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At the heart of general practice since 1960

Helping GP return benefited us all

his year our practice was one of the first to have a GP returner, although with increasing numbers of GP-trained doctors coming back into the workforce, many other practices are likely to follow.

We had no idea what to expect, but at the end of Julia's eight-month stint, both she and the practice have found it worthwhile, although with hindsight we might have done some things differently.

What's in it for the returner?

The National Returners Scheme provides funding via postgraduate medical deaneries to support the re-entry of qualified GPs into the profession. This covers the returner's salary, some professional expenses such as defence society fees, and the GP trainer's grant.

The placement can be full-time for up to six months or part-time for up to 12 months, and is based on an educational contract drawn up between the returner, the deanery and the practice.

The returner is normally expected to work a minimum of four sessions per week, but this can be arranged flexibly around other commitments to include:

la service commitment (similar to that of a GP registrar)

la weekly tutorial and a wide range of supported learning opportunities

lattendance at relevant local day release teaching sessions

lvisits to specific practices, clinics and outpatient departments

lother courses, such as minor surgery.

What's in it for the practice?

Currently only training practices can employ a returner, but this can be in addition to a GP registrar, provided the practice has the necessary space and educational resources.

GP returners are unlikely to be fully up-to-date, but they bring a wide range of skills and experience, and some of these may be valuable additions to practice services.

How was it for Julia?

Julia had been a GP principal for seven years before taking eight years out with her family, and came with excellent references, but she was naturally apprehensive after such a long gap. However, it soon became clear that she had retained many of her talents including consulting, communication and team-working skills; she also has both common sense and a GP's sixth sense for trouble.

What neither of us had realised, though, was how the nature and pace of general practice had changed. Significant gaps in her basic knowledge that gradually became apparent included:

ltherapeutics ­ when Julia last wrote a prescription, many drugs such as ACE inhibitors were used much more cautiously than today, while other routinely prescribed drugs such as proton pump inhibitors were in their infancy

linvestigations and procedures ­ ditto, especially direct access

lnational service frameworks

lthe Cancer Plan

lworking paperless and the internet

ltelephone triage and consulting

 · GP co-operatives

lpersonal development plans, clinical governance and appraisal

 · PCOs and other structural changes in the NHS.

Her educational contract included a videotaped assessment of her consulting skills, and the summative assessment audit (which tightened up our aspirin-prescribing records for CHD).

How was it for the practice?

On a personal level, Julia has been an asset to the practice, safe, and popular with patients; at times I felt almost embarrassed by my title of educator.

However, we may have been guilty of assuming too much from her track record and obvious competence, and on several occasions we expected her to have knowledge or skills that post-dated her exit from general practice. This could have been avoided to some extent by a much more detailed entry assessment of her learning needs, but the amount of teaching time reimbursed by the training grant also felt inadequate to both of us.

To the final question, would we do it again, the answer is: definitely.

Dr Melanie Wynne-Jones's experience with a GP returner was positive, but she would do some things differently

next time

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