Hero Number 3 (1)

This is going to be a lengthy contribution as it describes my experiences and feelings about postgraduate general practice education which has been the love of my life as a GP.

Dr Jamie Bahrami introduced me to the enriching world of Postgraduate General Practice Education. He is the only one of my three heroes to have worked as a GP. His practice was in Bradford where he was the Vocational Trainee Scheme’s Course organiser until he took up the post of Deputy Director of Postgraduate General Practice at the Yorkshire Deanery. At the present time, Bradford’s postgraduate general practice education is second to none. This is in large part due to the influence of Jamie Bahrami. He became the Director on the retirement of Dr John Sinson. He used to make a regular contribution to what is now called the Journal of Primary Care Education in the form of a diary. He was very skilled at teasing people. Once when we were emerging from a meeting he said to me “You had better be careful what you say or it will end up in my diary”. I replied “we can all write a bloody diary” – very rude of me, actually, but then I was never the most tactful of people. Well – here is my “diary”!!!


In the early 1980’s I was undertaking the very arduous task of getting the practice up to the standards that would ensure it was approved as a training practice. This involved all the medical records being summarised, having teaching aids, a library and my attending a course to ensure I had the necessary teaching skills. In the early days of Vocational Training it was very easy to become a trainer and now there are several courses one has to attend and be assessed as well as an interview.
One now has to have the MRCGP and I sat and passed that examination in 1984. The written papers were in Leeds and Jamie was an invigilator – waking up and down keeping an eye on things etc. My interview was with Dr Sinson. Jamie did a preliminary inspection of the practice and I was not quite up to scratch. I improved a few things and then got through the inspection easily. My partner, Dr John Lee was a great help \with summarising the notes and my wife, Kath, who was the Practice Manager for 15 years, was also a great support.

Before embarking on the journey of training I had a long talk with the then Course Organiser, Jeffrey Ellis. The meeting took place in our kitchen and I remember he smoked most of a packet of my cigarettes that afternoon. I promised him my loyalty and he was always a great supporter of my career in postgraduate general practice education.


The course prospective trainers had to attend was called The “O” Course. It was held at a Teacher Training College at Ripon and was a 3 night residential course. This course had a reputation of being harrowing in that one was being continuously assessed by those running it. The main man teaching on that course was Martin Rogers. He frightened us all to death. He was an educationalist but I thought he was a doctor for the first day. A few years late I found out that our housekeeper, Maureen, had a sister-in-law that was Martin’s next-door-neighbour. After he told me that he was always charming with me! On that course with me were two colleagues – Geof Slater (a GP in Wakefield) and Douglas Diggle (South Elmsal). During one session of our training Martin Rogers explored at what point we called a patient by their Christian name. Douglas ummed and ahed about this saying that it was very difficult. Martin said to Douglas, “you’re not married” and moved on. Douglas was shocked. He was not married but was divorced. He was the only person on that course not to be married. We teased him a lot about this. Douglas hated the course and did not proceed to become a trainer, which is a shame. He would have made an excellent trainer. Douglas told me to keep at it as one could only alter things if one was on the inside.
All of us on that course knew we were being assessed even at coffee and meal breaks. One evening Geof and I escaped to have a pint or two in the student bar. After a while there Geof pointed out to me that the barman might be a course organiser who was assessing us!
One had to untertake two other things in order to become a trainer. One was to attend some trainers’ workshops held monthly in the evening at the local postgraduate centre. The other was an interview.
When I attended the half day release for the first time none of the trainers acknowledged my existence. I did not really know any of them but it would have been nice if someone had welcomed me and said hello. I never understood why they behaved like that. As time went on, all was OK. When I became a course organiser this had an effect on me that I made great efforts to make new trainers welcome.
The interview was somewhat daunting as there were at least 8 on the interviewing panel, including Jamie. This was the first of 4 interviews I had for various jobs in Postgraduate General Practice Education.
You will read later that I ended up running part of the “O” course and chairing several of the interview panels for the appointment of GP Registrars, Course Organisers and GP Tutors.
So I was a trainer. I was due to have my first\ full time trainee (now called GP Registrar) about 6 months after my appointment. However, I received a phone call to inform me that one of the trainers had become ill and I was asked if I could take over his trainee. The trainer was David Wilkinson whom I see every week now (2006) as he is a member and chairman of the Castleford Choral Society. We rehearse every Wednesday evening. The trainee was Isabel and I was absolutely petrified waiting for her to start. One can only learn so much about vocational training by going on courses and attending workshops. In the end the only way to progress is to work with a trainee. At my first meeting with Isabel, she somewhat shocked me by informing me that she was not sure she really wanted to be a GP. However, as the three month of training progressed, I realised she was potentially a great GP and all went well.
One memory I have of her was when I took her to a meeting called by the Local Medical Committee. Isobel was a quiet and thinking person. This was a committee of GPs elected from colleagues from geographical patches and was supposed to represent us all. It was an important meeting and well attended – it must have been about pay and money! The chairman of the LMC was Dr Richard Smith and he wore a monocle. (I used to call him the “monocled mutineer”). He was a great protector of GPs and would take no nonsense from “management” – health authorities etc. At this meeting, Richard Smith was making a case for something or other. Suddenly, Isabel shouted out “rubbish!” in front of 100 GPs. I was really proud of her.
At that time she was married to her first husband who worked for the Inland Revenue. My medical partner, John Lee, was shocked about this and asked me not to discuss partnership money matters in front of her. I could not understand his fears as we were not doing anything to fiddle the tax. He always whispered financial matters if Isabel was in the building. Isabel was with me for only 3 months (the ususal length of attachment is 6 months).
Many years later we advertised for a locum to cover a period of maternity leave of one of my partners. One of the applicants was Isabel. My wife and I thought we had won the pools as she was so good. The maternity leave Isabel was covering was that of my partner, Anne Godridge.
My second trainee and first one to be full time (6 months ) with me was Dr Anne Whitehouse (now Goderidge). She had a great personality and sense of humour and I realised very early that she would make a brilliant GP. She had a bedside manner second to none. There was a consultant at Pontefract General Infirmary called Jean Wharton for whom Anne had worked as part of her training. Jean told me that Anne was the best Senior House Officer she had ever had as her communication skills were so good. Jean told me that Anne would plonk herself on the patient’s bed and simply chat away to him or her. Anne obviously loved it at the practice because after completing her training, she approached me and John Lee to take her on as a partner. We were not quite ready for this but working in one of the most deprived wards in the Wakefield District was not easy. We did a deal with her and she started on a part time basis.
I have intimated earlier that I ended up in quite senior positions in the Postgraduate General Practice Education Network. This was because of Jamie Bahrami’s encouragement.

When I was vice-chairman of the Postgraduate General Practice Committee I occasionally had to stand in for the Chairman when he was away. The Chairman had to not only chair the main committee meetings but also interviewing panels. These panels interviewed prospective trainers, course organisers and GP Tutors. The panels were not as daunting as when I was interviewed for a trainer’s appointment. They consisted of the chairman, director (Jamie), a course organiser and trainer. I had the somewhat surreal experience of chairing the panel that interviewed Anne Godridge for the post of trainer. I remember that Jamie was in an impish mood that afternoon and I had to tell him to behave himself in the middle of Anne’s interview. She was appointed and was well deserved of this appointment. She is a great trainer and loves the job. The practice, where she is now senior partner, has two of her ex GP Registrars as partners and two of my exes are partners. This gives me a very warm feeling.

Being a trainer kept me up to date better than if I had not been one. Each week there were one to one tutorials with me and the GP Registrar as well as sometimes joint surgeries. The learning needs of the GPR were assessed at the start and addressed in various ways including tutorials. The GPR attended a half day release teaching session each week and learned with his or her fellow GP Registrars. The trainers sometimes led these training sessions and the content of the half day release was managed by the course organiser. When I started I dreaded leading these sessions but now I do them to help out and find them easy – experience, I suppose. When Jeffery Ellis, the course organiser, asked me to run a half day release on Audit my heart sank. I thought this was a really dry subject. I looked it up in detail and enjoyed the learning experience for me in preparing the teaching session. Jeffery was very much on the ball and had all trainees (now called GP registrars) undertaking one audit during their training time.

What happened after that was that I developed a serious interest in audit. I undertook an audit of patient satisfaction with the out of hours emergency service and repeated the cycle another twice. Most people only do the first bit of the audit. I was appointed by the Health Authority a member of the Medical Audit and Advisory Committee (MAAG). When I went to my first meeting of this, the then chairman of the Local Medical Committee (LMC), the late Dr Richard Smith (who was also the chairman of the MAAG) turned his back on me and I was referred to as the “health authority member” as though I was some sort of scab. The LMC generally reacts in a negative way to changes that involve more work for GPs and audit was one such example. In the end all was OK and Richard Smith became a most friendly colleague and a patron of the Castleford Choral Society (he and his wife Veronica had a great love of music and I am the Patrons’ Secretary). I used to undertake teaching sessions on audit in general practices. I realised that to undertake the extra work involved in audit someone in a General Practice would have to devote some time to it. I put in for a grant from the Health Authority for the salary of an Audit Administrator and got funding for 15 months and I think about 5 hours a week. We advertised for the post and Kath (my wife and then practice manager) interviewed the couple of candidates. The successful applicant was Richard Levitt, a patient, lay preacher with a degree in classics from Oxford University. What a fantastic luxury for a GP to have a person that would read up the background papers for the audit and then undertake the work. He did some high quality work and it was a shame when the grant ran out. In later years when I worked at the Deanery I was involved in managing the project and audit element for Summative Assessment of GP Registrars. Now at the Wakefield District PCT I chair the Clinical Effectiveness and Audit Group but really I have simply been the chairman of meetings with my colleague Elaine Horder undertaking the real work. The reason I believe so fervently in the value of audit is that it’s objective is to improve patient care. How can we do that if one does not look at where one is, introduce changes and look at it again, which is what audit basically is. In 2006 the Quality Outcome Framework scheme is basically a massive audit tool with indicators, targets, standards and criteria, the measurements being undertaken annually and the financial rewards for improving patient care huge. So here ends a digression into the world of audit.

I learned such a lot from the GP registrars and I hope they learned from me. I had 2 Spanish, one German and an Iraqi registrar.

Paco Fernandez was one of the Spanish GP Registrars and was big trouble. He seemed to attract trouble. On one occasion a patient hit him. An important part of the training was to look at videos of consultations with an objective of improving consultation skills. Paco showed me one of his which took place on a hot summer’s day. He asked a female patient to go behind the screen round the couch and undress. She went behind the screen and then Paco proceeded to take his jumper off ( he was hot). It looked on the video that he was getting undressed and was about to join her behind the screen! I could write a couple of thousand words about Paco. He is a truly good person and eventually gave up General Practice in the UK and is now a Franciscan Friar in Bolivia. He emailed me from there a few years ago and posed the philosophical point thet he fel that one could not be a really good doctor unless one was a good person. I totally agree and I read A C Grayling’s book “What is good” after that correspondence.

I could write about each GP registrar I have had and I hope if any of them reads this he or she will not be upset if they have not had a mention.

Patricia, the other Spanish GP registrar, had a completely different personality from Paco. Calm, good English and no problems. I was once with him when we were doing an evening emergency out of hours session and we had a visit request to a hotel in Ossett to a business man with migraine. We arrived at reception and the receptionist started the process for booking us a room for the night!

Jutta Prekov was a fantastic GP Registrar. She is German, as was my mother. She had the traits of a German – thoroughness, somewhat of a perfectionist, consciencious and a different but good sense of humour. In her CV under “hobbies” was the Argentinian Tango. She and her now husband Sven were on Yorkshire Television demonstrating and they used to teach this sexy dance. I never saw them dance but they did so at one of the Practice’s Christmas parties that I could not attend. She passed the MRCGP first time and I thought that was a fantastic achievement for someone where English was not her first language. A few years later I tried to head hunt her as a partner but she stayed in the excellent Bradford scheme.

After I had been a trainer for 10 years the Practice happened to be celebrating achieving the Investor in People award. A party was being held in Castleford Civic Centre. Absolutely unbeknown to me, Kath had invited ex trainees/GP registrars of mine. They had all to be hidden until the appropriate time. They came from all over the country. The photograph was taken that night.


From left to right starting at the back –Alan Kerry, Simon Acey, Norman Dawes, Simon Anderson Second row - Christine Dumitrescu, Isabel McCormick, Paco Fernandez, me, Carolyn Hall. Front row – Collette Coleman, Anne Godridge, Andrew Sykes.
I have shown this photograph at many teaching sessions I have been involved with.
There is a special relationship between trainer and GP registrar because of the one to one nature of GP Training. I am very pleased that two of my ex GP reguistrars are now partners in Tieve Tara Medical Centre – Anne Godridge and my last GPR, Deborah Hewitt – both absolutely fantastic GPs, of course! Andrew Sykes is now chairman of our Local Medical Committee and Carolyn an PEC member of the Wakefield District PCT. Anne runs the drug rehabilitation scheme for the PCT.

After a while as a trainer I was persuaded by a fellow trainer, the late Jean Lewis, to apply for the post of Continuing Medical Education (CME) tutor for Pontefract. Jean was the second course organiser working with Jeffrey Ellis. Course Organisers managed the education of doctors training to become GPs. CME tutors provided education and support for established General Practitioners. I applied and was very nervous waiting to be interviewed by the panel (which of course included Jamie Bahrami). There was one other colleague waiting to be interviewed and when he observed my anxiety pointed out that I was the only applicant and that they were desperate. I felt a bit more relaxed after that and got the job!

The great thing about Jamie is that he let you get on with itand motivated you to take innovative ideas forward. My job as CME Tutor was to provide educational events for the 100 or so GPs in the patch – Pontefract, Castleford, Normanton, S Elmsall and Kirby, Hemworth as well as Knottingley and Featherstone. What are the educational needs of that group of GPs? Huge and varied. I held the occasional focus group and had the benefit of a questionnaire that Jean Lewis had sent out.

In the end I took my guidance by looking at my needs and discussions that took place at CME Tutor’s Seminars held 3 or 4 times year. All the CME tutors from Yorkshire were expected to attend these seminars. They were greatly creative and this creativity was facilitated by the input of the director, Jamie, deputies such as Brian Ormston and Philip Nolan and other fantastic educationalists such as Paul Robinson and Alison Evans. The seminars were held in a marvellous venue in Ripon – a teacher training college with residential facilities, great food and a superb wine cellar. As `a trainer one was expected to attend a seminar there every 2 years. I also became a tutor on the Summer School on the ethics subschool and this was held in Ripon. I will describe life at Ripon later but it was a privilege to go there and be with such colleagues.

So what did I do as a CME tutor? I think I was innovative and tried to make the education interesting. However, there were bog standard stuff to put on. I had to approve/accredit educational events suggested by pharmaceutical companies, consultants, general practices etc. This was not innovative stuff at all but was pretty important as it constituted what is now called “maintenance of knowledge and skills”. There were events about cholesterol, menopause, gastroenterology, resuscitation etc. It was good to approve an educational event suggested by a new consultant so that GPs could meet him or her. There were lunchtime lectures at the Pontefract Postgraduate Centre. There were lots of evening events. Many of these events were paid for and sponsored by Pharmaceutical Companies.

I was a CME tutor for about 8 years and it was a great experience. I often say that “I have CME Tutor’s blood coursing through my veins”. I will describe some of the innovative and exciting educational events I set up and I must say this work was greatly appreciated by Jamie Bahrami who motivated me to continue this sort of stuff. I must say that most of my CME tutor colleagues in Yorkshire were innovators and encouraged to be such by Jamie. I got some of my ideas from these colleagues. At CME tutors seminars we were encouraged to present to one another our achievements.

I organised a large debate at Pontefract. The first had the motion which was something like “that this house believes that fundholding is the best development of the NHS since its inception”. It was packed. We hired Pontefract town hall. The event was sponsored by 6 or more pharmaceutical companies. We videoed the debate and the video is in Pontefract Postgraduate Centre library. The motion was defeated.

The second large event, again held in Pontefract town hall, was a lecture from the ex Bishop of Durham, Bishop Jenkins, on “Spiritual Care”. It was riveting and he was challenging. I was sat next to him and his notes for the talk fascinated me. They were one big doodle. I realised later that they were a form of mind mapping.
Another event took place as the 1997 General Election was approaching. I held an event on the lines of the BBC’s “Questiontime”. I invited each of the 4 prospective parliamentary candidates (Labour, Conservative, LibDem, UKIP) standing for the Pontefract and Castleford Constituency. Each was allowed to bring one other person as a guest. All, apart from Yvette Cooper (Labour) brought their agent. At the back of the lecture hall in the postgraduate centre was a bloke wearing a flat cap. He was Yvette’s guest and was, I think, a retire miner from Knottingley. The questions were all about health policies. It was a good evening.
I held several education events for GPs and another discipline – pharmacists, the clergy and vets. The evening with the vets was memorable to me. It started with a 10 minute talk from the Hospice doctor about how she was against euthanasia. There was a perception from the GPs that the vets put animals down if they coughed once. One vet had specialised in bereavement counselling. Another gave a short talk on medical conditions humans could get from animals.

The events described above are an illustration of how we GP tutors were encouraged to be creative and we shared our ides at the seminars at Ripon.
What about Ripon. Please see Hero Number 3 (2).