Independent General Practitioners Research Articles

Investigating How the Use of Technology Can Reduce Missed Appointments: Quantitative Case Study at a General Practitioner Surgery.

SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers. This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments. To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom's most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility. Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both). This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings.

Tele-education by an orthopedic specialist increased the confidence in orthopedics of a general practitioner at a rural solo-practice clinic.

Objective: General practitioners in rural clinics are required to deal with musculoskeletal problems, but they often lack the confidence. We aim to confirm changes in their confidence in orthopedic practices after using tele-education. Materials and Methods: We conducted tele-education in orthopedic practices from June 1, 2022, to November 30, 2022. Using a teleconference system, the first author, an orthopedic specialist, provided tele-education training to an independent general practitioner in a rural clinic. We adopted a 7-point Likert scale to assess the general practitioner's confidence levels. In pre- and post-research, the counts and confidence levels in the scale were assessed for 18 types of orthopedic practices each month. Furthermore, we interviewed the general practitioner to examine the factors influencing their confidence. Results: The confidence levels increased for all measurement items. The most experienced orthopedic practice was "Advising on daily care for musculoskeletal problems", with confidence levels increasing from 3 to 6. The least experienced orthopedic practice was "Manipulative reduction of radial head subluxation", with confidence levels increasing from 4 to 5. The factors that influenced the change in confidence levels were regular feedback and unrestricted availability of consultations. Conclusion: Tele-education in orthopedics may enhance general practitioners' confidence in orthopedic practices.

Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study.

Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.

Evaluation of a training programme for Pharmacist Independent Prescribers in a care home medicine management intervention

BackgroundThe provision of independent prescribing rights for United Kingdom (UK) pharmacists has enabled them to prescribe within their area of competence. The aim of this study was to evaluate an evidence-based training programme designed to prepare Pharmacist Independent Prescribers (PIPs) to safely and effectively assume responsibility for pharmaceutical care of older people in care homes in the UK, within a randomised controlled trial.MethodsThe training and competency assessment process included two training days, professional development planning against a bespoke competency framework, mentor support, and a viva with an independent General Practitioner (GP). Data on the PIPs’ perceptions of the training were collected through evaluation forms immediately after the training days and through online questionnaires and interviews after delivery of the 6-month intervention. Using a mixed method approach each data set was analysed separately then triangulated providing a detailed evaluation of the process. Kaufman’s Model of Learning Evaluation guided interpretations.ResultsAll 25 PIPs who received the training completed an evaluation form (N = 25). Post-intervention questionnaires were completed by 16 PIPs and 14 PIPs took part in interviews. PIPs reported the training days and mentorship enabled them to develop a personalised portfolio of competence in preparation for discussion during a viva with an independent GP. Contact with the mentor reduced as PIPs gained confidence in their role. PIPs applied their new learning throughout the delivery of the intervention leading to perceived improvements in residents’ quality of life and medicines management. A few PIPs reported that developing a portfolio of competence was time intensive, and that further training on leadership skills would have been beneficial.ConclusionsThe bespoke training programme was fit for purpose. Mentorship and competency assessment were resource intensive but appropriate. An additional benefit was that many PIPs reported professional growth beyond the requirement of the study.Trial registrationThe definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17,847,169).

MHealth-community health worker telemedicine intervention for surgical site infection diagnosis: a prospective study among women delivering via caesarean section in rural Rwanda

BackgroundSurgical site infections (SSIs) cause a significant global public health burden in low and middle-income countries. Most SSIs develop after patient discharge and may go undetected. We assessed the feasibility...

What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study

ObjectiveAssess the suitability of clinical vignettes in benchmarking the performance of online symptom checkers (OSCs).DesignObservational study using a publicly available free OSC.ParticipantsHealthily OSC, which provided consultations in English, was used...

Satisfaction survey of general practitioners calling upon an external mobile geriatric team.

The external mobile geriatric team (équipe mobile de gériatrie extrahospitalière [EMGEH]) at the University Hospital of Grenoble-Alps intervenes with elderly subjects in complex medical and social situations at home at the request of general practitioners (GPs). To evaluate the satisfaction of GPs after EMGEH intervention. The secondary outcomes were the follow-up of recommendations and training requests from community care partners. Retrospective monocentric satisfaction survey of the 124 GPs who used the EMGEH between January 2015 and December 2018. Participation rate of 44%, representative of independent GPs in urban or semi-rural practices. Participants were "satisfied" or "very satisfied" (84.2%) with the responsiveness of the EMGEH, and 85.5% responded favourably to the content of the evaluation. The EMGEH was described as playing an expert and supportive role for GPs. The recommendations were followed by more than 89% of respondents. As many as 83.6% of participants wanted the EMGEH to conduct training sessions, mainly for the management of "behavioural disorders". Following this survey, five recommendations were formulated: decrease the response time by recruiting trained staff, systematically send an e-mail following the report to the requesting doctor, use a platform to exchange information, develop partnerships with the psychiatry team, and create an online resource space. This study contributed towards improving the relationship between the community and the hospital by strengthening links between the GPs within the CHUGA health region and the EMGEH.

Systematic Review and Meta-Analysis of Intervention Studies with General Practitioner Involvement Focused on Falls Prevention for Community-Dwelling Older People.

Objectives: Falls are a significant health problem for the ageing population. This review aimed to identify effective falls prevention interventions with involvement of general practitioners (GPs). Methods: Systematic review of randomised controlled trials conducted from 1999-2019, with meta-analysis. Searches located 2736 articles. A quality assessment was conducted of all included studies. Results: 21 randomised controlled trials met the inclusion criteria and 19 studies could be included in a meta-analysis. Overall, studies were not effective for reducing multiple falls (Relative Risk (RR) 1.16, 95% CI .97-1.39 and p = .10) or reducing one or more falls (RR .91, 95% CI: .82-1.01 and p = .08), but were effective for reducing injurious falls (RR .76, 95% CI: .66-.87 and p = .001). Discussion: Studies involving the GP in an active role and aligned with the primary care context were effective. The fidelity of interventions was limited by independent GP decisions and older participants being required to initiate the intervention.

The Capacities of Primary Health Care in Hungary: A Problem Statement.

In the establishment, development, and provision of equal access to the health care system, the operation of adequate primary health care is essential and has undergone significant transformation in the most developed countries over the past decades. The central and eastern European countries, including Hungary, are struggling with the disadvantages of the traditional model of primary health care, based on independent general practitioner and family paediatrician practices: the ability of the system is extremely limited to meet emerging needs and is facing a chronic human resource crisis. In the current study, the functions, legislation, and challenges of the Hungarian primary health care system, as well as the basic interrelations of the development of vacant general practitioner and family paediatrician districts were examined, and the government measures for the sake of solving the occurrence of the vacancy and improving access in the lagging areas. (The situation of the other fields of primary health care—e.g., dental care, child care officer care, etc.—was not subject of the analysis.). The basic characteristics of the vacant districts (type by supplied age group, bounding region, population size, length of vacancy) were primarily examined by the analysis of categorical and metric variables, with the use of cross-tabulation and nonparametric correlation, while the discovery of soft interrelations was supported by an expert interview conducted with the professionals of the Primary Health Care Department of the National Health Care Services Centre. In Hungary, the fundamentals of primary health care are made up of the individual practices of general practitioners and paediatricians, and there is a growing concern about the permanent vacancy of the districts, and the fact that the system is less suitable for meeting the needs of the population. The ever-increasing number of vacant general practitioner and family paediatrician districts due to the growing shortage of professionals because of aging and emigration poses the burden of substitution on the physicians in existing practices, that concerns the access of more than a half million people to health care, almost 70 percent of which live in settlements with a population less than 5000 inhabitants.

Development and cohort study of an audit approach to evaluate patient management in family practice in the UK: the 7S tool.

In the UK, there is increased pressure on general practitioners' time due to an increase in (elderly) population and a shortage of general practitioners. This means that time has to be used efficiently, whilst optimizing adherence to consistent, appropriate and timely provision of care. Create an audit tool that assists general practitioners and family practice staff to evaluate if patients are managed as effectively as possible, and to test the usefulness of this tool in a family practice. The '7S' audit tool has seven outcome elements; these broadly stand for what the actual and desired patient contact outcome was, or should have been. Terms include 'surgery', 'speak' and 'specific other' for an appointment at the practice, by telephone or with a dedicated specialist such as a practice nurse or phlebotomist, respectively. A very small, rural, general practice in the UK was audited using the 7S tool. Five hundred patient contacts were reviewed by an independent general practitioner and the decision made if the mode of contact was appropriate or not for each case; in one of the three cases, the choice of care provision was inappropriate and chronic disease cases contributed most to this. General practitioners instigated the majority of poor patient management choices, and chronic disease patients were frequently seen in suboptimal settings. Inefficiencies in the management of patients in family practice can be identified with the 7S audit tool, thereby producing evidence for staff education and service reconfiguration.

New alumni EXperiences of Training and independent Unsupervised Practice (NEXT-UP): protocol for a cross-sectional study of early career general practitioners

IntroductionGeneral practice in Australia, as in many countries, faces challenges in the areas of workforce capacity and workforce distribution. General practice vocational training in Australia not only addresses the training...

‘How was it for you?’ – GP trainees’ experiences of a novel practice swap

ABSTRACTNewly-qualified General Practitioners (GPs) are underprepared for the challenges of working as independent GPs. This study describes a practice swap – an innovative experiential learning opportunity to increase confidence amongst final year GP trainees for the challenges of future work. The effectiveness of the practice swap was evaluated across two separate GP training areas using questionnaires for GP trainees, practice managers, educational supervisors and newly-qualified GPs. In addition, GP trainees were interviewed in focus groups. The results demonstrated the positive educational value of the practice swap. GP trainees reported increased confidence in the ability to work as independent GPs specifically as a locum doctor, improved Information Technology (IT) competence, clinical knowledge and time keeping. The practice swap helped to inform the trainees on future career choices. Practice swapping has become one of the building blocks of a wider programme to equip newly-qualified GPs for the numerous challenges of being a GP, with a series of workshops on self-employment, job applications, practice management and IT training. The arrangements and benefits of practice swapping are transferrable to other GP Training Schemes across the UK and possibly internationally.

From local organisational harmonisation to Global change leader: a story of operational success

Introduction: (comprising context and problem statement) Like many countries, Ireland is facing a rise in chronic disease and the underutilisation of healthcare delivered to patients in the community. Services comprise publicly funded hospital and community services, and independent general practitioners. There is overreliance on hospital services and a lack of community services to provide alternative care. Short description of practice change implemented: CareDoc is a not-for-profit organisation and works as a service providing trusted third party, funded by item-of-service charges. It developed Community intervention team (CIT) services and offered them to move care from inpatient settings to deliver acute care in the community. A CIT is a nurse led service providing acute care to patients in the community, who otherwise would require hospitalisation. There is in house EHR support. Aim and theory of change: The aim is to provide appropriate patients with appropriate care in their community thus preventing unnecessary hospital admission or facilitating early discharge from hospital. The CIT uses strict clinical criteria to accept a patient into the service and must be avoiding a hospital admission or facilitating early discharge. Targeted population and stakeholders: The CIT is for patients over 16 years who require an acute clinical treatment that would usually take place in the hospital setting. Timeline: The first Caredoc CIT model of care concept and design was developed in early 2011 and the first patient accepted in the Carlow and Kilkenny area, covering a population of 145,659, in September 2011. Based on initial success, the Caredoc CIT model of care was extended in: - 2014 South Wicklow Population 118,379 - 2015 Waterford Population 127,807 - 2016 Tipperary Population 94,136. Highlights: (innovation, Impact and outcomes) The implementation required trusted partnership working with all stakeholders, engaging at an early stage, including management, clinicians, and allied health professionals from both primary and secondary care. The team developed and enhanced the relationships between the hospital, community and primary care settings to support patients and care delivery in the community. Comments on sustainability: The number of patients treated by the CIT service has increased annually with 2,866 treated in 2015 and 3,642 from January – October 2016. Comments on transferability: The Caredoc model of CIT has successfully expanded over 4 regions throughout Ireland. Conclusions and Discussion: (comprising key findings) The Caredoc model was included in “Lessons from transforming health services delivery: compendium of initiatives in the WHO European Region” and as a WHO reference site for Connected Integrated Health Service Delivery. Following on from this the Caredoc team have been asked by the WHO to lead a Global Community of Practice on Change Management. Lessons learned - Automatic buy-in not a given - Communication to all stakeholders is key - Key leaders and champions are vital - Do not encroach on clinical time - Arrange meetings to suit stakeholders - Fit-for-purpose IT (inter-operable real-time EHR) is essential - Mutual trust and added clinical value are key enablers

Exhausting Physicians Employed in Hospitals in Japan Assessed by a Health Questionnaire.

Japanese physicians employed and working in general hospitals have become busier since 2005, as they had to teach and guide the increased number of medical residents graduated from medical schools. Working hours and chronic fatigue of employed physicians were surveyed compared with independent physicians working in their own out-patient clinics and with usual employed men in Japan, and their mental health was assessed. (1) 75 employed physicians in hospitals were surveyed of their working hours a week and compared with (2) 48 independent general practitioners (GP) who work in their own out-patient clinics. (3) 47 employed physicians aged 40s and 50s out of (1) were compared with group (4) or 277 men of the same age employed in an automobile company. A symptom check list questionnaire, the Total Health Index (THI), was used to assess their stress and mental health status. The THI has 130 questions including physical symptoms, mental complaints, lifestyle and habits. 130 items have been grouped into 12 scales: vague complaints, respiratory symptoms, depression, and 9 other scales. The average weekly working hours of employed physicians of (1) and GPs of (2) were 55.7 h and 51.3 h, respectively, and those who worked 60 h or more a week were 44.0% and 27.0%, respectively. They had significantly higher average scale scores than GPs with respect to vague complaints, irregular daily life, mental instability, depression, neurotics and psychosomatics scales. They also had significantly higher yes response rates for question items, "envy for richer friends", "feel my life is going badly", and other items than the GPs. 47 employed physicians of group (3) and 277 men workers of group (4) worked for 57.0 h and 46.0 h a week, respectively, in average, and 51.1% and 6.2% of group (3) and (4), respectively, worked for 60 h or more a week. The average scale scores of physicians of (3) were highly significantly poorer than group (4) in many scales of THI. Physicians employed also had significantly higher yes response rates for question items "feel too heavy work load", "stressed state", "irritated", "depressed", "lack of sleep", and "low back pain". Most of the physicians of group (3) were exhausted due to the hard work, showing a sharp contrast to group (4). Physicians employed in hospitals work for 57.0 h a week on average, although usual labors of the same age in a large farm work for 46.0 h a week. Physicians employed were exhausted or burnout and under poorer mental condition.

Comparing the diagnostic accuracy of ultrasound in the community and in the hospital setting for urinary calculi: A retrospective cohort study

Objective: The objective of this article is to test whether there is a significant difference in diagnostic accuracy between hospital and community-based ultrasound (US) for the detection of urinary calculi in the United Kingdom (UK). Materials and methods: A 30-month, single-blind, retrospective cohort study of all patients referred to Kent and Canterbury Hospital urology multidisciplinary meeting for suspected urinary calculi was conducted. Only those investigated with US and non-contrast computed tomography (NCCT, the gold standard) for their calculi were included. Concordance of US and NCCT was stratified by US location: i.e. either the hospital or community setting (e.g. the latter via general practitioners (GPs) or independent radiographers). Fisher’s exact test was subsequently utilised to test for any significant difference between these two patient groups. Results: Of 2464 patients referred, 257 had both ultrasound and NCCT in their diagnostic workup. Of these, 150 and 107 patients had their US performed in hospital and community settings, respectively. No significant difference in the accuracy of US was detected between the two groups for the detection of urinary calculi when compared with NCCT. Conclusion: US carried out by independent radiographers and GPs in the community is just as accurate as US carried out by hospital sonographers for the detection of urinary calculi in the UK. Greater use of community US for the diagnosis of urinary calculi may promote greater patient/GP satisfaction and reduce hospital attendance without loss of diagnostic accuracy.

Einschätzung der Weiterbildung im Fach Allgemeinmedizin in Bayern – eine Online-Befragung von Ärzten in Weiterbildung

Statistical projections suggest that by 2020 the number of general practitioners (GPs) in Germany will have decreased by about 13%, which will lead to a risk of medical undersupply, especially in rural areas. This study was conducted on behalf of the Bavarian Ministry of Environment and Health in order to answer the following questions: How satisfied are young Bavarian physicians in GP specialty training with their training situation? To what extent are they willing to start a private practice, in general and, in particular, in rural areas? The study's online questionnaire contained items concerning the context of GP specialty training and the willingness to set up a private practice. In addition, the "Heidelberger Niederlassungsbarometer", a structured questionnaire illustrating self-assessment of competencies of GPs in training, was included in the survey. We asked GP specialty trainees to participate by e-maiI, directly or via their GP trainers. In total, 99 questionnaires were returned, whereof 95 fulfilled the criteria for analysis. In 76% of the cases participants were female, 63% working in practice and 37% in a structured training programme. The majority of participants (58%) preferred to work in a practice with more than one GP, followed by those preferring to work as a salaried GP (26%). Their disposition to work in rural areas after having passed their specialty certificate examination was high or very high (59%). Feedback on a regular basis was given to 29% of the study participants. Almost every second participant received a structured initial training programme. Most of the participating GP trainees (59%) were satisfied or very satisfied with their training. In general, there is a high level of motivation among study participants to become an independent and self-employed GP, also in rural areas. Despite the fact that not even every second received central training elements like individual feedback and structured initial training, the participants were mostly satisfied with their GP specialty training.

An Assessment of Private General Practitioners Contracting for Public Health Services Delivery in O.R. Tambo District, South Africa.

Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contarct related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The idea of a one-size-fits-all contract was probably inappropriate.

Determination of risk factors for drug-related problems: a multidisciplinary triangulation process

Introduction and objectivesDrug-related problems (DRPs) constitute a frequent safety issue among hospitalised patients leading to patient harm and increased healthcare costs. Because many DRPs are preventable, the specific risk factors...

Adult Self-Directed Learning: Setting Your Own Agenda

Medical education often uses terms like ‘adult learning’ and ‘self-directed learning’. We are told that we trained to be self-directed and adult learners from the commencement of basic medical education and that this is important if we are to remain competent over a career that may span 30–40 years. However, the ability to be an adult or self-directed learner is difficult to measure and it is therefore difficult to determine whether these processes (or are they skills?) are either innate or learnable. There is a risk that the terms are seen simply as impractical educational jargon, and so education organizations feel safest when they provide a tightly structured curriculum and assess learners through examinations based on that curriculum. The Postgraduate Medical Education Training Board has required this for all postgraduate specialties, including general practice. The obvious question then is ‘what happens next?’ as there is no such thing as a curriculum for lifelong competence. There is therefore a need for GP registrars, as part of the new RCGP curriculum, to develop the skills to be lifelong learners for two reasons. The first is to facilitate maintaining currency of practice and the second is to role model that for other learners. This paper aims to explain in simple terms how, in the context of being on the pathway to becoming an independent general practitioner, the theory can be applied to enhance adult and self-directed learning in GP registrars.

The future of higher professional education for general practice

Arthur Hibble explains how this scheme will continue to ease the transition from trainee to fully independent general practitioner