Dr Mark Attah MBA, MCMI, MRCGP

GP Partner & Commissioning Lead,

Bretton Medical Practice, Peterborough

Programme Director, GP Speciality Training,

North Cambridgeshire

GENERAL PRACTICE: TRAINING, OPPORTUNITIES &

LIFESTYLE

AIMS

To provide an overview of General Practice and the role of GPs

To discuss General Practice Training

To identify the various opportunities available in General Practice

To understand the lifestyle of GPs

“An approach orientated to the individual, their family and their community; provision and co-ordination of care from birth to death; and promotion of health and wellbeing.” So in addition to “general” interest in the body and mind, there must in these circumstances be an overriding interest in the person rather than the illness, a commitment to continuity of care through the life term, an ability to manage the boundaries of different forms of care and support, and an understanding of the health needs of the wider community.

‘Generalist practice is decision-making which is person-, not disease-focused, which is continuous and not episodic, which integrates the biographical and the biotechnical knowledge … all with a view to supporting health as a resource for living and not an end in itself.’

Joanne Reeve, NIHR Clinical Scientist in Primary Care, University of Liverpool

‘The difference between generalists and specialists is important because it depends which lens is in front: the disease lens or the patient’s lens. Young doctors need to decide (and both decisions are legitimate) whether they are more interested in the science of disease or the way in which disease affects individual people.’

Iona Heath, President, Royal College of General Practitioners

GPs are uniqueSimultaneously manage physical, psychological and social problemsOffer care in the patients communityManage undifferentiated symptoms & uncertaintyExpertise in risk managementSimultaneously manage acute & chronic problems and multiple problemsAddress both individual and public health issuesCo-ordinate the patients overall care and offer advocacyPersonalised, focused individual care founded on mutual trust also family care

GP Speciality Training

Selection process

Training

Assessment

Certification

GP ST Selection

Based on criteria needed to make a successful GP

Assessment of criteria by-• Stage I (Long-list) Online application• Stage II (Short List) MCQ- Clinical, Situational

Judgement and Professional dilemma paper• Stage III (Selection) 3 Communication Skills

Scenarios (Patient/ Patient Relation/ Health professional)

Qualities needed for GP

Clinical competenceCommunication skillsOrganisation and planningProblem solvingAble to cope with pressureProfessional integrity/ ProbityEmpathy and sensitivityTeam working, managing conflict and negotiationProfessional development

GP Speciality TrainingCurrently 3 years (4 years from 2014)

Minimum of 18 months F/T GP training under supervision of a GP Trainer

Rotation through various Secondary care and community departments (4-6 Months each) e.g. Med, A&E, O&G, Paeds, Palliative care, Public Health, Psychiatry

Innovative posts- Combining GP practice + clinics e.g. Ophthalmology, ENT, GUM

Protected teaching times

AssessmentWorkplace-based Assessment- WPBA

• e-portfolio

Applied Knowledge Test- AKT Computer based. Clinical 80%, Critical appraisal/EBM 10%, Admin/IT 10%

Clinical Skills Assessment- CSA Consultation skills 13 patients encounter

Regulars assessment by clinical & educational supervisors

Certification/ Licensing

MRCGP

CCT General Practice

PCT Performers list

Annual appraisal

Revalidation

What does General Practice offer as a career?

An opportunity to have a real impact on people’s lives

The chance to become directly involved with patients and families

Flexible working practices

Independent working patterns and autonomy

General Practice as a career II

Involvement in teamwork with other health professionalsScope to develop specialist interest within general practiceA key role in decision makingDirect involvement in health at the grass roots levelA rewarding career with an involvement in people and medicine

Career options

Full Time/ Part- Time GP

Partner/ Salaried/ Locum

GP Practice/ Community/ Hospital/ OOH

Portfolio careers- becoming increasingly popular

GP Career OptionsWithin the practice-GPWSI- Diabetes, Minor Surgery, Dermatology, Sports Medicine, Education

Outside practice- Hospital Clinical assistant e.g. Endoscopy, Community Services e.g. Dermatology, FME

Academic/ Legal, MDU adviser, Journalism, Occupational health

Management- PCT, Commissioning

Case Studies

RD Part time Salaried

RS P/T Portfolio Management

KW Locum Education

JL Locum OOH

ROLE OF A GP

CarerEmployerTeacherLeaderTeam memberAdvocateGate keeper (navigator)ResearcherHealth promoterResource allocatorPublic Health Practitioner

Role of a Partner

Business owner

Employer

NHS Manager

Public Health Physician

Diplomat

Investor-(property, staff, Risk)

Becoming a Partner

PROS

Stability

Own boss

Decision making

Financial reward

Flexibility

CONS

Hard work

Long hours

More responsibilities

Financial risks

Joint and several liability

Tied down

Partnership Case Study: Bretton Medical Practice

Suburban GP practice 12,000 patients

4 partners (6 WTE) GPs

Premises practice owned with 12 consulting Rooms, Large treatment Room, Operating Theatre, Pharmacy and Dental Surgery

Various provider services using different models of strategic partnerships, commissioning and delivery

Bretton Medical Practice

Full GMS (GP) services• Contraception, Child Health, minor surgery

Education /Training Practice• GP Registrar, Cambridge Medical

students, Paramedics, Nurse Prescribers

Research-RCGP Accreditation, Level 2 PCRN

• DECISION, EUDREGENE, PACE, 3CS

Bretton Medical PracticeCommissioned / Ext ServicesUpper and Lower GI Endoscopy

No Scalpel Vasectomy

Plastic & Aesthetic Surgery

Ultrasound Scan Services

Physiotherapy

Counselling

Lifestyle

4 day week- No on calls / OOH optional

Flexibility- Career options / portfolio

Job security & Career prospects with good income

Opportunities- Business, Ext interests, hobbies, transferrable skills

Sabbatical

Case Study

?