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Questions from GPs in the early stages of their career

Is a six-month GP sabbatical every five years reasonable?

I would like to have a six-month sabbatical every five years. Would this be an unreasonable request?

Taking time off to pursue an educational goal, travel or spend time with family and friends is an excellent way of recharging your batteries and preventing burnout.

The first question, of course, is whether you can afford it. Regular saving for planned sabbaticals is a good idea, especially as locum costs rise. Prolonged study leave for GP principals is intended to support educational sabbaticals and includes an education allowance plus an (increasingly inadequate) contribution towards locum costs; apply to your PCT.

Some PCTs are exploring ways to support both principals' and non-principals' sabbaticals, or you may obtain sponsorship elsewhere.

If your practice agrees to a sabbatical, include the ground rules in your partnership agreement to avoid acrimony later; reasonable points to cover will include the effects of cumulative absences on the remaining partners and patients.

You will need to agree on how long sabbaticals should be, how often they can be taken, who goes first, and what happens if partners want to change their turn. Can successive sabbaticals be taken back to back, or added to holiday entitlement or maternity/paternity leave? How will this affect holiday rotas, and what happens if the sabbatical partner or another falls sick? Will full locum cover be provided, who will appoint and pay the locums, and what happens if locums back out at short notice? How should partners' administrative responsibilities and private work be covered, and will drawings be affected?

If you are a salaried doctor you may be able to build sabbatical arrangements into your contract, but as a non-principal, how you arrange your working life may be entirely up to you.

Where can I find an outside mentor in general practice?

I would like an outside mentor to discuss personal and tricky practice issues with. How do I

find one?

The idea of a mentor sounds excellent. Throughout the years as a junior hospital doctor and as a GP registrar there is support. By the end of the training this should have moved from didactic teaching to a more heuristic approach ­ working with the trainer to look at problems together.

As a new principal the support network may not be available. Many doctors find it difficult to make the jump from being a registrar to a principal.

There is no one available to discuss both clinical and career issues. It may be difficult to discuss these with your partners, especially if the problems involve the practice. Some people find it helpful to go back to their trainer to discuss specific issues. For a new principal the young principal's group is useful. The convener may be known to your partners but can also be obtained from the GP clinical tutor.

For many GPs, both new and experienced, a mentor is useful. A good mentor should be an effective guide, helping you to come to your own decisions. The LMC will help you find a mentor. You could write or phone the chair, who will be a local GP.

For more specific problems the BMA offers several useful services.

 · The BMA counselling service.

A 24-hour service open to BMA members

Tel: 08459 200169

 · National Counselling Service For Sick Doctors is an independent advisory service.

Tel: 0870 241 0535

website: www.ncssd.org.uk.

 · Doctors support network for mental illness

Tel: 0870 321 0642

 · The Support Line

Anonymous help service

Tel: 0870 765 0001

 · Sick Doctor's Trust

for alcohol and drug problems

Tel: 01252 345 163

How can I avoid becoming practice 'gynaecologist'?

Q I am replacing the only female partner in a practice of four male GPs. How can I avoid adopting her role as the 'gynaecologist'?

This issue should have been discussed when you agreed to the partnership.

Start as you mean to go on, although changing the culture will be gradual. You need a three-pronged attack. Your new partners and nurses, the reception staff and the patients need to be clear how you feel.

Try to stress your areas of special interest and expertise. Be very confident about men's problems and you may find that men will be happy to see you and not just when they have emotional problems.

It might be possible to encourage the practice nurses to develop their skills in contraception, menopause and other women's health areas as well as sexual health.

You could do worse than to write a letter about yourself and your medical interests to be put up in the surgery and be given out to the patients. Whether you are interested or not, don't mention anything about paediatrics, women's health, psychological problems and the ilk. They will pour in anyway!

If all else fails, you could suggest personal lists but only if you do not have to inherit the list of the outgoing doctor. That route, however, will limit you from taking on work outside the practice, which may be your salvation if all other strategies have failed.

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