A Life Without Bread and Pasta?
GLUTEN ALLERGY, otherwise known as gluten-sensitive enteropathy or coeliac disease, is an immune system disorder. Sufferers react to gluten in foodstuffs which contain wheat, barley and rye. More specifically, the gluten damages the lining of the small intestine causing malabsorption and malnutrition.
The background to the disease
The small intestine is normally lined by villi which enhances the absorption of nutrients. In people with gluten allergy, the immune system attacks the villi leading to partial or complete loss and a subsequent decline in nutrient and vitamin absorption and enzymatic digestion.
Those with a genetic predisposition to the disease carry the biggest risk of contracting it. An individual with an immediate relative who suffers from gluten allergy has a 10 per cent chance of also developing the disease and more significantly, when one identical twin has the condition, the other twin has a 70-75 per cent chance of also developing the disease.
Moreover, gluten allergy is often associated with other conditions such as thyroid problems, insulin-dependent diabetes or ulcerative colitis and sufferers of those diseases having a higher risk of developing gluten intolerance. The nature and severity of symptoms varies greatly and may include impaired growth among infants, diarrhoea or constipation, abdominal pain, flatulence, mouth ulcers, dermatitis herpetiformis, (itchy blisters usually on the elbows and knees), vitamin and mineral deficiency, (especially calcium and iron),fatigue, anaemia and/or weight loss.
Diagnosis
Although the condition is often diagnosed in childhood when cereals are first introduced into the diet, it can develop at any age. However, half of all adults with gluten allergy do not display any bowel symptoms which has lead to a high level of misdiagnosis by physicians. Blood tests are useful as screening tests for anaemia and mineral and nutrient deficiency and in recent years numerous blood testing procedures for elevated levels of gluten allergy-related antibodies have been developed including anti-gliadin and antiendomysial antibody assays. However, despite these recent developments the only reliable test for gluten allergy remains an intestinal biopsy performed when the patient is on a normal gluten-containing diet.
Treatment
The first line of defence against gluten allergy is an adherence to a strict, life-long, gluten-free diet. Foods containing wheat, rye or barley should be replaced by non-gluten foods such as rice, millet or maize and other gluten-free products such as flour, bread, biscuits and pasta are becoming more common and easily available. In addition, mineral and vitamin supplements are often added to the diet to reduce the risk of micronutrient deficiencies.
A gluten-free diet usually results in the improvement in the damage done to the lining of the bowel although the damage will recur should gluten be re-introduced. However, because gluten-free food tends to be low in fibre, constipation may occur in some cases although this problem is usually countered by the increased intake of fruit and vegetables. In rare cases, patients with severe gluten allergy may also require medication such as steroids to suppress the immune system.
However, should the condition be left untreated, it may ultimately lead to anaemia, bone disease, (such as osteoporosis), and some forms of cancer, (in particular non- Hodgkin’s lymphoma). Recent studies have shown that the long-term mortality rate among gluten allergy patients is twice as high as the general population with the main cause of death being non-Hodgkin lymphoma. In addition, it has been proved that long delays between the onset of symptoms and diagnosis by a physician significantly increased the mortality risk. For instance, a 10-year delay (or longer) in diagnosis increases the risk of death by more than three times.
Summary
In the most basic terms, the key to managing gluten allergy effectively and avoiding the long-term health consequences of the disease, lie in early diagnosis of the condition and the immediate implementation of a strict gluten-free diet.

By now you’ll have seen something about it on the TV news or heard it on the radio so what is it and what does it mean?

The 6th April 2003 is a significant day for employers and employees as it marks the start of a number of changes which will introduce both new and extended rights to employees as well as pose one or two challenges for employers in getting to grips with their implementation.
As part of the governments’ commitment to helping working parents balance the needs of their home life with that of work, a number of changes will be introduced to existing legislation together with the introduction of new measures.
In an article in Personnel Today it was reported that a recent survey conducted in partnership between the Department of Trade and Industry and Reed found that of the 4,000 respondents in its survey, almost half said that they looked for flexible working hours when searching for a new job, which re-enforces the need to look at this.
Flexible Working
For many employers the idea of working more flexibly is not new and will probably have introduced ways of working that cover:
- Job Sharing
- Home Working
- Flexi-Time
- Annualised Hours
- Compressed Hours
- Tele-Working
- Shift Working
- Term-Time

However, those that have not will once again be “encouraged” through legislation with the introduction of the new right on 6th April 2003 for working parents to request that they be allowed to work more flexibly.
It is important to understand that the new right for employees is the right to request to work flexibly, it does not mean that they have an automatic right to do so. Furthermore, employers need not get too concerned as in practice the new right only formalises the best practice than many employers currently adopt. However, in considering such a request employers will, as has always been the case, be entitled to consider requests within the context of its own business needs. The new right is intended to meet the needs of both employers and parents in trying to find appropriate ways to enable working parents balance the demands of their home and work life. Only time will tell if the new rights achieve the desired intention!

So who is eligible to apply?
In order to make a request to their employer the individual must have been employed by their current employer continuously for at least 26 weeks at the date of application, have or expect to have responsibility for the upbringing of a child aged under 6, or under 18 if disabled and be making the application to enable them to care for the child.

What might such an application cover?
Such a request will relate to a variation in their contract of employment in relation to working more flexibility as determined by a change in the number of hours they work, where they work and their starting or finishing times.

How should you make a request?
The new right sets out a certain criteria that must be followed when making a request. In general, employees should make their request in writing, setting out how they satisfy the above eligibility criteria, the variation that is being requested and desired date of change. In addition they should explain how they think their request will effect their employer and how this could be dealt with. Before making a request you may wish to check with your employer as they may have developed their own approach based on the requirements.

How should employers respond?
Whilst, as mentioned above, the new right for many will not mean a major change from the normal day to day discussions between managers and their staff centred around maximising the employment relationship it does however, place a new burden of following a specific process that must be followed. In responding to such a request employers should:
- Meet with the employee within 28 days
- Ensure their decision is provided in writing to the employee within 14 days of the meeting and in the case of a refusal
- Explain why
- Provide a right for the employee to appeal against the decision within 14 days
- Ensure that the appeal decision is provided in writing to the employee within 14 days of the meeting and in the case of a refusal explain why
- Allow the employee to be accompanied by another work colleague.

Why might it be okay to refuse a request to work flexibly?
Naturally, whilst an employer will do what it can to consider a request favourably, it must do so against the backdrop of business continuity. As a result it is possible for an employer to turn down a request where such request will result in the employer; incurring additional costs, having an adverse effect on their ability to meet customer demands, being unable to reorganise work among existing staff or where such a variation results in a detrimental impact on quality or performance. Whilst this is not an exhaustive list it does give an indication of why a request might reasonably be refused. As with all employment legislation failure to apply the new rights effectively will be dealt with via the Employment Tribunals.

So what can we do to prepare for 6th April 2003?
Employers In order to effectively respond employers will need to:

• Draft a policy setting out how it intends to deal with requests and the procedure, which should be followed by their staff when making one.
• Consider pro-active ways which work may be redesigned, without impacting business efficiency.
• Review and amend existing policies to accommodate the new requirements.

Employee
As an employee will only be permitted to make one such request within any 12-month period they should give careful thought to:

• the nature of their request
• how it will enable them to manage their child care arrangements
• how such a change may affect them financially (e.g. can they afford to reduce their salary if asking to reduce their hours)
• how they think their employer might be able to accommodate their request

To arrive at a workable solution, as always it is important for everyone to remember the spirit of the law and not the letter!
In addition to this new right the Department of Trade and Industry have confirmed the introduction of a new right to Paternity Leave and Adoption Leave as well as changes to the existing Maternity Leave provisions. You can find out more about them in next month’s issue.

Flexible Working

Industry Commentary
Pf spoke to three companies Pfizer, Abbott and Alchemy who have already introduced flexible working ahead of the 2003 government legislation.
Pfizer introduced it first flexible working policies more than five years ago, and in June 2001 embraced the concept fully as part of a strategy to become the industry’s employer of choice. The strategy also addressed salaries and wider benefits for employees.

Joel Morris - HR Advisor
Pfizer
Joel Morris commented “We now have four flexible working contracts available within the UK sales division and continually review the type and availability of contracts to ensure they are meeting real needs.”
Why did Pfizer embrace flexible working?
“Pfizer believes it is vital that its people have a good work/life balance, and flexible working makes it easier for them to achieve this. We also recognised that it was key for us to provide some career progression for all field force colleagues, and this was another reason why we embraced flexible working.”
“The main benefits to the company are retention and recruitment. Since we introduced the system, staff turnover has dropped significantly, which means we are retaining people and their expertise. The other main benefit is that we now have access to a greater pool of job applicants – the best people want to come and work for Pfizer. As a result of our approach to flexible working we have achieved a much lower attrition rate than the industry average. What is doubly exciting is that flexible working and the move towards work/life balance is available to head office as well as field based staff.”
When asked if there are any downsides to employees working part time contracts Joel commented “to be absolutely honest we are yet to witness any.”

Amanda White - HR Director
Abbot Laboratories
“Abbott introduced flexible working in its head office and manufacturing sites in 2002 in response to employee feedback from a “Working Environment” survey. Sales force response to that survey indicated that representatives already enjoyed a certain amount of flexibility by virtue of being in control of their working hours to a greater extent than employees in head office.”
Therefore the changes Abbott has made primarily affect office based employees. We embarked on a process of building greater flexibility as part of a goal “to win the war for talent”, to both attract and retain excellent employees and as a result we have a had high sales force retention with a turnover of only 8% for 2002. Flexibility has become an important strategic objective, reflected in the General Manager and HR Director’s goals for 2003.”
When asked what the issues could be for the company Pamela commented “Some managers are keener than others to practice flexibility, so from an HR point of view, we need to support those who struggle to see clear benefits. Consistency can be perceived as a problem –hence the need for clear policies.”

Jane Edwards - Business Development Manager
Alchemy
“Alchemy pioneered the concept of term time employment in 1997 with our first time term time contract sales team. We felt that it offers our clients a cost-effective way to attract the widest choice of quality, experienced candidates for their sales teams with little or no loss to effective selling time. Adapting the working conditions for employees to offer them flexibility, in a way that does not compromise their overall value to the company, generates a huge sense of loyalty, which equates to low turnover and high motivation. The average turnover of flex-time contract sales representatives at Alchemy has been less than 5% per annum over the last 5 years. As a business our “raison d’être” is obviously work. However, recognising the importance of and encouraging people to have a full life outside work enhances their contribution to work. So, we accommodate the work/life balance where it is possible to do so without compromising either aspect.”

Pf are delighted to introduce a new series of articles specifically dedicated to First Line Sales Management. The job of First Line Manager carries a wide variety of names that vary from one organisation to another. An Area Manager in one, may be a Regional Manager in another, or simply a Business Manager in a third. Whatever the nomenclature, two elements are key. Firstly, the first line manager is the most critical factor in producing a successful sales team and secondly, the role is exceedingly difficult. With the stakes so high, it is important that those who wish to develop into management are intrinsically suited for it and those already doing the job are continually developed.

Over the next five editions Pf has commissioned In2Focus to provide an independent, industry wide, perspective on management. The series will explore what management is, the key skills required and most importantly how to continue growing when in the role. It is our hope that the series becomes a reference source in the development of new and experienced managers. To help achieve this the articles will be made into a reference brochure that will be distributed to every reader in the September edition of Pf. We are able to produce the brochure through an educational grant provided by Eli Lilly.

Derica Rice, General Manager, explains why Lilly has become involved in this project. “ At Eli Lilly we believe the role of the sales manager is critical to the success of any company within the pharmaceutical industry. We have invested significantly in the development of career frameworks for managers through competency based approaches. The importance of the role can often be understated so we are therefore happy to support key programmes and initiatives designed to help raise the profile of sales management across the industry.

First Line Management in the spotlight

MANAGEMENT has been called one of the greatest social innovations of modern times. Many people in many walks of life aspire to reach the elevated status of “the manager” and yet this social phenomenon is relatively new and really finds its roots as a profession in the mid nineteenth century. Before this managers were often those in positions of institutional power such as the mine or factory owner. Take a look at the number of management schools and universities that have degree and masters courses in management, there are hundreds of courses on offer now, which is a true sign of a subject coming of age. Yet unlike most other professions, for example law or medicine, you don’t need to have a licence to practice management or have formally recognised qualifications. Your training is likely on the job with some external input. Management is truly a liberal art, which draws from many disciplines and tries to help individuals make sense and get the best out of their work environments; its roots are in people although the outputs are often economic.

A good starting point in reviewing regional management in the pharmaceutical industry is to get the views of some of the senior industry professionals as to the importance of good management. It is clear that excellence in regional management is paramount in the eyes of all the people asked. Dave Moore, the Northern Sales manager, from Solvay said, “High quality first line managers are crucial to any pharmaceutical business. They have an enormous influence on the hearts and minds of their sales people, influencing their attitude, belief and confidence. They also hold the key to successful implementation of company strategies. Mark Blower, the Healthcare Development Manager adds “first line managers are absolutely pivotal, they are the interface between the theory and the reality, they are the people that make the strategies work”. Duncan Morris, Commercial Director at Lundbeck said, “Regional managers are the most important link between the companies product strategies, tactics and the customer. It is vital that first line managers are bought into all plans, because if they are not the company will simply not succeed in the long term.”

Data generated by the Pf Company Perception and Motivation Survey run in 2002 also gives some interesting food for thought as it was clearly recognised by the survey respondents (c 1000), predominately medical representatives, that their relationship with their regional managers was a key motivational factor for them. (Although in all groups of responder’s salary was listed as the single most important factor.)

Survey respondents are saying that their relationship with their manager is critical. Although it is interesting to note that the greater the length of service a representative has, the less satisfied they are with their current manager. This could perhaps be an indicator that it is harder to motivate employees with a long service history.

It is also interesting to see from the findings of the survey that so many representatives see their personal development as a key factor in their own motivation, No surprise then that about 70% of the responding medical representatives wanted to move job within the next year to a new position either within their own company or to a new company altogether.

Drilling down into this particular group reveals some interesting facts in terms of what representatives see as their next move. It emphasises very strongly that regional managers need to strongly manage expectations; (74% of representatives with less than one years experience want to move to a new role within the next twelve months) and be able to develop their staff as much as possible to fulfil the desire for development and also to develop people for a variety of different roles.

In this forthcoming series of articles, we will look at first line management, its complexities and challenges in the pharmaceutical industry. Most companies believe that recruiting and developing their first line managers is critical. Steve Kerridge, Chairman of In2Focus commented, “Recruiting and developing high quality first line managers is critical to any companies success. In the modern pharmaceutical sales environment, with rigorous codes of practice and increasingly complex employment legislation, managers need to be highly trained and capable individuals. The role of the first line manager often requires the finesse and balance of a tight rope-walker, when balancing head office and field commitments. We are delighted to be involved in this series which we hope will highlight the importance of this role.” The purpose of the new series is thus two fold:

• To highlight the importance of the role of first line management in the pharmaceutical sales environment, and to help shape Pf’s reader’s career aspirations through providing information on the role of first line management.
• Pf will look at first line sales management in the industry from a variety of angles over the forthcoming months. The articles will take you through the life cycle of line management looking first of all at the view of what a manager does from a sales representatives perspective right through to the career options a first line manager has.

Future Features

• A Representative’s Perspective
• What is the role of a first line manager and how is this likely to change over the next few years?
• What is a typical first line managers’ job like today?
• Getting to be a Manager
• The first year as a first line sales Manager
• Management with Experience

the selling route of choice for the NHS

Creating partnerships with the NHS is a favoured route for selling. It involves finding out what particular problems the potential customer is facing and then working together to find solutions – and selling product as part of the solution.
It requires a bit more effort than simply collecting the order, but it can give significant benefits all round and allow long-term and profitable relationships to be formed.

It does mean that you have to develop a very good understanding of what is happening in the NHS. In the past this normally involved an often frustrating time searching the Internet, and never finding the real answers.

Now the required understanding is provided at your fingertips by the web-based National Health Intelligence Service. At www.nhis.info/pf this unique datasource not only gives access to NHS publications but, more importantly it tells you what they mean.

With NHIS you can appreciate the strategic importance of events – a basic necessity for identifying and building partnership opportunities.

Imagine, for example, that you are selling a diabetes product.
There is a range of activities on which the NHS is focusing, where the professionals often need considerable help to achieve what is required. Hence the opportunity to build a cooperative activity which lets you sell, but as a valued partner.
The table sets out a number of diabetes-related areas where action is needed and shows where in the National Health Intelligence Service you can gain access to the necessary understanding. Building on NHIS information, you can follow up the links provided to take your research onwards.

The phrase “Healthcare is changing” is often heard within the NHS and today it is more relevant than ever in terms of diversity and patient choice. Nevertheless, within the NHS, change is often laborious, bound by bureaucracy and characterised by limited patient choice. Conversely, private healthcare is emerging as a paradigm of choice, speed and convenience.

THIS ARTICLE concentrates on primary private healthcare (PPH) rather than secondary healthcare, as this ‘new kid’ is becoming increasingly important to the healthcare consumer. The NHS has the back-up of a myriad of departments and community services when compared with the options offered by PPH; however, PPH offers contemporary up-todate screening and health checks which are not routinely offered by the NHS. PPH differs from general private healthcare, as its use may be ad hoc, although membership schemes are available. It offers similar functions to the community GP, as well as ‘optional extras’. In addition, we can also see the rise of the ‘health boutique’, which offers one-off treatments such as laser eye correction, alternative therapies or a temporary botox face-lift.

Any simple sociological analysis will reveal the reasons why PPH has slotted so neatly into the lives of professionals. Professionals today tend to have more disposable income compared with professionals 20 years ago and, in addition, the number of professionals has been rising since the demise of heavy industry and, paradoxically, leisure time is becoming increasingly busier. All this impacts on the viability of PPH, and consumers, faced with copious choices, are increasingly looking outside the traditional arenas of health provision to meet their needs. The concept is simple, provide busy workers with convenient on-demand PPH and cosmetic services at well-situated venues, and it is sure to attract customers. It is about providing a shop-window for health needs, enticing the consumer in to browse and buy.

Healthcare provision outside the NHS has taken on evolutionary characteristics. The PPH boom suggests that if there is a niche, where there is no competition for resources, an adaptable organism can exploit those resources if the organism’s survival mechanisms are suited to that environment. This is the basic principle behind the emergence of PPH. The niche here is not providers of healthcare who focus on surgery, treatments and consultations which fill the gap left by long NHS waiting lists and relative inconvenience, but the providers who are more specialised, recognising that even when NHS treatment is available, they can provide ‘better’ treatments at a perceived higher standard. That is the sales pitch. The attributes which a private provider can offer are noticeably different from the NHS. These are convenience, speed of delivery and access, and pleasant, contemporary surroundings. The NHS cannot, at present, compete in this market. It remains to be seen whether they will in the future, with the Conservatives’ market forces being slipped in through the back door by the Labour Party, in the guise of autonomy and better access to care.

Fundamentally, the NHS remains an integral aspect of health provision, providing care ‘from the cradle to the grave’ despite our own provisions, simply because the NHS cannot be matched on the scale and sophistication of healthcare which it provides. However, in the day-today management of lifestyles, people are segmenting their choice of health provider, and moving away from the ideological to the consumer- based. People who can afford it and who are not ideologically opposed to private health provision are increasingly becoming adaptable to the concept that we can control our own health provision. Today PPH is becoming an integral part of many of our lives in an increasingly choice-driven society.

The government can dismiss the notion that a health hierarchy exists, and perhaps it does not within the NHS. However, it is obvious that healthcare in the UK can be divided into a hierarchy between those who can and those who cannot afford private health insurance or those who can access PPH on an ad hoc basis. It does not take a great deal of investigation to reveal how this translates into access and delivery of healthcare throughout the UK. To complicate the picture further, there is a general rule that people from low-income groups may tend towards a higher incidence of illnesses, involving more frequent visits to a GP’s surgery or another primary healthcare provider. Therefore, for these patients to have access to private care would translate into a higher outlay of finances. High disposable incomes are not common among the lowpaid earner group, and this will serve to increase health inequalities.

The Office for National Statistics General Household Survey explains that almost one-quarter of professionals and/or managers are likely to be covered by medical insurance; however, only 4% of those in manual groups have medical insurance. The survey also illustrates that people with a long-standing illness are less likely to have private medical insurance (about 5%). A person’s socio-economic group also influences this figure. In addition, the Social Trends Report shows that since the early 1970s, the uptake of private medical insurance has increased by over 30%. Professionals, however, may have private insurance provided by their company, but this figure does not take into account the occasional purchasing of PPH outside their existing plan. Although these figures do not show who is most likely to use primary private medical care, such as private dentists, private walk-in centres, or highstreet health boutiques, it can be assumed that there is a correlation between income and private health access. This is because the influences pushing consumers to buy private medical insurance will be the same factors influencing primary private care choice.

One question which arises is, ‘what does private primary healthcare offer that the NHS doesn’t?’ The answer is simple – convenience, convenience, convenience! According to the DoH, around 70% of patients are satisfied with their GP services, although this figure falls to around 55% of patients who are happy with GP appointment systems. This indicates one area where boutique healthcare is ‘filling the niche’. If professionals and managers are more likely to have private medical insurance, this is because their life-style, or rather work-style, is suited to it. Boutique healthcare has capitalised on the necessity for quick, accessible healthcare for people who prefer not to wait for a GP’s appointment. As a professional, whether covered by company insurance or not, a good disposable income means that £45 for a private GP consultation may not hurt as much as a two-week wait for a GP appointment. Alternatively, private primary care offers people who can pay the option of central locations, convenient consultation times (for example, some private centres have late-night opening), and some companies have not only slotted themselves into the quick, convenient, healthcare provision market, they have also physically placed themselves in places of high professional, busy work environments, for example, mainline train stations.

The emphasis is on convenience and health promotion/illness prevention, although not exclusively. They are well placed, due to their facilities, equipment and attractive advertising, to attract people in for tests who may not normally ask for a test. It is the supermarket of healthcare. At a supermarket, the consumer is faced with options which they may not normally consider. In the same way, PPH places options in front of the consumer, using both media and emotional promotion. The advertising of some companies shows a happy family as something which is to be achieved or maintained. The subliminal message is that this is not the case when there is ill health. The promotion of actual and perceived good health is an underlying message used in the promotion of this commodity.

The placement of PPH and boutique healthcare is a growing phenomenon in the high streets of the UK and they are not likely to disappear. They fill a gap left vacant by the NHS, to provide certain people with additional healthcare notoriously ignored by the NHS. Although this is not a criticism of the NHS, it does point to the fact that there are growing numbers of people who are happy to pay for their own healthcare if this means quicker access and convenience to maintaining their health. Access to private healthcare also includes the boutique aspect of ‘cosmetic’ treatment, again open only to those with an adequate income, highlighting the fact that access to healthcare is divided between social groups. For the promoters of PPH it is therefore necessary to target an audience which will have the ‘ability to access’ this type of healthcare. Marketing and emotional concepts used to tempt the ad hoc patient into these facilities should reflect the social aspects, that is, maintaining the concept that optimum health is attainable and maintainable. The ad hoc nature of this type of provision means that customers may switch suppliers. Prevention of this is ensured by professional customer service, incentives and, again, convenience, maintaining loyalty among those people who are not subscribers to one company. In the supermarket of health provision, loyalty is key to maintaining and expanding on a customer base. Company profiles and placement should be carefully managed to ensure visibility and healthcare excellence, emphasising convenience, quality care, and health maintenance, which is necessary in a society where health is increasingly seen as a precarious commodity.

THE CV IS PROBABLY THE MOST IMPORTANT selling tool for any prospective employee. Most employers and recruiters will require your CV in order to gauge what experience, skills and talents you might bring to a company. A well written CV should provide evidence that you are the best person for the position on offer and properly tailored to the advertised job, it can considerably boost your chances of getting an interview. Therefore, the importance of the CV should not be underestimated.

Most recruiters and HR executives will spend no more than a minute looking at each CV they encounter so it is crucial that yours makes an immediate impact (You may need to put together more than one CV if you intend to apply for different types of jobs across different sectors). Consider what skills, abilities and experience the employer requires in an ideal candidate and then craft your CV to suit. It is usually possible to tell what an employer is looking for from the job advertisement or job description. However, you may need to carry out your own research on both the company and the advertised position. But whatever way you get your information, once you are sure of what is required by the company, focus your CV appropriately.

The main areas of your CV
1. Name and contact details - include your name, address, phone numbers and e-mail address. You may wish to add details of your nationality, date of birth and driving licence but this is not obligatory.

2. Profile - compile a brief summary about yourself but make sure that any grand statements can be backed up by facts.

3. Work experience - start with your current or most recent position and work backwards. Describe your work experience in short sentences using straightforward and positive language. List your achievements under each job description e.g. increased the sales of Product X from £12,000 to £26,000. Simply describing a job gives no indication of your talents and success in carrying out your duties so also highlight the job requirements such as the ability to manage staff or work to tight deadlines.

4. Education/qualifications and skills - list brief details of qualifications - GCSE’s, A-levels, degree - along with grades attained. Applicants looking for their first job since leaving school, college or university can include their educational attainments before noting their work experience. Ensure you include any IT skills and additional languages spoken and also include the names of professional bodies of which you are a member.

5. Hobbies and interests - including details of your interests away from the workplace is optional. However, by adding brief details of your activities and hobbies you are giving an employer a more rounded picture of you as a person.

6. Referees - It is usual to provide the names and contact details of two referees, one of which should preferably be your most recent employer. However, graduates with limited work experience can nominate university lecturers or their work experience managers. But whoever you nominate as your referees, be sure to ask their permission in advance.

7. Presentation - It is crucial that your CV is well presented and preferably it should take up just two sides of A4 paper. Do not bind or insert it in a folder as it may be difficult to scan or fit in a company’s filing system. Most people follow a historical CV format with employment history placed in chronological order because it is relatively easy to compose and the structure is familiar to employers. However, if your career history is fragmented perhaps you should consider a skills-based CV which talks up your abilities rather than revealing your erratic employment record. Highlight your work experience and education in bold and ensure that the dates are on the left hand side. Also, indent the information so that the prospective employer finds it easy to pick out. In addition, check the fonts are consistent, alignment is appropriate and most of all make sure that your spelling and grammar is impeccable. Nothing is more off-putting to an employer than glaring spelling mistakes in a CV - this can mean the difference between getting an interview or not!

More CV tips.
- Use a confident tone and positive language
- Concentrate on your achievements rather than responsibilities
- Get a second opinion from someone you trust
- Use good quality paper
- white is usually best
- E-mail your prospective employer a copy of your CV as well as sending a hard copy

What not to do in a CV.
- Don’t leave any gaps in your work record
- employers will always think the worse
- Don’t tell lies
- you may be found out!
- Don’t include a photograph unless requested
- Don’t use elaborate fonts or colours
- keep it simple

Covering letters.
Most employers will expect a cover letter with your CV. This is an important part of your job application and you should use it to both show your interest in the position and underline your suitability.

Tips for covering letters.
- Address your letter to a specific person whenever possible
- Keep your letter brief and to the point
- Make the reader easily see how your skills and experience are relevant
- As with your CV, use good quality paper and envelopes

Obviously each new position applied for should entail compiling a relevant CV and fresh cover letter. However, regardless of how many jobs you apply for, your CV should be updated on an annual basis. If you neglect to update regularly then there could be a string of achievements which will get lost in history!

- Support your doctors through their first appraisal

Only now is the NHS starting to emulate what has long been good practice in commerce - having annual appraisals. But how can GPs benefit from what many see as a form-filling chore – and how can you take this opportunity to work more closely with key customers to support them through this anxious time? Paul Midgley of the Healthcare Partnership explains.

Background
Consultants in most acute Hospital Trusts have been appraised for at least two years. Now it’s the GPs’ turn. Sir Liam Donaldson, Chief Medical Officer, wrote to all GPs in England in March 2002 to launch GP appraisal. Since then, doctors across the UK have been gearing up to take part. Many have already seen the Department of Health (DoH) appraisal documentation. There are lots and lots of words, and the concept is totally new for many. As a result, most GPs have waited for instructions from their local PCT before getting down to it. The DoH target for PCTs to have completed the first wave of GP appraisals by March 2003 will not be met, for a variety of reasons:

• Insufficient numbers of volunteer GPs to train up as appraisers
• Insufficient places on DoH-approved appraiser training courses
• Inadequate funding provision by PCTs to provide protected time for appraisees both to prepare for and to attend an appraisal interview
• A lack of locums to cover GPs taking time out to prepare
• A lack of training for appraisees on the benefits of appraisal/PDP and its link to successful revalidation

In Scotland, one of these hurdles was overcome in Autumn 2002 when a funding package was agreed by the Scottish Parliament to pay each GP £315 to cover appraisal. A similar arrangement has also been agreed by the Welsh Assembly. In England, as yet, each PCT has been left to provide its own funding for appraisal, leading to marked differences between PCTs in the amount of money offered to GPs to cover time for appraisal preparation and the appraisal meeting itself. As a result the British Medical Association’s Local Medical Committees’ (LMCs) instructions to their GP members about engagement in appraisal, have ranged from outright rejection (where funding has been either absent or inadequate), to wholehearted recommendation and full cooperation in PCTs where adequate funding and resources for appraisal have been forthcoming.

Given that most of the 305 PCTs across England will fail to achieve their targets on GP appraisal by the end of March, and that GP Appraisal is a key measure of a PCT’s Clinical Governance arrangements by the Strategic Health Authorities, we can expect a flurry of activity between now and the end of the year to catch up and ensure GP appraisal is implemented. This puts you in a good position to help out key customers in key PCTs, and provide a service fulfilling a real need which will set you apart from most of your contemporaries in the Pharma industry. Let’s look now at what help is needed, and where you might be of assistance.

Understand what GP Appraisal is all about
GP Appraisal is not an examination, nor an investigation. It is meant to boost GPs’ morale and to help them to ‘raise their game’.

Some GPs may have unhappy memories of medical school and house officer assessments and feedback, and equate this with appraisal. They can be reassured that GP Appraisers are being trained to eliminate negativity during the appraisal process and to strengthen the motivational aspects of the event.

Each GP appraiser should create a situation where the GP being appraised can say exactly what their concerns, needs and achievements are. Details of what GPs say will remain confidential. They should feel free to talk, and take the appraisal as an opportunity to get things off their chests and confide in a supportive colleague.

Another potential benefit of GP appraisal is the opportunity to influence the local PCT agenda. The Appraisal discussion might show that there are gaps or inconsistencies in what the primary care organisation provides for primary care. The DoH appraisal paperwork asks for commentary on ‘constraints’, opening the way for GPs to demand improvements. If other GPs in their patch do the same, feedback from the appraisers and from the collated summaries from each appraisal (sent to Clinical Governance lead and Chief Exec) will get the PCT to sit up and take notice. The PDP element of Appraisals will also provide a snapshot of local learning needs for the GP tutors to put together more relevant learning sessions.

GP concerns about appraisal – revalidation link, PCT control, time and money
GPs have been operating in a climate of blame and guilt post-Bristol and post- Shipman. The announcement that doctors would be revalidated during this time consolidated that feeling. However, appraisal is not an extension of revalidation, but could be an aid to revalidation success. Revalidation commences Spring 2005, with GPs and Consultants being called up on a random basis. Helpful advice is now available at the website www.revalidationuk.info which suggests what information from appraisals will facilitate a doctor’s revalidation. GPs will be relieved to have a step-by-step approach made clear to them – there should be no need for a last minute panic if their name is first out of the Revalidation hat in 2005!

You can reassure your GPs that appraisal has not been designed for the purpose of identifying poor performance; there are other methods and processes for this.

A GP cannot ‘fail’ an appraisal. However, a series of up-beat appraisals means that GPs will need to do little more to accomplish successful GMC revalidation (which GPs will require to continue to practice medicine).

Many doctors express anxiety about the real motive behind appraisal. Some GPs worry that appraisal might be a plot by primary care organisations to gain control of doctors. It’s not.

The BMA’s General Practitioners Committee (GPC) had a marathon task in persuading the Government to provide remuneration for time spent preparing and participating in appraisal. The result was that DoH instructed that PCTs must provide funding for the expenses of appraisal activity. GPs should seek support from their PCT to provide them with locum cover for one ‘session’ to compile the appraisal information for forms 1-3 (half day), and a further session for the appraisal meeting itself (i.e. a full day in total), if this has not been forthcoming so far.

Best advice for GPs - Start collecting information now
Suggest to your GPs to look at the sections in Form 3 of the Department of Health appraisal document – this breaks the GPs’ job into key areas, as follows, and forms the basis for the 2-hour appraisal interview discussion:

• Good clinical care
• Maintaining good medical practice
• Working relationships with colleagues
• Relationships with patients
• Teaching and Training
• Probity
• GP’s own health
• Research activities
• Management activities

The DoH templates look dreary and overwhelming at first, but there is help at hand. The new Appraisal Toolkit, available on www.appraisals.nhs.uk, provides a wealth of practical support and a password-protected place for more IT-literate GPs to deposit all their appraisal, PDP and revalidation paperwork. This site offers the following to users:

• The DoH appraisal questionnaire
• An appraisal checklist
• Review of critical incidents/significant events
• Review of their audits
• Review of prescribing data, referral data and other aspects of practice performance
• Review of what the practice does and the practitioner’s role
• Review of teaching activities
• Review of educational activities and learning needs including Personal Development Plan
• Review of any concerns about probity
• Review of any concerns about health and fitness to practice
• Review of research activities
• Review of management activities
• Appraisal statement
• Summary of the appraisal discussion
• Confidential account of the appraisal meeting
• Review of the Practice Professional Development Plan
• Lists of local and national priorities
• Review of complaints or suggestions from patients
• Example completed appraisal forms

Helping your GPs get started
GPs will find they already have many of the items of information to put in their collection to support appraisal forms 1-3 – its just a matter of finding it and collating it in one readily accessible ‘portfolio’. Ideally, they should get it together, bit by bit and not try to do it all at once. Human nature and past experience indicates that a sizeable proportion of GPs will need more help, and if their PCT are dragging their heels, you can help.

You could organise a ‘Preparing for Appraisal’ workshop where GPs get advice from experts about the purpose and benefits of appraisal, and a chance to talk to their colleagues, exchange ideas on how to put their portfolio together, and most importantly, win you lots of brownie points and opportunities for improved access (see below).

In addition, many organisations have useful appraisal information and advice on their websites, for example, the Department of Health, medical defence organisations, the GMC and the GPC. Use this material to increase your knowledge and confidence base of GP appraisal, and in turn provide an enormous help to your anxious, overworked but otherwise willing GPs and win new friends and more prescriptions at each GP call.