Post-Certification Career Planning Life after the MRCGP Examination. Kevin Hurrell. Head of KSS Post-Certification GP School

GP Deanery The Quality Assurance of GP Training and Continuing Professional Development in Kent Surrey and Sussex. Including support for doctors throughout their career in general practice.

GP Vocational training schemes 3 year programmes (4 soon) 16 months in general practice Day release and learning sets MRCGP assessments Training programme visits 800 Trainees

The Post-Certification GP School The whole world is now in your hands years hard graft 2,400 GPs in 3 counties A new Paradigm for CPD

Workshop Aims: WHAT…..do you want to be doing in 10 years? WHO…..do you want to be working with? WHEN …..do you make your moves? HOW…..do you get what you want? …..stay safe, sane and secure?

Audience questions: 1. How to get your CV ready/up to date for Job applications 2. Practical advice on commissioning, what commissioning skills we need to develop now and how to develop them. 3. Career Options. Where else can we work other than GP surgeries/hospitals? 4. During interviews what questions should we be asking prospective employers? 5. What are the things to look out for in a contract? How do you ensure you get a good contract?

I know.. So much to consider ‘Salaried’ ‘Part-time’ ‘Revalidation’ ‘Appraisal’ ‘Unemployment’ ‘Portfolio careers’ ‘Private providers’ ‘Commissioning’ ‘QOF’ ‘PCTs’ ‘Work-life balance’ ‘Colleagues’ ‘Complaints’ ‘GPwSI’ ‘Access’ ‘Marriage’ ‘Health’ £££

WHAT DO YOU WANT? Have you really thought through your career options? Have you shared your ideas, dreams and aspirations? How hard are you prepared to work?

Choices to be made: Full time. Part time. Portfolio. Salaried. Partner. Both? Property sharing? PMS. GMS. aPMS. OOH. Agencies. Opportunities aplenty………

Who will you be working with?

WHEN? How do we manage change? Do opportunities find us out…or do we find opportunity? What does ‘networking’ really mean? Can you say ‘no’ as well as you can say ‘yes’?

How….do you ‘find opportunities’? Group discussion How can you network? How do you present yourself? What do you need to ask?

Looking ahead…..NHS Appraisal Experience as ST3 Linkage to ESR Additional competencies: Financial skills Conflicting obligations Multiple agendas Adult learning as independent GP Helps shape your career Encourages ‘proper PDP’ A new paradigm for CPD!

t.nhs.uk The purposes of medical appraisal for revalidation To enable doctors to discuss their practice and performance with their appraiser in order to demonstrate that they continue to meet the principles and values set out in “Good Medical Practice” and thus to inform the responsible officer’s revalidation recommendation to the GMC.“Good Medical Practice To enable doctors to enhance the quality of their professional work by planning their professional development. To enable doctors to consider their own needs in planning their professional development. To enable doctors to ensure that they are working productively and in line with the priorities and requirements of the organisation they practise in.

Revalidation Started 2012 Strengthened appraisal More governance 5 year cycle. 3 at first 50 CPD credits per year Multi-source feedback Clinical audit Declarations Deanery business: Support the Responsible Officer Including RO for doctors in training Leadership training for appraisers RCGP Revalidation Facilitators

“Of course, long before you mature, most of you will be eaten ”

GMC Principles for CPD Improving healthcare and promoting a healthier society Encouraging individual responsibility for participation and recording of CPD activities Improving professional effectiveness and work satisfaction Ensuring CPD covers all areas of Good Medical Practice and all GPs keep up to date Encouraging reflection upon a great range of clinical activities, planned and opportunistic Encouraging patient and public involvement Ensuring annual appraisal monitors CPD and produces appropriate PDPs Providing a continuing measure of assessment of performance where possible

Appraisal mapped to GMP Domain 1- Knowledge, skills and performance Attribute 1: Maintain your professional performance Attribute 2: Apply knowledge and experience to practice Attribute 3: Keep clear, accurate and legible records Domain 2- Safety and Quality Attribute 1: Systems to protect patients and improve care Attribute 2: Respond to risks to safety Attribute 3: Protect patients from risk posed by your health Domain 3- Communication, Partnership and Teamwork Attribute 1: Communicate effectively Attribute 2: Work well with colleagues and delegate effectively Attribute 3: Establish and maintain partnerships with patients Domain 4- Maintaining Trust Attribute 1:Show respect for patients Attribute 2:Treat patients and colleagues fairly and without discrimination Attribute 3: Act with honesty and integrity

GMC supporting information principles General information – providing context about what you do in all aspects of your work Keeping up to date – maintaining and enhancing the quality of your professional work Review of your practice – evaluating the quality of your professional work Feedback on your practice – how others perceive the quality of your professional work t.nhs.uk [26]

GMC supporting information requirements There are six types of supporting information: 1. Continuing professional development 2. Quality improvement activity 3. Significant events 4. Feedback from colleagues 5. Feedback from patients (where applicable) 6. Review of complaints and compliments t.nhs.uk [27]

Assessing continuing competence as independent practitioner Shows How Knows How Knows Does Knowledge Skills Clinical Communication Organisational Attitudes Values Miller GE (1990) The Assessment of Clinical skills/ Competence/performance Acad. Med,65:563-67

Suggested template for ST3 appraisal After ARCP but before CCT One to one with own trainer, build on ESR Ensure understanding of NHS Appraisal and Revalidation as 5 yearly cyclical programme Revisit weaker areas of curriculum and then use either appraisal toolkit or RCGP portfolio Stress the individual’s responsibility for continuing CPD Look forward, set priorities, produce PDP.

What makes up a good PDP?

Layered cake and icing: The 5P Paradigm Personal: Wants and needs of the individual Work on weaknesses before developing special interests. Practice: Wants and needs of new practice How will you choose your working place? What will you do to integrate? Where will you be in 5 years time? Patients: Wants and needs of patients How will you identify and respond to patients’ views and needs? Do you have sufficient knowledge and skills? Populations /Political: Wants/needs of local/national NHS What do you know of QUIPP? How will you keep up to date with new service pathways? Have you any commissioning ambitions?

Small group work Try to produce simple PDP for your next year. Try to produce a layered cake: Personal needs Practice needs Patient needs Population needs Political needs Compare / contrast PDPs within the group

Best practice Both ST3 and trainer keep copy of brief summary of appraisal discussion and PDP ST3 can make reflective statement in e-portfolio learning log and link Trainer can use document for own appraisal and for trainer reaccreditation (with reflection!) Trainee’s exit questionnaire can be completed soon after.

Quality CPD: The GP Tutor Role Appraiser Learning Sets Protected learning Time Some CPD Provision Support for CCGs Support for Sessional Doctors Support for federated training model Commissioning Awareness = New Paradigm for CPD. CPD for the doctor is mindful of: Personal needs Patient needs Practice needs Population needs Political agenda

Job opportunities: Trainee representative for local faculty. Trainee representative for Deanery Committee Sessional Doctor Learning Set Member and Convenor Foundation Supervisor GP Trainer Programme Director GP with Special Interest OOH work Prison doctor Armed forces GP Tutor Mentor Appraiser Lead Appraiser Commissioning lead Commissioner

Supporting ‘Grassroot GPs’ Sessional Doctor Learning Sets GP Tutors for CPD & PLT ‘Remedial support’ NHS Appraisers Revalidation Facilitators LMC and RCGP Links MENTORS

KSS Mentors Peer to peer Confidential Support and Guidance Practice and professional issues Free to all GPs working in NHS Protected time Single or series of meetings Lots of capacity!

1. How to get your CV ready/up to date for Job applications 2. Practical advice on commissioning, what commissioning skills we need to develop now and how to develop them. 3. Career Options. Where else can we work other than GP surgeries/hospitals? 4. During interviews what questions should we be asking prospective employers? 5. What are the things to look out for in a contract? How do you ensure you get a good contract? Checklist:

Why Reflect? “A goal without a plan is just a wish” Antoine de Saint-Exupery “If you don’t know where you’re going, any road will get you there.” The Cheshire Cat, Alice in Wonderland

Be a curious GP…. Keep asking questions Keep looking for opportunities Think in terms of clinical leadership and responsible followship! GOOD LUCK!