The New GP's Handbook

How to Make a Success of Your Early Years as a GP

Peter Davies, Lindsay Moran, Adrian Roebuck

• Publisher: CRC Press
• Year: 2022
• Print ISBN:
  9781138447141
• eBook ISBN:
  9781000605167
• Topic: Medicine
• Subtopic: Medical Education

General Practice has never been an easy occupation. In the past there were some clear structures and routes for new GPs to take. You could expect to join a practice and progress through the ranks, growing in seniority and confidence. You might have been informally mentored by one of the older colleagues; learning management and business skills gradually. It is no longer like this. The market has changed, the range of options is wider, and the way through the labyrinth is far from clear. You might find yourself confused and overwhelmed by all the new opportunities, possibilities and prospects. This book helps to clarify uncertainties and guide you towards the right path. It offers ways to formulate strategies when planning your career and maps out the landscape of general practice, enabling you to make, confident and informed decisions about your professional future. Supporting the initiative of First5(R), The New GP's Handbook is highly recommended for newly qualified GPs who will find it answers so many of their questions and helps make the first five years (and beyond) in general practice more understandable, productive and enjoyable. Experienced GPs too, will find the guide invaluable as a current, general overview. General practice is an exciting and rewarding career which provides a host of opportunities for new GPs entering the profession today. Finding the right job, achieving a good work-life balance and developing a culture of lifelong learning are vital not only for the fulfilment of new GPs themselves but for the future of the profession. This book will help you achieve these objectives. Clare J Taylor, in the Foreword

Chapter 1

Introduction

Peter Davies and Lindsay Moran

Si jeunesse savoit, si vieillesse pouvoit …

(If the young were to know, if the old were still able …)

—Henri Estienne

Welcome to The New GP’s Handbook.

General practice has never been an easy occupation. But at least in the past there were some clear structures and routes for newly qualified GPs to enter. New GPs could expect to join practices as partners and to progress through the ranks and grow in seniority and confidence as they did so. In the better partnerships the young GP would often be informally mentored by one of his or her older colleagues and gradually he or she could learn the practice management and business skills of general practice.

It is no longer like this. The market for new GPs has altered, the range of options is wider, and the way through the labyrinth is far from clear. As a new GP, you are likely to be rather confused and bewildered by the colourful new world you find yourself in. You may well be struggling to recognise the key features of this new world, and you may have little or no idea where you should position yourself in relation to these key features and which route you should take to get there.

This book is written to help with your bewilderment. We hope that by the end of this book we will have helped you to see clearly where you have got to now and where you want to get to in the future and how to get there. Along the way we hope to help you formulate the strategies you will need to use to define your priorities and so decide which jobs to aim for and which to avoid. We will try to map out the landscape of general practice so that you can navigate your way around it, and succeed in knowing and getting what you want from your professional life and how to overcome the hurdles you will inevitably encounter. Two of us, Lindsay Moran and Hussain Gandhi, are new GPs currently in the swamp of career uncertainties and impending appraisals but lightened with opportunities of new jobs, possible portfolio careers and leadership opportunities.

The need for this book became apparent aft er a number of meetings and discussions with various young GPs in the first 5 years following completion of their training, and the book itself emerges from events we have run in Yorkshire under the First5^® banner of the Royal College of General Practitioners (RCGP). From these events it is clear there are many things newly qualified GPs need to know that are not covered on the vocational training scheme (VTS). Alternatively, maybe as a GP registrar you were taught them but you did not appreciate their significance at the time. These things are very rarely clinical issues – indeed, the great strength of the VTS is that you tend to leave it with competent clinical knowledge and good communication and consultation skills. They are topics that tend to be much more practical, managerial and organisational (these are difficult to teach) and which only become sharply relevant when you enter the world beyond the VTS. If we could get GP training extended to 4 or 5 years (as the RCGP argues strongly for) then we could include most of these topics within the curriculum. However, at present we cannot, and this leaves newly qualified GPs with some significant weaknesses – weaknesses that we hope this book will help to remedy.

The GP VTS can be considered as rather like a womb – a protective environment in which a new life (professional identity) can form. The French word ‘naïve’ describes the property of just being born. The impression we have is that many new GPs are somewhat naïve. Moreover, the term ‘competent but not confident’ is currently bandied about. Aft er reading this book you won’t be naïve and you will be more confident; it is to be hoped that you will have acquired much of the knowledge of the old, yet without losing your youth.

THE BIRTH OF FIRST5^®

In this book we will introduce you to how the RCGP was born and how it grew to be the college it is today. The College Council is attended by a group of motivated ‘mover and shaker’ GPs who regularly attend meetings at the hub in London. They are an elected collection of experienced doctors with the influence to drive the direction of the college’s aims.

Initially, young GPs (particularly trainees) were poorly represented on this council. In 2007 the college became responsible for the licensing examination for all new GPs. This was created as the nMRCGP (new Membership of the Royal College of General Practitioners) examination, a long-overdue synthesis of the previously separate exams of ‘summative assessment’ and MRCGP. With young and new GPs uncomfortable amidst this change with the college voice coming from only older GPs, it was agreed through discussion that the Associates in Training (AiT) Committee be formed. The committee was first formed in November 2007. Aft er a successful beginning the committee was invited to attend College Council meetings. The College Council realised what an asset the voice of young GPs was, and the AiT Committee has continued to grow in strength.

However, when the AiTs came to the end of their training and were no longer sheltered under the trainee umbrella, they thought forlornly, ‘well, what happens to us now?’ Like years of GPs before them, these AiTs realised that aft er qualification the world of general practice is a potentially lonely and unsupported one. Three years of training is arguably not nearly enough training time to be a fully competent solo practitioner generalist of all the specialties. With those GPs who chose to work as salaried doctors or partners, there is hopefully the support of the more experienced GPs at the practice. However, for locums and salaried GPs, especially those who move to new areas, being a GP can be very isolated. Also, young GPs are often desperate not to appear inadequate in their skills; although they know to ask for help when they need it, I (Lindsay) know from conversations with my own peers that this is something you do not wish to do too often. You do not want to look like a fool in front of all the other clever, more experienced doctors when you barely feel like one yourself. Young GPs are a particularly vulnerable group, ‘a lost tribe’, who are currently more in need of support than any other group. AiTs have good support from the RCGP, their local deaneries and training schemes, but all this disappears on qualification. Equally, and often as a consequence of this, many young GPs see no advantage in continuing their membership with the college.

And so it was that these ex-AiTs sat in a room and saw a blind spot on the GP roller coaster. With the introduction of revalidation it seemed common sense to focus on this new group of GPs, supporting them from qualification until revalidation at 5 years.

Dr James Parsons, an AiT in Sheffield at the time, was the first to describe the concept of First5^®. Together with Dr Clare Taylor (the first AiT Committee chair), Dr Parsons formed the First5^® group in 2007, the aim of which is to give identity to and to support all newly qualified doctors within the first 5 years post completion of the VTS and the nMRCGP exam. First5^® leads were established throughout the country to work on five key pillars:

1. 1.  Connecting: promoting a sense of belonging and appropriate representation for the First5^® cohort within the college. Locally, young GPs are now involved on all faculty boards across the UK to champion the First5^® cause.
2. 2.  Networks: encouraging peer support and mentoring through the development of local networks.
3. 3.  Career mentorship: highlighting the opportunities a career in general practice offers and helping new GPs get the most out of being a GP.
4. 4.  Continuing professional development (CPD): identifying the CPD needs of those within the first 5 years following award of the Certificate of Completion of Training, highlighting existing relevant provision and developing new materials where gaps exist.
5. 5.  Revalidation: offering support through revalidation for those in the first 5 years following award of the Certificate of Completion of Training.

Although the First5^® initiative is only in its early stages, it has now extended to all areas of the UK. It is recognised that there are different needs in the different areas of the country, but just as the AiT Committee grew from a small seed into a successful entity so too has First5^®. The RCGP as a college enthusiastically supports this initiative as a service to its newer and younger members. As the authors of this book, we hope The New GP’s Handbook will help new GPs with these objectives.

The term First5^® has become a college trademark, so to avoid infringing this trademark in The New GP’s Handbook we use the term ‘new GPs’; however, when writing this book we were thinking about the specific information needs of GPs in their first 5 years of independent practice aft er passing the MRCGP examination. We hope new GPs will find this book helpful and that they will be able to use the knowledge and perspectives herein to benefit themselves, enabling them to enjoy their career more and to help their patients better.

HOW THIS BOOK CAME ABOUT

This book came about after a Yorkshire RCGP First5^® study day held in Leeds in June 2011. Peter Davies had run a similar session a year earlier with James Parsons (‘101 things they didn’t teach you on the VTS’). Lindsay Moran and Hussain Gandhi were the two First5^® leads on the Yorkshire Faculty Board and had arranged the day and its agenda. Lindsay and Hussain asked Peter, as former chair of the Yorkshire RCGP Faculty to be one of the speakers.

Peter had the chance to listen to the topics and the questions and he realised there was a need to capture the questions and their answers and make them widely available to new GPs. Lindsay and Hussain quickly agreed that this would be a useful project, and the result is The New GP’s Handbook.

Peter is responsible for writing most of the book. Lindsay has written about the practicalities of life for a new GP, focusing on the hurdles that new GPs need to overcome. Hussain has aided with the above and included his own viewpoints throughout the book, in addition to the editing. Adrian Roebuck led the business strategy session for the aforementioned Yorkshire RCGP First5^® study day in June 2011 and has turned his presentation into Chapter 15 of this book. Each chapter begins with the contributing author.

Throughout the process of writing the book, Lindsay and Hussain kept prodding Peter to remind him that once you know something it can sometimes be very diffcult to remember that you didn’t always know it. The result should be a useful text that is sufficiently down to earth to answer basic questions, and sufficiently elevated to let you understand what is happening, why things are as they are, and how these things may develop in the future. We hope this book inspires you to want to be part of shaping the future of primary care services in the UK.

Some of the topics covered are new, controversial or, indeed, not fully worked out yet by young or by old. In this book we have presented our best current understanding of revalidation, leadership and commissioning, but the information and our views on these topics may change over time. Many experienced GPs may find our accounts of these developments a useful current overview.

Some of the topics are perennials in general practice and are probably existential to our work. We have covered these topics because all GPs, new and old, need strategies for them. Obviously, new GPs cannot have as much experience as their older colleagues. We hope that what is presented here in The New GP’s Handbook is a useful distillation of the knowledge of older GPs and that this will speed up the learning for newer GPs.

This book is a combination of youth and experience. Our hope as authors is that this book will help to make your first 5 years – and indeed beyond – in general practice more understandable, productive and enjoyable.

REFERENCES

1. 1  Taylor CJ, Parsons J, Sparrow N, et al. The first5 concept. Br J Gen Pract. 2011; 61(582): 72–3.
2. 2  Taylor CJ. From the … new GP: first5. InnovAiT. 2010; 3(10): 587.

Chapter 2

The nature of a profession

Peter Davies

If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.

—Red Adair

WHAT IS A PROFESSION?

What is a profession? What does it mean to be a professional? What distinguishes a professional from an amateur? These are all questions worth thinking about as a new GP.¹ You may already have some answers to these questions – you became a member of the profession with your medical degree and your full General Medical Council registration. You are now stepping up, becoming a new member of an important specialty within the profession of medicine. What does this mean to you? What does this mean to others?

A profession arises when any trade or occupation transforms itself through ‘the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit and discipline members, and some degree of monopoly rights.’²

There is often an element of vocation to professions – you are called to them. There is often an element of mission to professions – you are sent out to do something, and that something is usually a noble purpose of some sort that will affect other people and their lives significantly. To some extent, professions are intrusive enterprises: think of divinity and its care for souls, of law and its care for disputes and legal boundaries of behaviour, of doctors and our permission to intrude into the hidden spaces of people’s lives and bodies. These are all intensely personal services that need to be provided with great concern for those we treat; they require deep knowledge and specific standards of behaviour if they are to be done well or even at all. These standards of knowledge and behaviour and their f...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• About the authors
• Acknowledgements
• 1 Introduction
• 2 The nature of a profession
• 3 The primary care landscape
• 4 The work of general practice
• 5 Levels of medical effectiveness
• 6 How to find a job
• 7 Continuing professional development, appraisal and revalidation
• 8 Leadership
• 9 Commissioning
• 10 A day in the life of a GP
• 11 The doctor’s bag
• 12 How to stay sane and healthy as a GP
• 13 Dealing with isolation and medical uncertainty
• 14 Adapting consultation skills to the world of actual general practice
• 15 The business of general practice
• 16 How to handle a complaint
• 17 How to deal with your heart sinking
• 18 Mentorship
• 19 Learning points
• 20 Ongoing learning and support: what’s the best way to achieve this?
• Index