Dr Daniel Donovan
I can’t remember a sudden ‘lightbulb’ moment. No, after three years of retirement from practice, it dawned on me quite gradually that I missed being a GP. I had changed from trying to avoid ex-patients in supermarkets, to wondering how they were coping in their lives. Also, instead of changing the channel when a medical item appeared on the news, I found I was googling myself back into knowledge.
My supportive wife raised just a single eyebrow when I told her I was thinking of going back to work, silently asking if I was sure. In contrast, some ex-colleagues were more direct – one wit, remembering that I was an approved clinician under the Mental Health Act, asked me if I was allowed to section myself!
Still feeling curious, in October last year I discovered there was a process, the grandly named ‘Induction and Refresher Scheme for General Practice’, or I&R scheme, for doctors who have been away from practice for more than two years. I contacted the head of continuing practice for Health Education England in my region, who, rather traditionally, said that it would be helpful if we could meet face to face to discuss the scheme. He was excellent – asking pertinent questions that probed my retirement, and then my change of heart. I left our meeting enthused that this potential return to practice might just work.
The myriad of forms and boxes to tick included performers list application, DBS check, GMC application, safeguarding training, CPR training and indemnity insurance. Ultimately, although the paperwork was a little daunting, it was nothing compared with the prospect of my first exam in nearly 30 years. In December, I attended the local exam centre where one of my kids had passed their driving theory test, hoping I would follow suit.
My reward for scraping through the MCQ was a trip to the RCGP in May 2017 for a simulated surgery exam, where actors played conundrum patients all afternoon. As I sat in the waiting area, I hoped the college had forgiven me for making a few disparaging remarks in 1990 about their lack of direction.
It wasn’t spectacular when I got my results, but a pass is a pass, and, after filling in all the forms, I was ready to start seeing patients again. The I&R scheme rules are very flexible, and the postgraduate dean was supportive and happy to let me enter the clinical phase of the scheme on a half-time basis.
He sanctioned a bursary which has more than covered the expenses involved. The next step involved finding a practice that would mentor me through the rest of the scheme, and I approached my old teaching practice from 1985 – so long ago that I was then called a GP Trainee. Following productive chats with the Practice Manager and GP Trainer, we shook hands and agreed a start date for my second foray into general practice.
And so, somewhat nervously, nine months after I first considered being a GP again, I saw my first real patient in nearly four years. I sat at my desk, feeling a bit like I was in Donald Trump’s White House, arriving with great anticipation just as everybody else seemed to be scrambling for the exit.
Over the past four months, as I have eased back into practice, I have been reassured how little has changed in the consultation, which remains the cornerstone of primary care. People still like to be looked in the eye, they still like being listened to, and they still seem to respond well to honesty.
I realise that, like a GP registrar, I am somewhat protected from the full-on assault of everything that makes up the role of a GP, but perhaps that is the real point. By stripping back general practice of all its managerial complexities and commissioning dilemmas, I have been able to rediscover the joy of caring for the patient in front of me.
I know it seems against the flow of a policy that wants doctors to be in charge of everything, but being able to concentrate on seeing patients is the reason I have been attracted back to the coal face, and I feel there are many other doctors who hold the same opinion.
I am sure the excellence of British general practice is robust enough to survive a transformation away from the independent small business model that has been so successful over the past fifty years. If it is to flourish in the future, then I think more of the recruitment funds should be channelled into retention. It may mean that, rather than being self-employed, many more pre-retirement GPs will remain as salaried clinicians. If, by this pathway, experienced doctors can be kept in the NHS, then it can only be a good thing for the future of primary care.
Dr Daniel Donovan is an I&R GP in Middlesbrough