Dr Honor Merriman highlights the importance of continuing professional development and what resources are available for GPs
The need for GPs to update their knowledge and skills has always been important, as it has direct bearing on their clinical performance. The concept of continuing professional development (CPD) was recognised in 1998 by the then Chief Medical Officer (CMO) Sir Kenneth Calman,1 and was defined as ‘A process of lifelong learning for all individuals and teams, which enables professionals to expand and fulfil their potential and which also meets the needs of patients and delivers the health and healthcare priorities of the NHS.’
In common with all those who work in a profession, GPs are able to adapt what they do to keep up to date. In general this is successful but if there are constraints to practice (e.g. financial changes to GP remuneration), CPD for GPs may suffer unless it is positively encouraged. Support from PCTs for GP education is often minimal or non-existent, and deaneries in many parts of the country have stopped funding for CPD tutors. In these days of change in the NHS, many GPs feel isolated in practice and are under increasing pressure to offer extended services to the public, beyond what was agreed in the GP contract. Moral and professional isolation of GPs can be improved by CPD, which helps them regain their self-esteem and pride in their clinical skills.
Defining what GPs need to learn is difficult as this must be dictated by the clinical needs of their patients. However, certain skills are essential, and GPs should be practised in:
- safeguarding children and young people
- resuscitation skills for adult and paediatric patients
- equality and diversity awareness
- IT skills and the ability to access the internet for medical and patient information
- communication skills
- palliative care
- cervical cytology for smear takers.
Analysis of CPD by GPs provides information about their learning needs, which are passed on to their PCTs as a result of the GP appraisal. However, there are many other needs that GPs are aware of that are not shared in this way. There is no summary of GP learning needs, because the range of knowledge and skills required of them is so broad. Often the challenge for GPs lies in maintaining awareness of all changes to clinical practice. Where there is new guidance for clinical practice that is based on substantial research evidence, it is of particular importance that individual clinicians should have good mechanisms for changing what they do for patients. Finding out about publication of new guidance is the first step and publications like Guidelines in Practice are an important source of information.
Establishing a link between what GPs need to know in the light of what they do each day and what they make time to learn is essential. A well recognised method of doing this is by using the patient unmet needs (PUN) and doctor’s educational needs (DEN) logs2 in which GPs record day-to-day problems in practice and then decide which of these needs can be met by GP education. The success of this method depends on the GP’s insight into where an unmet need may lie. If the need hits a blind spot, the learning may not be triggered so relying only on PUNs and DENs may not be wise.
How GPs choose to learn
In general, using more than one method to tackle a learning need is better than just ‘looking out for a meeting’ on a particular topic. Obtaining a theoretical basis through reading up on a subject and then finding a way to try out a new skill often works well; for example, I recently updated my soft tissue injection techniques by reading about the anatomy and pharmacology underlying the techniques and then trying out the injections on models. I now feel ready to treat patients. Much has been written about learning styles3 but, as adult learners, GPs are used to practising different methods of learning to suit the topic of study.
The increased availability of online learning has proved a particular benefit for GPs, who can now look up information for themselves and their patients during the consultation. In last month’s issue of Guidelines in Practice, Nia Roberts explained some of the tricks and tools GPs can use to search for evidence-based information online (click here to read this article).
General practitioners can also access interactive learning via several good websites: BMJ learning (learning.bmj.com/learning/main.html) is arguably the best established website but this month sees the launch of a new interactive CPD section on eGuidelines.co.uk (click here for the editorial; click here for the CPD section).
Another useful approach is the phased evaluation plan, which has recently been relaunched by the Royal College of General Practitioners in Scotland.4 An online system of testing can be used to affirm up-to-date knowledge as well as highlight areas for learning.
In reminding myself and other GPs of how to approach learning needs, I use the following list:
- reading, journals, online reference or interactive resources, emails
- meetings, lectures, courses, small group discussions (e.g. on journal articles or PUNs and DENs), in practice sessions when experiences are shared between different professional groups
- observation of somebody else at work in your practice, in another practice, or in secondary care
- writing, recording your learning (and thus understanding it better)—write about your own experiences at work, record research
- adding another qualification through distance learning or on a taught course.
Ideal requirements for GP learning
This list represents the ideal scenario for GPs to achieve optimum CPD learning. GPs should have access to:
- protected time—most GPs would agree that time is the main barrier to learning. Finding a time to learn away from interruptions either from work colleagues or family is essential. As most PCTs do not encourage formal protected learning time, individuals need to look carefully at their weekly schedules to make time for learning. A meeting where there is a chance to exchange ideas is as useful as an hour with a learned journal
- shared learning resources between practices—in many localities, meetings where practices share a learning resource reduces time spent travelling to larger meetings and encourages co-operative working
- meetings/courses—a website is a good way to share information about available courses (e.g. www.oxfordprimarycarelearning.org.uk). It reduces the risk that posted flyers will be overlooked, or emailed messages not opened or read
- more resources from PCTs and deaneries so that CPD tutors are kept on the staff; development for CPD tutors from a national organisation such as www.napce.net.
Would it take much for us to reach this ideal state? In financial terms the outlay would be small but the benefits to primary care and patients would be huge.
- Department of Health. A review of continuing professional development in general practice: a report by the Chief Medical Officer. London: DH, 1998.
- Eve R. Learning with PUNs and DENs—a method for determining educational needs and the evaluation of its use in primary care. Education for General Practice 2000; 11: 73–79.
- Honey P, Mumford A. The manual of learning styles. Peter Honey, Maidenhead, 1982