08 Careers


A SENSE OF URGENCY V


GPs are increasingly choosing to venture into the fast-paced world of emergency medicine


ISITORS to UK emergency departments in recent years might be surprised to discover general practitioners at work amongst the team of specialist hospital doctors and nurses. But


as the focus shifts away from distinct primary and secondary care provision, and as health boards and primary care trusts (or CCGs) look for new ways to improve patient care while also saving money and reducing A&E admissions, GPs are playing an increasingly important role. Opportunities in this fi eld are varied and GPs with a special interest (GPwSIs) in urgent and emergency care can choose to work one or more sessions a week in a variety of settings from hospital A&E or pre-A&E care centres to community locations such as walk-in clinics and the provision of out of hours care.


Entry and training Many GPs who choose to pursue a special interest do the additional training needed after their GP training, usually while continuing to work part time as a GP. This is still an option for emergency medicine however the training requirements for this specialty can be intense and trainees may fi nd it more manageable to undergo specialist training before they move into GP training. GPs interested in developing a special


interest in emergency medicine (EM) can undertake ACCS (EM) training which is a two year programme (comprising EM, acute medicine, anaesthesia and ITU) which then runs into a third year of EM-specifi c training targeted at the MCEM examination and would allow trainees to enter an EM ST4 post. Trainees seeking dual training have the


option to stop EM training at the end of ACCS (year two) which would give them a lot of experience and core competences but would only entitle them to work at a junior level in emergency departments (EDs) in the future. By completing the third year and passing the MCEM this would open the door to a more senior middle grade level role. The competences, training and


accreditation required to become a GPwSI in this fi eld are set out in Guidance and Competences for the Provision of Services Using Practitioners with Special Interests – Urgent and Emergency Care (www.tinyurl. com/akdpy42). The document highlights the many GPs


who are currently providing specialist services or clinical leadership who do not consider themselves to be special interest practitioners. The guidance says it is not intended to undermine these clinicians. For those who wish to achieve GPwSI status within the formal framework, it advises that


training can be acquired in several ways, including both practical and theoretical elements. Examples include experience of working in an ED, a recognised university course (i.e. Diploma in Urgent Care from Middlesex University), self-directed learning with evidence of completed tasks, undertaking a clinical placement or working under direct supervision with a specialist clinician. All GPwSIs in this area must also complete accredited specifi c consultation and communication skills training relevant to urgent and emergency care. The British Association for Immediate Care


(BASICS) also off ers training in pre-hospital emergency medicine for GPs who go on to work alongside the paid emergency services, providing medical support at accidents or while patients are in transit to hospital. GPwSIs are expected to maintain a personal


development portfolio to demonstrate they are maintaining these competences and this would form part of the GP’s annual appraisal. As well as demonstrating sound generalist skills (good communication skills, ability to explain risk and benefi ts of treatments) GPwSIs in urgent and emergency care will be expected to demonstrate skills in specialist areas including the clinical management of urgent and emergency conditions, provision of urgent care for the elderly, clinical management of children within urgent and emergency care services, and management and leadership.


In practice GPwSIs in urgent and emergency care provide


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