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For Primary Care | View from the ground

Straight in at the Deep End

View From the Ground, by Dr Heather Ryan

As my husband would testify, I have control-freak tendencies. If a life event is looming, I want to micromanage it. As soon as our wedding date was set, I was consulting NICE guidance on pre-conception care to optimise my chances of a healthy pregnancy. Once I’d conceived, I devoured data—the Birthplace cohort study, statistics about induction of labour versus expectant management at 41 weeks, the BUMPES trial examining maternal position during the second stage of labour—in the hope of having the best possible pregnancy and birth. This proved particularly useful when, in the throes of labour, I was told that my baby was breech and I was able to cite the absolute risks of vaginal versus Caesarean delivery when asked how I wished to proceed!

So it is hardly surprising that, as I neared the end of my GP training in 2017, I decided I wanted to go straight into partnership if possible. I knew the potential risks but I felt confident I could mitigate them—for example, by joining a large partnership rather than a small practice (where I might end up as the ‘last man standing’), and by choosing to work part-time to reduce risk of burnout. For me, the great appeal of the partnership model was the autonomy it gives individual GPs and their practices. I relished the prospect of having a say in how things were done, with the freedom to innovate when faced with challenges.

I finished my training in August 2017 and started my partnership the following month. So I was faced with two challenges simultaneously: the transition from the protected role of a registrar to working as a fully qualified GP, while getting to grips with the managerial challenges of partnership.

The former is a challenge that all newly qualified GPs must face, although as a partner I immediately assumed a proportional share of the overall practice workload, rather than benefiting from a circumscribed job plan, as some salaried GPs and locums do. When I was job-hunting, I was struck by how many practices offered salaried jobs specifically tailored to newly qualified GPs, including tutorials with a senior mentor and reduced or absent duty doctor commitments. In contrast, as soon as I started my partnership, I was straight in at the deep end, seeing as many patients as my colleagues who had been GPs for 20 years, and making countless clinical decisions without any formal support. For the first few weeks, I found this transition challenging—I struggled with the idea that the buck now stopped with me, and I often ruminated on difficult cases when I got home. However, I was well looked after: in my early months at the practice, my more experienced colleagues kept a watchful eye on me and helped me navigate difficult moments, such as my first complaint. Within a couple of months, I had settled in well and adjusted to my new role.

Trainees commonly complain that VTS teaching is too focused on portfolio box-ticking, leaving them ill-prepared for the managerial demands of partnership. I had extended my training by a year to undertake a Medical Leadership Fellowship offered by my Deanery. Although leadership training is sometimes derided as being overly focused on theory (some doctors feel that the only way to learn to lead is on the job), I found it tremendously helpful, particularly the teaching on how to engage stakeholders during times of change. This came in useful when, shortly after I joined the partnership, we implemented a major overhaul of our triage system to help better manage on-the-day demand. I was able to use my experience to gauge how best to communicate relevant information to our reception team, our nurse practitioners, and the patient participation group. Buy-in from all groups was excellent and the whole surgery team cooperated well to implement the new system.

Not all aspects of the partnership role came as easily to me. Almost 18 months into the job, I am still getting to grips with practice finances, not to mention QoF! I am slowly gaining a better grasp on contractual issues since joining the Local Medical Committee, but I still feel out of my depth.

Life as a newly qualified GP partner has not been easy, and from time to time I catch myself daydreaming about how much simpler life might have been had I chosen to take a salaried role when I finished my training. Although I have grown so much in ability and confidence since starting my partnership, it is humbling to reflect on how much more I have to learn. Despite the challenges and the bad days, the rewards are many, and one thing is certain: I don’t regret starting my career as a GP by going straight into partnership, and I’d recommend it to any young doctor today.

Dr Heather Ryan

GP, Swadlincote, Derbyshire