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At the heart of general practice since 1960

Why I'm HOOKED on my trust jobs

Don't be put off by the long boring job titles ­ my work at the cutting edge of primary and secondary care is fascinating, says

Dr Sarah Schofield

I work in both primary and secondary care, and I bridge the two. I'm a GP principal with a formal leadership job in an acute trust and a PCT. My official titles, other than GP, are assistant medical director of Southampton University Hospitals NHS Trust (SUHT) and assistant medical director of South West Hampshire PCTs.

I am involved in a variety of projects at the interface between primary and secondary care ­ the place where, often, patients 'drop' between services. Those on one side of the bridge often understand little of life on the other side, but someone who understands both can be useful when services are being redesigned and developed.

I started this role in 2000 by spending an eight-month sabbatical in a multiprofessional team involved in clinical service development in Southampton hospitals. At the time I was also a PCG chair and closely involved in developing primary care services.

Service change in primary care often affected secondary care, and vice versa. I enjoyed the challenge of working across boundaries so I decided, after my sabbatical, to go part-time at my practice and take up a half-time role in the trust.

Southampton Trust wanted primary care to play a clear, senior role in its organisation and so created my post. With the dissolution of PCGs, I declined a board role in the PCT. This enabled me to continue focusing on patient services projects.

The PCT then appointed me as assistant medical director, with the same role as in SUHT ­ working on projects at the interface between primary and secondary care. I hold a new consultant contract in both. I work three days a week as a principal and one day a week for each of the trusts.

I do not see myself as a representative of my GP or hospital colleagues as there are as many opinions as there are doctors, but I can bring a view from primary or secondary care. I provide an informal opinion for anyone with a problem or new idea for services that cross the interface.

With the experience of working as a clinician and with leadership roles in primary and secondary care, I have also been able to develop roles in the wider health community. I bring neutrality to many groups because of my multiplicity of employers.

I am the clinical lead for the South West Hampshire emergency care network covering two acute trusts, three PCTs, two social service departments, a mental health trust, an ambulance trust and the strategic health authority. Our remit is to identify problems in emergency care services, finding solutions by working closely together across boundaries.

I was the primary care lead for the Department of Health's forthcoming framework for musculoskeletal conditions, having been involved in the redesign of musculoskeletal services ­ including orthopaedics and chronic pain ­ across south-west Hampshire for the past five years.

Other projects that have been part of my portfolio are discharge planning and care, admission avoidance and pathways of care for a variety of specialties and directorates.

I am also involved in education both locally and nationally. I have visited other areas to give presentations on the musculoskeletal services developed locally, and have also been invited to review and help shape services in other areas of the country.

I sit on the SUHT Education Strategy Board and give regular input into the PRHO education programme. I have participated in several consultant appointment committees. I have been involved in prescribing projects, including collaboratives, prescribing risk, and an extensive audit and redesign of anticoagulation management.

Working one-to-one with patients as a GP, and then reviewing and developing services for whole populations, presents an interesting challenge. The job is never boring and is at times exciting.

It provides a wonderful opportunity to meet many people who are passionate about good-quality health care and developing local services for the NHS.

Cross-boundary working has a healthy future, as practice-based commissioning will require extensive work across primary, secondary and social care. This is an ideal role for someone who loves to work in developmental areas, who loves networking, and who enjoys a job without a strict job description and guide to what they are supposed to do. It is a superb job for someone like me.

Sarah Schofield is a GP principal in North Baddesley, near Southampton

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