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Independents' Day

Advice on how to thrive from our expert panel of GPs

Our experts give their views on how to thrive in a changing profession.

Our experts give their views on how to thrive in a changing profession.

Don't take continuity of care for granted

Continuity of care is under threat, warns Dr Peter Stott. Here are his tips for making sure patients get the care they deserve

Continuity of care cannot be taken for granted.

Inflexible appointment systems, patients' desire for immediate attention and the trend for GPs to work part-time all combine to make it difficult for patients to see who they want, when they want. It's a lottery out there.

Continuity of care increases job satisfaction – but if we want it, we have to work for it. Here are some dos.

• If you work part-time, tell your patients when you will be available and what you do the rest of the week. They will respect you as a person and tailor their requirements to your availability.

• If you see a patient with a long-term condition who needs follow-up, make their next appointment there and then. Don't leave them to chance their luck with the appointment system.

• Use the telephone intelligently too. If patients don't need an appointment, encourage them to ring. Make sure you get messages, and spend half an hour at the end of each surgery phoning patients back.

• Encourage patients who need home visits to wait until you are next available. Most non-emergencies can wait 24 or 48 hours.

• Follow up patients actively by telephone.

• If you receive a significantly abnormal test result, phone the patient directly

and arrange a meeting with them.

• Learn to love heartsinks – they are the glue that holds us together.

There are a few don'ts too.

• Don't simply tell patients to make an appointment to see you in a week. All those appointments will already have gone.

• Don't assume patients will be available when you are. Many prefer convenience to continuity.

• Don't arrange for patients to make their next appointment when you are on holiday. That is the behaviour of a scoundrel.

Dr Peter Stott is a GPSI in diabetes in Tadworth, Surrey

Take a corporate approach to keep on track

Keeping a large practice team together and motivated is no easy task. The key is good communication and a corporate approach, says Dr Charles Alessi

Our practice has 13,500 patients, covers three sites and employs 12 doctors plus training grades and full nursing and administrative support.

Keeping the staff happy, remaining successful and staying focused on caring for our communities all depends on one byword – corporacy.

Corporacy is the mechanism that keeps us together. We come up with ideas together and once adopted these pathways – clinical or administrative – are adhered to, not side-stepped.

Decisions are arrived at democratically and an audit manager ensures they are implemented.

All referrals are internally screened by colleagues, all prescribing is according to our formulary and deviations are raised and explanations sought.

To achieve this level of consistency there is one enabler and one pre-requisite.

• The enabler is communication. We meet often and are currently developing a new communication strategy to further ensure everyone feels involved.

We work in multidisciplinary teams where everyone is involved in managing our community and their needs and expectations.

• The prerequisite is quality. We are a quality award certificated practice – one of the few in the country.

This philosophy of quality drives all we do and makes engagement with new staff easier.

Anu Jain, previously our registrar, is joining our practice and has just obtained a distinction in her MRCGP.

She says: ‘We discuss all aspects of clinical care openly, including complaints, and this element of trust is what I value. We are always introducing new ways of managing our population.

'Life is challenging, but never boring at Churchill.'

Dr Charles Alessi is medical director of the Kingston Co-operative Initiative

Partners are better valuE than salaried GPs

Salaried doctors may be cheaper, but in the long-term, partners are likely to be better value for your practice – that's the view of Dr Eric Rose

Previously, if a partner retired, practices could be hit by a double whammy. Not only would they have to cover extra work but income would be reduced, since some fees and allowances were paid according to the number of partners rather than patients.

This changed when, through PMS and GMS, practice-based contracts were brought in. As a consequence, there has been a huge rise in the number of salaried GPs and a fall in available partnerships.

Some doctors prefer to work set hours for a guaranteed income without involvement in running the practice. For partners, a salaried GP has avoided carving up profits and kept partnerships at a manageable size.

But there are disadvantages in having salaried doctors. Financial benefits are not as great as they might at first seem, as employers' national insurance and superannuation contributions add more than 20% to salary costs.

Also, the model contract for all new salaried appointments provides for 37.5-hours a week. The average full-time principal works 44-hours.

Partners' terms and conditions are by mutual agreement while salaried staff are covered by much stricter employment laws.

On economic grounds alone there is an argument against salaried doctors.

And new partners contribute more equally to responsibilities and can bring fresh ideas and enthusiasm. So when a partner retires, it's worth taking a long-term view.

Dr Eric Rose is a GP in Milton Keynes and former member of the GPC

Find satisfaction but stay true to your GP calling

Planning your career? Think hard about what most interests you, but never lose your focus on generalism and patient care, says Professor Steve Field

General practice is the place to be. I finished training as a GP in 1986 and can honestly say that I've been enthused by everything I've done in my career.

I've worked both in rural Worcestershire and inner-city Birmingham and although I've spent fluctuating amounts of time in the surgery, it really is what I like doing best.

Interaction with patients is intellectually and emotionally stimulating.

Being a generalist is no mean feat. We're the drivers of primary healthcare and it's perfectly okay to be content with being a jobbing GP.

But if you are keen to diversify, the opportunities are countless. The key thing is to pin down what motivates you.

The most difficult part of looking to widen your professional portfolio is deciding what it is you want to do and achieve.

This is an individual thing. You might enjoy focusing on one specific area of research in an academic capacity, or you may enjoy networking and want to be more involved with your local health authority and influencing policy in your area.

My professional interests centre around education and training, as I believe this is the key to improving patient care.

My academic work and involvement with the RCGP has allowed me to be involved in revolutionising GP training by producing the first GP training curriculum, and to influence healthcare policy at a national level.

The work I've done at my practice is just as satisfying. I made a conscious decision to move to an inner-city training practice.

I grew up in a deprived part of the West Midlands and it's a great privilege to be able to give something back.

Whatever professional activities you have outside of the surgery, the core is a commitment to being a good generalist.

If this is your motivation I can guarantee you'll never be short of opportunities to make your mark outside of the consulting room too.

Professor Steve Field is chair of the RCGP

Professor Stephen Field: never lose your focus on generalism and patient care Professor Stephen Field

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