time.

Working Week

A standard working week on GP is 40 hours, which is made up of approximately 28 hours clinical and 12 hours of educational activity.

Clinical activity- you should get 1 hour of clinical admin time for every 3 hours of patient contact, so this breaks down into 21 hours of direct patient contact and 7 hours of clinical admin time.

Educational activity – this breaks down into 4 hours of structured education (GP teaching programme/ local teaching such as SET in Swindon), 4 hours of practice based teaching (for example supervised surgeries/tutorials with your supervisor/debriefing after surgeries) and 4 hours of independent educational activity.

Link from Severn deanery explaining the Working week (including for less than full time work)- https://primarycare.severndeanery.nhs.uk/training/trainees/the-working-week-andthe-new-junior-doctor-contract-njdc/

Hospital placements

GP trainees will spend 12 months in secondary care as part of their training. This can be in a wide range of rotations, from Emergency Medicine to Paediatrics and Psychiatry. You will have ranked all available rotations before starting training, and will have been given your rotations for the entire programme. This cannot normally be changed.

Less than full time working (LTFT)

All trainees are eligible to apply for LTFT working, see deanery website. You can apply for a range of reasons:

Category 1- disability/ill health, caring for children or caring for relative/other dependant. These reasons have priority and will be supported.

Category 2- unique opportunities for personal/professional development, religious commitment or non-medical development. Access to this category depends on individual circumstances and service considerations.

Category 3 – personal choice. You need to apply for this in set ‘application windows’ which are once or twice a year.

See the Severn Deanery website for more information - https://primarycare.severndeanery.nhs.uk/training/trainees/less-than-full-time-workingpolicy/

Currently on a skilled worker visa or health and care visa the lowest percentage you are able to work at is 80% (https://www.gov.uk/government/publications/skilled-worker-visashortage-occupations/skilled-worker-visa-shortage-occupations).

Less than full time work will extend your total duration of training, for example if you train at 80% from the start your training will take 45 months, or 60 months if you train at 60%.

If you work less than full time your pay will be calculated as a proportion of full time pay, but you will also be eligible to get the LTFT supplement which is currently £1000 per year.

Annual Leave

As a full time GP trainee you are eligible to 27 days of annual leave a year. You are also eligible to 8 days leave on the bank holidays. If you have worked in the NHS for more than 5 years then you will be eligible for an extra 5 days annual leave.

If you are working Less than Full time (LTFT) then you will get a proportion of this leave based on the percentage that you are working at, including a proportion of the bank holidays.

Study Leave

Trainees get 30 days of study leave a year, but some of this allowance is automatically deducted by the deanery for mandatory training such as the induction and Half Day Release Course (HDRC).

In order to apply for study leave you will need to discuss the course with your educational supervisor and then follow the policy in your area to get this approved. You should receive more information about how to do this at your local induction. For more detailed information about the types of courses/ events that will be granted funding please see the links below.

Severn and peninsula study leave policies here - https://primarycare.severndeanery.nhs.uk/training/trainees/leave/hesw-gp-study-leave-guidance/

https://primarycare.peninsuladeanery.nhs.uk/about-us/gp-specialty-trainees/hee-sw-gp-study-leave-guidance/#:~:text=Trainees%20get%2030%20days%20study,release%20are%20deducted%20from%20this.

E- Portfolio

You will learn to use the electronic Fourteenfish portfolio (see next section on how to arrange this) on which you will need to regularly write about interesting cases you have seen and how you have managed these, as well as on teaching sessions and other learning. The focus is on showing how learning has changed your practice.

The types of entries you will need to make include:

Learning logs:
Clinical Case Reviews– these should be used to reflect on an interesting case you have seen. The main purpose of these is to reflect on how you managed these cases and identify areas of strength as well as areas for improvement. For a full time trainee, you will need to show a minimum of 36 clinical case reviews by the end of each year. It’s a good idea to try and do about 3 of these every month so that you remain on track.

Case based discussion- This is a performed by a senior doctor and is an assessment based on a case that you have seen. It allows opportunity for feedback on any particular strengths as well as areas for improvement and to identify any learning needs. There is a minimum requirement of 4 of this type of assessment per year in ST1 and 2.

Mini-Cex (also called care assessment tool or CAT in primary care)- This should be done based on an observed interaction between you and a patient. Examples include history taking, examination skills, communication skills etc. There is a minimum requirement of 4 of this type of assessment per year in ST1 and 2.

CEPS – for examination skills. These need to be observed. As a minimum during your training you will need to be observed for a list of core intimate examinations, which are male genital, female genital (bimanual and speculum), prostate and breast examinations.

Multi-Source Feedback (MSF)- this is used to collect feedback from your colleagues on your clinical performance and professional behaviour. It should be done once per year with a minimum of 10 respondents each time
Quality improvement- Quality improvement refers to the idea of working towards improvements within the NHS to improve patient care. The GMC recommends all doctors demonstrate involvement in quality improvement at least once a year. This is explained in more detail in the link below

The RCGP website has information about all the assessments you will need to complete in each stage of GP training- https://www.rcgp.org.uk/mrcgp-exams/wpba/asssessments

At the end of each stage of training (ST1, ST2 and ST3) there is an ARCP panel to decide whether you have done what is required to progress to the next stage/year of training.
As part of your training you will also need to do mandatory training in safeguarding and basic life support training annually. 

Exams

There are 2 exams which need to be done as part of GP training. These are the AKT (Applied Knowledge Test) which is usually done in the second year of training or early in the third year and the SCA (Simulated Consultation Assessment). This has replaced the RCA (Remote Consultation Assessment)which is done in the third year of training. Please see the links below for more information regarding the two exams.

https://www.rcgp.org.uk/mrcgp-exams/applied-knowledge-test

https://www.rcgp.org.uk/mrcgp-exams/simulated-consultation-assessment

Time out of programme

It is possible to take time out of GP training for many reasons.
• OOP training (OOPT) in which non-programme experience counts towards the award of a CCT (Not generally applicable to general practice)
• OOP experience (OOPE) in which a trainee gains valuable experience, but still needs in addition to complete a full 3 years of GPST
• OOP research (OOPR) for research – usually towards a higher degree.
• OOP career break (OOPC) to spend time pursuing other interests or to meet (for example) a health or caring need.

See the deanery Out of Programme website for more details about these and how to apply for time out. This is normally for one calendar year between ST2 and ST3- https://primarycare.severndeanery.nhs.uk/training/trainees/taking-time-out-ofprogramme-oop/ https://peninsuladeanery.nhs.uk/about-us/policies-and-guidelines/peninsular-oop/

For policies around maternity/paternity/carers leave see Severn Deanery website (https://primarycare.severndeanery.nhs.uk/training/trainees/leave/ ).

Basic Pay

Under the new Junior Doctor Contract (2016) you will be paid based on your Grade of Training (unless you are eligible for pay protection – see https://www.bma.org.uk/pay-andcontracts/pay/transitional-pay/transitional-pay-protection ), and you will receive an extra ‘GP premium’ in GP placements and extra for additional hours above 40 hours/ out of hours for hospital placements For full time work the basic pay is £40,257 in ST1-2 and £51,017 in ST3. For posts within a GP surgery, there is a fixed additional payment which is £9144 for 1-year pro rata. For a 6 month placement, you would get a fixed additional payment of half this amount.

See the website below for more information about pay during GP training

https://gptraining.info/gp-training-pay-payscales-st1-st3-including-gp-registrar-net-pay/

Tax Relief

You are able to get tax relief on some of your expenses. These include professional fees such as GMC membership, RCGP fees (and exam fees), BMA membership and indemnity fees. There is much more information available on the Medics Money website (https://www.medicsmoney.co.uk/)

Commuting/ Travel Expenses

When on your GP placements you must ensure that your car insurance covers business use.You can be reimbursed for certain travel costs e.g. mileage for home visits. Please see this website for more details

https://severndeanery.nhs.uk/about-us/policies-and-procedures/severn-relocation-guidance/show/gp-home-visit-mileage-2

Getting back into clinical work

If you have been away from clinical practice for more than 12 weeks you can access the SuppoRTT process to give you extra support to help you back into clinical work.

https://www.severndeanery.nhs.uk/about-us/education-and-training/supportt-2/

https://foundation.peninsuladeanery.nhs.uk/about-us/supportt-2/

Where to get help if you are experiencing difficulties

If at any stage in your GP training you are experiencing difficulties there are lots of people you can turn to for help. This is regardless of whether they are clinical or personal difficulties.

It is best to discuss things early on with either your clinical supervisor or educational supervisor, or local trainee programme director. If the issue involves on of these people go to one of the others. Generally getting help early can help a problem escalating. They all want you to succeed in training and to try and help you.
If you are struggling with your health then make an appointment with your own GP. If you are suffering with mental illness and addiction problems you can also access NHS Practitioner Health who can provide additional support – www.practitionerhealth.nhs.uk

Please have a look at the section in this handbook entitled “Support and Wellbeing Resources”.

On hospital placements you can also access a registrar-led peer support network called the WARD (Well and Resilient Doctors) team – www.welldoctors.org/severn
https://www.welldoctors.org/peninsula (this is only available in RCHT in Peninsula)

If you are having professional or personal difficulties during your training, the Professional Support and Wellbeing (PSW) unit can help. These can include challenges related to training (they can offer coaching or help with studies or careers advice), or personal life/health. IMGs in the past have found the language coaching services helpful.

PSUs - https://www.severndeanery.nhs.uk/about-us/professional-support-and-well-beingsouth-west/
http://www.peninsuladeanery.nhs.uk/about-us/professional-support-unit

There is a further list of helpful resources on the GP Trainee Handbook - Handbook-2021-
22.pdf (hee.nhs.uk)

Top Tips from an International Medical Graduate

• Don’t be afraid to ask questions! You will not be expected to know everything, and people will not think less of you if you don’t know something. It’s better to ask than to guess and get it wrong.
• Do the little things - be punctual, and send apologies if you are absent
• Look at hospital ‘intranets’ for lots of useful information
• Play to your strengths – are you really good at putting in cannulas or suturing? Let people know
• Don’t get too distracted by super-specialist knowledge in hospital
• Talk to your trainer about how to write ‘reflections’ in the e-portfolio – it’s less about showing clinical knowledge and more about showing what you’ve learnt and how situations made you feel and think
• Answer your e-mails promptly
• Be willing to help out -people will always be grateful!

 

This page was last updated June 26th 2023 (1 year ago)