What The FCUKGP* Now?
What the FCUKGP* now?Life After Vocational Training for General Practice*Future Contributors to UK General Practiceadvice for GPs at the start of their careerSeventh EditionDr. Ramesh MehayProgramme Director (Bradford VTS)General Practitioner & Trainerwww.bradfordvts.co.ukAug 2008
1Are you a registrar going into your last 6 months of vocational training? Or perhaps you are anewly qualified GP? Still a bit worried about going out there on your own?Some of the things you will gain by attending this course: Where do you start at as locum & the implications of being self employed What to look for in a partnership or contract. Should you buy in? How to maintain your accounts; Pensions and Tax; Income Protection. Want to makesense of all this financial talk? Career choices in primary care Educational Portfolios, Higher Professional Education, Appraisal & Revalidation?All course material is presented in an easy to understand manner and in a relaxed, stress freeenvironment that is inducive to learning.This book accompanies the “Bradford Exit Course”Details available from Bradford’s VTS Secretary, Field House Postgraduate Centre, BradfordRoyal Infirmary, Duckworth Lane, Tel 01274 364 267AcknowledgementsMany thanks to: Professor John Lord & Dr. Martin Islip for their permission to reproduce the “2 minute”development without tears guides. Money Management Services for their input on finances for doctors Media Services, University of Leeds for printing the material1st Edition Feb 2003 as “The Exit Handbook”2nd Edition Aug 2003 as “The Exit Handbook”3rd Edition Feb 2004 as “The Exit Handbook”4rd Edition Feb 2005 as “The Exit Handbook”5th Edition Feb 2007 as “What the FCUK now?”6th Edition Aug 2007 as “What the FCUK now?”Printed by Media ServicesUniversity of Leeds
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3CONTENTSTHE BRADFORD EXIT COURSE – Aims & Objectives7SPEAKERS/FACILITATORS8COURSE TIMETABLE DAY 1 (THURSDAY)9COURSE TIMETABLE DAY 2 (FRIDAY)10List of Contributors11CONTINUING PROFESSIONAL DEVELOPMENT . 15GOVERNEMENT SCHEMES . 15SELF DIRECTED LEARNING . 15APPRAISAL . 15REVALIDATION . 15MENTORING. 15HPE (HIGHER PROFESSIONAL EDUCATION) . 15HELP AVAILABLE . 15WHERE DO I START?. 16GOOD MEDICAL PRACTICE . 16Development Without Tears17HOW TO USE THIS GUIDE . 19CONTENTS LEVEL 1 - THE BASICS . 21WHAT’S IT ALL ABOUT? - APPRAISAL AND PERSONAL DEVELOPMENT . 23WHAT DO I NEED TO KNOW? OR EDUCATIONAL NEEDS ASSESSMENT . 24HOW WILL I ADDRESS MY NEEDS? . 25OUTCOMES . 26COMPLETED?. 27CONTENTS LEVEL 2 MORE INFORMATION . 29MAKING IT HAPPEN - EDUCATIONAL CHANGE. 31HOW I LEARN - LEARNING STYLES . 32WANTING TO LEARN - MOTIVATION . 36CONTENTS LEVEL 3 - THE PAPERWORK . 39PERSONAL DEVELOPMENT PLAN SUMMARY / APPLICATION FOR PGEA . 41PERSONAL DEVELOPMENT PLAN TEMPLATE . 42“CERTIFICATION PACK”. 43MONITORING OF PERSONAL DEVELOPMENT PLAN . 43REFLECTIVE PERSONAL DEVELOPMENT PLAN . 48CONTENTS LEVEL 4 APPENDICES AND BIBLIOGRAPHY . 53APPENDIX 1: JO-HARI’S WINDOW. 55APPENDIX 2: KIRKPATRICKS HIERARCHY OF LEVELS OF EVALUATION . 56BIBLIOGRAPHY . 57WEBSITES . 58CONTINUING PROFESSIONAL DEVELOPMENT - OTHER USEFUL REFERENCE SOURCES . 59TASKS. 60TASK 1 – CPD (IN PAIRS) . 60TASK 2 – CPD (GROUP WORK) . 61TASK 3 – REVALIDATION (GROUP WORK) . 62
4Financial Issues for Doctors63BORROWING COST REIMBURSEMENT - COST RENT VS NOTIONAL RENT . 65COST RENT IS: . 65NOTIONAL RENT IS:. 65THE NHS PENSION SCHEME (NHSPS) . 66CONTRIBUTIONS. 66NHSPS BENEFITS . 66CALCULATING PENSION BENEFITS . 66NHS PENSION SCHEME (EARLY RETIREMENT). 67MAXIMUM SERVICE ALLOWED . 67ILL HEALTH RETIREMENT . 68DEATH BENEFITS (OVERVIEW) . 68PENSION FOR A DOCTOR’S SPOUSE . 70BASIC FINANCIAL PLANNING/PROTECTION ISSUES . 71LIFE ASSURANCE. 71CRITICAL ILLNESS COVER . 71INCOME PROTECTION (PERMANENT HEALTH INSURANCE) PHI. 71LOCUM COVER. 71WHAT THE PCT PROVIDES? . 71INCOME PROTECTION COVER – GENERAL KEY POINTS . 71GUIDE TO GP CAREER CHOICES73The first step77The second step79A GP Principal80A salaried post81Schemes with educational support83Retainer Scheme83Career start/ retention and recruitment scheme84Locum85Step Three88Final thoughts89
5Locuming Made Simple911. THE PROCESS OF BECOMING A LOCUM . 93SUMMARY OF THE PREPARATION TASKS . 942. BEFORE BECOMING A LOCUM – THE PREPARATORY WORK . 95CERTIFICATES . 95EQUIPMENT NEEDED. 95STATIONARY . 95PREPARING A CV. 95REGISTERING AS A LOCUM . 96MAKING CONTACT WITH LOCAL PRACTICES. . 96KEEP A TELEPHONE LIST OF OTHER LOCUM DOCTORS. 963. BOOKING SESSIONS . 97CHECKLIST FOR BOOKING SESSIONS . 97WHAT THE AVERAGE LOCUM DOES . 974. SENDING INVOICES & CHARGING FOR SESSIONS . 98SENDING INVOICES . 98COMPUTER GENERATED INVOICING AND FAXING . 98DEFINING SESSIONS . 99WHAT SHOULD I CHARGE?. 995. ON ARRIVAL AT THE PRACTICE . 101FIRST THINGS FIRST. 101WHERE ARE THINGS?. 101HOW DOES THE SYSTEM/SERVICE RUN?. 101BASIC ESSENTIALS – WHERE ARE THEY?. 1016. FINANCES, ACCOUNTANTS & TAX . 102PENNY PERFECT . 102SAVING FOR TAX . 102DON’T BE FOOLED BY LOW TAX RETURNS IN JANUARY. . 102GETTING AN ACCOUNTANT . 103THE ACCOUNTANT’S BILL . 104WHAT STUFF DO I NEED TO KEEP FOR TAX PURPOSES?. 105INCOME . 106EXPENSES. 107OTHER THINGS THE ACCOUNTANT WILL WANT TO SEE. 110THE PETROL LOG BOOK. 110FINAL CHECKLIST BEFORE SENDING STUFF TO THE ACCOUNTANT . 1127. FREQUENTLY ASKED QUESTIONS (FAQS). 113Q1 CAN LONG-TERM LOCUMS ASK FOR HOLIDAY AND SICK PAY ?. 113Q2 CAN LOCUM GPS TO BE ALLOWED TO JOIN THE NHS PENSION SCHEME ?. 113Q3 MY BNF IS OLD AND WAY OUT OF DATE. CAN I GET AN UP-TO-DATE BNF FREE OF CHARGE ? . 114Q4 DO LOCUMS NEED TO UNDERTAKE REVALIDATION ? . 114Q5 I CAN’T MAKE HEADS AND TAILS OF PRACTICE ACCOUNTS I’M THINKING OF JOINING THIS PARTICULAR PRACTICE. CAN YOUHELP ME?. 114USEFUL WEB ADDRESSES. 115The Art of Negotiation117HOW GOOD A NEGOTIATOR ARE YOU? A QUESTIONAIRRE. 119THE THEORY AND PRACTICAL SUGGESTIONS. 123TYPES OF NEGOTIATORS . 123KEY PRINCIPLES OF EFFECTIVE NEGOTIATION: . 123LET’S TALK ABOUT POWER . 123GIVING CONCESSIONS . 123HOW TO PUT IT ALL INTO PRACTICE . 124
6Appendices125APPENDIX 1 – A SAMPLE MAIL SHOT LETTER . 127APPENDIX 2– A SAMPLE CURRICULUM VITAE . 128APPENDIX 3 – A SAMPLE INVOICE . 130APPENDIX 4 – A LETTER REQUESTING AN UP TO DATE BNF . 131APPENDIX 5 – A LETTER REQUESTING SUPERANNUATION INFORMATION . 132APPENDIX 6 – GOOD MONEY SAVING WEBSITES . 133INDEX135
7THE BRADFORD EXIT COURSE – Aims & ObjectivesCriteria for EntryRegistrars/SHOs going into their last 6 months of vocational training.Doctors who have recently completed vocational training (within 1 year).Aims To encourage interaction between doctors at a similar stage of their careers andpossibly develop further links with each otherTo raise individual awareness of the options available at the end of GP training, toenable registrars to think about future plans (incl. financial) and about ways ofpreparing for themTo create a relaxed and open atmosphere in which people can air their viewsand concerns (small group work)To encourage interaction and cross-fertilisation of thought between those startingGP training and those leaving - hence exit & induction courses running at thesame timeTo enjoy the course and have some fun during the learning process (socialevenings)Objectives Career choices in primary care and striking a balance between them.At the end of the course, participants will be able to list the different types of GPposts available: locums, assistants, retainers, salaried, partners (and theimplications each imposes). The reflective practitioner, revalidation & the educational portfolio – tying it alltogether.Participants will understand the key principals of reflective practice, developingand maintaining educational portfolios, knowledge regarding higher professionaleducation, appraisal, revalidation, and role of mentoring. Partnerships, Contracts & FinancesAt the end of the course, participants will be aware of the financial implicationsof personal choices – eg partnership, the partnership contract, maintainingaccounts, buying in, NHS pensions, tax, medical sickness protection and theimplications of being self employed. Preparing to be a locumAt the end of the course, participants will be equipped with practical advice onhow to get started off as a locum, maintain personal records and accounts, lookafter themselves and be aware of the existence of the National Association ofNon-Principals (NANP) and how it might be able to help them.
8SPEAKERS/FACILITATORSDr. Ramesh MehayProgramme Director, Bradford Vocational Training Scheme, GPTrainer (Bradford), GP BradfordExit Course Organiser, Preparing to be a LocumDr. Paul BoltonGP KeighleyContinuing Professional DevelopmentDr. Nicola GillGP Tutor Retainer Scheme (Yorkshire), GP YorkCareer Choices in Primary CareDr. Lynsey FieldenLocum GP (Leeds)Preparing to be a Locum.Mr. Chris HopkinsonIndependent financial advisor, formerly national negotiator forcost rent schemesBuying into a practice & financial issuesMr. Kelvin TurnerIndependent financial advisorBuying into a practice & financial issuesMarie Butterfield &Shan SadiqEmployment Advisors BMA (Leeds Office)Partnerships & Contracts
9COURSE TIMETABLE DAY 1 (THURSDAY)9.30Arrival & Coffee1000amIntroduction. What do you want to know?Dr Ramesh Mehay GP Bradford. Course Organiser for Bradford.1015amContinuing Professional DevelopmentDr Martin Islip, CME Tutor LeedsReflective PracticeEducational PortfoliosHigher Professional EducationAppraisal, Revalidation, and Role of mentoring.Open floor for discussion1100Coffee1130Continuing Professional Development II(Martin Islip)Ram – intro to the SCHIN revalidation toolkit (?online demonstration)Open floor for discussion1pmLunch2.00pmCareer choices in Primary Care. Striking a balanceDifferent types of GPs. Locums, Assistants, Retainers, Salaried, Partner,GPSINicola Gill, GP Tutor (Retainer Scheme) GP Locum/Salaried GP3.00 pmSmall group work. Exploration of individual’s priorities. (Nicola Gill)1530 pmTea1600pmMore small group work (Nicola Gill)1730 pmClose
10COURSE TIMETABLE DAY 2 (FRIDAY)0900amPartnerships & ContractsMarie Butterfield & Shan Sadiq, BMA (Leeds)Q&As1045Coffee11 amBuying into a Practice. Financial Issues.Mr Chris Hopkinson, independent financial advisor, formerly nationalnegotiator for cost rent schemesMr Kelvin Turner, independent financial advisorinput on accounts, pension and medical sicknessMore hard data on finance/taximplications about being self-employed.12 noonCoffee1205More on FinancesQ&A sessionChris Hopkinson & Kelvin Turner1pmLunch2.00pmPreparing to Be a Locum Ipractical advice about getting started as a locumPitfalls to be aware ofLynsey Fielden & Ramesh Mehay3.30TEA3.45Preparing to be a Locum IILynsey Fielden & Ramesh Mehay1700Evaluation1730Close
11List of ContributorsDEVELOPMENT WITHOUT TEARSJohn BibbyGP and GP tutorBradfordPeter DarbyshireGP and GP tutorLeedsPeter DicksonGP and GP tutorAiredaleNicola GillGP and GP tutor for non principalsYorkPeter GreenGP and GP tutorNorthallertonMartin IslipGP and GP tutorLeedsSanjeev KapurGP and GP tutorHull & East YorkshireProf. John LordGP and GP tutorHuddersfieldPaul MetcalfeGP and GP tutorScarboroughJohn MoroneyGP and GP tutorYorkAnne ParkinGP and GP tutorHull & East YorkshireMike ScatchardGP and GP tutorHarrogateRamesh MehayGP and Course OrganiserBradfordLynsey FieldenGP locum (West Yorkshire)LeedsChris HopkinsonFinancial AdvisorLeedsKelvin TurnerFinancial AdvisorLeedsLOCUMING MADE SIMPLEFINANCES MADE SIMPLEPARTNERSHIPS AND CONTRACTSMarie ButterfieldBMALeeds OfficeShan SadiqBMALeeds Office
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13Continuing Professional DevelopmentDr. Martin IslipGP LeedsGP Tutor (Leeds)
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15Continuing Professional DevelopmentGovernment SchemesSection 63PGEAAppraisalRevalidationSelf Directed LearningChoosing what we learn (educational needs assessment)Choosing how we learn (preferred learning styles)Time to think about what has been learned (reflection)Making the learning work (application)Studying the effects of what we have learnt (evaluation)AppraisalFormative, developmental, supportiveStarts April 2003Should result in a PDPRevalidationAn assessment of fitness to practiseStarts Spring 20055 satisfactory appraisals necessaryBased on ‘Good Medical Practice’MentoringA one to one relationship with a colleagueVoluntaryConfidentialFacilitating personal and professional developmentHPE (Higher Professional Education)Available within 2 years of completing VTSFinanced (20 locum sessions expenses)Group work and tutor encourage PDPHelp availableIndividualsTrainerCourse OrganiserGP TutorHPE TutorMentorAppraiserGroupsHPERevalidation without Tears (RWT)NANP / local NP groupsRetainer groupsYoung principal groupsGuidesDevelopment without Tears
16Books and websites (see handout)Some useful reference .comBooksThe Toolbox for Portfolio Development by Roger Pietroni (Radcliffe)The GP’s Guide to PDPs by Amar Rughani (Radcliffe)Where Do I Start?Form 1 – basic detailsForm 2 – current medical activitiesForm 3 – material for appraisalForm 4 – formal summary / actions agreedForm 5 – confidential record (optional)Good Medical PracticeGood clinical careMaintaining good medical practiceRelationships with patientsWorking with colleaguesTeaching and trainingProbityManagement activityResearchHealth
17Development Without TearsGP TutorsYorkshire DeaneryApril 2003a series of two minute guides for busy GPs
18What’s In this Section?CONTENTS LEVEL 1 - THE BASICS.What’s it all about? - Appraisal and Personal DevelopmentWhat’s it all about? - Appraisal and Personal DevelopmentWhat do I need to know?or Educational Needs AssessmentHow will I address my needs?OutcomesCompleted?CONTENTS LEVEL 2 MORE INFORMATION.Making it happen - Educational ChangeMaking it happen - Educational ChangeHow I Learn - Learning StylesWanting to learn - MotivationCONTENTS LEVEL 3 - THE PAPERWORK .Personal Development Plan Summary / Application for PGEAPersonal Development Plan Template“Certification Pack”Monitoring of Personal Development PlanREFLECTIVE PERSONAL DEVELOPMENT PLANCONTENTS LEVEL 4 APPENDICES AND BIBLIOGRAPHY .APPENDIX 1: JO-HARI’S WINDOWAPPENDIX 2: KIRKPATRICKS HIERARCHY OF LEVELS OF EVALUATIONBIBLIOGRAPHYWEBSITESCONTINUING PROFESSIONAL DEVELOPMENT - OTHER USEFUL REFERENCE SOURCES .TASKS.Task 1 – CPD (in pairs)Task 2 – CPD (Group Work)Task 3 – Revalidation (Group Work)
19How to use this guideThese two-minute guides have been put together by a group of enthusiastic Yorkshire GPs whoalso work as GP tutors.The guides and attached information with links to other useful resources are also available athttp://www.john-lord.net/download.htm.The guides give you information at 4 colour coded levels. Like skiing Green is very basic andBlack is only for the very keen. Red and blue and for intermediatesThe headingsLevel 1:Is designed match the column titles in the personal development template in form 4 of thenational appraisal documentation and gives basic information to help you complete them.Level 2:explains ( for people who have time and are interested) in more depth about learning theoryLevel 3:Gives information on how to claim PGEA for your PDP. It also contains forms on which you canrecord your learning. If you are a reflective learner then there is also a second PDP, which maybe more suited to your learning styleLevel 4:Is appendices, which explain more fully the guides, a bibliography and internet guide so you canlearn moreThe levels have page numbers for paper copies and hyperlinks’ which can be used in a word textfile and will help you navigate the site.We hope you have as much fun using this resource as we did creating itThe GP Tutors, Yorkshire Deanery
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21Contents Level 1 - The basicsWhat’s it all about?page 3what is it allabout?page 18completed?page 22outcomespage 21Level 2for moreinformationpage 23what do Ineed toknow?page 19how will Iaddress myneedspage 20
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23What’s it all about? - Appraisal and Personal DevelopmentGP Appraisal is designed to encourage and support GPs in reflecting on their work andidentifying developmental needs. It will result in the GP producing a development plan (PDP) thatwill help focus their education over the coming yearMeeting both patient and government expectations while trying to keep up to date is challengingand frequently very difficult.But Learning is fun. Learning is life-long. Learning is a vital part of being a GPPlanning your learning by using a PDP is an efficient way of keeping up todate.Beginning to assess your own learning needs may feel daunting. However, it is a goodpreparation for your appraisal. We hope that the ‘hel
Dr. Lynsey Fielden Locum GP (Leeds) Preparing to be a Locum. Mr. Chris Hopkinson Independent financial advisor, formerly national negotiator for cost rent schemes Buying into a practice & financial issues Mr. Kelvin Turner Independent financial advisor Buying into a practice & financial issues M
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Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.
