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it sounds. Oh, goodness made an office. It doesn't always. No, we go. So I'll just give everybody a little second or two to connect into the audio so I don't have to go over things a couple of times. But for those joining us, everybody's very welcome. Torto First event of the year. I think most of the people here and have have managed to get on there. Okay, so more people will join us. Let me just turn off the waiting room so that people can conjoined right in. So, firstly, just open, folks. Welcome back. Another year off of Queens GP society. Hopefully, you can all hear me and say me My name's Tim Nail. I am the vice president this year, with a few other committee members joining us A swell. And so we have a lot in store this year with with plenty of things planned. We've had our first couple of meetings and we've put a lot of ideas forward and a lot of things already in the pipeline of getting sorted. And so the first thing I just want to remind everybody if you haven't already I know I'm probably preaching to the converted here. But if you make sure and remember to sign up to our society, you can find the links on on our social media channels. And just so that you get all the correspondent she can hear about our events on. Also, for anybody joining us who still in life, lectures and stuff, I'm faithfully to spread the word. Tell your friends, um, to do the same as well. So without any further ado a day, I will just do a quick introduction off who we have Tonight s so firstly, opening tonight we will have Doctor Lewy Sands on Doctor son's The GP, um on in another role is also one of the associates directors off GP career development in number. So that's the Northern Ireland Medical and Dental Training Agency and she would be open in this age and force on that will be closely followed by Dr Does san. She was a GP was also the UK head off Clinical solutions at the J Know, which is a medical tech company. To really looking forward to that special centrist on also will be joining us shortly is Doctor Lawrence Storm and who is a GP partner and kill kill on Also chair of the Royal College GPS and Northern Ireland on Hey, we'll be talking about his interest in politics, carry medicine. So without further ado, folks, I'm going to pass over to Dr Sounds to open our first event over the year. Thank you very much. Um, big shoes to fill. I feel very honored to pay the first finger for a a session. And so thank you for inviting me on. Put us to come along. The Grateful was basically just not too many words saying why you should be a GP or a little bit to set the state. So I have heard, um, I work in them stuff as this was directed for DTP career career development. So big long sentence. But actually, it's not as exciting as it signs. I love the rule I been involved in treating for a general practice for too many years to remember on. Then I know it after security there career development on education. I do, though probably know some of you because I also work in Queens as a chemical teaching fellow on I probably responsible for year five placements, so we potentially will make a movie away to that being. One of the reasons why I love having a career is a deep A because it'll eyes me to do so much. So, um, why a career don't practice is very might of head scratching, and I expect everybody in this special room is far too young to even have seen any episodes of Doctor Friend These kids book. But if you Google it, ever look out up in Wikipedia? Way back in the late sixties, early seventies, that was probably the most famous DP that you would have heard about it on. It was set back in the twenties and thirties, when the GP did everything from deliver babies to probably take your appendix sites. But we've come a long way from them from our point of view. Right now, I high do you think, and DP's our gate on Don't Martin was probably. They were popular view of a TV D P. And again the box said a better the and streaming online. And if you haven't called it, you might find it understanding, but maybe the other series. So doctors and BBC one. If you find that you're and got nothing better to do. You have the lunchtime embarrassing bodies, which is certainly got a following and on GPS behind closed doors. And that's what we particularly relevant because some of you I am. If you're in your for if I would have actually been watching some other values from that, too, because you to call it. We created three in the medical schools console brutal primary care, which is 150 that used to help you guys. Particularly when you weren't getting experience in practice on those were actually taken from realize consultations. So why is it a great career for me? Um, that picture is my practice. And quite a while ago, um, I think those were having for trees. I became a GP a very long time ago. I always wanted to be DPI tree and in Queens on did Pedes Um, an option gynie like I entry on medicine on. I just thought I left all of those things, but I didn't love any one of them. Enough to want to be doing them on dinner practice offered me the opportunity to have that bland I under the time when I didn't think you were off for the jobs that you pay. You jumped out because then they were, and in short supply on for me. It offered that flexibility. So I was able to work and part time when a chill state, it's been incredibly fulfilling. So I know I had graduated 29 years. I mean, you pay for 25 and on the friendship, but I put there is actually because those guys in the picture and we got most of us have got last hair. Some of us have got slightly bigger, but the GPS in my practice and I became a partner with are actually might some of my choices, friends and continue to be I'm not something which you just don't get in the hospital. And I was being very fortunate to be in the same partnership for 20 years. I am. I know people have had my back When things are being tough. I've had their box with things that being tough, Um, we've got our spots, but some of the things that actually you don't necessarily state hospital side it's also like me to balance having a family. I'm continuing to work. So a couple of really again. Silly pictures just is a prompt. And on one side, the bright idea You possibly just by recognize me as being second in from the right on this was our CDP and really ideas awards where they created this. This concept of asking TP is from right, you pay to come up with an idea that might be helpful. And I was very lucky to be able Teo win that in Northern Ireland on so again, opportunity Todnovir to do something different. The picture on the other side is may in Australia with my young family, because again, I was able to take a year right? I don't practice medicine for that year. My husband's a hospital consultant. He was doing his and, um, ultimate year, especially traveling. But again, don't practice the light me the time Teo, take that time away and to come back into my practice on do without without any difficulty. What I love about being a d. P. So it is always been like the continuity on the fact that seeing the CME family recognizing those connections between whose granny to hear you and the yaks he doesn't get on with things. Perhaps and high within a community, and those sort of connections really do help. Um, patients really appreciate it. And it's challenging. And those of you who again here further on the medical student with the high challenging of days you have seen it on. But it's particularly difficult right now, I but actually some of the challenges in terms off clinical and side of things are really and part of what makes us and enjoyed our practice. So the idea off not knowing what's going to come in the door next, so it could be a a five year old on the next day, it might be a an elderly mom has dementia, and the next it might be somebody with a social problem, and so you just don't know what's coming through the door. So it's always fresh and it's the last two times could be stressful, and we know that there's a lot of uncertainty in and working playing me cash. But actually, and you certainly will never get bored. I said that the fact that you have your college around you bottle with something to ask a good control, because I'm as a GP in a practice you do have a concern Control As a partner, you're in a business, So you actually have a sense of the say and what you take on on how you choose and what staph you have on a flight. You manage your workload on That's quite unique. So they're benefits to that on there. Sometimes signs because you've gotten a continent on yourself employed and so there are all sorts of things to consider. But actually it does give you a sense of control and what you're doing. Um, last but not least, is the career opportunities. So what's being a deep A for me again going out to dinner practice? That was all I want to say. 20 years from my joints don't practice. We know you know, that many G p A. Z are really making at more of a port for the career. They enjoy the patient base and part of it also, they're pursuing other rules. You're going to hear a lot better by fast. The picture there is actually because again they college did a little article the really t z tired. I need to see something sounds and because I switched from being a principal after 20 years, Teo Big, a sexual doctor to be able to take up some educational opportunities. I'm gonna just recognizing that we do have the opportunity to keep in practice. But the other things. So again, it was a very corny tide line. So what are the opportunities? I'm very conscious. A couple of minutes draft there are the less could go on and on. But just to give you a few, you'll be able to see their, Um, some of the ones at the top are much more policemen here, but looking, going towards the bottom and particularly things like working as a ship's doctor. And I've had friends and colleagues who have done travelling and being involved with expedition medicines and various other things occupational medicine, working in the present side of things. But then the more maybe, maybe and stream activities and so gp and I, a website that's been created on get It was an opportunity for myself in a couple of colleagues early in lock time. We were given the funding and Teo ally us to the to develop a website on an educational program. It again, something that we would probably have been able to get off the ground. It will be working in secondary care on so DPC extended rules. You'll hear a lot more a bite, I'm sure. And but again, that's a situation where that deep he has gone beyond the stone 100 level of treatment. And to be able to take on those responsibilities on you're going to hear about about palliative care of this evening. But there are a range of thumb, and you'll see lots of my bills on the R. C E P website. Deep collective care is again other opportunities for GPS to practice additional scales on again. Being able to take on real was that might only have been done previously with a hospital. Some DP's are just involved in an idea margin Argentaria rather than in artwork on going to get you the flexibility to fit your GP work around your life. Leadership roles on again Lawrence News, chair of the Royal College of GPS, is a shining example of that. But across and many different agencies, you can have the opportunity to be involved leadership on lots of dpt or so creative unimaginative. Still again, many books, journals and blog's and you're not a frog is another great one delight to say that Rachel and more issues the person behind that is going to come on, do it talk for, um, GP and I in a couple of weeks time. And then just I couldn't probably know I do this talk without mentioning private work because, like it a little that, um even in Northern Ireland, where we probably last with Cigna for it, private work is is coming and it's growing, whether it be online or whether or not be private appointments alongside any chest over practice. So I think that's pretty much may. I am hope. I just have. I've kept within time. Probably only other thing I was going to say is, um, from my point of view, I had the opportunity to be involved with and do exactly health services. Poison implants is well as's and working with the college and various rules on also working with charity such as diabetes UK on the Call it over mental health. So it's usually just wouldn't want to put a cross, is there are opportunities are almost limitless, so they're as big as you really won't, um, today on That's what I double by general practice, but not forgetting. Just seeing the patients. Okay, Sounds that is absolutely front aspect. Thank you so much for that. Those that there was a lot crowned in to 10 minutes. Very covered on all the driving. 10 minutes on all the opportunities that that they're actually are beyond take and GP tree and a training passed. I do love junk, Doc Martin. I do love GPS behind closed doors. I'm sure you can speak for some of the other people in the cold. Here is well and so I suppose, with it, without delay in things any longer, I'll also Passover then too, doctor dot Sand, Who is thehyperfix off clinical solutions at a medical tech company and DJ know. And hopefully it will give us a A really interesting talk on on the world of medical technology and digital interest. Doctor decides thing, Do you? Very much. Thanks very much for having me on, but it's gonna be really difficult to follow one from from Doctor sends. You brought in so much experience on be a quite a lot of passion, actually a swell but for dinner practice. So so hopefully I'll also be able to add to that somewhat. See if the morning is doctor nicked the sandwich, the title. I actually have a clinical solutions adviser that big neo, but to be honest with the title, um, so we can all see my screen on. But I kind of followed the simplest path, the pathway, Teo what sounds kind of them spoke about. So I'll start off with why I pick general practice. Um, for me, I think it's fair to say throughout my training, clubbing a deep enough for about 10 years, I just most of my training in the UK that one of my training in the East Midland in the UK for me, I've always been a bit of a jack of all trades. You know, I've enjoyed things like cardiology, and I've enjoyed things like surgery. I've enjoyed things like pediatrics and, you know, being an operation procedure that also goes to different things. But but I always like variety in a variety of me is definitely spice of life on. I found that general practice is Dr Son's mentioned is perhaps, um, one of the the main parts of medicine where you truly have such a diverse city in your day of not to Sam's mentioned you could be dealing with an individual who has dementia. One minute you could be breaking news about counts of the next minute, and then you could be going on, too. Speaking toe. You know someone about their child going on from that? So there really is a big variety in general practice, Not probably the one of the biggest thing that really captivated meat was gonna practice. Now you could argue that, you know, emergency medicine also have a lot of bright, and it certainly does. But actually, in emergency medicine, you're dealing predominantly with really, really acute stuff is in general practice, you know, not just dealing with the urgent stuff. You're also dealing with the long term condition, getting to know your patients over months and sometimes years while still having that front line aspect of care. You know, often, GPS don't get looked at as that. You know that those with tapes ast perhaps, are they any And I see you and people are stopping and cutting and fixing things, But we're still very much at the front line and we have to remember something close to 80 to 90% off conflict. Asians happening primary care. And it's also, for me a really privileged position. You know, I think they're just thinking about being a doctor. In whatever room you take. There are very few jobs out there were a complete stranger will walk in through the door on tell you things that they may never have said out allowed before. Uh, it's a really, really privileged position, which I'm really grateful to be A GP. So what's it like for me? So one. The questions are often get asked is Do I still do clinical medicine on Biaxin? Really? Do I love it? It's the very thing that really keeps me ticking, partly because of the things I mentioned know Day is ever the same. Every day for me is the Learning Day. I learned something new every single time. Even if I have the same cohort of individuals, let's assume I'm just doing baby checks all day long. Something will come out there from a mom or dad or even the baby, which I've never heard of before, Onda. So for me, it's always quite nice to be in that continuous learning pathway. But there is this thing that you may have heard. Of course, Impossible syndrome. Um, on what? I feel incredibly privileged. I still go through most days feeling, um I really a proper doctor. Um, I really a proper GP Or am I making this up every every single time as I go along. Now, the truth is, it's okay to be or feel like that on divan yourselves. At this point in time, during your careers, you may feel like you're not sure where the medical school is correct for you, whether current medicines, right, Because every day you will learn something, but that's okay. It's okay to reflect on that and to learn from that because the truth is you'll never know everything there is to know that medicine you'll never know everything there is to know about the no practice. But being able to reflect on that and being able to look up look at that is one of the most important parts and one of the most enjoyable parts of general practice. So I decided to come on to the question about how I got involved in digital healthcare. Now, digital healthcare means lots of different things. Too many different people for myself. I'm quite moved in is in digital transformation. So that is supporting clinical teams to adopt. A little practice is, But for me, my journey was very, very unique. It actually started from a plastic bottle. Um, I have a massive, interesting recycling on d have part of that. I was looking at some processes in which recycling businesses do their recycling elements. And I saw a gaps in these processes and I thought to myself, Well, this could be so much more efficient on what I ended up doing was I ended up, you know, over a period of time, reading up a solution. Now I didn't have very good knowledge of Cody. I get asked that question. Did I do some training courses? I mean, I let you like doing extra degree. No, I didn't. I just self taught myself again that whole reflection constantly in in pathway that we adopted with you Stoop. I know. And so I pulled myself have to develop simple software. And then it got bigger, and I thought, Wow, this could really go somewhere. So then I started to think about Could I make this into a business in itself. Could I actually launched the solution? And that's what took me a slightly aside. So I was very lucky. In that sense, I was a general practitioner. I could in a similar way, too. Dot sounds take some time away from medicine toe focus on something different. And that's why did I focused on entrepreneurship for a few months now. For me, that wasn't the full buzz. I didn't completely enjoy that pathway. There was lots of pros and lots of contents to it, and I've missed clinical medicine. So when I kind of thought about that process, I kind of thought, Well, look, how can I bring together that digital transformation part in the clinical part? Um merged the two together, and that's how I entered it to help so fast forward a few years on day. Probably for the past two or three years, I've been doing various bits of pieces within digital healthcare, And that's my biggest problem at the moment is with a company called Cigna. So what did you do? Did new are a solution which helps virtual wards be created sober towards that can look after a number of different conditions in fact, an infinite number of condition. So the next question you might be thinking was, well, what does the book toe have to do with a digital health tech company? So hopefully you are thinking that the lower quite complex because I do a number of different things that were a number of different house looks like I do in general practice. Part of my role is bridging the gap between the technicians or technical components of the up on the clinical staff. We have to remember, know all of our clinical colleagues, maybe a digitally birth. Some may be very happy to delve into digital technologies, and others may really be a bit shy from it. So I help bridge that gap. So thinking about all my experience with this one when I developed my own now because I have a good understanding of those solutions, it helps me do the technical speak with the technicians and because I'm a clinician, how to do the clinical speak with the clinic, have a clinician. I also understand the chemical pathways. We understand where they're broken, where they're not working as well. So we look to see how the solution can support the clinical pathways and then wrap things up because we still got little because I'm so the doctor. I can help the team that dignity and look at their own product to see how it can be improved. Okay, trade. So the next question is, what's it like being the digital innovation? Uh, doctor. And I think it's fair to say that there is a lot of overlap, um, in much the same way as I like the jack of all trades and we were lots of different hats is a GP. When you're working for a digital company, you also were lost a different one minute. I could be doing a clinical risk assessment about the tool and see whether it will be safe for something like heart failure. And the next minute I could be doing a clinical ordered it, and later on, I might be speaking to colleagues about how their cancer pathways could be increased well, how the politics care pathways to be improved. A lot of part of, um, working in digital transformation is that we have to try and change hearts and minds. The pandemic pushed almost 10 years' worth of digital transformation into us into a couple of months because there was a need. We have to do that. But when we think about traditional medicine, sometimes there is concerned about going towards digital, going towards better methods. So we have to try and understand and explore those concerns. And you may have heard of ideas concerned. The next dictation's in a similar way. I'm doing that lots of times, but just now I'm doing it with my clinical. I'm gonna try to understand what their concerns are when it comes to digital transformation and how about you supported. And it's actually that there are still pressures within the digital transformation, but those press it might be slightly different. There are still times friends now. Thankfully, we don't have 10 to 15 minutes per patient, but there may still be type timelines for bid writing or fun writing or delivering on a certain product. So I guess the next thing you might be thinking is, well, why is it useful toe have a clinician in the team or in a digital team on most of the people in the teams are they tried to find like business managers or they might be sales people that that that's obviously the technician. Technical people. So I would be If companies want a clinical person, why would these companies want someone like yourself? Well, I guess that's it. Other doctor and or as a clinician, you have a really good understanding off the patient perspective. Where is the patient come in from what are their current pain points? What are they struggling with? Almost all of the products I've done or middle of the companies are advised for at the very heart of any of those companies. If they don't have the patient heart or in the center of their processes, it doesn't interest for me and a clinician. I want to make sure whatever we do from a digital perspective, we have a positive impact on the patient. On being a clinician can really help focus the companies to do that, have a clinician. We also understand where are clinical colleagues are struggling on where they, you know, they could get way also understand the system on where the pressures are there and again. All of that makes doctors quite an interesting perspective. From business point of view. That's one question doctor after before this meeting was how his big new actually had an impact in the NHS. So the big no solution is for the NHS and is used by an excess patient on. But I'm really happy to to say that the work that I've done with Cigna has directly affected patients and impacted positively in lots of different settings. So in the care home setting route Covert 19 on providing proactive care by a little warts. And there's Bertel wards have basically bean like our traditional wards. But by allowing the technology to keep an eye on the BP keeping on the heart rate, check the Sutent Have all of these things allow the clinician sitting on the other side. So make changes before that the deterioration may happen on I'm really happy to say that just from a few of our projects, we've seen some, you know, close to 44% reduction in hospital admissions. On in a recent coated 19, study, we saw 95% of patients felt less anxious because they were being monitored remotely. So I think it's really bad, say that used correctly digital innovation and digital transformation can have a positive impact. Another clinician. We need more clinicians to help driver, so hopefully that will bring me on to the kind of closing few comments on this is really about you guys out there you are the future doctors'. On your probably be asking yourself. Well, that sounds really good, but how could I do it? I would probably ask yourself first. So ask yourself, what is your Why? What would be your reason? Now? I think back to my medical student years, I had no idea what my wife. What I knew is that I want to help patients. So that's okay if you haven't mapped out your your long journey, that's not a problem at all. But if you have, if you have, that's great. And if you haven't think about asking yourself your strengths on what do you enjoy? Do you enjoy variety? Do you enjoy complexity? Do you enjoy having lots of flexibility to explore doing different things? If you do, general practice is definitely want to you and finally ask questions. After lots of questions, the more questions, the merrier. I honestly believe that the medical student Andi, even now as a as a GP. I've yet to come across a doctor who, if you if they're faced with a really enthusiastic student who's asking lots of questions and is really genuinely curious, they won't take the time out to try and and some of this, um so it should be curious. Ask lost of DP's. What are they working lives like? Lots of dpt, what they love and what they don't know. Other colleagues, you know, after people who work in any and people who work in second care and restaurant, and that will hopefully help you make the decision. That's right for you. So with that, I like to come to a close eye on like, thank you for your time. I'm also happy just to carry on from that for any of you to to reach out to me. And I'll always find the best answer, any questions I can. A month later on, Boss one leading thanks very much that was great dot of the Sons. Thank you very much for that. I was really, really insightful again. A lawful lot. The pack in there from a from a probably lesser known sort of specialist interest. It's an extension of GP, and it's really interesting to hear about that. I just want to check this stage a popular a message into the chart box there. But I just want to check that that nobody has any burning questions at this stage for either Dr Sanjay, Doctor Sanjay or doctor sounds. And just regarding what? What I've heard so far, one thing that I have learned in my Jeep, a place where there's the importance of silence on the silence, which suggests to me that at the man that there's no questions. And I suppose just doctor to sign is just maybe ask a little bit more about how dignity has been involved directly through Cobra because I don't think any any talk or any child or presentation at the moment is quite complete with a deck without discussing what's going on at the moment so high. And what sort of space there any specific ways that that that corporate has been made a little bit easier through through digital healthcare? Yeah, I mean, absolutely. If we think about just the very basics virtual consultations. So the ability to now do consultations in what's the same way that we are through video constipations using your phone to send information through. I think dignity comes into a slightly different perspective, where we're thinking about more complex caters and complex conditions. So, um for, for example, digging It created a virtual covert 19 ward where individuals with Covert 19 had their oxygen, their heart rate, that respiratory rate on symptoms monitored by GPS to make sure that they were not becoming more and well and needed on a any assessment. Um, in another pathway, we we created for heart failure individuals when individuals heart failure, the weight is going to matter clear up, or when they are becoming more out of breath or having new symptoms again, that the deterioration is picked up earlier. I think I just saw a question, How many practices hospital in the UK using degree with movement. So at the moment, I didn't know it is a It's a market ready solution. So when we think about digital companies, there's lots of different variety on. All of them often are asking for clinicians to help them out. Some technologies are very new, they're very innovative and they're not yet tested in real life. They may be going for a project for a pilot. Others are market ready, so they're being tested there. Being trialed on there now effectively being procured by any chest providers for dignity falls into that matter on in terms of practice and hospitals. Dignity being used at the movement around four different places. So one of in north London, where there is a mental health, virtual ward one is in a Greater Manchester. So that's provided. It's kind of covering the whole of Stockport in it, in essence, where there are nine different virtual wards and they range from half a year. CAPD, a mental health proven 19 and a few of this, um in sulfa, which again is in a closed, agree to Manchester. There is a heart failure. Ward. There was a better took over 19 would in the West Midlands on against that. It wasn't serving practices that was serving the whole area on, But we are also starting up what will probably be one of the first complex patient pathways where we're looking at more than one disease pathway and again that come from that clinical push. But I don't know, I think that would be a question for the well yet? No, that's it, Doctor Santana. Me today is just about having that sort of clinical input on that side of things. That's really good. Did you get into that? Fantastic. Yes, Dr Sanjay just haven't we look in the chart box here with a little question for you? So how you do it early career. JP's get involved with teaching on academia, so I suppose, sort of thought that GP academic route. Could you tell us a little bit more about that? Yeah, So there are a few options. Obviously, when you after DP trailing, you can take the opportunity to be what's called a D Part's trainee, which is where you get up to geo experiment research. If it's more being involved in education and it's it's such a popular role to run alongside and working in practice, I really feel selling it on having medical students then, and at the moment of a practical point of view, there's a form I share the link in the chat, but again, I'm very happy for anyone to email me. And so we have to make it fair. Just ask people to put in expression of interesting on. They're not allies us. When should it be opportunities rising and on At the moment, those are quite varied. Test these people missed it. Just be an examiner, perhaps in C sec and the first times of doing things often that they're interested to come up on observe. First of them be able to do a little bit more. What we're crying like for is obviously people. Teo finish their traveling but become embedded in the practice. And then you get the have lots of opportunities, like Ron Skip tell you. But it is lower. So I put it in the chat again. I'm very happy. If anybody's any further questions about the email. Me, that's top class doctor sounds very much for going over that as another option, folks, where are covered and off a lot of ground we've been We've been through a lot of stuff so far From a complete overview, Dr Sanjay Gupta talked about that by digital health with Doctor do Sans and I, and without further holding back and gonna pass over to a doctor Lawrence doorman who is a GP that I have had the pleasure of been attached to in my own GP attachment for the past few weeks and to hear a little bit more about his interest in palliative care. Medicine soup. Doctor, Doorman, You have the floor. Yes, I understand. They're going to say everybody why I desperately trying put my slides up. I just see a blank wall it off like basis here because you'll give me a reaction around them, a movie or something. And just to make sure of New Year old you're over there. When I get these slides up here, I've got any write a good stuff now you can Can people see my slides? So keep you right here If I go to the slide show at the beginning, we counted a doctor dorm, and that's it. Now, if you want, just check their moving okay? Yeah. Yeah. Okay, so those are my slides there. Okay? So I'm I'm using a liam sort of group of letters. I think we said we've been with some four seasons. So and so this is just the people have a chunk of my pilot of care of the medicine. I said it's worked out with my career and so on on why I feel it's important on fire fit. It's important to do well for a long time ago. I have twins. A long time ago there were five. And remember, sitting with my day, they just started Primary group. The other term of people were reading, winning the which I think about boys, Winnie the which treat diabetes. And those looked at me and said, Daddy, that's a literation. So I thought, Well, I have a buddy boy 00 running a better school that I am. So I'm going to try and take that W the Lien Lee try and put it through the box of the first studies. Obviously, point me, I'm going to say What the I don't just mean why, why? He is in Lawrence Door with my general practice. Why it's so important. Went by it suits so well for general practice. So I had an interesting Pyatt medicine for it for quite a while at really tweaking it just whenever I was nice. But I recognized that you could do a lot of good for people who came to the end of life. Care was very important to do it right, but how much families appreciated it s so my career. Like I say, I I've had a very, very career. And so when I worked as a GP looking upgraded my on my CT training. I was in for five years and during those five years I was able to take a post. Is the medical officer and Neary hospice here with your left on? That was a great poster work. There is, Ah, medical research is equivalent to one Is the Children. I was there for 14 years. A while I was there, I joined the So they're fabulous place on your right on side there, which is more family surgery or just what that was been experiencing on the two specialties are very, very similar thing that they provide incredible holistic care. They not only look up to the patient, they're quite conscience off families. That way for a patient social setting is about this psychological aspects of a person's disease, the social aspects of it. And it was just fantastic bit or two fantastic teams. The other really good thing I liked about it with my own surgeries. Patients are covered by by the jury hospice, so we'll be able to refer my own patients to the hospice, catch up with him again on Friday and be able to continue the carrot right through for Terminal Cares. That's been a real privilege of my before the gym, he and one for me. So I think deeply has a really unique opportunity to do it on. To do it well on one of my favorite 90 points that I find is that but patients Mr in Strategy, we would do straight. We're in a rural practice. Um, cocaine use trains, drivers. Quite a bit of one of the things I find works very well for me of my patients is what I call the early morning. I spoke to my attending. We started pretty early. We started half it for usually in quite a bit earlier. But frequently, whenever I have patients in certain sharpest in, so we do a visit before surgery store. It's a quite frequently we have to sort of images sort of farm. Hi, sweet in the air in the morning night. I find doing any morning, I suppose, with strange drivers really, really helpful. Usually find which family member has been saying that before. Festus Robert, it's altered you can do it already not say which means you have time to get a problem in the morning that allows you to be available of things changed throughout the day. So where did he get a TV? Is huge operation did to provide care provision. Which books are good? So there's a couple of myths about hospice in a couple of messages you're aware, like general practice on, you know, being a doctor and hospice and being a doctor in general practice, I probably had a chip or both shoulders because both sometimes weren't respected for the professions that they were. So you mean the hostess. We like the term pain medicine, but in general practice, we know we're good conditions, and we have, you know, proper skills to offer. So one of the big things in the hospital, you know, we would prefer to get us given by hospital doctors aren't which books to use which drugs to use me. And the answer was always to see him. The books big use our one with the X. I would have used to know it was the ultrasound of chemical medicine on the drugs that used ones from the beer the FX accuracy and ones is in the hospital wards. But the reason that it was important and the reason that we were doing it this is through the basis of off medical examination. I'll talk to them just a little more very important part of the medicine. The palliative care is done well on. It's not just the right one human thing to be. Well, actually, the best thing is best practice with this landmark Studies correct The New England Journal of Medicine. I don't buy 2010 on the dinner. Otherwise controlled trial of the finding of patients got really pilot of those for palliative care. They lift longer. So it's not only the right thing to do that the best thing to do, the patients actually live longer on. Of course, as you would expect, they had a better quality of life. So it was really important that was done. Well, wisdom and again, my diabetes. You're getting 10 years of the stage and we need a good trend to do with the hydro. We take our our you know, back of Oxford hamburger, typical medicine, or B, and if so, how do we do it? Well, we like for you guys are No. We need to get training to do well. So how do we manage something control? It needs a good clinician on high. That inflammation does. It is. He has to find out why. Why is that symptom happening? Why is the patient breathless where they've already wire them in? But how do we do that? It's the basic skills and techniques if you have been told by my medical school, which is history, examination on investigation exactly the same in the hospice board as a dessert America ward as it is in a general practitioner results. And again we see a lot of these things. We see that astomic disease we find in the hospice we would find undiagnosed metabolic issues we would find on bag with your infusions and other causes for people. Quite frequently, we would have patients. That it did with a concert who are breathless on the defensive of state events is from the cancer. But actually, whenever we examine them and didn't proper test, they were they had significant could contest of cardiac figure on that changes the monitoring totally on some. So things move on from there So it really needs good clinical skills and come back and again. You mean general practice has a unique story in the way of a unique opportunity. It it it and it. Just this week, we like the GPA. They were, which is Doctor, Doctor, Don't and Rich. But previous winter of this award 2018 You know the patients nobody. This award, This is untoward. The college sort of designs are excited. She pays for this comes from patients. The security from this testimony that that David had problems is dementia on the the GP went really far it helping that family connected with compassion, urgency, professionalism. But understand that which I think just really highlights higher. I needed one important. It is to do panic the medicine to do well. But we use much more than drugs in the end, hospices to get this reputation overhearing. You just get on the on the morphine read and you know you're going to start the war and and and just just acting up. But actually, octopus, it appears with, um no more complexity than just cancer on Began with yes, with the new strokes. Insulin. But actually, sometimes some of our most effective interventions came from positioning patients with on with reassurances. We do look and read it Lincoln closely in the with the oncology team. So quite frequently, patients with data a single fraction of radiation therapy and we will prepare for emergencies and registries did help in In hospice we're not a major artery would have been several CTO militant disease, and sometimes we would have emergencies for a patient but suddenly wish to go with diet with the other days noticed to get that organized April work done in the ambulance, but actually was, it could be quite quite tight of time to make sure I wish this report as time was going. I mean 33 my days through hospice. Through those 14 years with care of the Bayer, the patient's medical conditions changed quite dramatically so. But I started in the hospital in 2003, was still reeling from from the the things that was set up today, so hospice in Northern Ireland was near the house was set up in 1989 on. It was designed for four conditions that was designed for concern for M s for motor neuron disease on being in 1989. What do you think the fourth almost HIV needs and again when you think about that now, when we have such good drugs for that. But I mean, it's picking another another, a terminal disease of them, just a chronic, chronic thing that patients you know, had to have medication of. The captain happened going, you know, compared to the body. But it was designed for was was, you know, multiple deaths. So his I certainly watched hospice developing. I could see patients coming in. They were becoming order. They had more concerts, but only conserve more chronic comorbidity and America. I think it's 20% of all new cancers are actually a second cancer. You know, the secondary cancer there a second cancer. So it's quite a still wind goes, but this is going to is here now. And we do see things like pulmonary fibrosis, end stage, feel it, see every day going here. So is the GP. I'm always trying to care for my patients in the best way I can try to get. The best care of part of that is to try and anticipate for emergencies. So I'm quite a bit funny, just in case boxes the 10 was able to see in your school. And also I could kill. There's these little boxes little people's houses with with emergency doses of medications with the pieces of paper. There are usually authorization sheets and for the district nurses to provide an administrator these drugs in, um, urgency like okay. Like I say, most parts of the other nurse has a twilight district pressing service, which usually runs the weight 11 o'clock. The most patients that they're prepared families are really one bacon. Get access to emergency the subcutaneous doses, and I was just really important. But but you do these things that I promise that the best form care was really important to panic medicine to bring families with you, bring them with you on the journey. And he asked me when patients Obviously we need to speak to her patients and educate them and so on. But But it's really very much a team approach with either. The medicine helped me. It's very much part of that fun, scary feeling like I say, just brief. You mentioned about it and again one of the things I saw in hospice was emergency for patient supposed to go home, but at the moment, with all the heard of a day and a c A r. And it's just no, actually, well, the woman, because it's got recognized your eyes are how service So each trust of the moment has a different day and a CPR form, as well as the community from a patient and hospice to go home. They have nobody in a city are forms signed in the hospice, and I have a separate one side to the ambulance because now this is a separate trust, then had to have a third one done from and everything came to community are grossly inefficient. Stick it on. This is a new document that's coming down and again. Keep your eyes on it for a place on the ward. Okay, they should be coming in the next people's respect for respect to four months, it'll be called, and it really sort of tries to bring the any CPR on offense, characterizing in all interval umbrella, and I'm really tries to ideally tries to speak to patients whenever they're relatively well. Then they convict I Congress a decision about what they would like done with her health care, and I think that's gonna be really important to the real goal is to get all healthcare professionals feel it's good. But with the mood that falls large doctors on GPS What we really want us for. The person who knows the patient best look at whether the nurse. So, for example, some of my patients attend a real new it for the FDA. Alice, Remember, they're really dialysis versus part of the TV was ready to our other healthcare professionals to Tuesdays. I don't remember actually advance care plans like this doctor, but they're not legally binding the only. But that's legally binding of this, where they discussed with patient on their found that their doctor with themselves isn't legally. But you know, I think that's quite important because it it annoys a bit of a lot of innovative when they got judgement from from A from a doctor. So if a patient with the condition that really suddenly comes up and it isn't you know, isn't treated with the doctor convicted decision on seven early if a patient maybe does need some sort of emergency treatment on the obvious one in remission homes as a fractured femur, which can help him and the doctor decided, No, no, that's appropriate of proportion to ask her care. So just watch. I fell out talking. So there's, um, usually resources. There's any number useful resources. McMillan have a lot of really good resources. Like they're fairly well, we're thinking about, uh, those were getting towards breathlessness Rest of the time. You'll see it'll take you back to the most of those on there. Well, there was nothing open squirt on. We have always better than I participated in A little care always don't better in the winter. Be sure things that you do things together and in general practice, we've really good teams. That again. This time I include our reception about They're fantastic, important members of our team in our chemical system. And so Okay, we have, ah, major nerve message. So whenever a patient record comes up, but anyways system quite frequently traffic like we put a major nervous. It says positive carry needs a little rays or amber or green not let her reception stuff to know how this person compared to where they need to be telling with just a little bit quicker and way we would start with. And but we have to find it. Everybody's everybody's really true. But thank you very much. I think I'm going to see if I could work out how to stop sharing. Uh, that's for your doctor room. Well, thank you very much. An EKG and just a fantastic and site just into another completely different arm. That general practice town late. Oh, of course, you primarily been GP and joining, joining into into the work in the hospice A z part of the training earlier and that it's just it's just fantastic. I just wanted to ask you, actually, I had the measure that you organized a session in the hospice with Doctor in or Michael Vanna for me. And just suppose we been on that the advanced care plan. And how does that make the experience of a patient on a family better in the community? It does not mean that patients get to stay at home for longer or high dose. What benefit doesn't have? So that's the goal, Okay. And what What you're trying to take away from is any surprise events. And so the problem is this. Whatever they should become somebody a whale or, for example, something complicated, like they become incontinent, or this simply can't breathe. Or they have a bleed that comes on expectedly, that people public. And it doesn't end up with the good. I'd commute early if you can prepare families and take a like a job where they would like their care to go. What sort of ceilings of care, what they like. Okay on getting better gauge for that. So it means that that we use healthcare professionals gonna enact their wishes. So usually we would try and start it with saying, If you got a chance infection high, would you like us to treat this Jackson fraction, which is just to treat it with tablets? And most patients will say yes, that's half a tablet, and then you can give them scenarios. Will say, Well, let's say for you couldn't take tablets. Would you like to organize out to go through the, um, would you like us to organize the hospital admission and then the friends and your you know, your your training there, and then they may say, Well, actually, hospital radial wouldn't fancy, and it would kind of keep me comfortable, told them the concert need into discussions, you know, sort of all right, that yes, absolutely fantastic. As it moves Lincoln into those where you mentioned about would you like to take tablets? Would you like to go in the hospital for, say, IV antibiotics? If the If the person you know came down with the chest infection or example, suppose it gives you the kind of unprotected with the new respect form common. And it will give us a little bit more control over where that patients ceiling of carries, which is, ah, free is that that some of us will be a world, so it'll give you a total. It'll give you a guy to a patient's wishes, but like I say, it's no findings. So it's not so you don't. It'll give you an insight into it, but it's not my neck. So they're in the biggest trouble. I get that. Yes, you can have a day are, you know, signed up for a patient to the care home. But if the Children a bit of apple, I think it's probably appropriate is a good slap of the back, you know, and try. Try and hear their own way. But it does give us an idea that there's many patients who say, Look, I really have a fear of I don't want to go to a care I don't want to go to a hospital And I think we need to respect that absolutely. And it gives It gives the patient that that amount of the Army is actually coming towards the end of life. Doctor, Doorman, That was our after you fantastic. So Harbor, with a couple of questions just coming through the chart here. First of all, I'm just going to I know Doctor Sounds has been eagerly typing away there. I can see there is a question of if, if you'd like to comment a little bit about what the training pathway to actually becoming a GP is, we spend a lot of time today talking about specialist interest, the on GP. But we'll have to get their first tooth. Could you maybe just a laboratory bit on that? So maybe coming out or Lawrence, do you want to cover it every day? Okay, so I put the link that it's it's like, Oh, they're especially training. So I suppose it's a recognized craving pathway in the way. And once you complete your foundation trimming, that's your pathway or your get way to opening up. The other opportunities, and so in Northern Ireland are generally for post graduate training. Is this thing called Member on that Is hospital primary care on it is a good part of a national process. The link I picked there is the National Equipment Office, so general practice trailing like other specialties, has a window that twice in the year where there is a time chip. I was also all the information there, a foot, things you need to have checked it, what you need it it achieves in terms of competencies, um, on the process and for the assessment of the stages to be able, Teo Progress to be able to get a place, some tree. And so it's It follows a similar process. The hospital specialties on. You can already will find that more information. If you want me bullshit with the college on, do with empty itself that people are just is obviously the number of foundation doctor, spend time and probably care not started, be increasing on, not potentially get a lot more opportunities to be able to know about more by it was a question that just a bite. The palliative care opportunities and DP training. I don't know whether it aren't you would say it, nothing more. That and so it it is within the curriculum is clearly it's it's and took apart all but still there is an opportunities, and there's not necessarily specific placements or because across Northern Ireland or we say they training programs for the panel, which hospitals in which practices. But you will definitely get a lot of exposure to kind of care mets and be involved and the teams that get to know what it is and the specialist nurses check it when you're a DPP, a smidge. So I think, on a really level, rather than I may be a getting a placement and a half of of seven. Yeah, on again, you mean it? It's very much of speaking to hospice is and speaking to people. And even if you're really just had milk, most hospices are very happy to take you for an afternoon. You know, if you just make the connections, absolutely, folks, if that is fantastic and I think we've covered on awful lot of growing the ER tonight. I know what keeps them conscious that I keep saying I'm not but what we really have We've dealt with a lot of different arms and the GP can lead to you on Also spoke about her together and first list off moved importance. So, folks, I if if there's no other questions from the audience, um, just a moment, give it just a few seconds just to see if there's anything else coming in there, I think would be happy enough to to start closing up then. So I'm unconscious that we are coming up just on the are on Deeper will be getting tired that they want to get back to their agents, I'm sure. But that first of all to say thank you very much for joining us first and foremost. Thanks for joining us for our first Avandia of the year. Uh, actually, Teo First Baker's your sons too, doctor dot Sanjuan. Doctor, doorman. And sure, everybody here will agree that we've had we've had a great evening discussing what it's like to both be a GP on have a specialist interest, and outside of that and a couple of things just to just to plug what's coming up in in in the near future. So where first of all, our first event coming up now on the fifth of October is the best your estate events through the estate? A. The situational judgment test is an exam that five years have to sit as part of graduation. So it might be relevant more to the clinical years. Years 3 to 5. But, um but definitely welcome anyone to that. And secondly, keep an eye out for the return over your colleague Siris, beginning on the 20th with an event be ester own domestic abuse, which is another topic that it's a little bit outside of the curriculum speakers or not to be confirmed at the moment, I'm. Thirdly, our podcast is getting back up running. Doctor Doorman will be acutely aware of that because I kept him left from getting home on getting our first episode open recorded for that to keep a night that would be being posted soon, we string that on Spotify, and the next again are available through our social media channels and, fourthly Tehran, one of our executive members on committee has organized Siris off talks really it into pediatrics in general practice on that will be starting to take this on Monday. He's in a couple of months time in November. And so what I suggest that we do is just run through a few of the lengths that have been post into the chart. So first of all, Doctor Sands, further up in the chart, has sent some links into express interest in GP academics. Also a link about the equipment process the GP on. Then we also turn thankfully has sent in some off the links that would be relevant. Everyone attending. So the feedback form, like is there. Certificates of attendance will be generated automatically through the feedback forms so you can get those three metal. If you haven't seen up, the middle would encourage you to do that. That is high. We will be getting all over event says she. Here, take a few other queen societies I know are taking that all those well so it would definitely be worth getting involved there. And below that we also have our society membership. Please feel like the Google form there and that will let us keep in touch with you on. Also, let you get in contact with us. A swell. Um, we've got a few things turning up the Sinus sent, in fact, a Dios for himself there. So, folks, that is, uh so we're wrapping up just a few seconds short off the fill our I hope you and social Media on our Twitter on instagram or Facebook page. You'll find details of all our upcoming events there. Um, on if there's nothing nasty odd thank you very much for common out in their doctor. Doorman also has sent in a little document there are linked for anyone who's interested. Um, on the and basement for DNA are north, and I so a bit of information there is well, for anybody would like to join onto that. But thank you all for coming. Maybe just ask our speaker's on any committee members. You want to just stay behind for a little second, for we've been debrief. After that, I will stop the recording