View From the Ground, by Dr Honor Merriman
A couple of weeks ago, I had coffee with four doctors with whom I worked for many happy years. They have retired from general practice, are well, and are content with their lives; in contrast, I have continued to work past the usual retirement age, but am no longer a GP partner. I sometimes ask myself if continuing to work is wise, but not as often as my friends ask me the same question!
General practice has changed considerably in recent years, and I am not at all surprised that many GPs have reduced their hours or left the profession. There are many reasons for this, among which are recent Government decisions and negative media portrayals of general practice. The departure of GPs leaves problems for those who remain: it feels like we are a row of dominoes that once stood in a line, but are now slowly falling against one another so that soon none will stand.
This may be old news, but it feels ever more acute. In many practices, regular resilience training is offered to help practitioners deal with pressures resulting from workforce shortages, but when the tasks are too large for any workforce to address, this can feel insulting. After 50 years of practising medicine, I have learnt many ways to be resilient. You certainly learn personal and family survival when you have to use all of your annual leave to have a baby, then come back to take your turn doing out-of-hours cover on top of your daytime duties. I have no quick answers to the problems facing general practice, and I would mistrust anyone who says that they do.
However, there are some glimmers of hope. Having a mix of skills in the practice can be really effective—where I work, I feel very privileged to be part of a great team. We have excellent paramedics and nurses working alongside us, as well as wonderful pharmacists and social prescribers. Our primary care visiting service also offers patients acute home visits of a very high standard.
In addition, our local training hub1 has provided free-of-charge GP wellbeing and career mentoring services for several years now. We also have resources to aid the recruitment and retention of GPs, and are developing support and development services for team members at all stages of their career. These include:
- new-to-practice programmes for GPs and nurses (part of a national initiative2)
- locum chambers,3 in affiliation with the National Association of Sessional GPs
- mid-career fellowships
- support for GPs nearing the end of their working life who would welcome a portfolio career, enabling them to share their skills and expertise
- preceptorship mentoring4 for new-to-practice physician associates
- mentoring for international medical graduates in training.
The first GPs to participate in our new-to-practice fellowship programme have nearly completed their 2-year course, and it has been a real pleasure to mentor five of them myself. Each of these GPs has an in-practice and an external mentor, and has had protected time to do practice-based project work. They have also had monthly meetings with local experts to help them develop as independent practitioners. The posts were open to salaried GPs, although one of those I meet regularly is already a GP partner, and they have all taken every opportunity to progress. Their enthusiasm is inspirational and, despite the many problems that they have faced, they go from strength to strength.
The training hub in my area also delivers training for mentors who do not have recognised qualifications; as a group, we see ourselves as coaches rather than mentors. The benefits to general practice are therefore twofold: we now have both enthusiastic new GPs, and more mature GPs gaining additional skills. I have even found my coaching skills useful when talking to patients, not just when teaching.
Let’s see glimmers of hope develop into a beacon of light for general practice.
Dr Honor Merriman
Senior Appraiser and Clinical Advisor, NHS England and NHS Improvement South East Region