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There we go. Um, so hopefully all being well, we are live. I wonder, Could somebody in the in the audience just pop us away? Message in the chat? Just let us know that you can hear and see us. That would be great. Hopefully the chats accessible on the right hand side of your screen. There. Brilliant. Got Jenny. Thank you very much, Jenny. Much appreciated. Brilliant. So, folks, welcome along to our GP society. GPS with special interests event. Thank you very much for giving up a bit of your time to join us Live. Um, if you're joining us after on the recording again, Thanks for tuning in and listen, hopefully, hopefully you'll find this evening interesting and informative. We've got a fantastic lineup. Three dedicated and great individuals who I want to from the outset. Say a big thank you. You too. Thank you, Doctor Rafferty, for giving up your time to give us a talk about out of ours. And med Doctor Hamilton e d is busy enough without without having to give some time, Does so really appreciate it. And Doctor Rusk, who I am well informed, has has scrambled home from a house call after work to join us. So I really appreciate you giving up your time. But look, I will not I will not start the ball anymore. We'll get up and going. And I'd like to welcome doctor on your property. And I'm going to pop your slides up for you and we will get underway. Thanks, Tyne. That'd be great. Thank you so good. Good evening, everyone. Um, firstly, I'd like to thank Tim Aura and L for, uh, opportunity to speak at this event. I really appreciate that. How much organization goes into something to to run something like this. So I just want to say thank you very much for this opportunity. I really appreciate it. I'd like to say hello to everyone online. It's a real privilege to be able to speak to you about something that I do and something that I love. So thank you, too. And thanks for coming along. I just like to set a few rooms before we start. I'm happy to take any questions. And if you guys are able to commute and speak to me, I'm happy or just pop them in this side in the chat, I'm more than happy to answer them as we go along. As you see here, my name is Doctor on your property. You can call me on you. I'm a GP medical education fellow. I'm a GP who works near the barge. I'm also a GP out of ours trainer, and I'm now recently named a facilitator for the scenery. Um, Tim, if you mind checking on, please, that'd be great. So the thing you need to ask yourself whenever you are at this stage of the game, which is medical school, I think from from the GP society folks from Queens, you're going to be a student. You need to ask yourself, what do I want to do? And literally, it could be anything. It could be anything from a non medical job such as some of my friends have done London that started banking. It could be a med tech job. Or we can go down to the traditional route that we all know and love. Tim, if you can just pop the next slide, please. But most importantly, you need to choose a job that you love. So choose a job that you love, and you will never have to work a day in your life. That's one of my favorite quotes from a Chinese philosopher and Confucius. And if you can bear that in mind, whenever you're thinking about your job, your future career and what you may be like into your thirties and forties and what kind of life you want to have family wise and on call wise commitments, then I think you won't go too far wrong next, like please him. So just before we go into how we've got to the stage is that we're at, I think it's good to set a basis of of our understanding of training. Okay, so in total, the shortest way to get to be a GP is 10 years, and thankfully, you guys are all in Q B. So you're somewhere along that green trajectory between zero and five. So the next slide there, please. You can see here your colleagues who may not decide to be GPS there trajectory can take from 0 to 14 years. These are all estimates. You might have additional things that you want to do with your life. If 234567, you might want to go to Australia. You also might want to do additional degrees. Of course, is maybe take a few years out, perhaps even start a family. Imagine. And therefore, that could be stretched longer that time frame. So bring that in mind. I think GPS really realistic for a lot of people and can attract a lot of people because of this time next week. Slide there, please. Great. So I'm just going to briefly talk about how so some people ask me, How did I get to the stage like that? I try to put in, like, a timeline kind of thing there. So if you want to tilt your head to the side, don't worry. I think I put you can click again for me, please. That's great. Yeah. So I'll put Timeline in there. So you guys are all in medical school, so we're going to start after foundation training. So I went to medical school in Bristol, over in England. I was there for five years. I did not enter plate. I went up to do my foundation training in Middlesborough in England. It was great in a big tertiary center. After I did my foundation training, I came home to Northern Ireland and worked as an E D s H O over and Gavin here. I took a full line on the S h O wrote it and just did it because I had to pay for the wedding. So that's what I did during that time I applied for GP because I always knew I wanted to the GP. So the application process at that stage stage 12 and 31 was the actual application of paper format to was something similar to the sgot that you guys will sit when you're in fifth year. Stage three is like an oscal so that if you got a black mark against journey and you weren't going to start the GP program currently, this is not the case due to covert and coated restriction. Stage three does not happen from my understanding. So yeah, Then in my e d s h o year, I started to do my MRI seepage, part one paper, and then I want to do the A ski in my first year of my training to do the, um, the pulmozyme Pediatrics. I then went on to diploma in psychiatry, followed by the Med med certificate at the last year of my GP training because it's GPS. The 12 and three on GPS D three. I completed my ERCP exams. Great. So then you're fully qualified GP, and you can do whatever you want so you can go into practice or you can just take a sidewards step like I did and I started the education job. So that's where I am currently. So now in my post for about a year and three months. And last year I completed my medical education diploma, and this year I'm working towards my Medicaid masters, and I'll be working, hopefully with some of the Q U B team in the simulation Sweet in Belfast. My trajectory for the next few years is, I don't really know. I'm enjoying the time that I have here and stuff, and I'm thinking maybe you want to do a PhD in education. There's so much places to go with this. You can go around the world in your PhD or you can do a smaller kind of PhD called an MD. So that's the kind of rude I'm thinking the moment. But the fact of the matter is, if you do GP, you don't have to be hand in or punched into any holder ship. You're a bit like your malleable and you can go whatever way you want. And so that's what I was going to check where I am now in my notes. That's great. If you can pop on another way bit third time, but remember to be a GP. This is all what you need to do. So I blanked out everything else that's unnecessary. So you just need to do those three stage application if it gets back there whenever you guys apply and the two exams okay, so it's called E r C E g p A k T A R c g p A R C A. BRCA used to be called CSA whenever we did it during Covina, you have to film yourself in your surgery and then our friends over in London. What annihilate you and give you a mark? A passer feel. And that's basically how it is currently. Um, I think that will move back in around this time if not for the next sitting. I haven't read the most latest guidelines for that. That's great time. If you don't mind popping on the next slide. So this is what I do. And so I work in the medical education department in the Southern Trust. So it's again on both sides. I work here Monday to Friday. It's a 9 to 5 job. It's a regular job pattern. Um, I get back home to improve. I believe on you. We might have lost you there with We got you back. I think I can see I've got you got you back. So I'm just talking about that. We make regularly with the team. There's what There's four of me. And so we made a regular gynecology piece. So once a surgeon and one's an ent doctor, another one is another GP who works some daytime sessions where, as I do that and, um, so anyway, we make regulate and discuss about what we can do. Then we also meet with the hospital consultants who are clinical directors and then how we can improve and we try to action those things, trying to maintain and start a culture of education and learning within the Southern Trust which is going and it's going well. It's going really well, and it's getting bigger and we took over more floors in the garden. So right now we've got a relatively new medical education center in Daily Hill. It's new, it's refurbished. And that's where we do all the FBI one inductions whenever they come in in August. So we'd like to support all of our junior training. So they want to stay and work with us later in in their lives. And they're doctoring career. Yeah, so that's basically what we do during the day. If you pop on the next slide there, please dot So this is what I would do generally during the week. This is one of my weeks, about two days a week. We run this platform metal, as we all know and love, and it's invaluable. It's one of these resources that has really helped us through, coded through abbvie absences, sickness and illness. But math and pat leave like these things. This has been invaluable. This resource that we all are currently sitting in virtually, um, it's been great. So I spent about two days a week trying to organize that uploaded, make sure it's correct and maintained there's a lot of clinical governance data regulations on GDP are issues surrounding metal and to ensure that they are correct and fall within trust policies. Takes a bit of my time. It takes a bit of the time people think I have I t behind me. No, it's just me. It's just me, But I enjoy it, so I really don't mind. Wednesdays we do F one teaching for at least an hour, 15 hour and a half, trying to get through some some sessions, acutely and well, patients and run through those things. If I don't know how to do this myself, I drafted consultants, specialty doctors, um, who who are in that field? So, for instance, we had major hemorrhage protocols ran out about three weeks ago. I've been on holidays past few weeks. So three weeks ago we had major hemorrhage protocols by one of the surgeons of myself, and we ran out of both sides. It was really interesting. Every morning I also take part in operations meetings in the hospital to ensure that any new developments in the hospital are disseminated and the information is dispersed among the juniors in the hospital. I also have to take part in stuff that's outside the realm of GP, such as LS Training, which I really don't mind. I like the acute scenario, so that was whatever week I did that I had to go through some more training sessions. So I'm fit and capable to teach other folks on Fridays again, maybe up in India, to ensure that we know how to teach our doctors to ensure that they get their portfolios done in time for April. Thanks to him the next week slide and people come up to me regularly and say, Oh yeah, that's a great number that you have in the hospital, So I just got too quickly talk to you about some of the challenges that I have in my role. Number one is probably that's the most common, but I don't know what I do, and that's fine. I completely understand this is a relatively new job role in the trust. It was about three years old, and I've been here for 1.5. So it's managing doctors expectations and see what they expect of the Medical Education Department and what they expect of myself. And, you know, you know as well as I do doctors can be very difficult. Maybe, maybe more easy. Easy to take a bag full of weasels who are like jumping around on top of each other because doctors have a mind of room because most of them are autonomous. Think that certain way it should be done in in certain things. So you smiling? Not. And you try to negotiate different ways in which how to develop and change the way in which were taught, attending and teaching due to the facilities in both the hospital. Because they're being used regularly, we need more. So we are trying to put in business plans and expand the department. Hospital pressures are also an issue that if you can't attend teaching because of somebody's unwell in the wars or in a and B or in theater that you're not going to attend. But thankfully to the computer system that we have called metal that's improved. Intense is limited resources, so we don't have that many blood arms. We don't have a big needles all the time, and that's that can be difficult to, but with new stuff and that was in place that might improve, and the technical ability of staff and teachers um, it can be quite challenging to try and ensure that everybody knows how to use this stuff whenever you're given, like, so that also can be a challenge. But I really enjoy my job, and I like working with people, and I'm generally easy to get on with, so that's why I like it. But there's some of the tricky things I have to deal with today is other folks who would like to teach other. We slide on there, please. And, um, another question. I get regular. Do not work in G P anymore. So, as you can see from this talk, that GP just isn't GP anymore, I just like to remind people that GP is portrayed as not a glamorous roll right now. If you were to go to any other country in the world, you would be snapped up in a pinch and you'll be gone so you can. You can work in Canada. You can work in Australia. You can work on the south of Ireland and the UK and including Scotland, Ireland Man and the Shetland Island. So those are things that you need to think about that if you're not happy with the way you're being treated in Northern Ireland, we'd love to keep you. We love you here, but you can go other places. And that's the other good thing about GPS that you can go anywhere. So do you not Working GP anymore. The Frank and short answer is no. I do not work in the daytime GP practice anymore because it doesn't facilitate my medical education role. Brilliant. So I work 10 next life. So what I do do is a GP in the in the out of hours. So I work from 12 to midnight. I do that twice a week. Um, there's normally six GPS covering the Southern Trust. The Southern Trust is the largest geographical area in Northern Ireland. It's population is about 365,000 people, and there's a phone first service. But prior to the get prior to that individual getting to any and there's also the urgent care center, so they should be using the phone first service first. And a lot of those phone calls can be diverted to somebody like myself to back them away from our important colleagues and prize colleagues in the hospital. Because a lot of stuff can be managed, I'd say, Um so there's two bases, one in DC Hill and one in Craigavon. There's three doctors in both, but a lot of time it could be one and one or two and two or none. None. Just me. Um, Thankfully, I'm lucky because I'm a trainer, so I may have one or two trainees with me. So most of the times there's always to me and somebody else. Maybe a third will have to trainees on. So the trainees I take ST two and three. What we see in the out of ours mainly is acutely unwell. Children, palliative care of patients and mental health patients. Uh, just bring in mind that we are not like our colleagues in England, who have the psychiatric mental health team who section people in Northern Ireland obviously GPS section their their patients tradition. That is a tradition and that Northern Ireland has that's different than the rest of the UK and as we are meant to know our patients and that's just developed that we do Section three in the community, part of care of patients. Just if they needed there, the syringe driver or if not more sub cut medication written up and titrated to ensure that they're comfortable over the next 12 hours to get them around to see their own GP colleagues. As we have limited resources and like everything else acutely and well patients, we all know the cough group wheezing temperatures rash is nonblanching rashes. We just need to ensure that they are safe during that period of time and a lot of the time patients just need education. There's a wonderful website called Healthier Together, in which I use regularly to try to educate parents to ensure that they know how to look after their Children. It's not that they don't know how to. Most of the time, it's just that the anxiety is, get the best of them and they need additional help. My role is a trainer, and it's great. I really enjoy that. There's very much like people like ourselves. They're they're funny, they're entertaining. Um, they just want to get the job done and do the best for the patient, and sometimes you do have the training and difficulty. They sometimes need closer monitoring and closer supervision, and that's probably the most trickiest part of my job because people mean the best. Generally when they're a doctor. It's just that some people need additional help in hand, and they may need to be referred to the PS You, which I think stands for the peer support unit. If they have any difficulties getting or attaining there proficiency, she's in training. That's meeting next night, so there's a new role at the moment. It's a clinical facilitator roll, and it's doing with Nimda. It's You may know this. So you may have heard of some of your older mates, and you know, you're now foundation doctors. It's something called flight modules, but you need to complete, attend, be certified that you've you've done these. Those like mental health, acutely deteriorate and patient, acutely unwell. Palliative care, definitely prescribing. Talk about warfarin, all those things. That's what flight modules about. So it's standardizing the foundation program teaching within Northern Ireland, which our colleagues over the waters already have done. So we're trying to do that, and it's mandatory. Teaching has to be completed, but we need to make sure it's engaging. So, um, I want to make sure that happens because it's nothing worse than death by power point or resume next. Next, over there, please him. Yeah. So I'm happy to receive questions by email. I'm more than happy to take questions now or in the chat. I will respond on some shape or form. I really appreciate your time listening to me. Ramble on about how much I like my job and how I got here. There's two more senior folks who are about to speak about GP lab. Um, yeah, they will have more experience than me. But, you know, my final thoughts and words would be Make sure that you're happy about what you do, and if you're not, just change direction. That's fine. Mhm. Have you gone in A. I think Tim has gone in my so well. We just keep moving on to yourself. Richard, I think we've actually got a question here in the chair. If we can just go through that. So Alexandra has asked, Why did you choose to go more down the education route rather than GP? That's a really good question and thank you very much, Alexandra, for asking that. And the reason why I went down the education route rather than GP is because the job came up and I thought, Heck, if I don't do this now, I'll never get a chance. But here I am left. So you're You're right. It was a perpendicular route, and I was offered partnerships and jobs when I left my training practices and I really love them, and they were really good to me. Um, I couldn't speak highly enough of them. Take it up to one point in stuff and trust Summerhill and Church walk in Logan. I love them both, but it's it's just that this job came up. I thought I thought of it as a good opportunity, and I really did make me dizzy. So I thought, How can I make a change? And that's why I went on to do this job. I've been here since because I enjoy it. So again, I think you need to enjoy what you do. That's why I chose to go down the educational route, because I know it would be something that I enjoyed the long term, and it would be something that I can see myself doing long term. I do have the view to go back the GP. It may not be this academic year, but hopefully next academic year. But thank you, Alexander. I really appreciate that. Thank you so much on your you laugh. They're about keeping colleagues going right and keeping the right and technical difficulty. I managed to exit the meeting there, which is a little bit embarrassing, but I did hear that. And thanks very much, Alex. For for asking that question, folks, If you have any other questions for you, keep them. Make a hold of them, pop them in the chat now, and we can we can we can catch up towards the end of the meeting again on you. Thank you so much. That was absolutely fantastic. Much appreciated. And we will move on to number two this evening. Excited to have Doctor Richard Hamilton along. Um, Richard works in in a and A and I'll let them introduce himself and and have a chat with us. Thanks very much. Yeah, I'm a GP partner in your e. And I've worked really, ever since I was a GP registrar. Back in 2008. I think it was I started doing shifts, um, in the local emergency department, and I never left. I stayed doing shifts the whole time and eventually came on a contract with the Southern Trust in the state of stayed doing shifts with it ever since, Um, in terms of my general working week, two days a week in general practice as a partner and 4.5 sessions average in the emergency department, where I do a decent amount of out of ours work as well. And I'll do a late shift every week. And then I do weekends. I do one in four full weekends in the emergency department. Um, so I I used to work in the out of ours as well. I've cut that back just because I'm already I've got quite a bit about of ours commitment going there, which currently suits me. Okay, But I can't really increase that Anything beyond that. At the minute I got into this role, I stayed in the department. I I'm older than the the FBI. One and two schemes. So I started with Preregistration year and then went straight into GP training after one year and my first s h O job was then was was in the emergency department just thoroughly enjoyed it as well. I just found the workload of the buzz of it. Um, and the cure of the patients just very interesting. And I just loved it with the general practice training, so I just started doing it. After that, it would have been a small department, so that wouldn't have been much in the way of middle grade sort of cover at that time. So whenever I came on in the evening that I would have become quite experienced quite quickly because I did. I do such a big balance between the two. I think developing an interest in something, you know, if you're only doing one session a week on this, you may be done a few years training in that specialty. I think it's difficult to develop skills in it, but when you're doing half, you're working weekends in a specialty. You do develop your skills quite quite well, particularly if you're invested with a particular trust, the particular department where they want you to become experienced in it. Um, so I think that's why I found it so enjoyable to sort of keep that balance going throughout my career. Um, in terms of what it brings to the practice uh, it obviously keeps your practical skills up to date. If you're doing a specialty, like like the emergency department, it keeps the practical skills going resuscitation skills, strong skills, all that. There it is. It is very, very useful. It's also really nice to have that link with your local hospital when you work in a hospital and you know, the consultants, the in patient consultants, the radiologists, the radiographers staff. It's so useful to have that link and when you're yeah, I'm not linked something. People that you know that you can run this by you. It's very, very useful. It's also useful for the partners in the practice who can also run things by me because there's a lot of changes that have happened in the last 10, 20 years and in the hospitals and how we manage things and how things are carried out in the hospital. And it's very useful to have somebody that my partners can bounce off me. Questions about what's happened in the hospital now with with the suction condition it's it's very useful, and my partners, I have partners who work in hospice and diabetes, interest and travel, medicine, interest and again, I would be going to them, asking them questions about the specialties as well. It's just it's very, very useful to have that as a balance in a partnership just for your own learning needs as well. Um, very, very keen to sort of keep it going and for to see GPS doing diverse rules because it's so useful for the practice in itself in terms of extra training that I did. I mean, once you're invested in a trust trust invested in new in terms of training, it's very easy to get on the courses and things that I would have done all my resuscitation courses. I would have instructed on the Alesse course as well in the past as well. I've been invited to that. After doing it, Um, I don't know. That's probably the third or fourth time and then and then became an instructor on it would have done trauma courses. There's lots of different sort, of course, is that you can get on relevant to your specialty and the trust because they you're you're on a contract with them and they invested in you. They'll fund those. They'll give you the study leave to do those, and it can really help you develop in your career as well and the opportunities that it gives them. Obviously, you've got your courses. I've previously had work done work with the pharmaceutical industry as well, who have known that I had done training out to different practices just on a particular interest I had in terms of venous thromboembolism. We would manage that a lot more in emergency medicine than in primary care, so I would I would have had a lot more experience in managing it, and I would have done educational talks, industry funded at the time and and an educational talk with all the GPS in the practice in the in the local area. So it was just very useful for that, Um, I think Tim had asked me to sort of come on here and frame. This is as promoting GP as a as a diverse specialty, and it's an easy thing to do. It's general practice, to me is by far the most diverse specialty. It's just you can develop an interest, and yes, we want we do. We need a lot more full time GPS to get the numbers up, but because we have these opportunities now, because we have and the wealth of experience that we can go into other specialties and actually really help out and make a difference with things. I think I think it's a lot of the way forward is that people are going to develop a particular interest. And, yes, do a bit of clinical general practice as well and and sort of balance that with with another interest and that interest is going to bring help to that practice as well. It's not just you're doing it for your own interest. It really does make a difference to partnership into practice and to your patients if you are able to sort of bring those skills back into your into your practice, Um, so again, I'm happy to take any sort of questions and stuff. My my route to it was quite simple. I just enjoyed it, got stuck into it and continue to work a lot. And I'm happy to take any questions in terms of how to develop those interests or in the balance between 80 and GP as well. That's fantastic. Thank you so much, Doctor Hamilton, That's brilliant to here. I have a question because because Because I'm nosey. How do you balance being a GP where you're out on your on your own, so to speak, with being an E d and having access to the CT scanner just around the corner? How is that? Is that a difficult thing to do? No. So I I don't find that difficult. There is. It's a very interesting question. It's something we actually talked about regularly with some of the consultants and things because we'll get a patient who, you know, certain presentation. And I think I don't need any blood results on that. I'm happy just seeing that patient and managing that patient. We were actually talking about this a week or two ago. The consultant was much more. But the expectation and the level of care that we should be providing in the emergency department is that we're doing these bloods and things, and so that will be the expectation and, you know, to me it should be clinical assessment, and they're happy with me doing my clinical assessment and the way I would normally manage things. But they get so that's so entrenched. Not just the juniors but right up to consultant level where they've got these investigations and therefore they do them. But I'm very happy with managing things clinically. It's quite nice to have a CT scan around the corner whenever you need it, but to me it doesn't make a difference. The patient either need to see, see scan or they don't know if I'm in general practice. They get sent wherever is most appropriate to arrange that, but I don't find it too difficult. I'm happy managing things without this intense investigation, and that's what GPS do now. GPS have been shown in any whenever they start working, and then they become any doctors. And I do a lot more investigations in the emergency department that I do in general practice because I know there's certain defensive expectations set. But I don't find that a difficult thing to balance, and that's that's probably patients. Maybe whenever they're arriving to any kind of have their own expectation and their own kind of vision of what will happen when they go in there, I'll get my blood checked and everything, and it's interesting that that doesn't have to be the way that's that's good to hear. We do have one other question in the chat. Um, maybe a very nosy questions feel free, Not the answer. But I suppose this is This is a good point because I think medical school is definitely, definitely taboos the subject of talking about, you know, if I don't work in GTP all the time, you know, how do I get paid? But just wondering is the pain if you're too little similar, or is there a big difference? Or are you happy to comment on that? Yeah, so there's a big point to make with this. So my session in emergency department is four hours. I will go in at two o'clock, finish at 10 o'clock. That's two sessions, and I'll get away reasonably on time. And if I don't, I'll maybe get that time back another time. It's four hours for a session, my role as a GP partner a day and four hours a session. So it's it's difficult to compare this. I was working there on Monday and I went down at seven in the morning and I actually got away reasonably. Okay, it would have been five half five, but that's a lot longer than the eight hours, and I'll often log on the night before as well to get up to date with things. And so it's generally GP. You're talking 12 hours, 11 hours, 12 hours. Days. Um, so you're trying to compare what you're getting paid per session, but you're working a lot more hours. I don't think it would be a massive difference. There's there's no doubt the GP partner pay is more per session, but the session is not four hours in general practice. Hmm. It's how you want to create your work. Life balance is the big thing, and balance and things without of ours out of ours, pay tends to attract sort of more, more sort of payment as well. But it's lifestyle as well. I mean, like, I have a young family. My wife's a nurse calls out of our shifts as well, so I can only do so much out of ours. There's more, more to life than the job. Also on your on your, uh, on your comment. Come on ahead. Can I ask you a question there, please? Richard? Yeah. Is that okay? And how do you cope with being a GP in e. D? and the passing comments that you might get from other clinicians about the GP special. You don't know if that's if that's too much or I get extremely defensive of the GP rule is the short answer to that GPS. Have a very, very difficult job at the minute. Um, they've always had a very difficult job, but it's extremely difficult with the workload pressures at the minute. They just aren't enough GPS, and there aren't enough physios and social workers and things that practice that even when there are patients, don't necessarily haven't gotten used to that roll yet. They very much see that they have to see the GP thing. There is too much negativity about general practice at the minute general to me GPs. So I worked in any from before coated, and we would have had patients regularly coming up, too. And he's saying, I can't get an appointment with GP for three weeks. Um, now, since coated, there's a lot less general practice cases in a d. D. I'm the one who generally see them. There's a lot less than there used to be. They're they're coming up saying they can't get through on the phone and stuff. And, yeah, it's very busy. You know, it is difficult to get through on the phone, but that's because we're so busy. But I am seeing less general practice stuff in me than I used to be. And I am very vocal about that, to the consultants and things and in fairness, when you pointed out to them. Yeah, they understand that there's been studies looking at a and the attendance is a GP cases back to the seventies, always saying the same things, you know, So I I'm very defensive of general practice. That's great to hear. I feel the same Richard, um, one of one of my babies, very jovial. I don't know if it's if it's appropriate or not, But I often say to my colleagues in the hospital, I go well, if you just look at it this way, you can get a clinician to consult you within a day and maybe even get seen. But you can't get to see your hairdresser for three weeks so you know, and you don't have to pay for it. So people keep forgetting about that aspect, too, so you can get like nearly instant health advice or care. That day I had a I had a great a great conversation with some of my final your colleagues in dizzy pill today about managing, managing expectations. Think there has to be. I think that definitely needs to be a wee bit more sort of change of the public perception. But that could be a whole event of its own. Couldn't folks by all By all means, Doctor, thanks so much. That was that was more than insightful, very informative. And personally, definitely, definitely good to hear those insights from from a Life in E d again, folks, if there are any other questions that problem in the chat and we can we can circle background, but we will move to our our last but not least speaker for this evening, Doctor Lewis Rusk GP with special interest in neurology. Doctor Rusk, thank you so much. Once again, you've also had a rather busy day. A house call, I believe. Yeah, so just an enema, scrubs slash pajamas and yeah, so, I mean, that's the reality of general practice. Is Richard just said it doesn't switch off Just when the end of your four. Our session, Um and I knew that I needed to be here. But I also had a patient coming up at quarter to six and another one, which was a safeguarding issue. Which means, you know, if there's somebody vulnerable, like an elderly person, and something happens to them in a care setting, a doctor is usually needed to go and look at that situation and assess. And you can't really put it off because you've got to talk to, like, seven o'clock. So, uh, so I ran off and did that, and I'm not here to speak with you, so I suppose Thank you for, uh, coming here this evening. Tim, I want to say thank you for inviting Richard and on you and I to speak this evening, but also for your leadership. You know, it's really great to see your enthusiasm. You do all this in your own time. I've met you obviously, through Twitter, I think, initially and then through the Royal College. Um, so and and it is really good. And I would say to the any students that are listening, you know, the leadership. Yes. You know, Tim has been very brave to do that, but it is really worth trying to to dip your to in these leadership opportunities early because we know, like we all know who Tim is. Um, and a lot of us doctors do because he has been brave enough to put his head head of all the parapet. Anyhow, moving on. I'm actually older than Richard. So although I qualified as a GP the year after you, I think Richard and so I'm also pretty f y two and and I really identify, But I really identify a lot with what he has said about that primary care secondary care thing. Because, as I'll tell you in a minute, I do both. I work as a GP and I work in a trust setting and actually in the current environment, where it can be quite toxic, it's actually really good to have to have a fit in both camps, and it means that our neurology colleagues like you would not hear them. I mean, it's a consistent and pretty small team now, and I work in the Southeastern Trust in it. But you wouldn't you might hear them give off a little bit about a particular referral, but generally speaking, very supportive of GPS and probably well, maybe it's just because they're really nice people. Or maybe it's because we have worked alongside each other for 12, 13 years. And I think I also don't like to hear people being critical of the consultants or the 80 or anybody in secondary care don't like to hear GPS added either, and GPS complaining as well. Um, so I think, uh, the ring is a really not a good thing. And so having being able to sit with it in both camps is is good, I think, for that breaking down barriers. So, yeah, I work as, Oh, can you go to the next like they're sorry. It's strange not having control of my own, my own presentation. Um, so I didn't always want to be a GP. Um, this photo is taken from my parents' home. I'm from the from down in the form in a cabin border. Um, I grew up in the country. I wanted to be a vet, not a doctor at all. And then whenever I was about 16, I think it was my sister became very, very unwell and had sepsis and, you know, life threatening condition. and was in the Royal in intensive care for quite a long time. Ventilated. And so we spent a lot of time up in the hospital as a family kind of up and down. And I was really aware of, you know, the battle that it was to save her life, but also the care that the doctors really showed to us as a family because we had the sickest young person in the hospital. And so I decided that I wanted to be a doctor instead of a vet because I thought it was the kind of saving lives and getting alongside people in their suffering that really attracted me. Um, so the GP was never on my radar. In fact, like when I think about it, my memories of going to see the GP as a child, it was a small little room somebody. It was quite isolating as boring sort of a place. And it certainly wasn't something that was talked about when I was in medical school. And so it's great that the GP Society is really working to try and make people know about general practice. So I know I headed off to Queens all bright eyed and excited about being a hospital doctor, and that's what I wanted to do. Um, do you want to go into the next thing? In fact, I actually really like, you know, I did reasonably well and exams and things. And then and, you know, I didn't like this narrative of, well, half of you're going to end up GPS, which was really annoying because I thought, Well, I'm not going to end up, you know, I'm not going to end up and and so that probably those little comments probably further made me think. Well, firstly, I never noticed GP. It wasn't something that I wanted to be. And now I definitely don't want to be it because I don't want to end up it. And so I Yeah, and I think at the moment it's difficult, because now you've got media and social media further saying these things about GPS. Thanks, Tim. Um and so this is a photograph I searched of Alcoholics Anonymous to look for an image, and this is an image of Alcoholics Anonymous. And so if I think about it, did I ever come across the GP with specialist interest in my career. I did, actually, as when it was a P R H O, which is was then became like f y one. I think that is. And I do remember being sitting and it was incredible in on you. And, uh, Consultant Reverend Forbes had done this education event for the junior doctors and he had a number of speakers in and one of the speakers that came in, he put he stood up and introduced himself, and he said that he felt like he was Alcoholics Anonymous that he had to say, I'm just a GP. He had to put his hand up and confess that he was a GP in the midst of all these hospital doctors that were speaking and these hospital doctors that were listening And you know what? He was the best speaker of the whole event, and I but I thought that's kind of interesting. And it made me think, Gosh, imagine that's how GPS feel about themselves. So I sort of started to think about GP. Um, so next one Tim. So, yeah, I did it and I did my registration job in Craigavon. It was great crack. It was, you know, six months of medicine. Six months of surgery. It was pretty full on, um and we got a lot of experience. It definitely was more hands on experience, maybe than our my peers and the royal. Probably because it was a deep district General hospital, and and And we work pretty hard. Um, I not wanting to do a GP. I went on to decide I wanted to do something that the medical rotation. So that's that's where your training to be, a hospital consultant, you know, working towards, you know, going on that direction of the hospital consultant. Um, I did my these exams membership exams, the M r C E P, which is a set of exams that you would do if you wanted to be a hospital. You know, go onto specialist training to be a hospital consultant and did those and went through those. You know, um, I was fortunate to get through them all first time because they weren't. They weren't They were tricky enough exams. And there's some luck when it comes to have multiple choice as well in the first favor. Um, but anyway, go through all of those find myself then and having examined. Haven't arrived at that stage before I was finished The train, you know, the rotation. And so I got bumped up onto the medical Reg wrote, uh, which was just because I had some extra letters behind my name. But I had not enough experience. It was absolutely terrifying. It was in the matter. I spent so much time in any scared out of my wits. But I had lots of brilliant support from the Ent doctors and from the consultant that was on call. It was great. And but one of the jobs I did was neurology. And I found neurology Absolutely fascinating. I just thought it was great that you could take the story, take a story and then you just did the investigation and all that the investigation was to do is to confirm that the lesion was where you thought it was from the story and from the examination, and I just found it really like a really interesting puzzle. So I applied for specialist training in there, did it for about 18 months, but I was doing it with I was doing this really specialized area of it called neurophysiology, and during that time, I thought You know what? I really miss all the other things that I did and love throughout that other training A mist of rheumatology I thought I quite liked. You know, Children were quite liked cardiology. I liked all of those things and I found and I remember one time sitting in a urology ward somebody became really, really well with the heart. And I had just done cardiology And I said, write I can, you know, sort out this and they said, Oh, no, no, no, no. We have to get the cardiologist. And I was like, Oh, no, no. But I was doing that, you know, in my last job last week, and it wasn't I wasn't able to do it, and I sort of thought, you know it. The the discontent with being so specialized coincided at that point with an opportunity that came up for a very, very small number. I think there are four or five posts that became available. That was shortened gp training posts, and they were for people who were in hospital and wanted to kind of move out. And I thought, I'm just going to push the store and see what happens? So did so. All right. Um, so yeah. So then I went to the GP gp training, and I think it might be missing a slide. Can you go on to the next one and see what it is? The next one? I think I'm missing side. So anyway, and yeah, So I did. Uh, I went on and the gp training have to say I had no clue really about about what a GP about who to even contact to arrange for my training. But I went and I found one. And the interesting thing was that when I told my neurophysiology consultant that I was thinking of doing this, I felt like, really embarrassed with want to change careers. But he said, actually, I was a GP and I became a neurophysiologist, and he so he said to me, I've got a friend who's a GP. Why don't you go and talk to them? So I went and I had a chat with them. They put me in touch with somebody else and I went and did my GP training with them. But what did I see? I know. I found that with the GP, the GP, the Jeep, the GP new. So much like they knew a bit about absolutely everything. And the GP also knew these extensive family trees and they had really strong relationships with family. They, you know, I found I loved going in the home visits and seeing people in the context of their home. I was really sort of inspired by that because actually, I was doing the GP training, but I wasn't still totally going. I definitely totally want to do this. But once I got into it, I thought, No, this is what I want to do. Like Richard already had the experience with neurology. I was very fortunate because my consultant colleagues were so supportive they didn't want me to go. But they said like when you finish your training, come back, do some epilepsy clinics, did that for a while. And then I thought, You know what? Actually, headache and I didn't learn anything about headache when I was in neurology, because it was so boring to neurologists that they would not have called you to see if they would have called you to say some weird case of some like Parkinson's plus thing, but definitely not a headache. And then I was sitting and GP going Who? Who is it that knows about headaches? And I then developed this interest, and and so I know I have. I have an interest in neurology, but in particular I taught myself and and went to lots of courses and things and learned about headache. And that's what I do with the neurology team in the Ulster Hospital. Um, I work as a GPS specialist, interest in headache, and I see almost all their headaches, which is about 25% of the referrals from GP from E D. From from, you know, general medicine and so on. So So I've got this mix. So at the basic end of it, I am a GP. But I also have this extra job. So, um yes, him. I don't even know what the next slide even is. Oh, yes, just about, you know, confidence in neurology. I don't know what you guys, and it's so hard because I can't. I'm looking at a light in the middle of my camera. Can see anybody's face is so it's really hard to know what people are. People are receiving this, but neurology. Um, this this little thing it talks about, you know, the difficulty of neurology as a specialty. And if you look at that little A one medical students were surveyed and they felt that gastroenterology was, you know, the easiest of them. And then as you go on respiratory cardiology, you know, on towards rheumatology endocrines more difficult, and neurology was thought to be the most difficult off them. And then, uh, as you look at these other ones, that's about coming up with a differential diagnosis. Neurology was the one with the medical students thought It's really difficult to come up with a differential diagnosis, and I started to realize that actually GPC loads of neurology. There's a lot of it there, and there's a There's a little bit of a gap there where, you know, neurologists. Neurology is generally taught to neurologists or sometimes occasionally reaching out to other specialties. But I think that GPS could do with some, uh, you know, help in getting more confident with this area that they see a lot of. So I have then, over the last number of years, developed the education aspect of my job as well. So Tim next one. And there's, you know, at the House of Commons. I know this is quite a while ago, but there's an all party party parliamentary group on headache disorders, and they pointed out to the Westminster that actually 97% of headache cases are treated entirely by the GP. This is not a neurology thing. This is a GP thing. And so they one of their outcomes was that educating all medical students and gp should be a priority. Um, and sorry, Tim. Uh um, So, yeah, one of the things. So you're Tim was asking, what other things do we do? So, apart from my specialist role, I also, you know, have teach at conferences that, uh, you know, I teach for the name today a teacher or, you know, along with a consultant neurologist, This is this whole sitting with 1 ft in each camp. I have a good relationship with the consultant neurologist, and we would do this joint teaching, and we teach all GPS gp train as they're coming out. And they're like, second, there's a second last year of training. They all have to go through this core neurology day that we do and we're constantly evolving it to try and, you know, make it very relevant to GPS. But it's really good having both the GP on the thing and a consultant because I can't answer all of the questions they have, you know, for him. But he also can't answer all the questions they have for me. Like what you're going to do in the 10 minutes version of this right, the next one, then 10. And then you get to go to lots of conferences. It's maybe not as big a GP thing, and I have there. That's I mean, I've been as low as the conferences through neurology. Um, I hope you don't mind me sharing on the right side of this screen the most interesting certificate that I have received from the European Headache Foundation. And that was in Florence a couple of years ago, and it was a headache conference, and it's a great opportunity to meet other GPS who have the specialist interest and sort of feel that you're not on your own doing it. And what was the next one Tim there and then organizing, uh, event organizing things like I'm organizing along with a neurologist. A big conference. I don't know if you're going to Richard, it's We've invited loads and loads of a GI doctor's going and and at the end of November and it's on headache and you know, so it's it's been really good to have this opportunity to because of my interest in education and my networks across the UK So this is a national conference that we have the privilege of organizing in, um, in Belfast, um, in November, But we're also so that's one for for clinicians of 100 and 50 with 100 and 50 booked already on it. And then we were also doing one for patients. And you can see there that it's, uh it's the following day. So that's another really great. An interesting thing that you get to do as a specialist GP if you get into the right links. My link with the migraine trust is that I, um I am a GP representative on their board. Um, so it's a big charity. It's one of the best things I think I've ever done is as a trustee and in a charity it is voluntary. So coming back to the pay That is a voluntary position, but I think I have learned so much for from it. So, um, what was the last one there? Yeah, probably. Do you know what? I've missed a lost half of my slides. So just it was one of them saying about what I actually do in the week. So, like, Richard, I do, um, two days a week in GP and then, like, on your I do like a good lot of the rest of it. I'm doing a kind of an education or in gypsy, you know, specialist roll. And the education role has just been brilliant. And I currently am working with the health board. You know, um, try and develop the the education and neurology for, you know, regionally for Northern Ireland. So yeah, so I don't regret being a GP. I, uh, it's not. It's probably it's challenging. It's definitely not like for people who don't quite make it to the hospital consultants. And I wouldn't let anybody ever say that lie. Oh, yeah, there's some more slides. What? That is. Um, so So I would say it's not. It's not like the field, the field hospital consultant, but the other thing that I would say is if you want to be a specialist specialist, be a specialist like I don't want to be a neurologist. I would have done that if I did want to be. I want to be a GP. Um, but I also want to, with the background of being that person who is is involved in people's lives on a, you know, in a generational way. I also want to add value to that with the experience that I have as a neuro as a neurology kind of interested person. So, um yeah, my clinic. Um, Richard, I'm going to use what you just said about, You know, it's hard to get really good at it. If you're only doing one clinical week, I'm going to go back to the trust and say, You know what somebody said, and I'll get a few more sessions. I haven't had time to do any more sessions because they use the rest of them for teaching. But But you know, you guys, you know what I would say as well is your the thing with the GP is your job just constantly evolving? I'm at a different stage in my career. Now, I actually do want to do a bit more of it. And so, um, you know, But you do. On the other hand, um, you can you skip right to the very last slide. Him, Uh, the very last side is missing. I am reading this book called 4000 Weeks. Oliver Berkman, Because your medical students and you think you have all the time in the world. You won't need to read this book. But Richard and I are like, almost halfway through your careers and almost, I mean, I'm a bit further on than than than Richard is. I'm not reading reading 4000 weeks because it is about actually getting the best out of the time that you have in this life. Yes. So So choosing what you you want to do and you can't actually do it all. There are trade offs. Um, even with me, as I have a really fulfilling portfolio career, I really do. But there are tradeoffs with stretching yourself too thin. Um, and when you have Children, you know, family as well leave. You can go through stages of thinking that I never actually do any of these things Well, because I'm doing so much. But the big challenge, of course, is about managing your time. And it's not about how to do absolutely everything. It's about how to decide most wisely, what not to do and to feel at peace about not doing it. So for, um, you start off trying to say yes to all of these opportunities, and then as you go along, you think, Well, what do I really start to need to say no to so that I can spend my time having a fulfilling career? So I would say the gel practice really gives you those opportunities to experiment with different areas and to, um, to to develop different things and just have the conversations as you go through, express your interest to the area that you are interested in, and people will grab that enthusiasm both hands. So anyway, thank you. Thank you so much, Doctor Rusk. Thank you so much. That was that was absolutely fantastic. I love the picking up on the medical student fear of neurology because I think that is really and it is tangible. I think I don't know about my colleagues in the call if you feel the same. But that's definitely something that's there. And it's great to see yourself just medical students. It's actually got It's actually got a name. It's called You're a Phobia. Oh, fantastic. We have We have one question has come in Probably more in a general sense for for all three of you. But but feel free to chip in on it. So there is. A colleague has asked. I have interest in OBS and any medical education and have grown a leg in for GP. Is there a way to mix it all up like being a GP with two special interest? Is that possible? Do you have to choose? Well, I mean, I I hope that I've just shown there that you've got I've got neurology and I've got education and I've got GP, um, so no, you don't have to choose in that sense. I mean, as a as an educator as well. I'm also a GP trainer. Um, what I would say about having to make choices is that you only have finite time. Um, I have to say that I find it more difficult to manage the training the GP training because of my other interests because actually, it's hard to do that when you're four. Session GP. Um, so it's possible, but it's not always wise, you know. So just because you can do it doesn't mean that it's a good thing to do. Um, you've also got you've got a limited amount of kind of stuff that you can manage to do a lot to your family as well. So, um so, yeah, I know what it is. It is possible you're saying about the oxygen is a really obvious gp one, actually, because, um, there's a lot of Afghani in a GP and there are GPS who have sessions within the GP. I mean, they're not running back to the hospital to do this. They've they've sessions within their GP of managing, you know, um, you know, women and girls with heavy periods were doing procedures like putting in, um, contraceptive devices like like oils and implants, and they're done in hospitals. But they're also GPS who really skilled at doing that, and they do it within the practice, and they also then teach other GPS how to do that. So it's an absolutely superb one. You will be very popular you could practice. Hopefully that answers the question. So it is. It is possible to somewhere to summarize. The whole thing gets on, you come out ahead. Sorry. Just admit myself. Um, I completely agree with Louise about having a special interest in being able to do that in the community. And I do have one man who's in this trust in the Southern Trust. She called the doctor Lee so many trees. She is a GP with special interest in and get me in the hospital. She she actually does the red flag referrals. So she takes a certain cohort specifically that she has a particular interest in and basically acting as a very high end Reg. The consultants love her in the hospital. And lo and behold, if there reg down and somebody needs to go to theater for a second pair of hands, empty is the first one that they call on. But they need to make sure that she's not in clinic. And she's not doing her partner work that day, So yeah, very trace. Another girl that we know loves working in the hospital with her sessions of friend as well. Who is a breast specialty doctor, but she is a GP, so she works most of her weak as in breast, but occasionally does a lot of hours with me in the skin trust. And that's another rule that has that she has manufactured. I think if you're particularly interested in a row just the way that Richard has done, take a go to a consultant or another colleague that you like and enjoy working with and approach them with what I'm done. Would you find me, have some use and then they go, Yeah, you know, or we can make you a job or come here looking for a while, and then we can manufacture one for you. But if you don't ask, you don't get so just ask away. That's a that's a that's a fine no definition. And I think on you don't ask, don't get the reality. Is that at any stage in my experience of going through medical school, um, like it's just it's it's resembled here. Tonight in the three of you folks, I came along to you. I hunted your head, hunted you and asked you and you've been willing and fantastic to give up your time to come and speak to us. So if you don't ask, you don't get It's a good a good model, which you finished. Um, folks really, really appreciate you giving up your time, Doctor Rafferty. Doctor. Doctor, I really appreciate it. I just want to quickly give a couple of plugs for upcoming events. Next Wednesday night. We are running R s, your SGPT event. It's going to be on the same platform on metal. So, do you know what? You could go right across there now and register for it most Most probably relevant for final years, because sgot he's coming up. But I did attend the event that we ran last year. It's no harm in getting ahead of the game as well, so everybody would be most welcome to that. That's Doctor Olivia Bradley, one of the F two currently working in orthopedics, is taking that for us, and we plan to run another one of this style events next semester. So probably after Christmas. We don't have a date set yet, but in the feedback form for tonight we have got a section in there and would love to hear what specialist interests you'd like to see showcasing that, because at the end of the day, it's great. And thank you, Louise, for your kind comments about us. But we're also here for you guys. We want to try and and Taylor ourselves to both the students and what they want. And also to the three of you folks. If there's anything GP society can be doing for yourselves for your colleagues know that we're there supporting, you know that we're there with an open email. Just drop us a line. Um, and, uh, apart from that, I think would be happy enough to call it a night there. So thank you all very much for 10. I hope you enjoyed it. And this recording will go up after. If there's any bit involved, you want to catch up?