A portfolio career in general practice and medical education

Jillwilson Following my GP training in Cornwall where I saw the best in ‘frontier medicine’ I moved to London and became a partner for a few years until the lure of the West Country drew me home to Somerset and the bosom of my family.

I have been in the same practice now for 24 years and have been senior partner there for the last 3.

During that time I have been able to pursue many interests in medical education – teaching medical students, becoming an appraiser and trainer, and for the last 7 years a programme director for the GP specialist training scheme as well as a keen member of the Tutor group for the GP school so am involved in training the next generation of educationalists. I even managed to squeeze in a masters in medical education.

Together with my husband I have also raised three amazing children and a few families of springer spaniels, burmese cats and shetland sheep.

For me this sums up the beauty of a career in general practice – I have been able to live where I wanted, work as I chose and follow up interests as and when they arose.

As a partner I have always been involved with direction-setting in my practice and had an equal voice with the full-timers.

As a GP educator I have been invited to sit at many tables – at the School of Primary Care, at the RCGP at Faculty and National level, at LMC and CCG meetings and most recently to give evidence at the Select Committee for Health in Parliament.

It is reassuring how open people are to the views of jobbing GPs like me, and how rewarding it has been to successfully juggle all my chosen roles over the years. I believe general practice is the best way to achieve the ideal work – life balance and am happy to support others to find the right balance for them.

Jill Wilson

Balancing Home Life and Extended Roles with a GP Career

Veronica Wilkie GP+ NetworkingI have been a GP for 25 years and still regard my clinical job (two and a half days a week) as core to who I am and it supports and informs my role as Professor of Primary Care at the University of Worcester.

Like many GPs I have had a number of roles in a number of organisations, rather than following a straightforward GP educator or Academic GP career. If I was to look back at the last 25 years there are a few key events that have coloured my career.

The first, becoming a GP tutor when I had been in practice for 5 years. This catapulted me into the word of education and started a networking habit I have never been able to lose. Although a rookie and relatively young, the West Midlands Tutor group were phenomenally welcoming and supportive. I read, and read and observed and went to every training session or educational conference I could.

The next was an opportunity to do a Masters Degree in Evidence Based Practice at Oxford University. My time out was covered by the Prolonged Study Leave Scheme (Oh so needed now), which enabled the practice to employ a locum for the 3 weeks of teaching a year for 3 years at Oxford. I paid for my tuition fees myself and learnt more than just the curriculum meeting with clinicians form all over the world. I continue to have a great network of EBM teachers and still run courses and conferences to this day. The academic rigour of writing essays “critically” has helped my future research and business case development for projects in the NHS, DoH and university since
I moved from the Deanery (which then used to be the regional centre for all doctor training) to a University in 2007. WE were in a small unit which worked at a national and international level. I was able to learn from a great mentor, and continued to network to develop academic skills

Through all of this I have looked at my home and work balance. I’m married to another GP and reduced my hours in the practice so that I could always attend school events, and managed always to work opposite my husband (although in another practice) so that one of us was always home by 6, and there for swimming lessons, changes in my non practice roles were decided as a family team. I used to never work when the children were small until they were in bed. I value all my non medical friends as much as the medics and have tried to have a charity input (now a governor of a hospice, but I have been a nursery trustee, and member of various parent committees at the boys school)

I have been lucky with the practice. We have an agreement that all full time or nearly full time partners can do one session out of the practice – even if its a lost leader, and can take a second one out at replacement cost. We are now a happy and settled partnership of 7, who have now grown to more than cover the cost of our salaried and PA team as we have got more senior over the years, and our outward facing culture I think makes us more resilient

I am now where I couldn’t have predicted a few years ago, I enjoy all aspects of my working week, and am enjoying another “start up” in another University.

So:

  • Surround yourselves with enthusiasts
  • Don’t look always at the money, paying for your own education or starting work in a role that pays less than a locum will bring dividends in the medium and long term
  • Home time is for families, try and separate work and home
  • Whatever role you have enjoy it

Veronica Wilkie
Professor of Primary Care
The University Of Worcester
Partner The Corbett Medical Practice
Academic Lead HEWM Urgent care GP project

I never had any doubt that I wanted a GP career

GP+ Networking Martin RolandI never had any doubt that I wanted a GP career. It always seemed to me the most varied, interesting and challenging branch of medicine and I’ve always liked never knowing what would come in the door next. I think the ‘routine’ bits of general practice must be more varied than almost any other job on earth. I also really like the freedom of being in a practice where we were our own bosses and could organise our own time within our GP career.

When I finished my vocational training, I thought I’d try academic general practice for a few years and found I really enjoyed the research though it took a while to discover whether I’d be any good at it.

Anyhow, 35 years and 250 research publications later, it seems to have worked out OK. I was Professor of General Practice in Manchester for 18 years and I’m now Professor of Health Services Research at Cambridge.

Much of my research has been about measuring and improving quality of care, and one of the continuing challenges has been how to influence primary care policy in the NHS. I have quite a lot of meetings in Whitehall and it’s surprising how often I’m round a table when I’m the only person who’s ever seen a patient. Not what I thought I’d be doing when I started out as a GP.

Professor Martin Roland CBE

Emergency Care GP and Urgent Care Leader

Kat Noble Dr Kat Noble is a very good example of a GP+ Networking coach.

She is an Emergency Care GP with extensive working knowledge of urgent and emergency care. She has over 11 years of current clinical experience working in pre-hospital care, GP, urgent care and in the Emergency Department.

In 2010 she was the sole nominee for the first North East (NE) NHS leadership academy clinical leadership fellowship from which she successfully graduated in 2012. She has a thorough knowledge of NHS 111 having held clinical leadership roles initially as NE Regional NHS 111 lead. After being invited to join the Department of Health as National Clinical advisor role for NHS 111, she further developed her expertise in dynamic clinical governance.

Kat’s first position at executive board level, as National Medical Director for NHS Direct, taught her how a mature effective board can work. She also held a position as joint Clinical Director for NHS Pathways and advised on the independent expert “Urgent Care Commission” group supporting Bruce Keogh’s Urgent and Emergency Care review. Kat supports workforce development and chairs the Emergency Care Taskforce for Health Education North East. An ALS instructor and volunteer doctor at the local race circuit Kat also enjoys keeping her emergency skills grounded.

Committed to her work but in enjoying her downtime Kat’s top priority is family life where she enjoys being a wife and mum of three, travelling and trying to beat her children in the “Park run”.

A few words about GP+ Networking from a GP trainer

GP+ Networking coachI was a GP trainer for many years so I feel I am able to say that the GP+ Networking website will become an essential tool for anyone working in or with Primary Care in the West Country.

It has been conceived and designed by an enthusiastic and very able young doctor who perceived a real need for an on-line forum to help with a wide range of Primary Care problems. If you need a job or have a job to be filled this website can help.

If you want to know what’s going on in CPD in your area – or even if you want to share a lift to a meeting or conference – find it on this website. If you want to network or develop a political career in medicine, then you need this forum.

Test your ideas and spread your ideas, develop new ways of working and promote what you are doing through this website. If you want to hear about the latest advances in Primary Care Medicine this may be the way forward.

In summary this website will be what its following makes of it. It could go in many different directions. So join up and contribute. You can make a difference very quickly and we should be very grateful to Cathryn and her team for getting the whole project up and running.

We wish you the very best of luck with this new and exciting venture.

Martin Minogue

A career in general practice is rewarding

A career in general practice is rewardingMy name is Ananda Pal. I changed from a career in general medicine to general practice. I had found that I enjoyed the general aspect of being a medic and that there wasn’t one specialty I particularly wished to undertake for the rest of my career. With hindsight I was fortunate enough that it was straightforward to sample 6 months as a GP registrar and since then I have never looked back. I soon realised that being a GP offered me a huge variety of interesting medical cases with often quite rare diseases initially presenting through GP.

As a medic I had always been interested in teaching, and took the opportunity to become a GP trainer which I find rewarding and adding some more variety to the week. Aside from spending time with trainees there are meetings with other trainers, which provide a welcome change from day to day surgeries.

I have the opportunity to use and apply other skills that I learnt from my time as a medic such as joint injections learnt in rheumatology. I am also the diabetic lead for my practice.

I find it really rewarding to work as a partner in a busy practice. There is a real sense of working in a team. We have moved into different roles within the business itself ensuring work is fairly shared. Partnership meetings are an opportunity to look at things with more than a clinician’s hat on and also a time when it is good to meet with the rest of the doctors. Prior to choosing medicine as a student, I had toyed with the idea of working in a finance based job in London. I now lead on the financial aspects of working in our practice so I get perhaps a little taste of what may have been!

I would wholeheartedly recommend a career in general practice.

Ananda Pal

GP+ Networking can help doctors make informed career choices and consider GPwSI

GP+ Networking ProfileI am a GP principle working out of Bridgwater, Somerset. I am Somerset born and bred. I studied in London a GKT qualifying in 2002.

Very early on in my training I decided I wanted to be a GP. I was very much attracted to the opportunity to work with a population of patients over many years, getting to know them and be able to walk through life’s challenges with them. I like the wide variety of opportunities offered in a career as a GP and particularly wanted to focus on taking a ‘whole person’ approach to delivering good health care. With this motivation, I went straight from my house jobs to GP training in Somerset.

I have been a GP Principle since 2006. Within weeks of starting in my practice, we were being asked to consider our involvement in Practice Based Commissioning. Heralded as the future of General practice, PBC soon came and went. And in many ways this has been the pattern of life working in the Health services. New pressures bring new challenges and demand answers. Whilst this can at times be disheartening, it can also make for a very exciting carer. Leadership opportunities exist for people who want invest time and energy into making the NHS fit for purpose in the 21st century.

After 3 years working as a GP, I took on the challenge of studying to gain further qualifications in Dermatology. This was afforded through the Diploma in Practical Dermatology course at Cardiff University and led to the accreditation process to work as a GPwSI in dermatology.

The pathway towards accreditation was not straightforward. Although guidelines are available and a curriculum of sorts can help focus learning, as so few take this route, there remains great variance in what actually should be done to demonstrate an adequate skill set. Which course demonstrates adequate surgical skills? Is the RCGP course adequate? Are further skills needed? What constitutes an adequate log book? How do you achieve the 50 sessions of supervision? Who pays for your time out of practices? There were no clear answers to these questions. The hope is this website will help plough a clear line through to accreditation.

I now work 6 sessions a week running a primary care dermatology clinic. The clinic has been designed to be paper free and runs entirely on the EMIS system. All referrals are received and processed digitally. All clinic notes are recorded digitally. All investigations requested, processed and actioned digitally. All clinical letters are created using templates and protocols within the EMIS system so that before the patient has left the room, the letter to the GP is on its way. Additional admin time is minimal. IT is the key to producing efficiency in the NHS and we believe that we have demonstrated this in our practice.

As such, my other passion in the NHS is working with our current IT systems and making the most of the functions they offer to bring about efficient and safe working. IT has a great role in supportive education for doctors and embedding education tips within the framework of a consultation template has been beneficial. I am currently working to expand this tool in our county.

Jon Upton

GP+ Networking can provide support to inexperienced doctors

GP+ Networking coachAs a medical student I represented my medical school at the founding of the European Medical Student Association in Belgium and a year later became mess President in my first house job. Alongside this came a representative role with a place on the regional Junior Doctor Committee and it was the time of the 120 hour working week and the successful negotiation of a seventy-two hour week and I helped in its implementation in subsequent jobs.

Thus at the first opportunity I stood for a place in my Local Medical Committee, I was driven by being a single-parent at the time having to pay for overnight childcare, with no reimbursement for my on-call shifts.

My drive was picked up on by the LMC Chief Executive who encouraged me to go to national conferences and stand for national roles. I was encouraged to stand for the Professional Executive Committee. My former course organiser encouraged me to set up and facilitate an educational group and to apply to the RCGP Leadership Programme. These more senior doctors belief in me and support was critical and I see that GP+ Networking can provide this to GPs now, looking to develop themselves in a special interest and leadership.

I like to listen to my colleagues’ views and try and impact on our working lives. Generally it provides less income than face-to-face general practice but it gives me an opportunity to do something about the frustrations we all experience.

Helena McKeown Ewing on the BMA council

Nationally I have been able to influence the healthcare system we all work in and our working lives in many diverse areas and I have been particularly rewarded by my work on the Standing Commission on Carers.

We are natural leaders in our communities, whether it’s cycle paths and air quality, children’s charities or refugees but at times as leaders we are vulnerable to public criticism and it’s vital that we are well supported by experienced colleagues. I feel that the GP+ Networking will supply this.

Helena McKeown

Why Harding loves being a GP with an extended role

My experience as a GP with an extended role

harding richards gps with extended rolesAs a medical student and foundation doctor, I could never find the one specialty that made me want to exclude all others. I liked acute medicine too much to be psychiatrist, and mental health too much for a career in the Emergency Department. In every field other than general practice I worried what I’d be giving up. So with my herringbone jacket and my bag slung over my shoulder, off I marched to GP selection.

I knew I wanted to train outside of a city, and I’m glad I did. Think of words like “radical”, “dynamic” and “revolutionary” and the GPs of Somerset are unlikely to spring to mind. Yet they have been early and enthusiastic adopters of new medicines, such as NOACs; they have organised a rolling programme of teaching throughout the county, via SGPET, that ignites genuinely useful discussions and makes the insights of our colleagues in specialist care easily accessible; and, whatever you may think of the concept, abandoning QoF for locally derived and developed performance targets was not a move for the faint-hearted.

Yet even so, I realise that there was something I had given up in becoming a GP – a niche; an area of my own, where I could hone my skills and develop a personal interest; a special interest; an extension of my role as a General Practitioner. Or so I thought.

For me, the route into having an extended role came in the form of the Severn Deanery Scholarship in Substance Misuse. The opportunity for ST3s to take a little longer with their training and nurture a new skill set was too good to pass up, and the rewards have been phenomenal. As a substance misuse scholar, I’ve had the chance to work in a community drug and alcohol team, and can now run my own clinics. I’ve been sent on part 2 of the RCGP’s course in substance misuse – a serious qualification with nationally recognised clout, and will qualify with the ability to call myself a GpwSI.

For me, the chance to have a specialist role alongside my work as a GP really is the best of both worlds. For the profession, it’s something of an antidote to the continuous workload that may grind down GPs young and old. And for the health service as a whole, it brings in new ways of working that can bring about those radical, dynamic and revolutionary changes to keep the NHS that we know and love going through the 21st century.

Harding Richards