The future of the NHS is in GP – Areeb Mazhar

areebGP recruitment is in a crisis. And although the headlines are doing plenty to inform us of the crisis, they are also deterring future students from this hidden gem of a specialty. So it’s more important now than ever, that we share our reasons and motivations on what draws us towards general practice and why medical students should consider it as a career option!

I remember sitting through a public health lecture given by a pair of enthusiastic GPs in my first year. At the end of the session, they curiously asked which of us were considering general practice as a career option. I feebly put my hand up and so did someone else; only two students in a lecture theatre full of 240 students. So, why did I raise my hand?

During my time on the wards, I’ve realised that I wasn’t fascinated by rare medical conditions or special surgical techniques.

What really excited me was the background of the patient, the stories they had to tell me and how grateful they were that someone wanted to listen to them. Without doubt, the medicine still interests me, but I would pick an interesting person over an interesting medical condition every time.

Often in medicine, we sometimes become so laser-focused on the medical aspect of patient care, we forget that we are treating a person. General practice emphasises a holistic approach to the patient; an approach that makes a patient feel like a person. I want to be able to comfort the elderly man who has been diagnosed with prostate cancer two weeks ago or reassure the anxious mother that the rash on her son’s face is not serious. Being in such a position to build long-term rapport and a relationship with a patient would be a privilege.

GPs are at the frontline of medicine and are the first point of contact for many patients. The truly challenging aspect of general practice, in my opinion, is that anything and everything can walk through the consultation room. door

The modern GP must be able to differentiate the child presenting with a headache due to the common cold, from the similar presenting child that may have life-threatening meningitis. This difficulty in taking a comprehensive history and examination in a short time period, without any advanced scans and investigations and using this information to come to a diagnosis appeals to me. It is medicine in its purest form. The incredible variety of medical conditions and patient demographics is not found in any other specialty of medicine.

If those GPs asked our year group the same question today, I’d hope there would be more hands raised. I would hope that our journey through medical school so far has broken down some of the misconceptions and stereotypes attributed to general practice. Not only do I want to be a GP, I want to be involved in recruiting the next generation of GPs and showing medical students the positive light of general practice.

I genuinely believe that the future of the NHS is in general practice; I want to be part of that future.

Areeb Mazhar, Medical Student, Sheffield

The Old Lady Wakes Up – Ben Jackson

dr_ben_jacksonThe old lady had broken her hip and had some sort of reaction to the prosthesis they had used to fix it. Sadly she had also suffered one or two small strokes that had meant that her stay in hospital had been longer than she’d hoped for. In the end it had been decided that she would be better off moving in with her Daughter and family in Sheffield. She spent most of her time in bed but her grandchildren would sometimes visit after school and sit for a while, though they never stayed for very long as she was always tired and couldn’t follow the conversation well.

Eventually a different, local doctor started to visit her. When he asked about the pictures on the wall, he learned what she really loved to do was to paint. Another time he heard her mention something about birdsong and soon understood that she had never minded her insomnia (and indeed thought it a blessing) as her favourite thing of all was to watch the day begin through the bedroom window. He recognised that she still had a lot to live for, and started to gradually withdraw some of the medication she’d been on since she had been ill.

It was then my Grandmother seemed to wake up. Soon she got out of bed, then eventually out of the house. Though she never went home, she did become a member of the village arts group and started to paint again. More importantly for me, the bedrooms she now permanently occupied in the house became my first point of call after school – where there was always a cup of tea, a piece of cake and a smile. By then I’d decided I wasn’t going to be an engineer after all, but a General Practitioner.

Ben Jackson, GP, Doncaster

 

How about #whyacademicGP by Dr Kamal R Mahtani

Kamal Mahtani

My mother tells me that it was from the age of about eight that I first said “I want to be a doctor!” Apparently it coincided with me getting my first toy doctors kit. This consisted of a plastic stethoscope (naturally), ophthalmoscope (for looking up my brother’s nose), syringe (to “give medicine”), clipboard (to take notes once I had “give medicine”) and a hammer (um…to repair Dad’s shed? – only recently realising this was for tendons). Unfortunately it was my younger brother who took the brunt of my first experimental steps as a (very very) junior doctor, with weekly laparotomies on his tummy that were closed with an Elastoplast or two.

By the time I was 13 I started to really appreciate the wonder of science and it wasn’t that long before I proclaimed I would one day “find a cure for cancer”. Well unfortunately I haven’t found the cure for cancer (although I have a much better understanding of the disease), but looking back I now realise that the idea of doing research in medicine, then applying it to patients made so much sense to me, and a seed had been sown.

So you want to be an academic?

My route to a becoming a clinical academic began a little more unusually in that I was already a postgraduate (having done a BSc and PhD in basic sciences) before I entered medical school. Although I knew I wanted to remain academic, I wasn’t sure in which clinical field. However, for me it became crystal clear which medical speciality I wanted to dedicate my career to once I had done my first month-long placement as a fourth year medical student: it had to be general practice.

As Iona Heath said in her monograph – “The Mystery of General Practice”:

“Each person and each context is unique and this is the joy and the challenge of general practitioner care”.

Despite dabbling with thoughts about being a gastroenterologist or a paediatrician, I couldn’t get away from the appeal of being a generalist. Providing long-term continuing care to my patients at all levels, where every encounter was unique.

The desire to be academic didn’t dessert and it soon dawned on me that being a generalist and an academic seemed even more appealing. I increasingly started appreciating the vast amounts of uncertainty and unanswered questions in general practice. So, I wanted to find the most relevant unanswered questions and provide my patients with the answers.

Why is academic GP so important?

Innovation and clinical research can improve the care and services we provide to patients in primary care.   As a marker of this the RCGP have a dedicated team and network to drive this forward. Recognising the importance and growth of academic general practice and primary care research in the UK, the research arm of the NHS, the National Institute for Health Research (NIHR), have committed a further £30 million over the next 5 years to the School for Primary Care Research, to build capacity and capability in the field.

Key to this NHS commitment is the recruitment and retention of innovative and forward thinking academic GPs. A recent editorial in the BMJ highlights the invaluable role that academic GPs play, stating: “Academic GPs make an essential contribution to the NHS through education, research, clinical practice, and service development, usually while continuing to provide direct patient care.” Given the widely stated statistic that 90 per cent of patient interaction is with primary care services (mostly general practice) it’s not that surprising to consider GPs as perfectly placed to work with other primary care researchers in identifying and delivering research priorities to improve patient care and service provision.

There are countless examples of impactful research outputs from academic general practitioners working in research teams that have or will lead to patient benefits. Examples of such work has led to a greater understanding of the: benefits of warfarin versus aspirin in preventing stroke, technology needed to support NICE guidelines to limit the use of antibiotics in primary care, interventions to reduce unplanned hospital admissions, programs to reduced domestic violence in general practice, quality of care from NHS primary care services, and ways to evaluate cardiovascular risk in primary care. Academic GPs are even world leaders in teaching us how to read a scientific paper. These are just a handful of examples of the impactful work with which academic GPs have been involved.

Academic GPs are also at the forefront in providing undergraduate medical education within university settings as well as general practice and community attachments. Teaching provides opportunities for professional development, reflective practice and is an asset to many academic departments, with funding streams available to compensate for teaching time. Many GPs already find teaching undergraduates on placements very rewarding as do patients involved with community based teaching. Some academic GPs go on to devote some if not all of their academic time to lead undergraduate teaching. For example some academic GPs take up 50:50 split clinical academic posts within medical schools and provide dedicated teaching and organisation of entire community based undergraduate curriculums. Access into this can be through more formal routes such as undertaking higher degrees in medical education, while for others this happens more organically through their research or independently advertised posts. The types of medical education to get involved with can be as equally diverse as research topics. Some GPs undertake research into medical education and others go on to become supervisors and mentors to primary care researchers undertaking a PhD.

Pathways to academic GP

My pathway to becoming an academic GP began a little unusually, having entered medical school as a biomedical graduate. Nevertheless about 10 years ago more formal training pathways were created that aided my progression and if anything now offer even more opportunities.

The 2005 report of the Academic Careers Sub-Committee of Modernising Medical Careers and the UK Clinical Research Collaboration, chaired by Sir Mark Walport, laid the foundations for medical and dental graduates to have the opportunities to enter into integrated clinical academic careers. As a result academic GP training is supported in England, Scotland, Wales and Northern Ireland.

In England, with the continued support from Health Education England and Department of Health, careers in academic general practice can begin as soon as medical school ends. The UK Foundation Programme Office (UKPFO) provides opportunities for foundation doctors to spend a portion of their FY2 time, usually 3-4 months, in an academic primary care department. A proportion of the week is spent attached to a GP practice seeing patients with a trainer and the remaining time engaging in academic activities within the department. During my FY2 placement, I was able to discuss with my academic GP supervisor a programme that gave me exposure to clinical practice as well as well as support my interests in research, develop medical education skills, conference attendance and networking with other academic GPs.

The integrated clinical academic pathways continue into GP specialist training with the academic clinical fellowships (ACF). In England, these posts, largely supported by the National Institute for Health Research (NIHR), differ from standard ST1 – ST3 training with the addition of an extra year of training. During ST3 and ST4 years GP trainees usually have a 50:50 split between their clinical time in practice and their academic activities. However there is flexibility to provide time in each area as needed. Many of the ACF posts come with support for Masters level training and conference attendance.

Personally this worked really well for me and if anything, spending two years in GP as a specialist trainee, provided me with an opportunity to get to know and look after a cohort of “my patients” for longer – which they appreciated. It also gave me more clinical exposure and time to achieve all my competencies. I also got a much better understanding of the unanswered issues we faced in our doctor-patient relationship. This meant I ended up bringing more ideas to my academic time. I also utilised some of my academic time to gain a postgraduate diploma in health research.

Clinical academic training pathways continue after GP qualification. Many GP ACFs are encouraged to apply for a doctorial fellowship to undertake a PhD (often 4 or 5 years part-time) in a focused area of research or education while maintaining clinical practice. Many of these are supported by funders such as the NIHR, MRC, Wellcome trust and others. Some GPs interested in academia consider In Practice Fellowships upon qualification. These are specifically designed for those with little formal academic training and wish to enter academic GP. For those choosing general practice from another speciality, prospects exist to slot into academic GP training posts at most levels. If the research idea is good, opportunities are certainly there.

Beyond this there are Clinical Lectureships in General Practice, Clinician Scientist, Post-Doctoral, Career Development and Senior Research Fellowships which can all support your academic GP career. Many university departments often show commitments to the most productive academic GPs by offering them Senior Lecturer or Professor posts after this. An outline, and by no way definitive, sketch of the integrated pathways available to prospective academic GPs is shown below.

Challenges of an academic GP

Despite so many opportunities, there are always challenges. One of the more consistent challenges of academic general practice (and one that I still ensure I stay aware of) is being able to get the balance right between your clinical and academic time. This usually first arises during specialist training ensuring that your number one priority is to gain your clinical competencies leading to your MRCGP while secondary priorities include developing your academic skills. My attitude was that I am always first and foremost a GP. Getting the balance right doesn’t go away later on, if anything becomes a greater challenge as your career grows. Your commitment to your patients is balanced with commitments to ensure academic outputs continue, develop new ideas, gain new project funding and in some cases teach as well, make it sometimes feel like a circus-juggling act. In addition, it’s safer not to think that academic GP involves “time off” from the hustle and bustle of clinical practice. All too common you can find yourself under pressure to deliver a program of work, or preparation of teaching material which easily leads to you to be working unsociable hours to complete. That said time in academia can be flexible which can also work well with having a family life. Plus most doctors are fairly resilient and each academic GP finds a way to get the balance right for them, allocating a proportion of their time for each activity in their week.

Conclusion: #whyGP? #whyacademicGP?

So while being an academic GP is not easy (which aspect of being any type of doctor is?) it can complement and support the care of your patients, be intellectually challenging, stimulating and rewarding (occasionally all at the same time), provide added diversity, build skills in leadership, create added networks and lead to a long term and successful portfolio career.

In a purely self-indulgent way (if you will forgive me), I can honestly say that I love being an academic GP – and here is why. Whether I’m seeing my patients in an inner city GP practice, completing research projects that become part of guidance, supporting the priority of primary care research for the NHS, providing commentary on research, working with current and future leaders in my field or teaching here and abroad – the week is never dull and I feel I’m a better GP for it. My patients seem to like it too, certainly as they have got to know more about what I do outside of practice. Not infrequently do our conversations reflect my academic work and can begin with “so anything new in the world of research then Dr Mahtani?” or better still, in the midst of a shared decision making conversation, they have been known to say “….yes, but what’s the evidence for that?”. It adds a whole new layer to our conversations. Brilliant.

General practice is an amazing vocation and will always need future leaders and innovators. Academic general practice might be the perfect platform to support them.

Try it, I promise you won’t regret it.

Further useful links

 

Mahtani K.R. (2015) #whyGP? How about #whyacademicGP?

 

 

 

 

 

Disclaimer

The views expressed are those of the authors and not necessarily of the any of the institutions mentioned in the article.

Falling in love with GP, Eddy Bridge – Medical Student

Eddy BridgeUntil recently I didn’t want to become a GP. I’ve always assumed general practice lacked excitement and wasn’t intellectually stimulating. However, during my primary care placement, I realised the rewarding aspect of medicine is the privilege of helping others. My time at Friarwood Surgery changed my attitude towards primary care. I now want to become a GP.

Medicine is a science, but being a good doctor involves being able to listen and communicate. I had witnessed how communication failures in hospitals left GPs to console confused or angry patients. I learnt that to take a good history you must understand the patient’s story.

My previous assumptions concerning general practice were completely flawed. How can general practice be intellectually inferior? The varied presentations make diagnoses incredibly difficult. And how can it not be exciting? You literally have no idea what will come through your door. That first consultation builds a relationship that can last until the end of a patient’s life.

General practice is where doctors really help people, by addressing their fears, understanding their beliefs and providing care to suit them.

This is where the real medicine happens and that is why I want to be a GP.

Getting though the day – Dr Jamie Wallis – First 5 GP

JamieWallisToday I left work late, exhausted, hungry and mute.
But today I also felt fulfilled.

Today I’ve had people swear at me because I won’t give them non indicated bloods, antibiotics or a scan. I’ve had one patient complain because I was running 15 min late. I’ve had one guy come in drunk and menacing. I’ve had the daily stack letters and bloods to deal with.

But all has been balanced by a home visit to a young dying man. I sat and spent time listening to him. Hearing the frightening journey he has been on so far, eliciting his fears about the journey ahead, trying to offer support to him and his partner, trying to find words to express the awfulness of the situation, trying to swallow the rising lump in my throat as he recounted his life before illness and the impact this has had on the life of his whole family unit.

For the first time in a long time, I forgot time. I ignored my watch and the clock on the wall. And I listened. I didn’t pressure him, finish his sentences for him, pre-empt what he was saying. I just let him speak. At the end he and his partner thanked me. I hadn’t done anything. Just listened. And I felt so humble. And I felt a renewed energy to support him and his young family.

I truly love this job and I wish there was more time. But patients like this remarkable man remind me why I became a GP..

Heart rendering moments where I feel I might be making a difference in some small way.

Amar Rughani – I won the lottery!

 

Amar RughaniI won the lottery! Being a doctor is one of the best ways to live a life and General Practice is the best way of being a doctor. This may sound flippant but I feel both proud and fortunate to be a family doctor; in fact it’s been the making of me and without the challenges that becoming an expert GP presents, I wouldn’t have grown as a doctor and as a person in the way that I have. Let me explain by sharing three aspects of my life as a GP.

Firstly, I have learned to be wary of certainty. I’m privileged to be trusted by my community, and patients bring me the problems and issues that worry them.

These problems, especially the significant ones, rarely have simple answers and I have to learn to manage the uncertainty until a way forward has been clarified. I work with probabilities rather than definites as a result of which:

my expertise begins where the algorithms end

That takes real skill, great judgment and a steady nerve as well as the relationship skills to share without scaring and support without taking over.

The better I’ve become at managing the uncertainty of problems, the less I’ve been frightened by the complexity and diversity of people and the more I’ve tried to understand them rather than just ‘assess’ them.

This leads me to the second aspect, which is that I have learned to see ‘status’ as a barrier rather than an entitlement.

If we really want to help our fellow human beings at their times of suffering, we need to connect with them.

That can’t happen to the degree that generates trust, if we feel in our hearts that we are different (especially, better) than them. We learn to impose our superiority and to feel entitled to do so. We even learn to justify it, for example we say it gives patients confidence in us. But the reality, well my reality, is that when we admit in our hearts that the differences between us are an accident of opportunity rather than a reflection of superiority, we free ourselves to experience empathy and understanding at a much more profound level. And that’s not only good for our relationships, it’s great for problem-solving and risk management too.

The third aspect of being a GP leads on from the second, and is the experience of fulfilment through connection. Learning to connect with people as individuals encourages us to use those skills to connect with communities of all sorts. These might be communities defined by geography or socioeconomic circumstance, but they might equally be communities of thought or belief. Learning to connect leads to learning to respect diversity and the great value of looking at the problems and issues of life from a variety of perspectives, including ones we find difficult or don’t sympathise with. This has made me curious but it has also made me more tolerant.

The feeling of being connected with people, understanding their complexity, respecting our equality and our differences and giving something that they value has been the recipe for a deeply fulfilling life.

General Practice gave me that, and I will find it so hard to walk away from it.

It can give you that too.

“Just a GP” – Liddy Mawer – ST3, Yorkshire

Lydia Mawer

I am not “just a GP”, I am a highly skilled specialist on the frontline of the NHS, a risk-taker, a problem solver and a gatekeeper to finite resources. I am a leader, a teacher, a businesswoman, an innovator and a champion and advocate for patients. I provide consistency and fairness and a helping hand to those at their time of need.

Being a doctor in any specialty is tough in the current political and financial climate. There is an ever-increasing workload as a consequence of increasingly available (and costly) treatments and the subsequent amassing demand from patients with inflated and at times unreasonable expectations. In the context of a growing society and a workforce that’s perpetually shrinking in not only numbers and resources, it’s no surprise that more recently, morale amongst passionate and dedicated doctors is also at an all time low. The current use of the NHS as a political vote wining pawn in an increasingly consumerist and fractured society has resulted in the unsustainable situation of a system with finite resources stretching itself dangerously to cater for patient’s ‘wants’ for services and access to healthcare in strong contrast to the reality of their actual medical needs and what is achievable.

The embers of unreasonable expectation and dissatisfaction may have been smoldering in the background of a 24-hour consumerist society but the flames have been strategically perpetuated by governments and further fanned by a vitriolic media. GPs were the first to take a hit with complaints of inadequate convenient accessibility and non-evidence based accusations that a lack of routine 7-day availability was contributing (amongst other things) to the pressures on A&E attendance and poor patient care. GPs have been maligned as overpaid money-grabbing doctors, clocking off at 5 pm with no regard for their patients’ wellbeing. With this present demonization of ‘fat cat, lazy’ GPs in the press and an increasingly overworked and demoralized workforce, it is easy to understand why general practice is failing to retain GPs let alone recruit young doctors. Add into this the uncertainty of the future structure, funding and expectations of general practice (and indeed the NHS itself) and the open dissatisfaction and ‘burn-out’ of GPs, recruiting future general practitioners seems an increasingly impossible task, already troublingly evident in significantly unfilled training posts.

So, why would any young eager doctor in their right mind even fleetingly consider training to become a GP in this climate? Even within the profession GPs are often depicted as subordinate to their secondary care colleagues: as failed specialists.

As a junior, specialists often commiserated me when I declared general practice as my vocation, repeatedly declaring with tilted head “that it’s a shame that such a good doctor is being lost to general practice”.

This was swiftly followed with the assumption that as a female doctor, I wanted a family and that the flexibility afforded by general practice to accommodate this was the only fathomable justification for ‘settling’ with primary care! It was not considered that I had chosen to become a GP. This subconscious contempt for general practice as a contingency stems from medical school and even now when asked about my specialty I have often described myself as “just a GP”, a line so subliminal and commonplace that it rolls off the tongue.

Recently a colleague asked me why I was a GP; the benefits of general practice over other specialties and how would I ‘sell’ the vocation to young doctors at a time of crisis?

Despite the current climate and ever increasing challenges of the profession I didn’t find it hard to justify my decision and passion to train as a GP or to find many benefits when compared with secondary care specialties.

So firstly from a pragmatic viewpoint there are many benefits. Although I did not choose primary care predominantly for its family friendly work-life balance, I know that many of my colleagues to varying degrees did and lets be honest, the prospect of free weekends and no night shifts after many years pounding the wards out of hours is attractive (whether you are planning on producing children or not) and it is understandable that the prospect of losing this work-life balance is deterring many would-be GPs. However, the fact remains that as a GP trainee and then a practitioner, even with extended working hours and the prospect of working weekends,

the work schedule is still more family friendly than the shifts of my secondary care colleagues (even more so in light of the current political propositions).

As a trainee your working week is for the large part sessional and extremely well supported. It is almost expected that you will bear children during your training and your progression is simply placed on hold until you return from your maternity leave. No scrabbling around trying to plan conception perfectly between work placements. Its sessional base also lends itself to less than full-time training and part-time working once you qualify and unlike secondary care it is quite feasible to work only mornings or to plan your working week to varying extents around your life. There is no worry of where in the UK you may be posted with a small child should you have been unfortunate enough to have not obtained run-through specialty training and there is no long commute once you settle into your regional training program. There is also no fear for your future career or the dreaded trepidation of informing your surgical boss that you are pregnant, that many of my friends have encountered. Your first thought when you are pregnant should not be how you are going to break the news to your boss! And while I’m being pragmatic, you can also park right outside of your office, for free.

No driving around for 30 minutes unable to find a space within a three-mile radius of the hospital that you have paid extortionate amounts for.

This seems a flippant point but I all too well remember being scared whilst running to my car in the early hours of the morning across a huge, poorly lit campus.

Although I cannot comment too much on hospital based training programs what I can say is that GP training is second to none. Where else can you get weekly genuine protected teaching time that is not repeatedly lost to service provision, (a whole day a week) and daily one-to-one teaching, training and supervision? Every day I have the opportunity to discuss every single one of my patient encounters with an experienced GP who is passionate about teaching and has chosen to become a trainer (with actual teaching qualifications), providing constructive feedback and support. My twice daily debrief is precious and enables clinical learning, reflection and often laughter and challenging debate. You also really get to know your colleagues and fellow trainees with such regular contact making lifelong friends and just as importantly, a wide supportive professional network- the key to any resilience and professional sustenance in the longrun. We all congregate every week, learn together, teach each other and most importantly regularly go out for dinner! This intimacy is difficult in secondary care where my colleagues are regularly on the move to different sites and their shifts preclude any extracurricular congregation and coherence. Their formal teaching is increasingly sacrificed to an unmanageable hospital workload and has to be done vicariously and it’s potluck as to how much training, ability and enthusiasm that your overstretched senior colleague has that day. I am not professing that standards are low in secondary care, merely that they simply cannot match the standards of the GP vocational training scheme.

However, if you are only attracted to general practice because of its work-life balance or if you see it as an easy option then your reasoning is defunct and perhaps it is not for you.

The truth is that it is a challenging, difficult and highly skilled specialty requiring a breadth of knowledge and the ability to deal with ever increasing complexity and new challenges and this is what really attracted me to the profession.

I enjoy being a doctor and found that I didn’t want to limit myself to one specialty. I have relished every aspect of medicine that I have worked in and found that general practice could provide me with that variety that I craved. The work is stimulating, increasingly multifaceted and more varied than secondary care. Although the move of many secondary care services into the community has added to our workload, it brings with it challenge, variety and an increased skillset, advancing my ability to treat patients holistically. No two days are ever the same and I genuinely have no idea what the next patient will expect of my aptitudes nor the challenges and problem solving that ensue. As a GP I can obtain a specialist interest and use those skills in secondary care or the community, I deal with acute and chronic conditions, and I can work in the out of hours service, A&E and in people’s own homes. There is nothing like consulting with a patient in their own surroundings to get a realistic insight into their lives and health needs. It is also great to be able to interrupt my day by leaving the office and it can lead to acute medical problems that often test my skills and risk-taking nerve! I have the privilege of working as part of a larger multidisciplinary team, (including my respected colleagues in secondary care) consisting of fun, inspiring and talented people. Working in a smaller setting also facilitates teamwork, cohesion and morale. I have never seen anything other than teamwork during any of my hospital placements but a busy ward with a revolving workforce can never match the consistency of working with the same people over a period of time. You learn to anticipate each other and find a balance. I have always felt more supported in primary care; on many occasions my colleagues have seen a patient of mine when I am running behind, or nipped to do a visit when I am overwhelmed on-call or even just signed my pile of prescription or made me a cup of tea. It’s the little things that make you feel supported and appreciated.

Like my secondary care colleagues I also have the option to take an academic or leadership role and become involved in teaching or research, I can also become more politically involved should I chose, by engaging with bodies such as the LMC or CCG etc. However, unlike my hospital colleagues I am afforded more autonomy as to where I work, who I work with and to a reasonable extent, how I practice and the boundaries that I prefer to work within (obviously within the limits of good practice and regulation).   I can chose to be employed or I can take the leap into business ownership. This opens up the world of business, management and leadership, enabling a GP to actually change things within their own practice in a meaningful way and influence their own working lives. If I am not happy with a system I can change it. If I want to start at 7am and leave earlier I will, if I want to spend a session performing minor surgery I can, if I want to drink a cup of tea at my desk during a busy day, I can and no-one can run in and tell me off! If a giant bound into business isn’t for you then it’s actually an excellent time to be a salaried GP. With the current recruitment shortfall there are more jobs than GPs so unlike our secondary care colleagues whose training positions have been cut and are highly elusive, the employment prospects in primary care are exceptional! There is no danger of having to settle for a practice that doesn’t match your ethos or forces you to relocate half way across the country in the opposite direction to your partner.

Doctors on the whole will proclaim that they were attracted to the profession because they are interested in people and want to help them (at least during their medical school interview anyway!) If that still bodes true then perhaps general practice is for you. The job is fascinating. I deal with a broad section of society full of interesting people of all ages, the vast majority of which (contrary to the current propaganda) are hugely appreciative of the care that they receive amid the constraints of an overstretched system.

I care for people not organs with a continuity that simply cannot be replicated in secondary care. Patients are people and managing their needs entails not only basic medical management but also the added complexity of dealing with their personality, values and beliefs, their wider family and friends and everything in between.

You really get to know people and support them through their lives ‘from cradle to grave’. This is a challenge and at times I feel more like a hostage negotiator than a doctor but it is a privilege to be involved with people’s lives at such a personal level and gives an insight into their health needs and understanding that is otherwise lost. If you don’t know what a patient wants and needs, no amount of medication or reassurance will address the underlying problem.

Despite the wider misconception that the important or life-saving medicine is conducted exclusively in secondary care, this is not the case. GPs do not just dole out statins and paracetamol all day. We make a real difference, even if it’s just ongoing through persistence and consistency, chipping away at a problem over many years. We change lives and we save lives.

I am passionate about general practice and its’ future. It is essential to the NHS and without dedicated and highly skilled GP’s the system will inevitably fail. General practice is understaffed and we need more doctors to commit themselves to this rewarding vocation but to be more specific, we need excellent, resilient and talented doctors that can stand up to the challenges and demands of general practice. Primary care is not a place for ‘those that can’t’ and the question should not be ‘why should I be a GP?’ but ‘what can I bring to the table and offer my community’?

Dr Liddy Mawer
ST3 Barnsley VTS