UK general practice faces workforce challenges. The pandemic, and cost-of-living crisis are felt hardest by our most deprived communities. The Scottish Government is keen to tackle Scotland's high drugs-related deaths. The perceptions and experiences of GP specialist trainees who have trained in deprived communities are already known. This qualitative study explored the perceptions and experiences of trainees from affluent practices and how this training may affect their future career. One-to-one in-depth interviews were conducted and analysed using grounded theory methods. Seven participants were interviewed. Five themes were constructed: training practice choices, perceptions of working in deprived areas, unmet learning needs for working in deprived areas, other sources of deprivation exposure and future working intentions. Most did not choose their training practice because of its affluence. They perceived that working in a deprived area would have challenges: less staff, higher rates of pathology, communication challenges, poorer patient health literacy. Addiction care was a significant unmet learning need. Most lacked confidence to work in deprived areas, and were likely to work in their training practice or similar, upon completion of training. This research has implications for ensuring equity of GP workforce provision and whether GP Specialty Training fulfils its intention of producing 'a GP who is capable of working independently in a variety of primary care settings'. Those training in highly-affluent settings may not feel able to meet this aim. Training providers should consider this limited experience and whether rotations, involving affluent and deprived area practices, would prepare future GPs to work with a range of socioeconomic populations.

In 2019, the Royal College of General Practitioners (RCGP) introduced a mandatory workplace-based prescribing assessment for general practice trainees in their final year of training (GPST3). This assessment aimed to improve the quality of prescribing and reduce prescribing errors and it did not require pharmacist involvement. NHS Education for Scotland (NES) is the education and training body for NHS Scotland: delivering postgraduate training for GP trainees working in NHS Scotland. NES wished to evaluate the role that general practice pharmacists could have in this assessment.A training event for pharmacists was designed and delivered by the researchers in collaboration with the NES pharmacy team. Pharmacists attached to training practices in the West region of Scotland, where a GPST3 was undertaking the prescribing assessment, were invited to attend. The training described the prescribing assessment and the value that pharmacists could add to this workplace-based assessment. The evaluation aimed to explore the role of appropriately trained pharmacists in the prescribing assessment and their feedback to GP trainees, and evaluate the impact pharmacists had by exploring the views of GP trainers, GP trainees and pharmacists.Results showed that the intervention was viewed as a positive educational experience for all participants, and the interprofessional approach broadened the learning experience for GP trainees. We believe this to be innovative work replicable to primary healthcare colleagues to promote prescribing safety and interprofessional learning with pharmacy colleagues.

Practice-Based Small Group Learning (PBSGL) is a continuing professional development programme use by various professions in primary healthcare teams in NHS Scotland. Primary healthcare teams have enlarged with the addition of new professions including First Contact Physiotherapists (FCP) who provide services to patients without the need for referral. In 2020 a pilot of FCPs groups using PBSGL was undertaken. The pilot involved volunteers from a FCP team in one large NHS board in Scotland. It lasted for 12 months and groups met in-person, switching to video-conferencing (VC) as a consequence of the pandemic. A grounded theory approach was adopted for the evaluation. Research participants took part in individual interviews held using VC. Interviews were recorded and transcribed. Data was analysed using grounded theory methods with codes and themes being constructed. Two PBSGL groups were formed from 10 participants and 2 facilitators. Ten took part in one-to-one research interviews. Seven main themes were constructed from the data. There was recognition that FCPs had a new role and work context. There was a sense of volunteerism in the pilot and that participants met in their own time. FCPs appreciated the PBSGL learning methods and their meetings fostered peer support and improved professional socialisation. There was a preference for in-person meetings rather than using VC and some participants wanted to join inter-professional groups in the future.

"General practice under the NHS: past, present and future." Education for Primary Care, 33(6), p. 369

Objectives To identify the learning needs of recently qualified general practitioners (GPs) (First5) in National Health Service (NHS) Scotland concerning GP partnership and the commercial business aspects of general practice. It aimed to identify learning opportunities during General Practice Specialty Training and the first 5 years of work, and to explore their suggestions of additional resources that would improve their sense of preparedness for partnership. A secondary aim was to explore what influenced their current choice of employment model and place of work. Design Qualitative research study using grounded theory methods. Recruitment was stratified to include First5 GPs from a range of NHS boards in Scotland including remote and rural areas. Participants were interviewed in small focus groups or individual interviews in person, or over the telephone depending on their preference. Interviews were audio-recorded and transcribed. Transcriptions were coded and codes developed into themes using Charmazian grounded theory methods. Data saturation was achieved and verified by the researchers. Setting General practice in NHS Scotland. Participant GPs, within the first 5 years of completion of General Practice Specialty Training, who were working in NHS Scotland. Results Twenty-seven recently qualified GPs participated in the study. Three main themes were constructed: preparedness for partnership from experiential learning in General Practice Specialty Training; perceived commercial business learning needs and preferred learning styles (with learning needs arranged into five topic areas); considerations that inform decision-making about choice of employment model and of practice. Factors that influenced the decision to enter into specific employment models were identified. Conclusion Lengthening the time spent in specialty training may help GP trainees gain more knowledge, skills and confidence about the commercial business aspects of general practice and of GP partnership.

For those readers who have not heard of Roger Neighbour (I’m not sure if such people exist, but you never know) then he’s possibly the most widely recognised GP in the medical education community. At least in the UK if not further afield. His previous publications formed the mainstay of the literature of general practice, particularly that dealing with consulting skills. I remember as a GP trainee in the 1980s, that every training practice would have his textbook on consulting – The Inner Consultation, and that this textbook, with four or five notable others, was seen as essential reading for every trainee and trainer. Now Neighbour has launched a new textbook on primary care consulting which reflects the evolving assessments of consultations skills that have taken place since his earlier publications of the 1980s. We are all aware that much has changed since then: the introduction of the videotaped assessment of consultations for the MRCGP and then its replacement with the arrival of the Clinical Skills Assessment (CSA). Now we have the CSA’s pandemic-timed reworking into the Recorded Consultation Assessment (RCA) as a consequence of social distancing and safety. I have read through his new book and the question that is usually put to me by the editorial team is: ‘Should I buy it?’ And my reply to this would be: ‘Yes, you should, and buy two copies when you’re doing so, as you’ll need to read one copy and lend the other to your trainee’. Let me tell you why I recommend this strategy to you. At first glance this is not a large textbook. It is some 190 pages compared to the 271 pages in The Inner Consultation, so it is a faster read. But size is not always a measure of impact. This new textbook brims with carefully chosen pearls of wisdom that I found to be both thought-provoking and profound. There are a number of sentences in this text that will really make you stop to ponder and reflect on the art of consulting. They are derived not from controlled experiments, or from observational studies, but from decades of interactions and involvements with people. These pearls stimulated me to consider previous interactions with patients and to think about how I might change my consulting for the future. I would argue that his statement is a marker of an effective book – you practise differently after reading it. I am confident that this will likely happen to you too, and importantly, for those who are travelling through the General Practice Specialist Training journey. The book is very clearly written, and just like good consultations themselves, uses simple uncomplicated language that is free of unexplained jargon. Neighbour has restructured his five tasks of consulting presented in The Inner Consultation (remember using your fingers and thumb on one hand to guide you?) into a more flowing sequence of three events. These components of the consultation are: ‘the patient’s part’, ‘the doctor’s part’ and ‘the shared part.’ Much is made of this new structure in the text and the reader can quickly see the sense and logic of the three events in the book. Some new concepts were introduced to the reader (well, at least to me): the use of receipts, and the identification of cues or signals from patients. Perhaps the advice and information I thought was most important was about the first few minutes of every consultation. In this section of the book, Neighbour gives us some very useful hints and ideas that can be put into practice to make these few minutes really count. There is effective use of diagrams and of drawings and pictures which broke up the text. I particularly like the case presentation of fictitious patients and of constructed transcripts illustrating how patients interact with primary care clinicians. Ultimately this is a book that does deliver what it sets out to do. It is a practical guide to successful GP consultations and will help readers become more skilful consulters. This book will prove very useful for those who are preparing for the CSA/ RCA and for those involved in wider GP training. More than this, it would be very useful for GPs at any stage in their careers and I would argue that it should be picked up and read by GP nurses who provide many millions of consultations to patients in the NHS every year. Primary care and community pharmacists are increasingly interacting with patients and consulting with them – this text should be highlighted to them too.

The slightly more mature readers of the Green Journal (like me) will recognise Amar Rughani’s name and remember his first textbook from some years ago. This was on personal development plans and wa...

Objectives To identify the learning needs and preferred learning methods of First5 general practitioners (GPs) in National Health Service (NHS) Scotland. Design Qualitative research study using grounded theory methods. First5 GPs were interviewed in small focus groups or individual interviews in-person, or over the telephone depending on their preference. Setting General practice in NHS Scotland. Participants GPs, within the first 5 years of completion of GP training, who were working in NHS Scotland. Results Thirty-eight First5s were recruited to the study. Participants recognised that gaps in their GP training became apparent in independent practice. Some of this related to NHS appraisal and revalidation, and with the business of general practice. They were interested in learning from an older generation of GPs but perceived that preferred learning methods differed. First5 GPs were less reliant on reading journals to change their practice, preferring to find learning resources that allowed them to gain new knowledge quickly and easily. There were considerations about resilience and of the challenges of learning in remote and rural areas of NHS Scotland. This related to travel costs and time, and to accessibility of learning courses. Participants appreciated collective learning and commented about the logistics and costs of learning. Conclusions Preferred learning methods and learning resources differ with First5 GPs compared with those who have been in practice for some years. Learning providers need to recognise this and take these differences into account when planning and preparing learning in the future.

"The influence of a CSA Educational Intervention for International Medical Graduate General Practice Trainees - A Qualitative Study." Education for Primary Care, 31(1), pp. 61–62

General practitioners (GPs) and secondary care doctors share a common background of learning together whilst at medical school but their learning paths diverge after specialist qualification. Reconnect is an initiative in NHS Grampian in Scotland which offered a variety of shared activities, including learning, to both groups of medical practitioners. One learning activity was of Practice-Based Small Group Learning (PBSGL) which has proved popular with primary care clinicians. Groups drawn from both health care sectors were started and met over a five month pilot period. A qualitative research method was chosen to identify the perceptions and experiences of participants. They were interviewed in one-to-one telephone interviews. Interviews were audio-recorded, transcribed and analysed using grounded theory methods. Two PBSGL groups were formed with a total of 13 members. One group met twice in the pilot period and the other group met only once. Nine participants were interviewed and four main themes emerged from analysis of the data. Reasons for participation were often related to a desire to improve working relationships between the two sectors and to increase understanding. Practitioners learned about how working conditions and team working affected the working lives of the other sector. Participants found the logistics of arranging further meetings challenging and considered they had a lack of shared learning time together. Considerations to the future of the project were positive but this contrasted with the few meetings that had taken place.

In the United Kingdom, undertaking continuing professional development (CPD) is required for revalidation with regulatory authorities for general practitioners, general practice nurses and registered pharmacy staff - pharmacists and pharmacy technicians. A survey of CPD preferences and activities of these four professions has been published and this paper focuses on one qualitative question in the survey: 'Please describe any changes that you anticipate in the way in which you will undertake CPD over the next 12 months.' Responses were analysed using content analysis, then codes and themes were developed into a coding framework. 1,159 respondents provided comments to the question and five themes were identified: options for learning, time, appraisal and revalidation, people in transition and use of technology. There was a desire for face-to-face courses, for interactive learning and for variety of learning methods. Respondents valued learning with others and Practice-Based Small Group Learning was considered to be flexible and promoted inter-professional learning and socialisation. Lack of time for learning was seen as a barrier for respondents. Respondents considered that CPD was needed to support them as their roles developed in primary healthcare.

NHS Scotland faces significant challenges in delivering the Scottish Government's 2020 Strategy for Healthcare. GP recruitment and retention are problematic for deprived area practices (DAPs). Recently-qualified GPs are more likely to join practices in areas where they have trained and so it is important to encourage GP training in deprived areas. This study aimed to identify the perceptions and experiences of recently-qualified GPs who had trained in DAPs. A grounded theory approach was used with 14 GPs interviewed in focus groups and in-depth interviews. Six themes were identified: allocation to training practices in deprived areas and anxieties about working there, positive training experiences, attributes of trainers, consultation differences, preferences for large practice teams and health centres, and future career plans. GPs were very positive about their training experiences in DAPs and appreciated their trainer and training practice. One concern was of the limited experience of patient-centred consulting which they felt weakened their performance in the Clinical Skills Assessment (CSA) component of the MRCGP examination. Rotations between affluent and deprived areas would benefit General Practice Specialty Trainees (GPSTs) particularly with the CSA examination. Training authorities should encourage and support practices in deprived areas to become training practices and encourage GPSTs to train there.

In the United Kingdom, taking part in continuing professional development (CPD) is required for revalidation for general practitioners, general practice nurses and registered pharmacy staff - pharmacists and pharmacy technicians. The literature has many research studies which describe one profession's activities, or a specific learning method or topic. Few studies compared the CPD preferences across these four professional groups or compared their CPD activity. A survey was designed by the authors with assistance from colleagues within NHS Education for Scotland (NES). It was sent to the four professions and 2,813 clinicians responded. More than 75% of all respondents spent between 0 and 10 h per month on CPD activities. Participation in formal Protected Learning Time (PLT) varied across different NHS boards in NHS Scotland and ranged from 23.9% of respondents in the board with the lowest participation, to 68.6% in the board with the highest participation. All professions indicated a greatest preference to learn with other members of their profession. The preferred time for learning during the day varied amongst professions. The CPD activity of greatest preference for all professions was discussion with peers. There were some minor differences in learning preferences and activities from professionals working in remote and rural areas and in areas of socio-economic deprivation in Scotland.

Practice-based Small Group Learning (PBSGL) originated in Canada and transferred to Scotland in 2003 with a successful pilot involving 45 general practitioners (GPs). The Scottish programme has grown considerably since then and now has 3,400 members drawn from GPs, GP nurses, pharmacists and other professions. Members get together in small groups and discuss case presentations written by authors who have drawn on their own experiences with real patients. The group review a distillation of the current evidence base included in the module and propose changes to their own practice. Members make a commitment to change and log these changes in a shared document.In Scotland, 34% of groups are inter-professional, reflecting the dynamic changes to the primary health care team as it meets the health care needs of the Scottish population. Professional (and inter-professional) socialisation is a key feature of many PBSGL groups. Some groups have peer support as a central function to their meetings.The programme has recruited a small team of module writers and authors and most modules are now produced in Scotland by primary health care members. In addition, over 1,000 members have been trained up to be peer facilitators for their small group. The PBSGL programme in Scotland has ensured that continuing professional development of the primary health care team is available to teams across Scotland and that PBSGL groups can control the content and logistics of their own meetings.

The World Health Organisation reported that health-care systems worldwide have problems with the recruitment and retention of general practitioners (GPs) into clinical practice, particularly to rural and under-served areas. A recent survey of United Kingdom (UK) trainees found that they valued posts with good training conditions, were in desirable locations and gave opportunities for their partner. The Scottish Government has set a target to increase the number of GPs in Scotland by 800 in the next 10 years. In recent years, GP speciality training recruitment has been challenging with significant vacancies in some training programmes, primarily in rural areas, or urban areas with a history of poorer recruitment. Recruitment incentive schemes are in operation in different countries in the UK. The Scottish Government introduced a Targeted Enhanced Recruitment Scheme (TERS), offering a 20,000 pound payment to GPST trainees accepting a targeted post. This study aimed to evaluate awareness and influence of the TERS initiative on programme choice in Scotland in August 2017. A survey was developed and sent to GP trainees taking up a GPST post in August 2017. Ninety-five out of 245 doctors responded (response rate of 39%). Almost two-thirds (65.3%) were aware of TERS at the time of application and this was via word of mouth and from the National Recruitment Office website. Only 21% of GPSTs aware of TERS were influenced by it in their choice of training location. The locations of family, spouse or partner, and of pre-existing geographical preferences were more influential than TERS.

A considerable number of Green Journal readers will be involved in the selection and recruitment of those entering into healthcare professions, in the UK, and across the world. This textbook edited...