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We need to teach GP trainees how to be partners

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Autumn is upon us: the days are shortening, the leaves are falling, and Facebook is overrun with photographs of your friends’ little darlings posing in their new school uniform. As a doctor in training, I have continued to associate the end of summer with new beginnings, as every August the job description on my ID badge has changed and I have inched closer to gaining my CCT and becoming, as one friend puts it, ‘a proper doctor’. This year feels bittersweet: thanks to a Fellowship, I am extending my training by a year while my VTS colleagues start work as qualified GPs. As I have watched them in their first weeks of independent practice, I have found myself wondering what exactly GP training has prepared them for.

Tomorrow’s GPs need not only with clinical competence, but also an understanding of the wider context

General practice is unique as a specialty in being delivered by independent contractors. In order for the current model of primary care to thrive in the current crisis, tomorrow’s GPs need to finish their training equipped not only with clinical competence, but also with an understanding of the wider context in which they will be working. Instead, many GPVTS half-day release schemes – the so-called ‘playschools’ that qualified GPs deride – have an obsessional focus on the CSA, with most of the year dominated by preparation for the exam. Half-day release teaching is typically learner-directed, and trainees want to talk about clinical topics. On many occasions during my own ST3 teaching sessions I saw our facilitator attempt to broach wider organisational issues when clinical cases were being discussed, only to be met by bemusement and indifference by most of the group. But is this exam fixation any surprise when every attempt at the CSA costs £1,600, and failure may delay completion of training?

The independent contractor model cannot survive without a new generation of GPs taking up partnership. But the current, clinically-focused, tick-box model of GP training is doing little to encourage this. Indeed, almost all of my newly-qualified contemporaries have taken locum or salaried roles, with partnership seen as a liability to be avoided, rather than as a goal to be aspired to. It is seemingly possible to reach the end of training despite lacking even the most basic knowledge. A chance conversation over coffee revealed that one of my fellow ST3s had never heard of the concept of a ‘session’ and didn’t understand that his salary might be calculated according to the number of sessions he worked.

Another trainee told his colleagues that he had been offered a job and admitted he had no idea how to negotiate pay. When asked whether the practice he’d applied to was GMS or PMS, in relation to the BMA model contract, he had no idea what those acronyms meant and didn’t know there was a BMA model contract. Are we not doing our registrars a disservice by sending them out into the workplace so ill-equipped?

The tools are there, if only trainees and trainers would use them. At Pulse Live Liverpool, Dr Farah Jameel spoke eloquently about the work that the GPC has done to help GPs manage inappropriate workload requests. The BMA’s ’Quality First’ initiative includes guidelines and template letters to help GPs respond to such requests. I was introduced to these templates shortly after they were released, by a GP at my practice who is passionate about resisting unfunded work. I use them frequently and find that they greatly expedite the process of pushing back against unreasonable secondary care requests. Yet most of my fellow registrars – and, sadly, many qualified GPs – have not heard of them.

In order for general practice to survive, we need training which better equips tomorrow’s GPs for the challenges they will face. Training programme directors and GP trainers must challenge trainees to engage with questions about resource allocation, rising patient demand, and requests for non-contractual services. LMCs should reach out to training schemes in their locality to promote this dialogue. Trainees must be willing to think beyond their CSA and look at the bigger picture. Primary care is under unprecedented strain, and we need a workforce that is ready and willing to fight back.

Dr Heather Ryan is a GP registrar in Liverpool. You can follow her on Twitter @DrHFRyan and view any conflicts of interest here.

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Readers' comments (19)

  • Farah Jameel

    The Quality First webpages https://www.bma.org.uk/advice/employment/gp-practices/quality-first are much more than templates for pushing back on unresourced work, but our vision on how GPs and practices can be empowered to take some control of their own workload.

    They feature case studies on skill mix, delegation, working with others, new pieces of work like hub working and other things like LMC survey results, a list of enhanced services around the country, information on patient empowerment and so much more. Essentially lots of guidance for GPs to use as they see fit.

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  • In my experience about 20% of GPs have the business skills to effectively run the non-clinical aspects of a GP practice. And precisely 0% have the necessary time. So in my view GPs Partners need to be investing in Business Managers who have the necessary skills and experience to lead the practice through the changes that are required now and in the future.

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  • GPSTRs should be taught how to avoid becoming a slave for NHSE and their future senior partners.

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  • I have been a partner for 20 years and have finally decided enough is enough. My partner and I have resigned our list. I am leaving the NHS and the prospect is FANTASTIC. No more being told what to do, how to do it (as if I was never trained - despite their opinion, I actually DO know more about medicine and about being a prinicipal than the arrogant sh*ts who boss us around). My only regret is I didn't do it earlier. There's only so long you can poke as stick even at a creature you believe to be a useless skivvy before it either bites back (have tried that) or crawl away. I'm not sure if they have won, but frankly I don't care any more even if they have. I WILL BE FREE, YIPPEE!

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  • I was a GP trainee in the 80s. Playschool was the main term used for the Wednesday afternoon sessions. The topics were never about Practice management and Partnership issues. I learnt directly from my Trainer and attending partnership meetings. In 1990 I attended a trainers' Course at Guys'. It was completely learner orientated and didn't prepare prospective Trainers how to practically manage Trainees at all. It was all touchy feely groupie orientated stuff and quite useless. Things have improved but much depends on those who run these courses.
    Medicine remains a vocation and as a partner you carry the can. It might be an old-fashioned concept these days but in the community our opinions are still of value. We are highly trained professionals and responsibilty goes with this. However,in spite of all Governments' attempts to discourage us even today you still have some autonomy on how to run your practice if you are a partner.
    Being a salaried GP is fine for some people but there must be encouragement for GPs to embrace partnership. If there were no more partners and all GPs became salaried there would be no desire for innovation and thinking how to mprove the system.
    As a GP heading towards retirement I do feel for younger doctors. The so-called "Golden Age of General Practice" is long gone.

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  • I am in the retirement process right now but see it as my professional duty to help ease the transition. Others need to seize this as an opportunity.
    Partnership - in its present form dead. There is no point in bemoaning it's loss. We need to do different - big time and soon.
    No matter how much SWOT you do it's the PEST factors that shape our everyday job.
    The training programmes don't seem to recognize that - but neither does the thinking and behavior of the vast majority of the profession.
    Revolutions are an inevitable and often painful part of history - maybe some history teaching should be on the medical curriculum! The Russian revolution is an interesting read.....

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  • People like to moan, but that sometimes gets in the way of the truth.

    I do not think i work particularly hard (per session - although i do a lot of sessions).
    I do earn a lot more per session than any locum that I have ever heard of earns.
    I think my earnings, if spread out throughout my entire workload still means I earn more than a locum does per hour.
    I think my work is much more varied and enjoyable than locum work.
    I value being part of the team and having the same colleagues every day.

    I know not every practice is the same financially, but some trainees think that being a partner is never as lucrative as being a locum. It is simply not true.

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  • I'm not sure what the issue is where you're training, but I think most trainees I trained with know what a 'session' is!
    Having had a BMA standard contract since F1, I also think most people know what it is.
    In your patronising view of trainees, your admiration of your own 'brilliance' is a bit cringey to read.

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  • "In your patronising view of trainees, your admiration of your own 'brilliance' is a bit cringey to read."

    Agreed.

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