General Practice in the Armed Forces: A Definition and Model

The Defence General Practitioner: an Updated Definition and Model

The geopolitical setting has changed significantly since the definition of UK Armed Forces General Practice was published in 2012. New operating models require medical services to provide smaller teams operating at greater reach from secondary care and logistical support. The Defence Medical Services have reorganised to meet these changing needs. Defence general practices (DGPs) are key enablers of the Defence strategic effort, both integral to deployed units, in preparing forces for deployment and managing their rehabilitation back to fitness. A formal role performance statement (RPS) has been created to guide the training and development of DGPs to meet these changing requirements. The RPS details the additional scope of practice, beyond the national GP licensing standard, in which DGPs work. In this article, we compare and contrast the RPS with the previous definition of a DGP. The resultant updated model recharacterises the extended roles into five themes of DGP built on the foundation of the Royal College of General Practitioners curriculum. This new model provides the platform on which to develop the clinical specialty over the next decade and highlights avenues for educational interventions to develop future generations of DGPs.

Can Defence be assured that future civilian specialty training programmes will produce suitably qualified and experienced military doctors?

UK Defence's doctors receive the majority of their pre-accreditation clinical training within the National Health Service's (NHS) specialty training programmes. These are designed primarily to serve the needs of a civilian patient population and are undergoing changes. Examination of these changes in relation to the training requirements of Defence's doctors, suggests that future NHS training programmes present both opportunity and threat to the provision of competent military consultants and general practitioners (GPs). Opportunity to more easily integrate military-specific courses, experience and modules will be present in the form of curricula that are more receptive to change and more flexible with respect to time out of programme. This offers definite advantage in terms of ability to robustly equip military doctors with the skills required to serve their future patients. Narrowing scopes of practice and a reduction in acute care exposure for GPs are potential future threats.

Developing the military GP using immersive simulation in specialty training

Military general practice requires wider knowledge and more diverse skillset than that defined by the Royal College of General Practitioners curriculum. Following completion of specialty training, military general practitioners (GPs) were returning from mostly civilian training environments feeling deskilled and ill-prepared for their military role. The Academic Department of Military General Practice defined the training gap and used co-creative curriculum development to incorporate military topics throughout the GP specialty training programme. Simulation was identified as a key teaching method employed throughout undergraduate and postgraduate health professional education, which could be used to improve the trainee's learning. The resulting operational preparedness training week used layered teaching methods and feedback to build trainees' knowledge and skills before a final major immersive simulation exercise. This article describes the educational design process in terms of the '10 goal conditions' described by Issenberg for high-fidelity medical simulations leading to effective learning.

Exercise ASKARI SERPENT: enabling clinical data collection during exercises and operations to support future contingency planning and assurance of category-based reporting systems

INTRODUCTION

Exercise ASKARI SERPENT (Ex AS) is a British Army exercise that provides primary healthcare (PHC) to Kenyan civilians in support of local health authorities. It is conducted in partnership with the Kenya Defence Force Medical Services (KDFMS). Accurate epidemiological data is critical in planning the exercise and for any future short-notice contingency operations in similar environments. This paper reports epidemiological data for Ex AS using a novel data collection system.

METHODS

PHC on Ex AS was delivered by trained and validated combat medical technicians (CMTs) using a set of Read-coded protocols. The CMTs were also directly supported and supervised by medical officers and nurses.

RESULTS

A total of 3093 consultations were conducted over a 16-day period. Of these, 2707 (87.5%) consultations fell within the remit of the CMT protocols, with only 386 consultations (12.5%) being conducted exclusively by the medical officers or nurses.

DISCUSSION

A Read-coded matrix built on CMT protocols is a simple and useful tool, particularly in civilian populations, for collecting morbidity data with the vast majority of conditions accounted for in the protocols. It is anticipated that such a system can better inform training, manning, medical material and pharmaceutical procurement than current category-based morbidity surveillance systems such as EPINATO (NATO epidemiological data). There is clear advantage to directly linking data capture to treatment algorithms. Accuracy, both in terms of numbers and condition, is likely improved. Data is also captured contemporaneously rather than after indeterminate time. Read coding has the added benefit of being an established electronic standard. In addition, the system would support traditional reporting methods such as EPINATO by providing increased assurance.

Medical provision in forward locations in Afghanistan: the experiences of General Duties Medical Officers on Op HERRICK 15

Op HERRICK in Afghanistan remains the current focus of the British Armed Forces. General Duties Medical Officers (GDMOs) commonly deploy to Role 1 locations in Afghanistan, which remains a continuously evolving theatre of operations. This article is based on the experiences of four GDMOs who deployed to forward Company locations on Op HERRICK 15 (September 2011-April 2012) and aims to offer an insight into the challenges of this role and identify areas in which improvements could be made to the training and preparation for future tours.