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CAMHS won't see you now

Watch out for the new generation of career-driven GPs

With this year's training changes set to produce a wave of highly focused young GPs, Professor Ruth Chambers looks at why this will keep the rest of the profession on its toes

With this year's training changes set to produce a wave of highly focused young GPs, Professor Ruth Chambers looks at why this will keep the rest of the profession on its toes

Established GPs had better look out. The way GP specialty training is developing with the Modernising Medical Careers initiative means that there will be wave upon wave of keen and focused GPs completing their training, close on their heels. These young and fresh GPs will be hungry for career opportunities, and eager to take on new responsibilities.

The new shape of GP training

From August 2007, GP specialty training will be far more targeted on the trainee doctor preparing to become a GP throughout all three years.

There is fierce competition for GP training places from doctors who have progressed through the two foundation years, those who have been senior house officer for the past few years, and other doctors with right of residence in the UK who are eligible to apply. With this degree of competition for specialty training places, the increasing number of fast-track medical students with a previous degree, the extra training that the foundation years bring and the challenge of being assessed against the new GP curriculum, we can expect the calibre of young doctors entering GP training to soar.

The GPs of the future will be well prepared to practise in a way that respects patient safety and high-quality care above all else, while embracing new ways of working and development.

Then what?

So these new GPs will be applying for jobs in an NHS where replacing or appointing doctors has to be justified – that the medical post is really necessary and that nurses or other health professionals cannot be employed instead. It is a confused situation, with NHS strategic plans full of new models of skill mixing, promoting physicians' assistants and advanced nursing roles as providing effective healthcare with fewer doctors. But we do still need GPs – lots of them. There is evidence that nurse substitution for doctors is not cost-effective and survey after survey shows that the public value the care they get from their own doctor.

In general practice, the pay differential between salaried GPs and individual GP partners or private providers has resulted in the potential exploitation of salaried GPs. In reality, many salaried GPs do earn less money than a GP partner or singlehanded GP principal – but they also work fewer hours, have protected time for CPD, and rarely take on responsibility for practice management or shoulder business concerns. But it is this pay differential that gets publicity and has resulted in an excess of job applications for the relatively few vacancies for practice partnerships that are currently advertised.

Keep on your toes

So if you are a GP who is already established in a practice and fancy a change, think hard before you risk competing for another GP post with the fresh-faced GPs straight out of training. You could stay in the same practice instead for your whole GP career, but it is wise to diversify every few years so that you do not stagnate. Look for fresh challenges or development within your current job. It is easy to take the security of your highly paid GP post for granted and crave the excitement a career change would bring. But if you no longer have your regular income, any financial worries will most likely blight your job satisfaction or enjoyment of your new career.

If you stay in the same practice, you're likely to assume increasing responsibilities for running the practice as you become more senior – and you may find you enjoy that role. As you become more embedded in the local area, you might be elected to the professional executive committee or local medical committee, or your primary care organisation might employ you in a skilled role – maybe as a GP appraiser or clinical lead or GP with a special interest.

Alternatively, if you think it's right for you and your family circumstances, you could move between GP posts. You might opt for part-time GP positions that allow you to be employed by a university as a GP lecturer or researcher, or even set up your own business. You might choose a salaried GP position or be a GP locum because having limited responsibilities for the practice where you work allows you to concentrate on other aspects of your GP career. Your income might be derived from different sources, making you less dependent on one GP employer or practice.

Moving forward

Take time to make any major career decisions. Talk it over with your family, discuss the options with a colleague, mentor or coach, and meet up with one or two doctors working in the post or special interest you think you want. Draft a plan based on your favoured options – and reflect on it before taking any action.

Ruth Chambers is director of postgraduate GP education and associate head for primary care, Workforce Deanery, NHS West Midlands Strategic Health Authority

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