InnovAiT: Education and inspiration for general practice

General practice is a complex discipline and GPs require many attributes and skills to provide safe, effective, patient-centred care. The duration of current training in the UK is 3 years for general practice but Recommendation 45 of the Tooke report ‘Aspiring to Excellence’ suggests that this should be increased to 5 years. So is there a case for extending GP training?

You have spent at least 5 years as a junior doctor before graduating as a fully fledged GP. Most potential GPs go into GP training with the vision of a future as a GP partner, running a business and maintaining high-quality care with continuity for practice patients. Is this the reality in modern general practice?

Qualifying as a GP can be an unqualified let-down. We spend our training learning how to be a partner, but actually we nearly all end up locuming for a significant amount of time. And then, when … if, we get that partnership, we can end up re-examining why we went to Medical School in the first place, and why did we decide to be a GP? Was it because we fancied the idea of one day becoming a manager, hiring and firing staff and managing budgets? Was it because we liked the idea of reaching targets that seem to be changing on a regular basis? I suspect not. We wanted to be GPs because we enjoy the clinical aspects of care, being involved in the management of people from cradle to grave and working at the coalface of health care. So, although partnerships and salaried posts can deliver our aims, we invariably have to suffer the baggage too. And as business management is often the polar opposite to being a carer, we frequently find the more often mundane role of management to be more stressful than the highly complex and skilled task of being a GP.

It has been a slog but it was worth it. You have done the training and passed the examination. Some of you will know exactly what you want to do now and where you want to work but others may not be sure or perhaps you just want to have the equivalent of a professional gap year and take some time out. Travel and experiencing other cultures and traditions have attractions for many but can be costly. Combining work with travel can solve that problem.

This article covers the following aspects of the business side of general practice: the different ways in which practices are funded, depending on the nature of their contracts with their Primary Care Organization, and the constituent lements of those contracts; how practices operate as differently constituted business entities; how financial considerations affect the delivery of services; the responsibilities of GPs as employers and how general practice is affected by a changing and increasingly competitive market environment.

When I first qualified as a fully-fledged GP and started practising as a GP Partner, the tax system and accounting was a mystery to me. It was a steep learning curve. In this article, with the help of an experienced medical accountant, I aim to provide a basic guide to unravel the mysteries of the private finances of a GP.

In 2009, the Medical Leadership Curriculum (MLC), based on the Medical Leadership Competency Framework (MLCF), was presented as the first shared curriculum across all medical specialties in the UK to the Postgraduate Medical Education and Training Board (PMETB). Since then, all the Medical Royal Colleges have been reviewing their own specialty curricula to integrate the MLC and working with Postgraduate Deaneries to determine how this part of the curriculum can be delivered. This article gives a summary of how the MLCF was developed, what it is and how general practice Associates-in-Training can develop their own skills further.

Buying the equipment for your medical bag is an important—and potentially expensive—necessity for your career in general practice. In this article we outline some of the things to consider to ensure that your kit is reliable and cost-effective. Being prepared will enable you to react to the more common medical scenarios that you will face outside your practice and stay within the guidance of the General Medical Council.

Few things are more challenging or indeed more flattering than being consulted by another doctor about their health. After 25 years' practice, this still makes me, and probably all GPs, anxious. I also visit GPs whose performance is giving concern and they frequently have health issues contributing to their difficulties. We all need to be aware of the main evidence on this subject so that we can best care for this group of atypical patients with particular needs.

We currently have an excellent GP specialty training programme where trainees are very well supported in all aspects. Once qualified, however, many GPs not only feel isolated but also have to face challenges such as looking for a job, organizing locum work, understanding quality and outcomes framework, etc, while also dealing with the real, exciting and rewarding work that is general practice. Additionally, this often involves a move to a new area, where there is a need to get to know the local services and medical community. These problems together with the new and important revalidation and relicensing hoops to jump through can induce great uncertainty, vulnerability and sense of isolation in the initial stages of your life as an independent practitioner. This is a far cry from the regular educational and supportive peer group meetings that most of you have in your training.