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In November 2018 I was approached by the Clinical Director of my local GP Federation, who asked if I would be interested in sitting a Diploma in Urgent Medical Care – a new Diploma run by the Royal College of Surgeons Edinburgh. The Diploma was entirely self-study, with a written and oral exam set over two days in March.

The only revision tool available at the time was the syllabus, due to this being a new exam there were no past papers or practice questions, although there are now sample questions available on the Royal College of Surgeons Edinburgh website. I studied for the exam with a friend, and we met twice with a local GP who had experience in emergency planning and management, had a session on injuries with a  local A+E consultant, and we spent a day with the ambulance service in their call centre looking at how ambulance dispatch and the 111 service works. The majority of the revision was otherwise done at home in my own time – at a guess I suspect I spent approximately 100 hours preparing for the exam in total, over four months.

The written exam was challenging – three hours to answer 180 multiple choice questions looking for the single best answer. the questions are designed to evaluate higher levels of leaning, such as clinical reasoning, rather than just knowledge recall. As a result, answering all the questions in the allocated time, requires candidates to pay attention to their progress through the paper. There were a few questions specifically on injuries which I struggled with, as this is outside my normal area of competence.

The following day the oral exam was in the form of 12 OSCE style stations, each with two examiners and a scenario given which the candidate had to talk through what they would do, and wider considerations. General topics included cardiac arrest care, organisation of urgent care centres, management of difficult staff situations as an urgent care lead, management of a head injury, safeguarding of a child following an injury, sepsis and capacity/mental health issues.

Happily I passed the Diploma and was thrilled to do so.

In terms of what I have learnt and how the Diploma has affected my work in Urgent Care I have reflected on the following points

• I am more up to date on management of acute presentations such as asthma, COPD exacerbation, pneumonia and infections which could lead to sepsis. Particularly I am more able to spot signs of deterioration early, and pre-empt whether I might need more senior level of care and know how to access this when working in Urgent Care. I can also apply this knowledge to my day to day GP work.
• I have a broader understanding of how Urgent Care Centres function within the system of Urgent and emergency care, and how this would change in the event of a major incident, how I would prioritise patients and maintain a safe level of care at all times in the Urgent Care Centre.
• I understand how both 999 and 111 services work, from the moment a patient makes a phone call to the point an ambulance is sent to the patient or the patient signposted for further care. This has led me to contact my local MP regarding how 111 is branded and what the general public perception of the purpose of 111 is. I have noticed that patients think of 111 as an advice line if they have questions regarding their illness, whereas 111 actually functions as a signposting line to tell patients where they need to go to access care. This disparity between agendas leads to overuse of resources, in my opinion.

I feel more confident in my role as a Clinical Lead for Urgent Care. Part of my role includes reviewing the work of other GPs, many of whom have been working far longer than me and I now feel I have authority to make suggestions to them about their clinical practice to improve their urgent care work. I also have a part in managing complaints regarding GPs in Urgent Care, and again when discussing with patients about their concerns I now feel I have the qualification to do this, which has given me more confidence.

Dr Lucy Falcus