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'Now is the time to consider a career in general practice'

RCGP chair Dr Maureen Baker wrote an open letter to trainee doctors saying that additional funding for general practice could be the beginning of ‘a bright future’

Dr Maureen Baker CBE DM FRCGP DRCOG DCH
Chair of Council

December 2014


Dear Colleague

Now is the time to consider a career in general practice

I am writing to you to urge you to consider a career in general practice.

There is now a real push to put more resources into general practice and build up the GP workforce. As a result, the future of general practice is looking bright.

In its ground-breaking document, the Five Year Forward View, NHS England calls for a ‘new deal for primary care’, with investment being shifted from acute to primary and community services.

The Government recently demonstrated its support for the ‘new deal’ with the Chancellor promising in his autumn statement that there would be ‘a £1.2bn investment in GP services across the UK’.

With this increased backing for primary care, the expert generalist skills of GPs have never been more in demand. And, as care is shifted out of hospitals, GPs will increasingly lead the development of new integrated services for patients in their communities.

GP practices are part of the fabric of their local communities, and the relationship that family doctors build up with their patients remains a key reason why it is one of the most satisfying jobs in the world.

General practice is also one of the most challenging jobs in medicine, as GPs must have the knowledge, expertise and confidence to be able to deal with whatever comes through the consultation room door.

A career in general practice offers a great deal of flexibility. It allows you to fit the job around other major commitments, such as having a young family. It also gives you the chance to practise in the region of your choice and to decide whether to be wholly a generalist or to develop skills in a specific area as a GP with a special interest.

I hope that the prospect of working in general practice sounds exciting. If you have any unanswered questions about what a career in general practice might hold in store, please find more information at www.rcgp.org.uk or ask your LETB or deanery, who would be happy to direct you to someone with whom to talk directly.

Please do consider joining me in this fantastic profession.

 

Best wishes

Dr Maureen Baker
Chair of Council
Royal College of General Practitioners

Readers' comments (7)

  • Secure environments GP

    “Optimism is a strategy for making a better future. Because unless you believe that the future can be better, you are unlikely to step up and take responsibility for making it so.”

    ― Noam Chomsky

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  • Take care which GPs you ask as many are now actively discouraging young doctors from entering general practice. Here's an online comment in Pulse few months back. It was so eloquently articulated it's reprinted here:

    'Dear prospective GP,

    Our responsible chief is worried that we are talking down the profession so here are some things to think about;

    1. New doctors-to-be have to stump up their fees which for mature students amounts to circa a debt of £100k (including living costs). Universities are already saying that £9k a year tuition is not enough and some private medical schools are charging £35k a year for fees. So expect your debts to rise even higher in the future. These debts you will have to pay pass or fail.


    2. It is getting harder to get up the ladder as the public and the professional leadership want the best - so A* students need only apply. You are then going to have a series of academic hurdles which look set to get tougher as 'only the best' are wanted. If you fail at any point you will get no support and you will be blamed for failing as 'for patient safety' society will not tolerate less than the best. In fact the GMC want to introduce additional hurdles just to make sure as they are not convinced that UK medical schools are generating good enough doctors. Although our European colleagues are exempt.

    3. If you 'mess up' during your career at any point i.e. get a complaint - it will be scrutinised and in effect you may be treated as guilty until proven innocent. You will also be liable for multiple jeopardy for a single incident. These incidents do not need to include clinical issues but can include conduct in your private life - so be very careful how you 'enjoy' your time in university less it comes to the attention of the GMC. You will not be protected or compensated by malicious accusations and expect no support from anyone if you come under the radar of the GMC. Your rights are not important. In fact you have a yearly risk of being suspended or struck off and as you will need to work to 70 (at least) it means there is a high chance over your working life that it will happen. Expect complaints and expect a lot of stress as you have to please everyone.
    4. Your training will be to deal with clinical problems but you will find most of your time dealing with social problems presenting as medical issues, worried well, and unrealistic expectations of the public. Occasionally you will get a clinically valid problem like a DVT or new heart failure. You will find a lot of your time ticking boxes and learning to jump through hoops as the next non-evidence based politically motivated and not thought through 'innovation' is forced on you.
    5. You will see your income fall and expenses rise. As the NHSE and politicians have mentioned independent 'corner shop' practices are going out. Expect to be part of a dynamic team of salaried micro-managed tick boxing doctors. You will have to provide your expertise on a rota basis probably on 24/7 cover. As politicians want to drop the EWTD don't expect a 40 hr week and don't expect locum cover. As in hospital medicine you will have to do internal cover or be disciplined. All for the princely sum of £54k a year (salaried average).
    6. As for career development - well once you become a salaried GP that's it . If you 'impress' your management team they might let you become a lead GP (or the one to 'blame' GP) where you don't make any decisions but are wheeled out to represent your department. You might think about locuming but by the time the new federated / salaried / cottage hospital or whatever model they call it comes out - you can be sure that they will only employ internal doctors aka mobile salaried GP.

    So in short you are stuck on a £50k a year job with no prospects where you know you are going to get the blame for something at some point and are unlikely to stay in the job to reach your pension.

    I don't think what I've stated is scaremongering but reflects the realities and trends of where we are going. These views are my own based on reading the reports from various sources - all of which are on the internet.'

    Yours ANON
    --
    So you are intelligent doctors, eyes wide open please (thanks Una Coales for below):

    Pay and working conditions for NHS GPs continues to deteriorate year on year.

    A NHS hospital consultant pays only 12% to the NHS pension yet NHS GP partners have to pay 27% ! Now note, that GP partners' pay is dependent on practice income and the government has taken away the 'minimum practice income guarantee' so we see GP partners' pay nose dive. But hospital consultants are guaranteed their NHS salary of up to £101k regardless of the NHS hospital revenue. And their pay reflects their seniority whereas seniority pay for NHS GPs has also been scrapped.

    As if NHS GP partners are not suffering enough in this time of NHS austerity, NHS hospital consultants continue to receive large annual bonuses to top up their guaranteed NHS salary! These annual NHS financial bonuses are called 'clinical excellence awards' as if private practice income was not bonus enough?

    So a NHS hospital consultant may end up with a £101,451 guaranteed NHS salary + bonus of up to £75,796 + private practice income or a total semi-private income of well over £200k! Consultants may charge between £150 to £260 for a 30-minute private consultation and £100s-£1000s for private operations to top up their already lucrative guaranteed NHS income.

    Contrast this with a NHS GP partner whose take home pay (drawings) is now, in many cases, less than the salaried GP. A salaried GP may earn between £57k and £78k or £44/hour. A GP partner has seen a drop in drawings between 20-50% due to government cuts to practice reimbursements and a GP partner's pay is NOT guaranteed but dependent on practice revenue. A NHS GP has little scope for private practice to supplement the huge loss in NHS earnings. And there are NO clinical excellence financial NHS awards for GPs. After pension outgoings of 27% and rising indemnity fees of £7-8k a year (vs NHS consultants get crown indemnity), there is little left over.

    THESE ARE FACTS - So don't get locked into a big mortgage anytime soon...

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  • Took Early Retirement

    I agree with her: it can be a fantastic career choice- IN CANADA ,AUS, or NZ.

    Ponder on the above eloquent and accurate posts well.

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  • Made me smile...Thanks Dr Baker, it's a lovely Christmas parody!

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  • what a great reprint comment, must have missed it the first time.

    Medicine as a career is a very poor choice for bright young minds in this country.........although being a doctor is one of the best things I have done in my life. What a paradox!

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  • There is a big problem with sending this out in December - the applications are closed for 2015 entry - the next main recruitment round will open in November 2015. There will be a limited 2nd round for the jobs that were less popular / unfillled in April / May, but most people have already picked which specialty to apply for in the main round.

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  • Dr Baker said at a recent conference that General Practice was in crisis, but although the BMA and RCGP are clearly stating this to the government there is very little evidence that anything concrete is being done to help the situation. For me it is too late!

    At 56 I have resigned as a GP Partner in a superb practice. The figures no longer stack up. Combined with the workload and intensity of each day in General Practice it no longer makes sense to continue as I am for the sake of my own health and for my family. For the past month my regular patients have come just to say goodbye and they are incredulous that I am leaving what is a well respected practice.
    I am no longer able to provide the type of care that I have always provided and can no longer take the continuous barrage of media condemnation when i know that all of us are working harder than ever. I have joined a GP chambers to achieve a work life balance. As a resident and patient I fear for the future of general practice. We throw away what general practice was at our peril because we will never get it back. General Practice however has to be properly funded and can't just be the 'sink' for everything. I am frankly fed up with being the secondary care consultants houseman and general dogsbody!

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