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At the heart of general practice since 1960

Build your support network to combat isolation

Don't wait

until disaster strikes to find out where

to turn in a crisis, writes

Dr Jason Twinn

ew anticipate the yawning void of isolation that opens up when you move from registrar training to full-blown general practice. As a registrar you can get help or have a cathartic whinge with peers and tutors at half-day release programmes or at weekly meetings with your trainer. But the step to becoming a locum or new principal can be a lonely one.

Even new partners in friendly group practices can find themselves isolated for a variety of reasons, let alone singlehanded GPs. If you are nearing the end of your registrar year, or already in practice, it is worth considering how to build and maintain networks for advice and support. It is worth establishing where to find help and where to turn when things get difficult, rather than waiting until disaster strikes.

Network solutions

 · Family Obviously family is the lynchpin of your network. For some this may not be there, or it may not be enough, or they may not understand the unique pressures you face. Often they may not be able to give you the specific advice you seek so you will need other channels.

 · Friends Making time for friends and outside interests can help you maintain a healthier perspective on life. All work and no play doesn't just make Jack very dull; it makes him vulnerable to professional isolation and the dreaded burnout.

 · Balint groups These have gone out of fashion, but this doesn't mean they no longer exist and that you cannot use them. Your local postgraduate department can put you in contact with like-minded GPs or current groups. If this is too fluffy for you, there may be a 'new principals' group locally that has meetings and weekends away dressed up as PGEA earners where you can meet local colleagues.

 · Mentoring This pairs you with an experienced GP who can guide you through difficulties from another perspective.

 · The internet There has been a growth of message board-type forums, and these provide an excellent opportunity to discuss problems with colleagues, anonymously if you wish, or ask for specific advice. Two main ones are Doctors net and GP-UK. The former is slightly less formal and not open to the public, but even so beware of posting any patient-identifiable information or sensitive personal information: the press, both medical and lay, do manage to access these sites. They can be an immensely useful tool for both clinical advice, cathartic rants and a bit of support.

Help is out there

Sometimes things get so bad you need more than catharsis. At times like this try not to subscribe to the 'physician heal thyself' philosophy. Be prepared to seek help early. Don't forget your own GP, or your occupational health service, which as a GP you should be able to access.

Occupational health services will often have rapid access to psychology or counselling services that can take weeks or months to access via your own GP. But if you don't feel up to facing anyone just yet there are plenty of organisations willing to help. The following all offer confidential advice and support:

 · BMA counselling service

(08459 200169)

 · National Counselling Service for Sick Doctors (0870 2410 535)

 · Sick Doctors Trust (01252 345163)

Doctors are notorious for seeking help late and alcohol dependency is seemingly as prevalent today among doctors as when we were so notoriousy fond of booze that people often said 'an alcoholic is someone who drinks more than their doctor'.

One thing is certain in life as a GP: there will be difficult times in your career when you might need to reach out for some support.

That's when you will have to use the networks you have invested time in building.

The question is not how good

a GP or how good or strong a

person you are, but how you deal

with your stress. Don't make

the off-licence your first port of

call in a storm.

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