1. Dr M Feldman

2.  Medical school [ 5 yrs ]  Foundation year 1 – typically 6 months surgery, and 6 months medicine  Foundation year 2 – 3x 4/12 of ◦ Various specialties ◦ May include a spell in GP

3.  Entry onto training scheme ◦ Knowledge test ◦ Assessment centre  Consultation  Group work  Written test

4.  Scheme consists of 3 yrs ◦ 2 yrs in hosp then one in GP ◦ Increasingly 18 months in hosp then 18 months gp ◦ Selection of specialties  A&E  Hospice  O&G  Paeds  Care of elderly  Medicine  Rheumatology +GP ( ITP)  Dermatology +GP ( ITP )

5.  Training practices ◦ Specially approved  Premises  Trainers – one year course now  Standards –  Notes  Library  Accommodation  Teaching assessed

6.  nMRCGP ◦ Applied Knowledge Test – often taken in 2 nd year ◦ Work Based Assessment  Patient satisfaction questionnaire  Multisource feedback  Consultation observation tool  Direct Observation Procedures  Case Based Discussion  Eportfolio log diary  Educational Reviews

7.  nMRGGP ◦ Clinical Skills Analysis  12 Cases like a real surgery –  10 minute consultations

8.  Work in teams  Average practice about 5900 patients  About 1800 per GP  35% partners are female  60% GP registrars are female

9. ActivityFull time GP / Week Surgery consults102.3 Phone consults18.8 Home Visits6.4 Care home visits1.9 Clinics1.5

10.  Most British full time GP work either 8 or 9 sessions per week  Typical sessions are 2- 2.5 hours long with 12 – 15 booked patients  Average time per consult 11.7 mins  Average time per home visit 26 mins

11.  Working from own premises  Working from health centres  Polyclinics – to come

12.  Most GP self employed – partners  We employ ◦ Nurses ◦ Nurse assistants and phlebotomists ◦ Receptionists ◦ Admin staff and practice managers ◦ Occasionally counsellors We rarely employ Midwives (5%) Physiotherapists ( 3%)

14.  Almost all increase in clinical contact due to extra nursing input

15.  Average income GP 2007 about  ◦ £100 000 = Euro 124000 – partner ◦ £70 000 = Euro 86,800 – salaried gp ◦ Currently dropping due to government clawbacks ◦ Need for GP’s to fund staff increase ◦ Our practice approx Euro 248 000 staff bill excluding doctors