In this section:
Paediatrics Medicine Obstetrics and Gynaecology Orthopaedics Emergency Medicine Dermatology Palliative Care Psychiatry
Hospital post: Paediatrics
Team structure
- Doctors are split into Tier 1 (FY2/ GPST/ CDF), Tier 2 (ST3+) and Tier 3 (Consultants).
- 09:00 – 17:00 – three Tier 1 doctors (one for Neonatal unit NNU, one for transitional care TC, one for Children’s ward), two Tier 2 doctors (one for NNU/ TC, one for Children’s ward) and two Tier 3 doctors (one for NNU/ TC, one for Children’s ward).
- 17:00 – 21:00 – two Tier 2 doctors (one for NNU/ TC, one for Children’s ward), one Tier 2 doctor (covering all three areas)
- Night shift – one Tier 1 doctor and one Tier 2 doctor covering all areas
Role and responsibilities
- NNU (Neonatal page holder) – Ward round and associated jobs. Taking referrals and perform routine reviews for the obstetric ward. This can be anything from a grunting baby to attending instrumental deliveries. Also will be first point of contact for Paediatric team at emergency or routine caesarean sections*.
- TC – Perform the obstetric ward baby checks and miscellaneous tasks generated by midwifery staff.
- Children’s ward (Paediatric page holder) – Ward round and associated jobs. Clerk in new patients on the ward.
Learning opportunities
The rota is generous for clinic opportunities. There are many clinic slots allocated through the rota; use these opportunities to go to as wide a range of clinics as possible. There are many opportunities to get involved in QIA/ research if required, speak to your Educational Supervisor early.
What I wish I knew before starting
- Teamwork is especially important – the workload is often not evenly spread. For example, the TC doctor often has the lightest workload. Offer to help your colleagues, you will be grateful for a helping hand when it is your turn.
- Understand and work within your limits – for a lot of us this will be our first paediatric job. If you are not confident in any aspect, especially at the start of the rotation, please ask for help early. You do not want to work outside your competence – e.g. ask for senior support when attending Caesarean sections initially, if you are not confident with neonatal resuscitation!
Hospital post: Medicine
Team structure
- Doctors are split into FY1, middle grade (FY2 – ST2), registrars (ST3+) and consultants.
- Daytime staffing depends on size of ward. Typically will have at least one doctor from each tier on every day, but this is very variable due to leave/ absences.
- Night shift – one FY1 doctor and one middle grade doctor cover the back of the hospital (i.e. all wards), with the assistance of two HAN ANNPs. Minimum of one FY1 doctor, one middle grade doctor and one registrar cover the front of the hospital (i.e. receiving/ admission units).
Role and responsibilities
- Dayshift – As the middle grader, you are expected to see patients independently and carry out the ward rounds on days where the consultant isn’t present. Jobs generated to be shared between you and the FY1.
- Night shift – Back of hospital: attend to review patients as requested by the wards. There is a ward jobs book in every ward, ensure these are all completed. Wards are usually split equally with the ANNPs. Front of hospital: clerk all new patients and implement initial management whilst awaiting consultant r/v in the morning.
Learning opportunities
The rota is tends to be quite tight for staffing. As such, there are few opportunities to get involved in clinics etc. Negotiate with your team if there is sufficient staffing. There are weekly formal lunchtime teaching/ grand rounds – these are protected learning times and you should attend if possible.
What I wish I knew before starting
- There will be a consultant who acts as a “GP champion” – they will identify themselves to you at the start of the rotation. Their role is to ensure GPSTs are being fairly treated in terms of learning opportunities/ responsibility/ general well-being. If there are any systemic issues (e.g. lack of clinic opportunities), the GP champion should be your first port of call.
- HAN ANNPs are basically experienced middle graders. They have a wealth of experience on how the hospital works, so are a good source of advice!
Hospital post: Obstetrics & Gynaecology
Team structure
- Doctors are split into Tier 1 (FY2/ GPST/ ST2), Tier 2 (ST3+) and Tier 3 (Consultants).
- Daytime – three Tier 1 doctors (one for postnatal/ maternity triage, one for labour ward, one for Gynae), two Tier 2 doctors (one for Gynae, one for labour/ postnatal ward) and one Tier 3 doctors.
- Night shift – one Tier 1 doctor and one Tier 2 doctor covering all areas
Role and responsibilities
- Labour ward (Labour page holder) – Ward round and associated jobs; Assisting in caesarean sections.
- Postnates/ maternity triage – Complete jobs generated by midwifery staff for the postnatal ward. Clerk and review all new obstetric referrals as guided by maternity triage midwifery staff.
- Gynae ward (Gynae page holder) – Ward round and associated jobs. Clerk in new patients on the ward.
Learning opportunities
The rota is generous for clinic opportunities. There are many clinic slots allocated through the rota; use these opportunities to go to as wide a range of clinics as possible. There are many opportunities to get involved in QIA/ research if required, speak to your Educational Supervisor early.
What I wish I knew before starting
- No prior experience is expected – the Tier 2 staff are generally helpful in helping you become competent in assisting in C sections, and performing speculums independently.
- There are local obstetrics protocols on the intranet – this is invaluable in guiding your assessments/ managements especially in maternity triage.
Hospital post: Orthopaedics
Team Structure
- Doctors are split into 4 tiers – Tier 1 (FY1), Tier 2 (FY2, GPST, ST1/2), Tier 3 (ST3+) and Tier 4 (Consultants).
- There are also 2 trauma co-ordinators who are ANPs who are essential in compiling the trauma list, contacting patients and keeping in contact with theatres to create surgical lists. There is also a specialist doctor who works on the orthopaedic ward to manage the medical needs of the elderly patients with fractures.
- Shifts are 0800-2030, 2000-0830 and 0800-1630.
- Night shift: first point of contact for ortho, ENT, urology and maxillofacial referrals. Other specialities have a consultant on call who can be contacted for advice.
Role and Responsibilities
- The FY1s cover the orthopaedic ward and do a daily ward round with consultant on call that week. This job is quite unique in that the GPST has very little involvement with day to day ward work. You are not expected to attend ward round or complete IDLs.
- GPST’s main responsibility is covering the tier 2 orthopaedic page in which you receive referrals from ED or other specialities. There is also a tier 3 registrar who is on call with you (day and night) who will assist you.
- Main referrer is the emergency department. You are expected to assess these patients, clerk if required and add them to a trauma list which is discussed daily at 8am. Some patients require manipulation of fractures or dislocations. Full support is provided by the registrars on duty although as your experiences builds in the job you may progress to manipulating simple fractures independently.
- Theatre shifts – surgical assistant, good opportunity for teaching one on one by consultant and to develop surgical skills e.g. suturing
- Clinics – plenty of time build into the rota to attend clinics. As a GP resident you had the opportunity to see patients independently then discuss with seniors or also sit in with experienced orthopaedic consultants who were very happy to teach.
Learning opportunities
The main benefit of this job is that there is very little ward work. You are primarily assessing patients across various surgical specialities. As a GP resident I found the night shifts quite interesting as you are exposed to ENT/urology/max fax.
What I wish I knew before starting
- It is really helpful to get to grips with the outpatient clinic IT systems (of which there are multiple). By getting used to this early on in the job you are able to see patients yourself (with appropriate support) and practice skills like dictation which I think helps you to make the most out of the post.
- There can be pressure by the emergency department to see patients promptly to ensure patients don’t breach the 4 hour target which can, at times, cause tension. I would recommend keeping an organised job list and documenting times of referral and your assessment.
- In the surgical specialities (ENT, urology) there is a lack of a tier 3 specialist registrar which means you have to liaise directly with the consultant in the middle of the night. As a GP resident it is important not to work outwith your competence level. Spending some time at the start of the block becoming familiar with common ENT/urology problems e.g. epistaxis, frank haematuria is time well spent and will increase your confidence on the first few shifts. If there are any supervision issues overnight I would escalate this at an early stage to management.
Hospital post: Emergency Medicine
Team structure
- Doctors are split into junior tier (FY2/ GPST/ CDF/ CT1-2), Middle grade (ST3+/ staff grades) and Consultants.
- Shifts are usually 8 hours, with shifts starting at 08:00, 12:00, 16:00 and 22:00 – staff numbers are variable, but there are usually at least 5 junior tier, 3 middle grade and 2 consultants on during the day.
- The on-call Consultant tends to leave just as night shift begins, and are available via phone.
Role and responsibilities
- There are no page holding responsibilities in A&E.
- A&E is split into minors and majors. Minors are cases that can likely be dealt with as a day-case/ don’t need a bed. Examples include head injuries, ankle fractures, eye complaints etc. Majors are cases that may need admission/ need a bed. These include your septic patients, acute abdomens, overdoses etc.
- You will be expected to see patients based on time of attendance and triage urgency (triaged by nursing staff on arrival).
- There may be category 1 stand-by calls where you have to be the first attender, but this should be communicated to you in advance, in a timely manner once the ambulance call is received.
Learning opportunities
- There are weekly departmental teaching sessions, and there are opportunities to present cases/ SEAs if you wish.
- A&E is a chance to pick up useful skills that (while not totally relevant to GP) you would otherwise never have been involved with. Examples include cauterising or packing epistaxis, nerve blocks, dislocation reductions, removing foreign bodies from eyes etc.
What I wish I knew before starting
- The ED rota is very tight and quite unsociable. Be prepared to be working ~half your weekends, and having random weekdays off.
- The main pressure comes from having to see + have a management plan in place within 4 hours of attendance. Whilst it is important to be efficient, do not let this compromise quality of care as mistakes can easily happen.
- Nursing staff in ED are very competent – communicate with them early in terms of what bloods you may want (yes, some nurses do your bloods for you!).
- Look out for each other – ED can be a stressful environment so always make sure that your colleagues are coping. Similarly, if you have any issues please communicate with your clinical supervisor early!
- Please work within your limits – if you have never reduced a dislocation before/ done a nerve block/ removed a foreign body from an eye/ not comfortable attending a stand-by call yourself, please ask for help early.
Hospital post: Dermatology
Team structure
- Mainly Consultant led service. GPSTs are considered to be supernumery. There may occasionally be dermatology residents/ CDFs in the department at the same time, who have their own service provision requirements.
- Nursing staff are also very specialised, and often run their own clinics.
- 09:00 – 17:00, Mon to Fri working hours.
Role and responsibilities
- As GPSTs are supernumery, a lot of the initial weeks would be spent shadowing clinics and gaining experience.
- As you get more confident, you will be given the opportunity to run Consultant-led clinics. This means that you will see the Consultant’s patients for the day, under their strict supervision. You will be expected to run all patients by them initially, but this becomes less strict with experience.
Learning opportunities
- This job has a wealth of clinic opportunities, both to sit in initially and run yourself thereafter.
- There are a range of clinics – suspicious lesion clinic, phototherapy clinic, general clinic, paediatric clinic, minor surgery etc.; use these opportunities to go to as wide a range of clinics as possible.
- If minor surgery is something you may be interested in, voice your interest early as the team will be more than happy to let teach and supervise procedures like punch biopsies etc.
- There are many opportunities to get involved in QIA/ research if required, speak to your Educational Supervisor early.
What I wish I knew before starting
- While the working hours are great, this also means that the job is un-banded! You are actively encouraged to do some locum work at the weekend if this is an issue.
- It is possible to be a GP with special interest (GPwSI) in Dermatology. This involves doing a diploma that is offered across different institutions in the UK. Some require you to do a prior job in Dermatology, so this rotation ticks that box.
- Because of the terrific working hours, this rotation is a good time to do some AKT revision.
Hospital post: Palliative Care
Team structure
- 5 consultants in Palliative Care each covering a different geographical area
- Middle grade doctors including specialty doctors and GPSTs each allocated to a consultant team
- Specialty doctors cover community patients and ward patients for their consultant’s geographical area
- GPSTs cover the ward patients for their consultant team as well as reviewing other patients as required on the day – usually 2 doctors covering ward each day
Role and responsibilities
- Attendance at morning meeting where all inpatients are discussed and decisions made regarding which patients need medical review – following this divide the reviews and jobs between ward medical staff for the day
- Clerk in new patients to ward and discuss with their named consultant. Usually an afternoon job.
- Twice weekly consultant ward round attendance
- Weekly attendance at MDT where you take the notes for your consultant’s patients
- Carry the duty doctor phone approx. once per week (usually on your on call day so you are aware of any issues in the community). This is where GP and community palliative care nurse queries will come in the first instance. There is always plenty of opportunity to discuss the questions raised before calling back.
- On call – approximately once per week. Non-resident on call. You are first on for the ward and community patients. The ward will take all calls from community and discuss any problems with on call doctor as well as any ward queries that arise. You are always on with a named consultant and they expect to be called with any questions!
- Weekends – Daily ward meeting then ward round (consultant will usually come in for this) and any jobs generated from this. Only see patients identified as needing review by nursing staff. Usually manage to leave by mid-late afternoon. You are then on call (as during the week) until 9am on the Monday morning.
- Death certificates – try to have a plan written in the handover for the death certificate and be as specific as possible
- Discharge letters – template available
Learning opportunities
- Weekly teaching session (you will get the opportunity to present here as well) on variety of topics delivered by all levels of doctor as well as hospice pharmacists, community nurses and various other teams
- Weekly meeting with educational supervisor after consultant ward round -ideal for doing Mini-Cex/CBD can usually do at least one assessment per week
- Lots of opportunity for research/QI – just need to ask
- Can also get involved in community MDT if you have time/reviewing patients in community
- Weekly SPA session which can often be done from home and allows lots of time to complete portfolio/ do additional CPD
What I wish I knew before starting
- There is a lot to learn but this is a hugely supportive environment for doing so.
- The consultant’s expect to be called when the GPST is first on so don’t be scared to ask for help overnight (even if just to double check a calculation)
- Talk to colleagues and family members about how you are feeling – can be a tough job at times due to the psychological distress of some patients but everyone is well aware of this and plenty of time for reflection/discussion
- Pain is not always purely physical – explore patient’s emotional response to their illness and adjust treatment accordingly
- The pharmacist will help you out with almost any query and will also help with discharge medications etc.
- Take your time – it is a differently paced job to most acute wards. Take a chair when speaking to someone on the ward round and take your time to listen to them. You may only see 4 patients in a morning but that’s ok!
Hospital post: Psychiatry
Team structure
- Doctors are split into Tier 1 (FY2/ GPST/ CDF), Tier 2 (ST3+) and Tier 3 (Consultants).
- 09:00 – 17:00 – Two Tier 1 doctors are on call / duty to cover any admissions or ward work for other colleagues off site, remaining Tier 1 and Tier 2 present to manage their respective consultant patients. There are 4 wards (ward 2, 3, 4 and 5) plus high security ward IPCU.
- 17:00 – 21:00 – The two Tier 1 doctors on call continue the Long Day shift till 2100. ED and ward referrals are dealt with by MHATS unless busy and asked to help out. Exception to this is young and elderly patients would be seen by doctor instead of MHATS.
- Night shift 2045 – 0900 – one Tier 1 doctor and one member from MHATS team on call. Jointly see any referrals via ED.
Role and responsibilities
- NWD (Normal working day: 0900 – 1700) – Ward round and associated jobs. Attending MDT rounds where your primary responsibility is updating the patient records as each patient is reviewed by the consultant with input other members of the team (pharmacist, SN and charge nurse). Sometimes may also be required to provide cover at MDT when colleagues off on AL/ SL.
- LD – On call cover, clerk in any admissions and carry out routine admission investigations. Also provide ward cover for colleagues who may be off site, in clinics or on AL/SL.
- Clinics – Usually on average 2 sessions per week. This maybe offsite at SCH or Woodlands depending on which team you are attached to.
Learning opportunities
The rota is generous for clinic opportunities. These are great learning opportunities where you sit in with consultants or sometimes go on home visits with the CPN. There is usually opportunity on agreement to use a week to attend a speciality that may be of interest / benefit professionally, in my case e.g. I attended the addiction clinic / CGL that was conducted by a former GP. Overall, the workload compared to other specialities in your rotation provides an ideal opportunity to sit your AKT if you are in ST2 and would recommend trying to do so during this rotation. The unit is very much geared to making sure you get the most out of it educationally and they are all very supportive and the Psych ST resident are usually all very helpful and friendly to work with.
What I wish I knew before starting
- Teamwork is especially important – the workload is often evenly spread. Working together makes settling in quicker / easier especially for GP residents as we usually have little prior experience of psychiatry but the Psych residents are always there for you.
- Understand and work within your limits – the consultants prefer to be informed, no matter how trivial you feel your query may be, they are all very supportive / approachable and prefer to be contacted.