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General Practice is about caring for the whole person as well as their illnesses, the promotion of healthy life styles, and providing the first point of contact and out of hospital care for patients. Doctors working in General Practice enjoy problem-solving with their patients, combining evidence-based medicine, wide ranging clinical skills and compassion to care for the individual. They provide a holistic approach aimed at managing risk, and dealing with (rather than resolving) uncertainty and complexity. The added value is delivered by allowing a story to evolve and develop rather than applying a protocol to every presentation in an attempt to resolve it.
Now THAT is variety! The patients above all presented with great uncertainty in their history and were dealt with using no resources other than being able to take a history and conduct an examination.
The personal qualities required to be a good GP include:
General Practice needs doctors who are ready to undertake this challenge. Applications for GP Specialty Training are welcomed from all levels including: Doctors who are just completing F2 training. Doctors already qualified in another specialty but looking for a change of career. Doctors already in Specialist Training in another specialty post but beginning to realise that they would prefer to deliver care closer to the patient.
A great service is provided by general practice, and GPs will remain the bedrock of the NHS whatever model of delivery is used (traditional GP, walk-in centres or Darzi practices or poly-clinics), and regardless of whether you choose to be a salaried doctor or a partner. If you enjoy intellectual challenge and the chance of continuity of care for patients and their families, GP is for you.
General practitioners will continue to have a critical role in the NHS, not only consulting with patients but also as providers and organisers of an increasing range of high quality services in the community, and as gatekeepers of hospital care. This pivotal position is dependent upon the clinical role of general practitioners with their patients and their ability to manage and provide leadership.
General practice has tremendous potential to remain at the centre of care. Most chronic care will be done by the primary care team, and increasingly diagnostics (near-patient testing) will be done in the surgery without requiring consent of the specialist. GPs within their individual organisations will be encouraged to develop special interests and skills.
All GP’s of the future will need to be generalists, clinicians, team players, life-long learners and managers (at least of themselves). Some will need to provide leadership for the larger and more complex primary care organisations that will emerge, and more widely for the primary care led NHS. Good communication and the formation of professional doctor-patient relationships are crucial to General Practice.
In recent years there has been a trend for many general practitioners to develop special interests in certain areas. This might be in education, in the management arena, medical politics, or in clinical topics. The level at which general practitioners operate can vary too, with some working at a practice level, some taking referrals from local practices, some working for a primary care organisation, some working in a hospital setting, and some working at a regional or national level. Many general practitioners enjoy developing special skills and doing so fits in with changes in the National Health Service and improves services to patients.
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There is little doubt that enthusiasm for a special interest is truly beneficial to morale, recruitment and retention, and most importantly, to patient care. |
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In most practices, individual general practitioners take on more specialised roles. Most practices now will have at least one member specialising in diabetes care, and another will probably lead on gynaecology and contraception. For instance in my practice I take the lead on neurology care, acting as a source for internal referrals, I am part of the education team, and take responsibility for the Quality and Outcomes Framework and Clinical Governance. The future for developing a special arm to your general practice career looks good. The coalition government wants to continue the trend to move services out of secondary care into the community, and wants general practitioners to take on the role of commissioning services. This seems likely to increase the need for general practitioners with special interests (GPwSI) at every level of the health service. The RCGP wants to see groups of practices federate together to provide internal referral pathways.
A 2006 survey by the Royal College of General Practitioners demonstrated how wide the range of clinical topics covered by GPwSIs is; http://www.rcgp.org.uk/pdf/ISS_INFO_11_JAN06.pdf. Dermatology and cardiology were the commonest topics covered outside the practice, with minor surgery, A&E, ENT, sexual health and rheumatology following on. Extensive evaluation of GPwSIs working in ENT has shown how the service can be improved economically, which makes taking on GPwSIs attractive to health service planners.
One of the great things about working in general practice is the career flexibility, and there are many possible routes. If you have a burning ambition to be involved in one particular clinical topic then you may be able to plan for this by selecting appropriate foundation posts and general practice rotations during your training but for most people the training to be a GPwSI will come outside of the three year training program for general practice. Once you have got your Certificate of Completion of Training for general practice there are lots of opportunities both inside and outside practices. Your practice may perceive the need to develop skills in a clinical topic and encourage you to train in this area. Or a primary care organisation may want to move services into the community and be looking for general practices to take this on.
Bradford, for instance, has developed services in cardiology, neurology, gynaecology, urology and diabetes using GPwSIs. Another possibility is to take a career break between ST2 and ST3 years and use this sabbatical time to develop a special interest. This option does need a considerable amount of forward planning, but it is the route one of my trainees is taking as he plans to do an MSc in cardiology. Yet another way is to start off specialist training, develop your expertise in a clinical topic, then train as a general practitioner – which is how one of the partners in my practice learned his diabetology skills.
Of course, maintaining professional standards is important for patient safety and there has been a growth in training courses, appropriate qualifications and professional organisations to cater for GPwSIs. This has helped to ensure appropriate standards are maintained and that GPwSIs are not working in isolation and continue to be an asset for their patients. I think the main message should be if you have a passion for a particular clinical topic then you should look to develop that somehow in your career in general practice – it is very likely that opportunities will crop up for you to develop your skills which is likely to result in better services for your patients and enhanced job satisfaction for you.
Research articles have also played a role in highlighting the importance of the doctor-patient relationship. In 2007, Burkey, Black and Reeve found that “most patients talked positively about the quality of the relationship with their general practitioner. They felt their family doctor knew them as a person and cared about them.” This can be seen throughout a period of time with Kearley, Freeman and Heath (2001) maintaining that “within the context of general practice, the opportunity exists for a personal relationship to develop between the patient and doctor”. They also suggest that “seeing their ‘personal doctor’ increases patient satisfaction”. And more recently, Tarrant et al. (2003) state “Personal care in the context of a relationship was important if problems were complex or emotional”. It was also ascertained that “GP’s in particular emphasised the value of a continuing relationship in making care personal”.
A recent GP patient survey completed by over 2 million patients nationally and published by the Department of Health, has shown highly positive levels of patient satisfaction during July 2009 - June 2010. Results in brief state that 90% of patients are satisfied with the level of care received at the surgery. In regards to the importance of the patient-doctor relationship, 94% of patients have complete confidence and trust in their doctor. With communication skills for a GP being pivotal in providing the best care possible, 88% of patients believe doctors listen to them, and 78% are happy with the explanation of tests and treatments. Further results are available at: http://www.dh.gov.uk/en/Publicationsandstatistics/index.htm
To become an independent general practitioner in the UK, you must undertake at least three years of GP Specialty Training (GPST), normally including 18 months in an approved training practice with a further 18 months in approved hospital posts. To ensure that you become a competent, effective and confident GP of tomorrow as well as directly addressing the GP curriculum, Deaneries will tailor your training to your individual needs and your particular rate of progress. There is an increasing number of four year options available giving extra valuable experience. On joining a GP Specialty Training Programme you should register with the Royal College of General Practitioners. Gaining Valuable Experience
All GP posts are undertaken in a wide variety of locations, and always in an approved training practice under the supervision of a GP trainer. Here you will receive personalised tuition from an experienced GP who has had further training as an educationalist, as well as other members of the Primary Health Care Team. The training will be targeted to your identified needs.
The exact posts offered by Deaneries in their programmes vary, but you will be offered a complete programme that complies with the regulations set down by the GMC. All posts are accredited and approved for GP training. The specialties available include: General Medicine Elderly Care Medicine Paediatrics, Community Paediatrics Obstetrics and Gynaecology Psychiatry and old age Psychiatry ENT Accident and Emergency Dermatology Ophthalmology Palliative Care Some Deaneries have innovative programmes that combine hospital and General Practice posts.
To become a General Practitioner you must possess a Certificate of Completion of Training (CCT). During all your placements you will complete workplace based assessments as well as preparing for the external MRCGP examinations – the Applied Knowledge Test (AKT) and the Clinical Skills Assessment (CSA). Your progress will be monitored at least yearly by an Annual Review of Competency Progress (ARCP) Panel. More details of the examination can be found on the RCGP website www.rcgp.org.uk
You will be assigned to an educational supervisor based in General Practice throughout your time on the programme, who will help you through the MRCGP procedures, using an e-portfolio to do so.
Some deaneries may also offer a limited number of Academic Clinical Fellowship programmes where time is spent on additional academic projects or offer programmes where some time is spent abroad or working in a particular relevant area of interest. These are subject to availability and more information will be provided on individual deanery web sites.
Dr Williams, age 27, GP trainee
"I enjoy the sheer variety of conditions which I see on a day to day basis in the GP surgery...and the ability to follow up on a personal level and get to really know the people I am treating"
Sharif, age 30, GPST3
“I chose General Practice because I thought it would combine practicing medicine as well as building rapport and doctor-patient relationships. My experiences so far have justified my choice!”
Arwa, age 29, GPST4
“I originally chose to do GP when I was a FY1 as I liked the sound of the training programme and wanted to be able to deal with problems from a variety of specialties… We have been very lucky to have been trained by excellent, well rounded GP's”
Dr Benjamin Brown, age 27, GP Academic Clinical Fellow ST1
“I want to be a GP because of the wide clinical variety and opportunities for leadership and management whilst maintaining proximity to patients. I applied to be an Academic Clinical Fellow in the North Western Deanery because of the great work being done at the National Primary Care Research and Development Centre and CLAHRC at The University of Manchester”
Dr Naeem Khan, GPST2
"GP training gives me opportunities to broaden my knowledge and helps me to treat patients from all walks of life. I wanted to be a doctor will all-round abilities"
Julie, age 29, ST1
“The pace of life is good... with well structured teaching and good hospital posts”
© 2005 Crown copyright (photographic images) - © 2012The National Recruitment Office for General Practice Training (gprecruitment.org.uk) All rights reserved |
