Careers Series - GP



This webinar by mindedly covers everything you need to know about training to become a GP. Hear Doctor Zarah, a current GP ST3, discuss the training structure, how long it takes and what you need to do at each stage of it. You can also expect to find out the recruitment process, her personal experience and tips along the way. There will also be a session dedicated to asking questions and after the discussion, you can even get a feedback certificate!

Learning objectives

Learning Objectives: 1. Identify the benefits and drawbacks of a career in General Practice. 2. Understand the training structure and length of postgraduate study necessary to become a GP. 3. Recognize the difference between a smaller practice and one part of a Primary Care Network. 4. Analyze the varying requirements of referring patients to specialties within different regions. 5. Comprehend the importance of familiarizing yourself with local form requirements and protocols.
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Good evening, everyone to this webinar by mindedly on GP training become a GP and everything about GP by doctors. Murphy who's a GP? Uh, just to let you know we have got feedback certificates that can be provided. And that's once you complete the feedback which post a link for And Laura's also got the QR code on her, uh, slides. So if you have any questions, pop it in the chat box. But, um, otherwise, I think, uh, I'll we'll make a start. Doctor Zarah. Thank you. Right. So as Sample said, I am a GPS t three. I'm working down in Plymouth. I want to make this as interactive as possible. So I'm not just talking at my screen. It's also the first time I'm using this software. So if you can no longer see my my slides in full screen, please just pop your my card and tell me, um, in the chat, Are you able to just pop where about what stage of training or whether you're a medical student, whether you're a foundation doctor or or F three F four, or whether you're in a different specialty altogether? Thinking of becoming a GP just pop one short line in the chat, and I'll keep an eye on that as well. Now knowledge. It doesn't fail. This is what I plan on doing today. I'm going to talk to you a bit about my job and what my job looks like, What I like about it, what I don't like about it. Once we've gone through that, I have a little pause. You can ask any questions, Um, and then we'll look at the GP training scheme overall, Um, and whether it interests you are not in terms of the training structure, how long it takes, what you need to do at each stage of training. And then finally, it will look at the application process and how you can get into GP, and I will be open to questions as we go along. You don't need to save it til the end. Just pop it in the chat. Um, if you want to get my attention, pop your mix on and interrupt. So let's stay on this page for now. Okay? So the disclaimers I applied for GP training in 2016 and started in 2017. Since then, things have changed in terms of how the application process works and the, uh, the GP requirements have also changed. Most of my you guys are up today because I made them last week looking at the website. Um, but also bearing in mind when we come out of Cove in the pandemic, I don't know what going forward the application will look like. So all of this will be subject to change. But I can give you a rough idea of what it was like pre coated and what it's been like during coated. Um, I'm not part of the recruitment process. I'm here as a volunteer. Um, I just thought it'd be good to speak about GP and to answer any questions and be honest about it. And if it is for you to, then hopefully attract you to it, Um, there's nothing in it for me. So that that is my disclaimer. So as a GP training, I'm just going to check if anyone's got anything in the chat because I have to smoke screens and I don't want to lose the slides either. So we've got someone finishing f y one. Cool. So you're thinking about applying? Hopefully, we're just thinking about your options, so I'm 80% through personal choice. It's really easy to go less than full time in GP. You don't need a big reason. You can just say on your form that you want to go less than full time, and I like to spread. My hours are only 32 hours a week. I like to spread it over four days. Some people do full time and spread it over four days. When you get to working in GP itself, you can create your own schedule. And so at the minute my schedule looks like this, Monday's are my nonworking day. I don't work. Tuesday morning is pretty much a full day. I have a clinic in the morning and clinic in the afternoon, and I always have a home visit at lunchtime. Wednesday's I'll come back because it's quite complex Thursdays, um, similar to Tuesdays and then Friday morning. I tend to have a tutorial for a whole session, Um, and then the afternoon they call it independent study, where I could be doing my portfolio or, um, studying for my exams or it's up to me what I do. I don't need to be in practice for that time, and I don't have to justify that time. Um, Wednesday is the reason I say it's quite complex. It depends on where you end up in the country because each place runs its slightly differently Wednesday, it tends to be GP teaching day. Some places do Wednesday mornings. Every Wednesday mornings it's you're teaching time. So you will go along every Wednesday morning and then in the afternoon you're expected to be in clinic. You can move the independent study to the afternoon and have, um, all of Wednesday off, then. Well, not off, but not in clinical practice. But instead of teaching in the morning and then studying in the afternoon, the way it works in Plymouth at S T three is they do a full day twice a month, and that takes up to of the Wednesdays. The other two Wednesdays. I would be expected to be in clinic, except I'm also doing a differential attainment roll. So this is the great thing about GPS. There's lots of little extra rolls you can take on the differential attainment role is new to Plymouth. It only started this year, and it's essentially trying to support, um, people who may struggle in exams for usually down to their background. So a lot of international medical graduates are aware of the exam system or reflective writing might be new to them, and it's just supporting them as they transition into working in the N. H. S. And I've been doing quite a lot of that, and what they've given me for that is essentially 40 hours over the year, and I just extend training by a month, which I was happy to do. So that's what my current week looks like. I'm going to be changing it up from August to give you an idea where I make Mondays and Thursdays my full day. But I make them 10 hour days and then have Friday morning the same, but then have Tuesday and Wednesday to myself Wednesday for teaching. And Tuesday's my non work day so they can be flexible. Um, full time is 40 hours. There's no out of hours. I'll come on to that in a minute as well, and as long as your practice degrees, you have a lot of say over what time you're working. Now I'm just going to switch back to the chat because I can't see at the same time and just see if everyone's with me. Right? So that's my week. What I don't like. So I thought I'd start with the negative so it can end on the positive, Um, it can. The training you're getting will vary depending on your supervisor in the practice you're in. Um, so, generally speaking, you have been at least two different practices during your training and the first practice I was in it was a much smaller practice, and it was more isolating than my current one. And my supervisor was sort of part time close to retirement, not really sure of the portfolio requirements. She was really nice and approachable, Um, and she was supportive in the clinical sense. But when it came to keeping on top of the portfolio, we were both a little bit lost. And it depends on your personality. If you're quite easy going and relaxed, you probably don't mind. But if you're someone like me who likes to be a bit organized and on top of things, um, it can be frustrating. You can change Supervisor's. I've not gone through the process, but it's better if you try to work it out with your supervisor, I would say. Generally speaking, though, I have not heard any horror stories in Plymouth. Um, about breakdown in relationships, I think most people can make it work. Um, the practices urine can vary, so that that initial practice I was in was a a small practice. They were. When I say a small practice, I just mean that had the one branch, there were maybe about five partners in two or three salary doctors and everyone else part time and everything was operating in one little building. Whereas now I'm in a in a practice that's part of the that is essentially the primary care network. It covers a huge area, and there's about six or seven practices all under the same, um, management and partner partnership team. And it does affect things. Because in this practice, I've also got the pharmacist. I've got the urgent care team is made up of the nurses and paramedics and the services you offer do change. Um, So And you while I see you, I didn't know what I would and wouldn't like in a practice until I joined practices. So It's good to get different flavors to work out what it is you do, what going forward in your career. The other thing about GP, which which can be a bit frustrating, is the when you're referring people into the hospital or on 22 week weights or into investigations. What a GP can and can't do does vary slightly between regions. So I'm gonna pinpoint the Southwest as my examples because that's where I'm operating. But Plymouth is separate to Devin, and what I would say is the memory pathway in Torbay runs slightly better than the memory pathway in in Plymouth, in that in Torbay, if you refer someone because you think they may have memory issues like dementia, they will go to a one stop clinic and they will see a nurse and have their cognition tested, and they will get a CT scan, and then they will be booked in to see a doctor to talk about the results of both those tests in Plymouth. The way it works is you see the nurse, you get your cognition 10. Then you've got to wait to see the doctor because the nurse car order CT or an MRI, and then you see the doctor many months later who then request the scan. And then you wait many more months to see the doctor again to go through your results. So it's just a slower process. Um, the forms you need to fill in can be different as well, and it's it's more the logistical side rather than the medicine. It's just working out, making sure the patients on the right pathway. We do have a formula, an Internet formula that tells you what the pathways are, so you don't need to remember them all. And they kept up to date. So if you're thinking, oh, I need to send this one for off for specific investigation, you can just look up what form you need to fill in and what pathway it goes on. The other thing to think about is when you're in training, especially, you might feel a bit isolated if it's a small practice and there's no other trainees or there's maybe one other training, but you don't overlap a lot with them. Um, if it's a big practice where I am, there's quite a few trainees, and we also have 11 AM coffee breaks, and there's more of a social field there as well, so that can defer. UM, is not so much. The smaller practice are antisocial because they're not. They have their coffee breaks, but when you're going through exams or when you're going through certain things with the portfolio, it's good to bounce off of the trainees. But if then, if you have good GP friends in other practices, you can always talk to them. So it's nothing is necessarily a negative. Everything's got a bit of work around. Um, I don't like that there's no handover. So at the end of the day, if it's home time tough, you know you've got a list of patients to get through. In theory, you're super numerary. Your supervisor might take the work you've got left off of you and you you can go home. But in reality, what happens is you've got your patients, and you need to make sure that you've done all the referrals for them. You've done the admin for them. You've spoken to all of them and there's you can't really push push that work to the next day because then it impacts your next day at work. So it's so it is on you. You can't just hand over to the night team and say, All right, I'm off Now. There's this many people left clerking. You kind of have to, um, see you late sometimes. Um, there's a lot of clinical uncertainty in GP. And when your new fresh out of hospital, it can be quite frustrating because you need to really think about what tests you're ordering, why you are ordering them, what information you're going to get and whether what helped that gives you and the reality of patients come with you and they don't have bond or symptoms and they don't have. Um, you know, sometimes you just look at them and you just think I don't know what's wrong with you. Um, and that can be really uncomfortable when you're first starting out. But the more experience you get, the more you can go. You know what? I don't know what's wrong, but I know that it's not a two week break for a cancer. So why don't I just bring you in, say, a month's time and see what's going on? Um, and that takes a while to build up to that. And also, you feel a bit like an imposter. Like, all of a sudden, you think I'm an s t one n one s, t two. And I've got my own list of patients, but actually, I don't know what I'm doing, and that can be quite strong for some people. Okay, So what I do like is, actually I do like the wide spectrum of illnesses were getting through the door. Anything from a good bit of pins and needles in my hand. And I don't know what it is, doc to, um, you know, end stage, heart failure, palliative care in the community. You got hypertension. You've got most things you see in the hospital, and you go go to your GP about that, or so you've managed someone with a stroke, and then you send them home. The GP is then picking up the pieces, working out medications. They still need to be on what care. They might need thinking what further tests they might need. Um, and I quite like piecing that together, and I quite like, think, especially with the elderly population. How can I try to keep them at home safely? Especially when ambulance rates are ridiculously high, there's no bed flow. Um, and there's no beds in the hospital. So is it really the best thing for them to go and wait for 52 hours in the hospital trolley when I could maybe do something in the community first? Um, So I'm thinking of a patient I saw with obstructive jaundice who had known obstruct, um, reasons for obstructing. But he was becoming more and well in the community. And the question and the discussion we had was Does he want to go in when they might not be a surgical intervention available for him because of his priority and comorbidities? And if he decided not to, then how can we manage his symptoms in the community? Because I'm not going to reverse this obstruction. And so it was. It's thinking you manage a lot more in in the community. Then I then you would maybe expect, um, and that's why communication is really good being clear with patients about when to seek further help, or what you kind of can't offer because you can't. You can't. Um, not everyone would be suitable for all interventions, and it's been clear with them, and if you're not sure that's okay, you can just say, Look, I don't know what you know The specialist will offer you. You can have a chat with them, um, and then decide or you can or if you don't think is suitable to even refer them and you have a good reason why. So someone with pins and needles wants an MRI, and you don't think the needle and you you've got to be able to sell that to the patient, and I also like being able to follow up the patient. So if it's someone that I was worried about a certain condition for or someone I wasn't really sure what was going on, I like being able to say, You know what? I'll bring you in about three weeks or let's do a blood test and I'll bring you and see how things are. And I feel like you don't get a lot of that. When I was in hospital, you sort of see them and then if they are having routine followups, it's done by the consultants. But even and they only touch on that particular condition where, as in the community, you get to start piecing people together and you get to work out, right? So this person is partners of that person. And actually, they both had this happen in the past, and you kind of work out just from getting to know people over time, what's going on for them. And that sort of stuff is in the notes, like you don't know. You know? That may be, um, their dog died because it's not in the notes or something. Um, and you get more of that personal relationship and there are still named patient doctors in most practices that I know of. Um, and so there is that continuity of care, but again, it differs. Practice, practice, and practice is don't do registered. Uh, they don't register patients to a specific doctors, and then they end up talking to any old doctor. Um, I like that a lot of it is clinical judgment as well, because we don't have instant tests we can do. It's not like I can say I'll do a blood test. I'll get the results in an hour, and then we'll work out what to do next. It's very much if I want to do a blood test. I probably won't get the results till the next day. So how urgently do I need to get things done? Can I do this safely in the community while we wait for results? And it's a lot about making, um, using all that medical knowledge you have and making a decision without relying on investigations that you might be doing in secondary care. You also can watch and wait. So in hospital, you kind of if you had someone and you weren't really sure what was going on, but you didn't think it was hospital sort of need a hospital care. You would sort of say, Go see your GP and then sometimes the GP. We don't know what's going on that we can use to watch and wait, approach and see how things manifest and time with the time either get better by itself. In which case, great or with time, it will become a bit more, um, recognizable as to what's going on. Okay, so before I go into the next thing, I can't see the chat. So if things are popping up, please do, um, just yell out. So what I do like is obviously the lifestyle Everyone talks about the lifestyle. When you're in a GP itself as a trainee, you don't need to do a night shift. You don't do weekends. It's Monday to Friday, and the flexibility of work hours depends on you in the practice. So some people who are full time might want to do 10 hour days over four days and have a three day weekend. And that's fine, um, for child care reasons. Some people might want a later start or an earlier finished, and they can accommodate that, especially as trainees. But also, when you go into, um, work as a salary door partner, you can choose. You can sort of lay out your terms. Um, the caveat with the new nights and weekends is that as part of training, and I'll come into this later is that you need to do some. So I think it s t three. My dentist wants me to do 36 hours of out of ours, and out of ours can be evenings. And it doesn't have to be nights. Um, not all the surgeries require that, So I will talk about that a little more detail later. Um, because it's not going to be relevant for everyone. But generally speaking as a GP training once your GP, you're not on an ongoing rotor. You are working more sensible hours and life is a bit more predictable. So you can make plans and also being super numerary. You get any leave you want now, in theory of practices might say, give us six weeks notice. But if I'm message and I go actually what next Tuesday off. And I did that say today they want more than likely authorize it because I don't have to arrange a swap. I don't have, um uh, clinical, sort of. What's the word? So all my clinics are technically my supervisors there, and so I don't want to leave anyone in the lurch. I wouldn't do that, but in theory, if they haven't got anyone waiting to see me, um and I'm not, I'm not needed. Then I should get the leave. I will be wanting, um and they don't need I don't factor into Oh, we need this many of doctors in the practice because I'm not a salary doctor. I'm not service provision, So I truly am super numeral, and they won't go low, but if you're not here, we'll be understaffed because I don't count in that sense. Um, there's also the flexibility in the type of work you do. So I talked a bit about different to attainment. Um, there's lots of scholar rolls and fellowship rolls coming out as well and GPS. When they do end up qualifying, they do. And some of them like to specialize or want to be a portfolio GP. Um, so, for example, I know friends who might be say, I think one was three days GP in the practice and then one day GP as an acute GP in our local hospital and then one day as, um, teaching for GP trainees. Um, so that's a bit of Portfolio GP going on. You get GPS everywhere now. So they were being recruited into a and into urgent care. Um, women's health. There's also lots of fellowships and research. Um, there's pretty much what you want to be doing. You can go off and pursue, so my plans will be two days in GP your typical GP when I'm qualified, and then I'd like to do either one or two days in medical education either with the university or with GP and trainees. But there's also new initiatives always coming up. And at the minute when you're qualified, you've got, um, two year fellowship you can get which essentially pays you a session a week to do what you're interested in. And if that that could be something like, um, doing a PG or doing a diploma or it doesn't even have to be that it could be looking at, well, being it could be a que i It could be whatever you're interested in, Um, and they're really flexible. No one turns around and says That doesn't meet the criteria or you have to jump through hoops. So this, um, two year fellowship program. It was only stuff. I think a year or two ago and for as far as I can see, is here to stay. Um, and it is. Everyone gets it. It's not competitive. There's not limited numbers. Um, there might be for, um, no, there's no limited number, So if you want to do it, you're pretty much started to get it down here anyway, right? I've talked quite a bit, and I have been kind of keep an eye on the chat. Um, right, So someone, how many minutes can you spend per patient for consult as a trainee. So when you first joined our practice, typically 30 minutes is what you get given. Um, there's no rush to be quicker. I am still my slots. It's a bit different coated, and I just end up getting on average 20 minutes slots because of the stage of training. I am. But no one pushes you to be quicker until you're right at the end of training, because it's unrealistic to be that quick and get things dealt with the exam portion, which I come onto. They aim for 12 minutes, and I think the main thing to remember, though, is that your list will start really manageable. So when you start in ST one, for example, you'll have five patients in the morning and five in the afternoon. And seeing as your sessions are four or five hours long, that they're giving you a good chunk of time for each patient without you feeling rushed and then they work, you know they'll increase that number. I'm on something like at most 10 in the morning, seven in the afternoon. Um, and I'm I'm going to be see CT next year. So I've slowly built up to that. And the idea is this time next year when I'm a month away from qualifying is when I'm hoping to be doing closer to maybe 16 per session. When you're qualified. It does depend on your practice. Some practices. Um, well, once, uh, so some practices split patient contact and admin time. Um, and roughly speaking, the max that they should be expecting is 20 contacts in the morning and 20 contacts in the afternoon. Some people, um some practices will include the admin time and your contacts. So you might only do 16 contacts in the morning 16 in the afternoon and then have four slots each to catch up on admin. Um, some practices because they don't have paramedics. You'll get the stuff that saves you minutes so you might have a really bond or UTI or a contraception chat. And that takes you less than five minutes, and then you have something really complex that takes a lot longer the way it is at the minute. With so much, so much complexity out there that you're handling I think it'd be unrealistic to be doing less than 15 minutes is a fully qualified um so my GP trainer. She has been working over 25 years, and the more complex stuff where she is now in the family for using is still takes her 15 20 minutes. And if you've got one or two patients like that, that's fine. But if your entire list is like that, it can add up. But then I think with the experience, you get sicker and quicker, and you know what corners you can sort of be shaving minutes off if you know the patient's really well, I hope that answers your question, but it's not like you hear like it's not. It's not 10 minutes. Like they say, even the exams don't expect 10 minute consult Any more questions about my personal experience before I move on? How does the salary progression work through training? Um, so I was on the slightly old scheme where ST One and s t two were roughly the same amount of money and then I had a massive jump in S T three, um, to essentially a registrar level that you would expect in the hospital. Now they're trying to even it out. So that s t one and two and three. You're paid roughly the same throughout. You also get less than full time. Premier, you get GP, you get an added bonus for being a GP trainee. If you're in London, you get your London living wage essentially at 80% as an S t two s. T one and two. I would have been bringing home. So if I was 80% what was I doing? About 2200. And now as an s t three, I'm bringing him about 2600. Having said that, fulltime trainees are getting over three grand that they're bringing home after tax. So it is well paid to a certain extent. Um, and you can look up the exact salary and how they break it down online because it also will defer whether you're working in England or Scotland. And it will defer whether you're working in London, not outside London. Um, and also, my trust pays back my mileage. So that makes a big difference to me because I commute quite a long way for work. So if you're doing home visits or if you're commuting for work, that's quite a fair distance. You can claim back your mileage. Um, so, yeah, it's not that bad. Is becoming a GP the best for work? Life balance, In my opinion, I'm glad you added that on because it will be my opinion. Oh, just about 2000 month. We get paid monthly, not weekly. Um and that's the 40 hour weeks. And I've never got that much because I've not been full time, but my friends have reported to get just over three grand. Take home a month for doing 40 hour weeks and no on calls at S t three. Um, sorry is becoming a GP the best for work life balance, in your opinion. Now I'm biased because I want to say yes. But essentially, from what I've seen, the reason I chose GP is because when I was in medical school, I thought I'd never be a GP. I wanted to be obscene, Johnny. I loved being gone, and I loved women's health. I loved the idea of it. And then I started working in hospitals and night. You know, pulling all nighters gets really tiring. And then the other thing I realized, is constantly moving, moving departments, moving hospitals. It's draining. And then to think you'd be doing that for eight years, for a time or even longer to become at a certain level in your career, just it really it really ground me. And I just thought, I can't do it. I wasn't in love with any particular specialty to want to be doing that. And then also, depending on what specialty you're going to like if you're going to be any or, um, intensive care jobs and go in the urine during the night anyway. So it's sort of like When does life get a bit more easier? Because nights are a killer for me and I wasn't fully invested in particular career. I decided, um, I would much rather look at what would be sustainable for the long term, and then you factor in if you have kids so I don't have kids yet, or if you want a family life or if you want to buy a house. What, which career path would suit that? So, for example, I was working on Registrar, So Southwest is a really big deal to cover as a hospital trainee, and I was working with medical doctors, registrars who were down in Cornwall, Truro for maybe two years and then moving up to Bristol for two years. And they're in their thirties and they're close to being a consult ER, and they maybe got a two or three year old and they've got a partner. But they can't buy a house because they don't know where they would be long term or if they buy a house. They don't know if it's a long term house, and then when they go the consultancy consultant jobs aren't necessarily where you've been training, so then they have to relocate, and then you've got to pull your family to another part of the country, and it's like starting all over again, and for me, I was just I can't do that. I need to be able to sit down Roots. I need to be able to say, This is my community and these are my hobbies. This is where I like to go swimming. These are the walks I like doing. I like that. You know, this is where I like to go shopping. It's for me that factor of life was way more important than a clinical career. And so, yes, it is best for work life balance for parents as well. We get a lot of trainees coming from other specialties. So I'm thinking this year we had three pediatric registrars join us because they got to s t four. And it just wasn't sustainable with having Children and childcare. Especially if their partners also doctors. And you do get a lot more support for flexible working in GP training. Okay, I hope that answers your question. Um, Then there was a question about any opportunities to increase your earning. Yes, a lot of doctors do. Shloh comes in the local trust. I did a bit of work with the local medical university as well. Um, So the what I would say is, um if you're less than full time like me at 80% if I then go pick up extra clinical work, they will ask me why I can't be a full time trainee. But if you're full time trainee and you want to pick up extra work, go for it. Um, you can't work as a GP or do the out of ours GP because you're not a GP when you're in training, but you can still do be on the hospital, local banks if you want to be within hospitals. I know quite a few people who just, um, Did I say Joe jobs for the departments they rotated through, um, medical university work or just non medical work? I don't think I'm just thinking if there could be anything else, I think those are the common ones. Um, just keep an eye on your overall income and the tax that you don't end up paying. And the pension right? Any difference between training a smaller town versus major towns? Oh, depends who you ask. I did my medical training six years in London, and I felt like I had a really good training. I was exposed to more stuff, but I haven't worked there as a doctor. And I don't want to, because I think it was the stress I'm feeling now. Put times 100. But I feel like my money goes further in outside of London because I'm not worried about commuting cost. The living costs are as bad as London. You know, I thought I can buy a house more affordably down here than I can in London. I am biased because I love. I love where I am now, I I would say so. I did my F one F two and two a day, and then I decided to do GP training in Plymouth because Plymouth is my local tertiary or big big hospital. Um, and the difference between the two is it's a small difference, but it's essentially that there are more services available in a tertiary hospital, but you're facing the same problems wherever you are. Um, I felt like people are friendlier down here, but I don't know if that's because the people who stay down here really want to be here because of the quality of life. Um, or if it was, because it's a smaller hospital, think about reality as well. So, for example, Cornwall is really rural, and some of your home visits might be 40 minutes each way, and also you're trying. You might be dealing with a lot of stuff, um, that you can easily call an ambulance for you get. It's not unheard of. I did actually have someone, um, a friend of mine working in a practice in Plymouth had a farmer turn up to cut his hand. Um, literally severed a finger or something, bleeding everywhere. I was just like, Oh, just catching up and you go back to work. Um, so I think it's more about the community you're serving and the community expectations. Um, so, yeah, the community will affect the sort of, uh, experience you're having in terms of training. In theory, you're supposed to be getting the same training everywhere. I will talk about the training structure. Um, but if you're thinking about the sort of experience you want with your training, I would say unbiased. But the quality of training I've had down here is really good, but the stuff I have outside of training is also really good, and I think you need a bit of both. Um, and the great thing about I guess major towns is you have more diversity. It's not very diverse. Down here is quite deprived. There's not a lot of culture in outside of I think exercise is the local. It's the closest place where there might be a bit of culture. Um, you don't get many gigs of concerts coming down this way, but it depends what's important to you. Um, I will talk a bit more about that. If you want about experiencing things from a my sort of minority ethnic background, if that's what you're interested in. I'm not an international graduate, but I also am aware of some of the struggles international graduates have. Um I got another question about training experience in Plymouth. I will be going into that later. And then if there's a specific question you have, then let me know. But I will talk about the breakdown of what s t 123. Looks like in Plymouth. Um, I have heard that renting about half of your monthly pay. Uh, where are you renting? That's the question. Um, so the rent would vary in the UK, and with the price rises and everything, it's is getting unbearable for some. I was fortunate enough that I managed to buy a house and my husband in November. My mortgage is not that bad. It's not half my pay, So if you're renting obscenely, it depends what sort of lifestyle you want. If you're happy with the little pokey bed, sit and paying, uh, you know, substantially less than a nice flat or a nice house, but yeah, rent. And also be careful where you're renting from and who you're renting from because you can get shafted essentially. But that's slightly outside of being a GP. Um, time and application process. Yes, that's coming on exams and such. Yeah, that's coming off. Which part of England would you recommend for that? Okay, so let's continue and that will hopefully answer some of your questions. And then if I haven't touched on your questions, especially around international graduates, um, remind me at the end. I haven't actually got anything formal about international graduate in this training in these slides, but I've done a bit of work around it in Plymouth, so I can answer that at the end. But let me just move on. So the GP training scheme, if you do it full time, is three years wherever you are in the country, um, less so I'm less than full time, so it's obviously taking me a bit longer. Um, it's taking me for years, and that's fine. Um, when I started, they had one system in place, so I did 18 months in the hospital. 18 months in the community. What that meant was I did in ST one and s t t. I did 1.5 years in hospital jobs that were either, so they can be anywhere from three months or six months long. Um and then I did a six month post in GP and then ST three. All of it is in the same GP practice. Um, the new scheme is, I think, a lot nicer, and a lot more areas are having this theme that they're calling integrated training programs. And the way that works is you do ST one in the hospital. All of it is in hospital. So you're on the ankle rotor cuff or whatever department you end up in that the specialties will be medical and relevant to GP. So you're not going to be on a surgical specialty, for example. Um, and the way you get put into specialties, I'll explain how that works in Plymouth in a second, Uh, and then in the second year, you're in a practice for the whole year, but you might only do two days in the practice, and then two of the days you'll be doing in an outpatient department relevant to GP. So, for example, a Plymouth You might do two days in sexual health or two days in dermatology, two days in rheumatology or two days in ophthalmology, and you won't be part of an uncle rotor. You'll just do, um, half of your time in a practice and half of your time in the outpatient department, um, in clinics, learning what's useful for the community. Um, and then your final year will be all of it in a practice, and I quite like that structure, um, denies cover smell, smaller areas as well for GPS. So, for example, down here, if you were a medical training or surgical trainee, you or even pediatrics, you could be down in Cornwall. You could be in Devon, and you could even be in parts of Somerset. And that's quite a big distance. So it's hard to then find a middle ground to then commute to all the places, and then you'll be constantly moving around. Whereas in G P, it's a much smaller contained area. So Plymouth covers Plymouth and it's it's you. You will not be expected to be commuting outside of Plymouth like a huge difference distance for work and you will not be asked to relocate during training. So all my hospital placements were in the Plymouth hospitals. Um, Torbay is another GP Diener E. And that covers Torbay, a turkey bricks, um, and painting and parts of South Devon. And that has one main hospital and two small hospitals that you could potentially do your training in and again, everything is comfortable so you can buy a house or find a base, and you can live there for three years. Um, some areas have a 20,000 recruitment scheme. There is some more information about this towards the end. Essentially, these are hard to recruit to area. So to attract trainees, they offer you 20 grand. Sometimes it's for it's for specific post. So if you do a specific job in, um part of your S t one, for example, you will get this bonus. You get it as one lump sum in your first paycheck so it gets heavy tax, and then you need to talk to HMRC and get them to adjust your tax code. Um, some people don't like this idea because they think, Why are you giving me 20,000? The reality is, it's hard to recruit everywhere right now, so it's not necessarily a rubbish area. But when I was applying, for example, Plymouth was eight hours and the lake district. And probably because there's, um, not as much drawers down here in terms of diversity and, uh, city life. And also like it's rural. And not everyone wants to be somewhere rural. Um, so you get that lump sum The caveat. You read the small print because the caveat might be that if they feel those spaces, um, they take away the offer. Or the caveat might be, um, if you leave training before you've completed it, you will then owe them the money back, depending on how much time of your training is left so that so there's there's pros and cons to it, and I think a few other specialties are beginning to do that. I think psychiatry now have it as well. Um, when you apply for training, you can either do your three year GP training scheme or you can do an academic fellowship. Now, the difference that I read about is that if you just want to be a GP, your bond or GP training, you apply through Oriole and I'll show you. If you screen a bit more about dynamic and you apply nationally, that's what you're doing. But if you want to be an academic GP training, you got to apply to specific sceneries. Um, I'm not an academic trainee, and I'm not 100% sure how that there training program works. It obviously runs with the rest of the GP program, but there will be time when you're doing an academic project. But I have got links. So if you're interested in that, you can look at yourself in the three years you will be doing a portfolio and I'll go through a bit more about that and they'll be two exams. Now. Driving is essential. You can start the GP program without having a driving license. You can start GP. Um, you could be in a GP training program and not have a car. Um, it makes life a little bit harder, but you can manage it. The problem is, when you're qualified, a lot of your contracts that you'll be getting from practices will require you to do home visits. And if you're not driving and you don't have a car. Then they'll expect you to somehow find a way to do a home visit. You're not exempt, so if you can use a bus or in London, it'll be easy. You can use the bus. You can use the underground, do your home visit. When you're somewhere in Devon and you don't have a car, it's hard, You know, even there's the public transport system is not reliable, and it's not that frequent. And it might even be going where you need to go. And taxes are expensive. So just bear in mind driving you will need as a GP. Maybe not in training, but definitely at the end. Okay, so we talked a bit about the training structure split into three years. You will have an educational supervisor who stays the same in ST one in ST T. Generally speaking, and this supervisor you'll meet up with every six months, even when you're in the hospital and you will do your GP placement with this education supervisor. When you get to ST through, your education supervisor will most likely to be your clinical supervisor because you're in their practice at each ST ST one. You only do a portfolio. You can't see any of the exams and s t one the portfolio requires. So the numbers changed because of povid. But essentially, you do regular reflections. You do, uh, per you need to do some many taxes, and you need to do some case based discussions and the numbers are not taxing. There are a lot less than they were pre coded, and there's also a lot less than you would have to do if you were a medical trainee. You have to do a quality improvement activity. So, like an audit, Um, I think if there's anything else you need to do, I think that's all you need to do is an S T. One. Um, you have to do your safeguarding and you have to do your BLS. But you got to do that every year in ST. To the portfolio. Requirements are roughly the same as S t. One, but you also are now eligible to sit the applied knowledge test. Now I've got another slide on that a k t. And I'll talk about that in a second in terms of how much it costs and what you do for it, and then in the final year. You've got a bit more to do on the portfolio, so I've got to do a prescribing assessment which isn't using, and I have to do a leadership and I have to do or something else I have to do that is new, but it's it's not a big chunks of work. They just sort of There are a little bit take doxy, but they can be done and they can be done in a short space of time. Um, and you also got to sit BRCA, which I will also talk about now before I took Oh, that's handy. I've got the exact breakdown there. Let me just check if anything happened in the chat. Since then. Okay, there's been a couple of questions, but what I'll do is I'll finish this section, come back to that. So I'm not going off on a tangent. So in terms of portfolio, we use 14 fish. Um, it's so I'll see when you when you become a trainee, you become an associate in training of the Royal College of GPS, and you have to pay a fee. Now. I can't remember that for years. You pay it every year it's a few 100. It's it's not. It's not cheap, but it's also not ridiculous. Um, I think it's 400 a year, maybe less, Um, and that will also give you access to 14 fish. 14 fish is a. It's where you upload all your evidence of your portfolio. They also have teaching modules, and they also have exam modules that you can pay extra for, um, and that's covered by the Royal College fees. Um, you also need to make sure you have your GMC fees every year paid, and the other thing is your defense union or the most GP training programs now provide you with the defense union cover. Um, I think those are the subscriptions. I can't think of it. I think there's anything else you need to pay for in terms of buying your own equipment. When you're training, the practice will give you the equipment to go on home visits. You are expected to have your own by the time you're salary, but only the basics, like a BP pulse oximeter a stethoscope. Um, if you want to tendon hammer and otoscope, but you can claim that all back on tax. So in ST One and two Reflections, a personal development plan and A it's just three things you like to do and mine are really basic. You know, I think this this rotation, my personal development plan, was to sit my take 80 and do a Q I I match them up with my portfolio, so that's easy to take off at the minute you need in a year for many taxes for CBDs. But if you're doing 26 month rotations, that's two per rotation. Um, you can't do four in one and none in the other. It's You have to do a certain amount per rotation. Quality improvement could be really short and easy, like an audit and MSF. So motor source feedback. You need 10 responses from teammates about whether that your professional or not, your six month supervisor meetings at six months supervisor of us, just to make sure you're taking all the boxes. And every year you do safeguarding and be less than an S T. Three, you've also got to do a little project that shows leadership you need to do something. Um, you need to do like an Excel spreadsheet to show your prescribing and whether you're you, just look at the prescriptions you've done and whether you can improve the quality of them is not looking at mistakes, but just like things like, Have you documented the indication for that medication? Have you documented when you're reviewing that medication? Have you made it clear what instructions are for taking the medication? It's It's a little bit ticked Oxy now. Urgent. Unscheduled care. It depends where you are in the country. So the Royal College says you do not need to do out of ours. This can be done as part of your day job. So you, for example, um, you can be the duty doctor or working with the duty doctor. So in theory, every GP practice has a duty doctor every day who takes, um, same day, same day sort of appointments and that can meet that requirement in Plymouth. They want you to do a certain number of hours with the out of ours team. It was Diovan docks. They just lost their contract. And because it can be hard, especially with coated and not having enough doctors out of hours to find time to go out of ours, they're not as strict with it, but they still want you to try if you can. And I think it's something like 12 hours in your ST one at ST to when you do GP at 36 hours when you're in S t three, um, which, if you do four hour shifts, you can spread out nicely. If you do a full day, 12 hours, you can do it in a short space of time. You take that off your clinical work in GP. If so, you don't. You're not working extra. In a sense, you're just getting the experience. If you can't get the time because of lack of shifts, you can just do reflections and and do do tee doctor stuff so that can vary depending where you are in the country and also 14 fish. That's also what you used to. So all of this has uploaded on 14 fish, and you also use 14 fish to sit your R C a exam. So the first exam you will come across is the a k a. P. Just checking the chat. Okay, so the a k t. You sit here in ST to you can sit in S t three. Um, it's made up of 200 questions. It takes three hours, 10 minutes. It's done in those driving centers where you probably did your, um, multi s are a or you're drawing test. Um, it's multiple choice. Uh, there's no s a answers, and 80% of it is testing your clinical knowledge. 10% is testing your stats knowledge, and 10% is testing your admin knowledge. Now, status is usually quite basic. It gives you, um, a graph you might see in a research paper and ask you which of these statements about this graph are correct. And so it's just making sure you're familiar with interpreting grafts. The admin. No one ever teaches you this stuff, but you can pick it up through. There's lots of really good YouTube resources, and it's just about the legal requirements of having your practice the health and safety law, because when you're a GP, if you're a GP partner, your private employer, so you need to know the rights of your staff, and you need to know the legal stuff around record keeping health and safety, and it's it's a bit dull, but it's information you can easily get. And remember, um, the Royal College of GPS has a free question bank with over 3000 questions. They are questions used in previous exams. Um, so in theory, you don't need to be paying above and beyond for extra course is some people. Do you have three opportunities to sit in the year? So you consider in January, April October, you're allowed four attempts, and they recently put the price up and it's now 470 quid per attempt. They say something like 99.7% past within two goes, um, eight can be a tough exam, especially for international doctors, because it's not testing knowledge. Is testing your clinical process in that? What, you got to read the question really carefully in that. What? They're either asking what is the initial thing you will do or what is the gold standard or what is the safest thing to do? So if this was a patient in your room, how would you manage it? And I used the nice CKs guidance I used our see a GP, and then I paid out of pocket for um for another exam bank and that was enough. And yeah, so that's the take 80. It's not the worst exam I've heard of. Like they you can pass it. It is very much you can pass it on your first go. If not your first, then your second. I only know one person in the last five years who is having a third attempt. The R C A. Okay, I'm just going to drink water because I've been talking quite a bit. So the a K T has been the Precose did has stayed the same during Coated, and it probably will keep going. The R C A. Is new. Before Cove ID there was something called the clinical Skills Assessment where you'd go down to London, and it's a bit like an oscal or risky where you had stations and each station would have a simulated patient with an examiner and you would consult them in a certain timeframe. And, you know, it was all done in one day. But obviously with co vid, they had to change things up. So they introduced the recorded consultation assessments are see A. This at the minute will be running until September next year. After that, they're talking about bringing in some sort of hybrid or options. So either something that can do a resume or something where you cannot do the R. C. A or the CSA. I'm not sure there's talks, but nothing is official at the minute. So what I will be doing is I will have to record on 14 fish, 13 patient consultations. They can be telephone calls or they can be video recordings, and they need to be in 12 minutes. So essentially, the Examiner start listening after you've introduced yourself and got the consent, and they stopped listening at the 12 minute mark from there, and you need to cover. You have to cover certain topics, So obviously nothing intimate will. You can't examine. You can't record and submit anything intimate like, you know, back passage exam or breast exam. You can't do that, but you can do a consult, for example, about breast pain, but what they would specifically want. So there's 13 categories and you need to hit them, so you need to make sure you do one with a sick child. One about mental health. One. About an older adult, one about women's health. Um, one about male men's health, and I can't remember the sixth one. So oh, a long term condition and then the others are up to you. So there's six that you definitely have to hit, and then the others that are ones that you can that you think are good. So you record them in practice. You can record them anytime up to six months before you submit them, and they you have to have a consult with the patient, which is done through the system. And that's what they're accepting at the minute. There's pros and cons. I've obviously not sat the CSA, but and I haven't got the Farxiga yet, either. But the pros are that you get to pick. Your case is, and you have more influence of what you're submitting. Um, and you have more time to get it, get it done. The downsides. Our patients are not, uh, your typical. If you had an actor, then they have a script, and as long as you do the ice and you get all the pertinent points from the script you past, But if you've got a patient, they don't follow a script, and sometimes you think you've done a great job and then right at the end and they go, Oh, one last thing. And you think, No, don't bring something up now. Um, so there's pros and cons, but essentially, it's assessing your consultation skills. Okay, Um, I can't remember how many attempts you get. Um, and it is quite sleep per sitting right? That's my checking point. So I think the next bit was talking a bit more about What's an expert talking about? I remember in a second, but let's just look at some questions. So someone's asked. Which part of England would I recommend for international doctors, I don't know, is the honest answer. Everyone's got different experiences. I don't like cities. Some people really want to be in the city. Some people want to be where they have a large community of a similar background. Um, I would say, work out what's important to you. Do you want a community around you of the same, uh, cultural background or the same faith? And then look for cities that offer that, and or if that's not as important to you as having a work life balance or or quality of life. So you've got a particular interest or sport that you're into Look for an area of country. The thing is, you always hear pros and cons. It's what you make of it. And if you decide that, like for me, for example, it wasn't a big deal that there was a a big community around me from my cultural background. So I'm happy down here. But then I know colleagues who aren't happy because they want to be around people of the same community. Um, so it's down to what you make of it. Um, someone asked. Anatomical knowledge from med school isn't the best noise. Mine is fine. Anatomy is not a very big part of being a good GP. Um, it's patient Communication is the biggest thing about being a GP. Because if you can reassure your patient and explain things to your patient, they won't keep coming back with the same thing. And if you can't, if you don't address, so we have ice. I'm sure a lot of you know about ice. If you don't address your patients concerns or their expectations, they will keep coming back. So a lot of GI be training is about communication skills. Um, Also, when I do my consult, I have the nice guidance open have the b n f Open. I have the local formulary open. I'm googling things all the time. You know, like, I'll do my annual exam and then go. What did I just test? And I'll do a quick Google to work out what my dermatomes. Well, what my muscle testing was it's not about being able to label every single thing. It's more about being safe. And so if you don't know where the latissimus dorsi it is fine. Just Are you safe? Have you documented, uh, clearly your clinical exam in your clinical reasoning and what your plan was? Um, what clinical subject do you come across most commonly on a day to day aches and pains? A lot of aches and pains? Um, I'm just thinking. So a lot of aches and pains. You got to get good at your contraception and menopause options, a lot of social issues, mental health, a lot of like complex co morbidity, frail people. So you might have someone, you know, older people having falls at home because there are, like, three anti hypertensives. Um, you know, people with type two diabetes. It's long term management as well. So people with management of type two diabetes and hypertension, um, occasionally you get you get something that might be quite exciting. I had a new diagnosis of ulcerative colitis as an idea if it was ulcerative colitis. But you clearly had inflammatory bowel disease, and he was clearly having an acute flare, and he clearly needed to go in the hospital. Um, so and I also have had renal colic because of renal stones, and I'm not saying that they're common common, but you do. You do get a good mix. Um, right. I know we're coming to time, and I know there was a little bit more I wanted to discuss. Um, someone's asking bit more about rotations. What I'm gonna do is just whiz through the last few slides, and then I will talk a bit more through your questions. So, oh, application process. If you're thinking about applying, you need to have a GMC license. You need to be eligible for full registration. So, essentially, if you're f two, you might be applying before you. Um, yeah, you might be applying before you've gotten your full license. But as long as you're not looking to fail after, you can still apply, Um, and they they say you need to be able to drive or have a way of being going on home visits. I don't know how closely they screen that, because I had a lot of people in my cohort without cars and not driving. Um, it's not mandatory. You know, this area is, um, at this stage, you do one application on Oriole for when I say four nations, so that can be England, Scotland, Wales and Northern Ireland. And what you do is they rank everyone that's applied, and you then get given your choices based on where you come in that rank. Now, obviously, if you're really high up, you're likely to get your first one. But don't be disheartened, because if you want to go somewhere that's not as popular like Plymouth and your lower down on this national ranking. That's fine because there's not many people coming to Plymouth, so you're likely to get that. Now They do around one in. I want to say November time. Oh, I got a timeline on the next slide, which is good because I can't remember. But you do around one quite early on, um, in the autumn, and then they give those jobs out. Then they re advertise for the round one with any jobs that are left. Um, and that's to start in the following August. You can defer your entry by a year so you can get your place and then defer it. And then once they feel the places for August starts, they then do another round recruiting people for February start the following year. The at the minute. So let me talk about to you about my experience. I had to sit the multi specialist recruitment assessment. The r M R S m s are a, um s are a in one of those drawing test centers. It was, uh, multiple choice clinical knowledge, nothing. Um, specialist, it was very much for being able to recognize an acute situation, knowing you're a to ease, um, seeing common things. And you do that and then you get ranked. Now, when I sat in the top, 10% will automatically given their first choice. Anything below that? You were asked to attend a face to face, so I did my face to face. And the first portion of it we did 30 minutes a bit like s J t. Where they give you, Um, it was paper based. I had to write, and you've got two or three questions saying No, it was just one. It was one or two questions saying rank what you would do in this situation and then write a little paragraph explaining why you drank the way you have. Um, And then I had to do, like, an oscal style where I had three consultations with actors and I had it was about communication, not my knowledge. So you know, someone wants to make a complaint or someone is nervous about a procedure. And it wasn't assessing what you knew, but more about how you handled things in your communication skills. Um, because of cove ID, what they've now done is you only have to do The m s are a long way around, but they've now introduced 50 s J T questions as well as the clinical questions you now also going to do the S J T questions the situation or judgment test where they give you a scenario and you've got to rank from the options, which you think is best down to the least best. There is no other way to boost your school, so there's no requirement. They don't ask for evidence like they don't ask for. If you've got a masters or another degree, they don't ask for audit our certificates, they don't ask for portfolio. So if you have all that stuff, great. But you won't strengthen your application. It's based purely on the MSR a and the SJP portions of the tests that you do. So the M s are a 97 questions 75 minutes and also you've got the 50 s t A. T questions. In addition, because of coated in 95 minutes, I don't know whether they're going to keep this format going forward or if they're going to revert back to the Precose did where they do the face to face, um, scenarios. And it was three cases. Um, I did face to face Now the timeline. So if you want to start in August this year, you would have applied in November. You would have sat your MSR in January, you would have known by march where you whether you got the post and where you were going in terms of how you can hold posts. I'm not an expert. I can direct you to the website. That explains it. Some people apply for two or three specialties. Um but you can only hold one post at a time. There is obviously upgrades and other things. I don't know the Internet's of it, but there is a useful guide that I've linked at the end That explains it in more detail. If you want to be starting in February next year, you can apply from July. You do your MSR after you've applied, and then you get your job offers by the end of September. This is last August was the last time? Yeah, last August. Competitive ratios? Yes, right. So it can vary year on you. Some places are more popular than other places, so London is obviously really popular. So what these numbers mean is for everyone place. You would be competing with 3.2 people if you wanted to do London. I'm down in the southwest. So for every every job place, you'd be competing with 1.5 people. You know, if it's 1.1, like in Yorkshire, in Humble or in Wales, then essentially, it's not that competitive now, it would always say is a competitive process. It's competitive in that you need to fulfill the requirements. But they are so desperate for doctors. And if they have a job, they're not going to say you can't have the job If you still feel that their requirements, these are some useful links. I will share these slides. But the GP national recruitment gives you a breakdown of the oral process. How you holding off for how you inject and off for how you upgrade offers? Um, the eligibility criteria will stay there and then turns in a bit more, uh, bit more of an explanation of what jobs are recruiting for tears when you rank jobs. So when you get your real when you got to order and you do your application, you rank regions of the UK you'd like to work in, and then once you got given a region you rank. So I had to then rank hospitals like specific areas I wanted to work in. Um, so in that way, I'm just wondering if I had to rank Southwest and then had to rank like Plymouth Extra. Yeah, I think that's the way it was. Or if things have changed, you might have to rank this Dean Aries. So, for example, Plymouth or external north different or Torbay? I don't think it's that way. I think you still ranked by, um, by hee areas. And then you rank again for which specific ones. Once you've got an area, Um, and then you rank once you so certain post you rank the jobs that you want. Another post, you just get given the jobs, um, again varies where you go. This is the feedback. Now, I'll leave that on your screen while I go back and look through some of the questions that have been coming in. Thank you for coming. If you don't have a question, feel free to fill in the feedback for him and and you can go If you want to stick around and ask questions. I'm happy to stay an answer now, just going back. So, as 21 rotation, which one would be most useful for GP? Oh, um, I'm of the opinion that the broader the better. So things that will help you understand the referral pathways and what hospitals can offer. So any acute medicine or a medical job is really good. Pediatrics. Maybe a bit of ARBs and Janie. I don't think things like ophthalmology or dermatology unnecessary because or ent, because you can pick that up in your day job. And sometimes the hospital stuff like, for example, the ent. You will never otitis media up acutely or the stuff that I manage. Activist ear infections. You won't learn that in E. N. T. Post, because that's mainly a surgical post. Um, ophthalmology again. You're not going to learn. You're not going to dilate eyes and look in the back of eyes in GP Um, and some with dermatology. If you've got suspicious lesion, you'll be sending it up. You won't. You won't be getting your Zometa scope out and be biopsying it. So I think the broader the better to understand the community pathways. Having said that, if you want a nice life, ophthalmology is a nice life, you know, 95 no one calls. As a junior, I I did mine more strategically. I did what I think would benefit the most, so I did health care of the elderly, which I think is really good to do because a lot of what you do is elderly population. And I had managing Comorbidities. And I did pediatrics because I hadn't done that in F one F two and that was really useful. And I did psychiatry, community, psychiatry and again, that was really useful as well, just to learn what was in the community resource wise, what was you know, what the threshold her were for referring from GP and what patients could expect once they were in the system. Um, so I found that really useful. But I'd also done a any acute medicine obscene gynie. And that's already another medical job in F one F two. So I felt like I had a good base. So I would say Go broad rather than specific and think when you're on those posts, think about the pathways and what could have been done in the community. And what at what point were they referred into the hospital and then what has the hospital done that couldn't be done in the community? And when you discharged them, what do you expect to continue in the community? Next? Question How stressful Is it being a GP because of the broadness? I think so. It depends what stresses you out. I find the workload is much better than when I was in a hospital job, because I can control it a lot more. Um, in terms of the breath, it's not. It's not about you Pick it up with time. You get faster and faster, you get to go. Oh, that's hypertension. Stage two. I'll start them on this. And this is the Ramipril, for example, because they're, you know, the guidelines better for the really common stuff. And that comes with time. Um, the biggest thing is knowing if knowing what he needs referring and what doesn't. So if you go, I don't know. So I've got someone who has weird pins and needles and weird places, but not fitting a particular pattern, but only pins and needles. And I've done the blood work on him and it's all normal and he's young and healthy, and I've got you know what? I don't know what's wrong, but I don't need to investigate, so we're just going to sit on this and I'll check back in with you in a month's time. Um, as long as you're safe and you've done what is appropriate, that's fine. The other thing is that I didn't mention in GPU debrief with your supervisor. When you first start, you go through every single patient you've spoken to that day, you go through your decision making, and that's really useful because you learn a lot from your trainer as well. When you get further into S t three, you might owe when you pick up one or two of the patients ago. I wasn't sure about that. Can I just double check that with you? But initially, you talk through every single patient, and that's how you learn about the pathways. You learn about what you could and couldn't do. You get more confident, not testing things. Um, also, you don't need to remember it all. It's like you have a computer screen looking up a nice CKs. Look it up on the local formula. Um, so as long as you know, that's not, say, a two week weight by two week Wait. I mean, you haven't got a 60 year old when you are in deficiency anemia, which needs a two week with colorectal, you can say? Uh, well, we have time. Let's think about this logically. What information do I need? Um, and sometimes, you know, it might take a bit of time for you to go. Oh, I need to refer you. And that's fine, because not everything is evidence straight away. It's just about being safe. Um, I don't find that part stressful. I find it stressful when I have lots of really complex patients back to back. But then I also have a really nice weekend. So it's how you deal with the stress. I I much prefer having a reliable work schedule to a hospital rotor based on what do they rank applicants? Your multi special tea recruitment assessment school is purely based on that. They don't look at anything else. Do they offer pre allocation for those needed to stay in the area for health issues like with F Y ones? I think I don't know. Look at the website, but I know that you can submit, um, exceptional circumstances forms. I don't know what they do and don't consider, um and I don't know how much weight they give it, but yeah, I think because people have caring responsibilities or other life things going on. There is a form you can submit, but I don't know how much weight they give it. You have to look up. I'm afraid, um, a lot of people thanking me. You're welcome. Okay. How many people stay here? I'm happy to answer questions. I know I didn't touch on international medical graduates, so I don't mind talking a bit about that here. So we have a large international medical graduate cohort because we've been hard to recruit the area and, um, that we have now also recruited, um, international GPS into some of the training rolls to support those trainees. I think the biggest thing is is the communication side. So we're doing a lot of support around communication in terms of, you know, Supervisor said I need a bit more detail in your reflection, and that could mean anything. And so some international doctors think they need to be quite literal. Write down every observation. Um, and actually, it's not that what they're saying is we need a bit more introspective reflection. And if it's a different way of thinking for you because you don't have to do reflections in your medical training. It can be a bit like being lost. So we do a lot of work around portfolio and portfolio expectations. A lot of work around communication skills, a lot of work around exam techniques. Um, and we're building. We're not perfect. We're building it up. And one of the things we're now looking at is when you apply as an international graduate, the DN we will be your tier two Visa sponsor. When you then qualified, you need to find a practice to be your sponsor. And not many practices include Martha set up to be sponsors, and it's about too much process, and it can be a bit arduous. But what Cornwell are doing is the CCG takes on your tear to sponsor ship, and they then put you in place practices. Um, and that's one of the things that that Plymouth might consider. So we know it's a bit of an issue. We're working around that there is, um what? It depends. I mean, there's there is communities to be found. I've been doing monthly social, family friendly social. I won't be continuing that. But there is also a local doctors in Plymouth who for all doctors do a lot of social in the Southwest, but they also give towards international doctor's appointment. On a lot, of course, is about life in the UK life in Plymouth. And that's over all specialties, not just GP trainees. Um, so that's a good way to meet lots of other people. Okay, Any questions? I think some people really want you to fill in the feedback, please. And that is how you will get your certificate job. And let's say we welcome doctors from an underrepresented group in this organization. Does this apply to I MGs in general, or will you be prioritized if you are? I don't know about prioritization. I guess what they're trying to say is, and part of it is being cynical, right? What, by underrepresented it could be essentially, um, your ethnic minority. It could be your sexuality. It could be a protected characteristic that they don't have a lot of, um and so, you know, older graduate, for example. Um, there's certain things that they're saying they're just trying to attract people. I don't think it gives you a priority. They're just saying apply and we will consider it. But no, there is a a prioritization. Um, or what do they call it? I can't remember. There's a term for recruiting certain certain characteristics. It's not that in the NHS, they're just saying apply. And we will look at it like we do with everything else. Okay? They're still 35 of you. All messages, right? Can I mg supply all year round or posting start by August. Okay, So, um, let me show. Well, it's on the slides. You can apply their application windows. You can't apply outside those application windows. So the first lot of application window is from November through. I say that. Let's have a look. Let me bring it back up. Application window. Here we go. Is November through to March, and that's for August. To start the other time, you could start it in February. And that application window is July to September. So those are the only application windows to get onto a training program. I hope that answers that question. You're all welcome. Just seeing if any more questions trickle through if you just want to leave, and I know or I don't know if you're waiting for me to end it, but I don't want to end if there's still questions coming through, so I'll give it a few more. Um, I think at this point what we can do if there's any other further questions they can always post applying to GP article and mindedly. Um, and then I think we can probably just best take it from there. Yeah, Okay. Um, I just want the last couple of questions, and then I will end this, and then you can pop any questions in mind the sleep on the Facebook event group or wherever, and I will get back to you if I can, Um, I will share the slides in mind the sleep, and hopefully they will then pass it on. How best to prepare for the M. S. R. I did a lot of questions. Where did I do those questions? I think I used past medicine, but I always find past medicine to be a lot harder than the real thing. There's a lot of companies out there a rural medical, the medical, you know, big companies that do a lot of work around exam prep, I would say Choose one that you think suits your style and just do lots of questions. Okay. All right. So, thank you, everyone for coming and for engaging. I will end this here. I'll share the slides with mind the bleep. Any further questions? Pop it on the event either on Medrol if you can. Or over on Facebook, I will go through an answer. What I see, if I don't, If I miss it for whatever reason, mind the blood can answer. And if they want to reach out to me and ask me, I'll answer through them. Okay? So thank everyone for spending your evening with me. I hope you've done the feedback by for me.