GP Trainer's Report - 1st March 2007

LONDON POSTGRADUATE MEDICAL & DENTAL EDUCATION - University of London

THE LONDON DEANERY

Stewart House
32 Russell Square
London
WC1B 5DN

VISIT REPORT TO

Dr. Carolyn Lynch, Little Park Surgery
281 Hounslow Road, Hanworth
Middlesex
TW13 5JG


 

VISITORS

Dr. Ramesh Bhatt (Associate Director, lead visitor)
Dr. Cedric Solomon (GP trainer)
Ms. Debbie Lyford (Practice manager)

DATE OF VISIT

1st March 2007

1. BACKGROUND & INTRODUCTION

Dr. Lynch has been a trainer for about 10 years and works from a high quality, converted corner property with her partner and salaried doctors who, together, look after just over 5,500 patients.

At the last visit, the visitors had expressed concern about the GPR’s workload, medical records needed ‘tweaking’, and clarity about the registrar’s out of hours exposure was required. The visitors were also aware that Dr. Lynch was undertaking a masters and that this would need to be incorporated into registrar training.

The practice has met most of the concerns raised at the last visit, including, in particular, GPR workload.

2. THE LEARNING ORGANISATION

2.i Medical Staff

The visitors were pleased to meet Dr. Paska, who, like Dr. Lynch, is a full time GP. He is very supportive of training and has undertaken a substantial amount of GPR training by way of tutorials and clinical supervision. The practice also teaches medical students and has F2 doctor and ITP doctors. Two salaried GPs also act as educational supervisors to the ITP and F2 doctors whilst overall responsibility is held by Dr. Lynch. The visitors were made aware of concerns expressed by partners about stress on the practice as a result of the absence one way or the other of some of the salaried doctors. This was discussed further by Dr. Lynch.

2.ii Primary Health Care Team

The visitors were particularly impressed by the large number of primary health care team members who attended for interview. They included district nurses, health visitors, palliative care nurse, community psychiatric nurse and pharmaceutical adviser. There was clearly excellent social and professional contact within the primary health care team, who spoke enthusiastically about the support from and access they have to the practice, underpinned by a structured induction programme at the start of the training programme each year.

The practice has undergone recent change in the practice nurse configuration. The visitors were pleased to meet two nurses who showed a great deal of enthusiasm for developing various services for patient care, including respiratory care and diabetic care. The visitors noted that the major contact with the GPR occurred during induction and then tended to fall away. The visitors would strongly recommend a continuing contact between teams and the GPR, who should understand the roles and responsibilities of other members of the team and how to work as part of such a team.

The practice’s administrative team is ably led by an experienced practice manager. She is very supportive of learning and development and entirely aware of her role in SPR training; she regularly undertakes protected tutorials. The visitors were keen to ensure that management topics were covered throughout the year to ensure early understanding of management issues and to avoid loading up the second six months of training.

2.iii The Library and Learning Resources

The practice has a good library located in the common room, and well organised access to on-line literature searches and other resources. The library is catalogued and indexed.

3. INTERVIEW WITH THE TRAINER

Dr. Lynch is a full time, hard working general practitioner providing high quality continuity of care as demonstrated by the practice’s QOF achievements. Dr. Lynch has recently completed a masters degree that included diabetes care and is currently enhancing the care of diabetes in the practice with the new practice nurse – an excellent learning opportunity for the registrar.

Dr. Lynch has kept up to date with training in general practice by regularly attending the trainers’ workshop; she also attended the nMRCGP curriculum workshop and the clinical supervision workshop. She gave an impressive account of how she identified the learner’s needs, using a variety of tools, including learning style questionnaires, confidence rating scales, regular reviews of referrals, and case analysis. Learning is planned b jointly with the SPR based on these learning needs. There is a structured two-week induction programme that provides a good introduction to the practice and its team members. The curriculum is flexible so that topics are defined on a regular basis through clinical practice incorporated into the training programme. She has used various teaching methods, including presentation, tutorials, case discussions and, occasionally, role play.

The visitors were shown a video of a topic teaching session that clearly demonstrated Dr. Lynch’s ability to teach in a learner-centred fashion.

4. INTERVIEW WITH THE LEARNER

Dr. Lynch’s current GPR has been in post for six months and appears to be thoroughly enjoying her attachment. Her induction was very useful in that it enabled her to get to know the staff, and she feels that she leads on planning her curriculum, based on her learning needs identified jointly with her trainer. She has good access to the half-day release programme, which she enjoys, and recalls having learning style questionnaires, PUNS and DENS and monthly TRAD, along with confidence rating scales. She is currently seeing patients at 15 minutes and feels that she sees an excellent case mix. She has had good exposure to out of hours care via Harmoni. She is currently doing her MRCGP modules. She confirmed that, although she has had good exposure to child care, having done paediatrics and post-natal checks, she is arranging minor surgery training through the West Middlesex Hospital and has good teaching on IT from the partners. She confirmed regular tutorials with the practice manager on practice management and has learned quite a lot about chronic disease management through Dr. Lynch’s interest in diabetes. She also confirmed joint monthly reviews of her learning plan to feed into tutorials and has had tutorials with other members of the team, including Dr. Paska.

5. SUMMARY AND HIGHLIGHTS

1. This is a well organised practice with a stable team that is caring and friendly.

2. Dr. Lynch and her practice benefit from excellent premises.

3. Dr. Lynch is an excellent GP who is extremely hard working and an effective educator.

6. RECOMMENDATIONS

1. Dr. Lynch’s clinical workload requires a review. The visitors would suggest that she drop a clinical session in order to meet her teaching commitments, which include F2 doctors, ITP doctors and medical students as well as the GP SPR.

2. Concern was raised about clinical cover/stress during the partners’ absence and this also needs to be addressed to reduce clinical and supervision risk.

3. The practice manager’s tutorials should occur throughout the year, avoiding the crowded second six months.

The visitors were happy to reapprove the Little Park Surgery as a learning organisation for a period of three years and Dr. Lynch as a full time trainer in general practice for a period of three years starting on 18th December 2007.

The practice is approved to take one wte GPR at any one time.

Dr. Ramesh Bhatt
Associate Director

March 2007

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