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Gold, incentives and meh

Lesson I learned from my trainer's tragic example

Dr Stephen Farley, who was found hanged in January, was described by colleagues as 'the most caring GP you can imagine' ­ here his former trainee, Dr Ian Stuart, says first-hand experience of such commitment caused warning bells to ring

In 1986 I was a trainee at the practice where Dr Stephen Farley worked. I remember him well. He was a lovely man and an extremely devoted doctor. He was always available to patients; sometimes he would even see them when he was off duty. I was hugely impressed but remember thinking at the time that I doubted I could sustain such a level of commitment. I felt that when I was not working I needed to be away from the 'risk' of patient demand in order to relax properly.

As a result I have always tried to keep a balance between the competing demands and pressures in my life. Since becoming a GP I have tried to stick to this philosophy.

My chief priorities, in no particular order of importance, are as follows:

 · The clinical and emotional needs of my patients

 · My desire to practise medicine enjoyably and to a high standard

 · Continuing medical education and personal/career development

 · Personal values

 · Maintaining a good relationship with my partners

 · Practice management and staff relations

 · The wish/need to keep my income up

 · Making sure I have enough time and energy to enjoy a happy home life

 · The need to make time to keep physically fit.

It might be interesting to see whether your partners ­ at home and work ­ share the same priorities.

Personally I do not think any one of these priorities should be allowed to dominate the others. Some doctors have very fixed ideas and goals and values, others are happy to make the best of what comes along.

The important thing is that your personal values should coincide with those of the rest of your practice team.

It is true that some practices give certain priorities a higher rating than others. But in my experience successful practices always retain a sense of balance.

It is over-emphasis on just one thing that lessens the excellence of the service to patients and causes stress for the partners ­ this can just as easily be the result of partners burning out through over-commitment as putting money-making above all else.

So how do we keep happy and sane in my practice?

We have agreed that while income is important we are not prepared to risk stress-related illness in its pursuit. We also agree that high clinical standards are a major priority.

So the rules are:

 · There are an agreed minimum number of doctor sessions per day (more on Mondays); locums are used if there is insufficient cover

 · Half-days are always protected

 · The list size is kept to a reasonable level (2,000 per whole time equivalent) for a suburban and reasonably affluent area

 · We meet over coffee daily for mutual support

 · We recruit in order to control our list size and workload ­ this has made recruitment easier as most young doctors want to enjoy their life outside work

 · We keep a sensible professional distance between our patients and ourselves

 · We work flexibly with a team of nurses and ancillary staff; pressures at busy times are shared among those available as part of our team ethos.

The system works well for us and I genuinely do think the practice is a successful and well-functioning one that meets the needs of partners and patients alike.

One thing I do very strongly feel is that young doctors should be encouraged to develop a good balance between work and lifestyle ­ starting at medical school. Perhaps we can then hope for a happier and healthier GP workforce.

Ian Stuart is a GP in Farnborough, Hampshire

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