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For Primary Care| View from the ground

Lessons from the Dark Side: Returning to GP Training after Spending Time as a Leadership Fellow

View From the Ground, by Dr Sarah Merrifield

The term ‘medical leadership’ provokes mixed opinions. To some, displaying an interest in this area suggests one is only interested in shimmying up a greasy pole or trying to avoid clinical work.

My own motivations for applying for a leadership fellow post were multifactorial. Following the junior doctor contract dispute I felt frustrated in my role as a trainee. I felt like I wanted to have influence but wasn’t sure how. I had a longstanding interest in education but wasn’t sure how to go about combining this with clinical work.

At the start of my fellowship, I felt very much an impostor. I’m not a leader, I thought, as I sat in meetings filled with acronyms and people whose job titles I’d never heard of. To me, a leader was someone in a suit with a grand title. Why had I, still in my GP training, been given this job? I was sure I’d be found out sooner or later.

As my first year went on I was pleasantly surprised. From a fantastic group of peers, supervisors, and mentors I learned that leadership wasn’t just for the person at the top of the tree; it simply meant making a difference to bring about positive change. Whether we like it or not, clinicians at all stages of training ‘lead’, be it as the CCG lead, the GP trainee who completes a successful quality improvement project, or even the medical student who brings in cake to improve morale in practice meetings.

I gained a fascinating insight into Health Education England and how training is organised. Of course, it wasn’t all good. I witnessed the redundancies and the effect this had on the staff who remained. I made mistakes and learned what resilience actually meant. I felt the frustrations of a system grossly underfunded and the need for staff to do more and more with less and less.

What was perhaps most valuable about my time was the space it gave me to reflect on my training and what I could do with the future. I was lucky enough to have a PG Cert funded in Medical Education and the opportunity to develop training on a regional basis. I had access to fantastic courses such as Myers Briggs, Rank and Power, and Tribalism in the NHS. The insight into why I and others act the way we do was a revelation and will have significant influence on how I interact in the future.

I’m starting in ST3 again in a few weeks on the final leg of my GP training. Currently my overwhelming feeling is of fear (how do I manage hypertension again?!). After not seeing a patient for nearly 2 years I’m hesitantly looking forward to getting back into clinical and relearning everything. I’m going back to training 80% so that I can continue to work on some of my projects. I hope that doing a variety of work will help keep me increasingly motivated.

I don’t particularly have a desire to conquer the world, but I would like to find myself in a position where I have an element of control and don’t feel like everything is ‘done to me’. This might be as a GP trainer, a training programme director or maybe even a dean, one day. For now, I just need to figure out how to pass the CSA!

While a fellowship in medical leadership may be frowned upon by some, personally I can’t recommend it enough. There’s a lot to learn from the other side.

Dr Sarah Merrifield

GP Trainee