is the essence of being a GP.
Variety, challenge and uncertainty
is the essence of General Practice.
Do you enjoy challenges? Do you thrive off variety and uncertainty? -
This is the essence of General Practice! Can you be empathetic and sensitive whilst maintaining
professionalism and communication skills? - This is the essence of being
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.
A recent (and typical) morning surgery consisted of:
|A potential case of malignant melanoma
|A possible diagnosis of Weil’s disease
|A lady who needed her hypertension
monitored who always asks about my family
|Someone who had become dysfunctional
which a recurrence of their panic attacks and paranoia
|A person that turned out to have acute
|And a few coughs and colds for good
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.
Dr Williams, age 27, GP trainee
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
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!”
The personal qualities required to be a good GP include:
|Ability to care about patients and
|A commitment to providing high quality
|An awareness of one's own limitations
|An ability to seek help when
|Commitment to keeping up to date and
improving quality of one's own performance
|Appreciation of the value of team work
|Ability to manage oneself
|Good interpersonal and communication
|Ability to work with others
|Maintaining good practice
|Relating to the public
|Ability to deal with uncertainty
Arwa, age 29,
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”
General Practice needs doctors who are ready to undertake this
challenge. Applications for GP Specialty Training are welcomed from all
|Doctors who are just completing F2
|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
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.
Dr Bill Hall, a GP in Settle, North
Yorkshire and Associate Postgraduate Dean for General Practice at
the Yorkshire & Humber deanery explains the role of GPwSIs:
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.
Haslam, recent president of the RCGP
"There is little doubt that enthusiasm for a special interest is
truly beneficial to morale,
recruitment and retention, and most importantly, to patient care."
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
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.
So, how do you become a GPwSI?
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.
Dr. Bill Hall.
Royal College of General Practitioners
The Royal College of General Practitioners (RCGP) produces some
excellent booklets and information sheets for anyone considering a
career in general practice.
NHS Careers www.nhscareers.nhs.uk
and Medical Careers
Find out what it is like working in the NHS plus GP careers advice and
Information about the training requirements for general practice can
also be found on...
|A Guide to General Practice Careers
Edited by Baker M & Chambers R, London, Royal College of General
|So you want to be a general
Dr David Haslam, Royal College of General Practitioners 2000
|Opportunities and Options in
Chambers R, Mohanna K, & Field, S. Radcliffe Medical Press, 2000.
|A Celebration of General Practice
Mayur Lakhani, Radcliffe Medical Press, 2003
|Choosing General Practice – Your
Edited by Anne Hastie and Anne Stephenson. Blackwell Publishing 2008
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”.
Burkey, Y., Black, M., & Reeve, H. (2007) Patients' views on their
discharge from follow up in outpatient clinics: qualitative study. BMJ
(electronic) Vol 315, pp 1138-1141. Available:
[Accessed, 28th October 2010].
Kearley, K.E., Freeman, G.K., & Heath, A. (2001) An exploration of
the value of the personal doctor-patient relationship in general
practice. British Journal of General Practice (electronic) Vol 51, pp
[Accessed, 26th October 2010].
Tarrant, C., Windridge, K., Boulton, M., Baker, R., Freeman, G.
(2003) Research: Qualitative study of the meaning of personal care in
general practice. BMJ (electronic) Vol 326, pp 1310-1317. Available:
[Accessed 28th October 2010].
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:
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.
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.
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"
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:
|Elderly Care Medicine
|Paediatrics, Community Paediatrics
|Obstetrics and Gynaecology
|Psychiatry and old age Psychiatry
|Accident and Emergency
Some Deaneries have innovative programmes that combine hospital and
General Practice posts.
Julie, age 29, ST1
pace of life is good... with well structured teaching and good
Assessments and Examinations...
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
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.
Academic Clinical Fellowships...
Some deaneries may also offer a limited number of
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
Dr Benjamin Brown, age
GP Academic Clinical Fellow ST1
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”
The personal skills assessed
in the recruitment and selection process for entry to GP specialty
|Clinical Knowledge & Expertise:
Capacity to apply sound clinical knowledge & awareness to full
investigation of problems
|Empathy & Sensitivity:
motivation to take in others’ perspectives & to treat others with
adjust behaviour & language as appropriate to needs of differing
|Conceptual Thinking & Problem Solving:
Capacity to think beyond the obvious, with analytical and flexible
|Coping with Pressure:
recognise own limitations and develop appropriate coping mechanisms
|Organisation & Planning:
organise information/time effectively in a planned manner
|Managing Others & Team Involvement:
Capacity to work effectively in partnership with others