It's that time of year again; the transition from secondary to primary care for the start of the ST3 or GP registrar year. For trainees about to relish the tantalising prospect of a chair, a PC, a mug of coffee and a toilet break whenever you need it; here is everything you need to know.
The six-month year
Once you have taken into account five weeks of annual leave; six weeks of study leave; 12 out-of-hours sessions and 36 VTS sessions; and bearing in mind most deaneries want to sign off your workplace-based assessments by the end of May; not to mention the AKT and the CSA to get through, you actually only have six months. So you really do have to get cracking.
Before you start
Before you even walk through the door of your surgery, you should have already completed paperwork to get you onto your PCT's Primary Medical Performer's list so you are eligible to practise - you cannot start without this.
Your GMC certificate should be updated and you should have informed your medical indemnity organisation that you will be engaged in general practice duties. This will see your fees rise from under £100 to over £1,500, but this will be reimbursed by your practice.
Update your enhanced Criminal Records Bureau (CRB) clearance and make sure your car insurance is also covered for business use.
You should be registered with the RCGP as an Associate in Training and have logged on to your ePortfolio. Make sure your training practice has issued you with the BMA's model contract for GP specialty registrars - this is available for members to print off from the BMA website.
Your first week
A good training practice will recognise the importance of a proper induction. You should not be expected to run surgeries at this stage. Ensure you are on the payroll with the practice manager, take your P45/46 with you from your previous post, and if you have set up additional voluntary contributions to your pension your practice manager will inform the PCT on your behalf.
This is the time to get to know the staff and, more importantly, your trainer. Log into email systems, get your NHS smartcard and get to grips with the practice's IT system.
Sit in with the team: there is much knowledge to be gleaned from the practice nurses and receptionists (telephones, appointments, records, referrals) and some time spent visiting the district nurses and community teams can be invaluable.
If you don't know your practice's area, now is the time to explore. Always remember personal safety - you will need keys, emergency contact numbers and parking permits if required. Your home visits should be supervised to begin with.
Buy your own equipment for your doctor's bag so that you can get to know and trust your own instruments. Don't forget to secure it with a lock and to keep a log of practice drugs used and their expiry dates.
Label what is yours and keep all receipts - you'll need these for your accountant at the end of the year. When on visits remember to always let your practice know where you are, ensure your mobile battery is topped-up and that you have plenty of gloves, paper and numbers for next of kin, district nurses or local admissions.
Keep a log of all your visits. You will need these to claim for your motor vehicle allowance. Read the guidance carefully. For example, you can claim the return journey from home to the practice on the days when you make a visit on practice business or to your VTS afternoon.
It is most likely that you will be in the 'standard user' category - up to 3,500 business miles per annum.
Your first surgery should begin with 30-minute appointments and should move to 20 minutes only when you feel comfortable to do so. It can be useful to keep a note of your 'patient's unmet needs' and 'doctor's educational needs'.
A job list kept on paper or on your desktop is a good idea and should be updated daily. Don't rush to get your appointment times down; this will happen naturally with time. Remember to take your coffee break to chat with colleagues about problems and to read around widely.
Use your first tutorials with your trainer to come to mutually agreeable terms and your personal learning needs.
You will have the weekdays broken up loosely into morning and afternoon sessions. One of these will be for the VTS; two for educational tutorials/private study and seven clinical. If your trainer would like you to do more clinical sessions, speak with your VTS and deanery.
If your trainer is keen for you to undertake sessions in the evenings or weekends to help contribute towards extended hours, be cautious. While these sessions can be valuable to help develop your skills for life after training, it is good practice to have your trainer available at all times. You cannot work unsupervised.
It may be more worthwhile to consider these sessions towards the end of your year. If you do agree to them, ensure you are appropriately given time off in lieu during the core hours of 8am-6pm, Monday to Friday.
Now is the time to book your out-of-hours sessions, and basic life support and AED courses. Keep receipts from all study courses and spend what the deanery has allocated to you for the year. Finally, book your exams and away you go.
1. Before you start, ensure all your paperwork is up to date, including GMC certificate, CRB clearance and professional indemnity.
2. Get to know the practice team - spend time with the practice manager and receptionists and sit in with a variety of GPs and practice community nurses.
3. Get to know the area and consider personal safety on home visits.
4. Don't rush to get your consultations down to 10 minutes.
- Dr Bramall is a salaried GP in north London and a member of the GPC