Dr Nicola Moerdyk Offers 10 Top Tips on How to Assist Recently Qualified GPs to Develop Into Independent Practitioners
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Once upon a time, a trainee GP would apply to a variety of 6- to 12-month posts that they were interested in. They applied for them individually, building up a portfolio of clinical experience, which gave them a breadth and depth of clinical exposure. They then went on to do a year’s training at a GP practice. The trainee would complete a variety of assessments, and ultimately be launched into the world as an independent GP.
A lot has changed since then—the pathway from graduation to receiving a Certificate of Completion of Training (CCT) is far more prescriptive, and the exposure to specialties and wider medicine is much more defined. For a summary of the GP specialty training pathway, see Figure 1.1 The key professional capabilities that a trainee GP is expected to gain during the current 3-year GP specialty training programme are shown in Figure 2.2
The role of the GP continues to evolve; the complexity of the conditions that patients present with is increasing, and the backlog of cases requiring consultant opinion and definitive management continues to grow, increasing the pressure on GPs. The way we work has also diversified, with the use of remote consulting by telephone, video link, and e-consults. As a result, the experiences of today’s GP trainees are different from those of the GP trainees of the past. This is not necessarily a bad thing—GP training is, after all, designed to prepare the doctor for real-world practice post-CCT.
But it does not mean that the path to becoming an independent GP is plain sailing. The jump from trainee to independent practitioner can be daunting. The COVID-19 pandemic and the relative isolation that this has brought, together with the increased pressures of the job, can make for choppy waters. In my experience, lack of a support network, clinical isolation, and the step up in managing administrative tasks required for blood tests and other reports, and patient-related correspondence, can make things positively stormy for trainees.
The training journey, and trainers’ efforts to prepare future GPs for the real world—together with their post-CCT practice—clearly have a role to play in helping nearly independent GPs to make a seamless transition. The support that they receive from their colleagues, as well as from the wider workforce and organisations such as training hubs,3 will no doubt have a significant impact on their experiences as they become independent GPs and, in turn, on their career pathway. We need to champion these doctors as they take their first steps as ‘grown-up’ GPs by helping them to settle into their roles and making them feel valued.
1. Maximise Opportunities for Training
Now that your GP trainees have passed their exams and completed their portfolio, perhaps it’s time for a break? Looking at ways to consider sustainability and prevent burnout are an important part of their transition to independent GPs (see tip 10). But, while a break may be in order, it should be a short one, because it is also important to use the final weeks and months of their training wisely.
Reflect on the timings of their day, the number of appointments, the number of administrative tasks, and the extras added to their lists, and compare them with those of a salaried GP or partner in the practice. What does their administrative load look like, and how many blood test results are they reviewing daily? What meetings do they attend, both during the working day and after the surgery has closed? At what point do they undertake their continuing professional development?
It may be tempting for trainees to leave work at 5.00 pm having started at 9.00 am, but this is not the reality of general practice. Likewise, the luxury of continuing with 15-minute appointments will not make for a soft landing post-CCT. Use this time judiciously, rearranging their day to reflect real life—trainees should aim to work from 8.00 am to 6.30 pm and take time back in lieu to meet contractual obligations, as agreed with the practice manager and trainer.
By the third year of their specialty training (ST3), trainees should take responsibility for the investigations they have ordered and the correspondence for the patients they have seen. Could they also take responsibility for their trainer’s investigations and correspondence when they are on holiday, instead of this work falling to another GP? Perhaps they could also start to be approached by the nursing team between patients if the nurses have questions or if a patient needs a quick review or antibiotics prescribed. Essentially, trainees should aim to build up to working like a post-CCT GP.
Another consideration is to develop an additional skill. Is this the time to gain a Diploma of the Faculty of Sexual and Reproductive Healthcare and learn to fit intrauterine contraceptive devices? Or to learn to perform joint injections? Trainees are still entitled to teaching after they have passed their exams—use the opportunity wisely.
2. Encourage Trainees to Think About Where They Land
Does your trainee intend to become a locum? A salaried GP? A partner? Stay at the training practice? Move to a practice close by, or one serving a different patient population—with a different level of deprivation or cultural makeup—in another part of the country? All of these options have pros and cons. It is currently a buyer’s market, but this potentially makes it harder for a trainee to choose their destination. Everyone’s priorities are different, as are their personalities and approaches to risk. The smoothest transition may, at first glance, be achieved by staying in the familiar environment of the training practice. However, GP trainees who choose to do this face the risk that they will continue to be treated as a trainee, and won’t develop as expected.
Working in one practice provides stability, allows a trainee to build relationships, and makes it easier for them to ask for support. There is also much to be said for staying in the same area, or in the same primary care network (PCN). However, trainees should be encouraged to look beyond the building and the lovely little village or market town in which the practice is situated. They should also do their homework about the practice’s reputation, and try to establish how it treats its staff.
Alternatively, locum work has its advantages. There is more flexibility—GPs can work as much or as little as they like. Through locum work, a GP straight out of a training practice could learn how different practices work, start to figure out what aspects of a practice are most important to them, and see where they best fit in. However, there is a bewildering array of information technology systems that must be navigated, together with new referral pathways and protocols, all of which can add to the pressure on trainees still finding their feet—although negotiating these hurdles can boost a trainee’s confidence as an independent practitioner. Another factor to consider is that, as a locum, you are not really part of a team, and that can be isolating—although, increasingly, there are ways around this (see tip 3).
The COVID-19 pandemic has demonstrated the feasibility of a variety of working models, including working from home and remote consulting, both to support the NHS and privately. Online consultation platforms, such as HealthHero (www.healthhero.com) or Livi (www.livi.co.uk), offer alternatives to more traditional ways of working. A blended model may work best—for example, a few days of salaried general practice mixed with some extended access/out of hours/locum work at other surgeries—to gain insight into different ways of working.
3. Advise Trainees to Form ‘Support Bubbles’
Just when you thought that support bubbles were a thing of the past, my third top tip is to resuscitate them. Being a GP can be tough. It can be difficult if you feel unsupported by your practice colleagues, or are working in a new environment. It can be particularly isolating if you are a locum, or do a low volume of clinical sessions. However, trainees have an established support bubble in the form of their Vocational Training Scheme group. How trainees choose to connect with and establish their bubble once they have completed their training will largely depend on legacy group dynamics, the size of their cohort, and whether their bubble communicates virtually or via face-to-face meetings. Using a group messaging app is a good way to get clarification from others quickly, and can be a useful method of exchanging ideas.
4. Highlight the Benefits of Mentoring
Trainees should be encouraged to discuss, in a confidential and informal way, their hopes and aspirations with a mentor. Mentors provide a sounding board to talk over a range of professional issues, from career progression and wellbeing to managing a tricky colleague. They can advise on navigating parental leave, dealing with a complaint, and developing a role beyond clinical medicine. Most training hubs now offer a mentoring scheme, as does the Royal College of General Practitioners (RCGP).4
In addition, it may be helpful for trainees to identify a senior colleague in the practice who they can approach with clinical questions and concerns.
5. Recommend Enrolling in Support Schemes and Fellowships
NHS England has developed a 2-year fellowship designed to help newly qualified GPs settle into general practice. The General Practice Fellowship Programme aims to support all newly qualified GPs (and GP nurses) to have the best possible experience through a structured programme that includes support, networking opportunities, and PCN portfolio working.5,6 Other initiatives should also be considered, including those offered by NHS Health Education England such as the Trailblazer Deprivation Fellowship Scheme,7 as well as local-level projects such as Coventry and Warwickshire Training Hub’s Aspiring Leaders Fellowships (although this particular scheme is open to the GP workforce within Coventry and Warwickshire, other training hubs offer similar programmes).8
6. Signpost to Wider Support Programmes
Trainees may also benefit from participation in established support schemes. The RCGP developed the First5 scheme in 2008–2009 to support newly qualified GPs from the completion of their training to 5 years post-CCT.9 The RCGP website has lots of useful information about the First5 initiative.10
Similarly, Next Generation GP is a funded, national leadership programme designed to equip newly qualified GPs with the skills, insights, and networks to succeed in the early stages of their career. The programme offers peer support, presentations, discussions, and workshops.11
7. Remind Trainees to Prepare Their Paperwork
In advance of becoming an independent GP, a trainee should:
- complete the paperwork for the CCT
- ensure that they are on the Primary Care Support England (PCSE) GP Performers List for England12
- submit a change of status (from trainee to GP performer) to PCSE Online (pcse.england.nhs.uk), which triggers a request to the NHS Business Services Authority to update/issue a prescriber number.
Trainees should be advised to set time aside as they finish their training to ensure that they have filled in all of the correct forms. The General Medical Council (GMC) releases a form when their Trainee Portfolio13 has been submitted, and trainees must make sure that they fill it in correctly.
Trainees should also be encouraged to think about engaging an accountant. Although it is perfectly possible to do your own tax return and submit your Type-2 Medical Practitioner Self Assessment of Tiered Contributions pension form14 to PCSE, this can be time consuming. A good medical accountant will ease the pain, and ensure that everything is compliant.
8. Prompt Trainees to Think About Appraisal
A newly qualified GP’s first year passes quickly. Trainees should consider having an informal appraisal with their trainer before the end of ST3, in which they agree upon an interim personal development plan that will give them something to action, reflect upon, and discuss with their appraiser when the time comes.
The transition from the GP trainee portfolio to the post-CCT appraisal and revalidation portfolio is increasingly seamless, with the same provider potentially offering both portfolios (for example, FourteenFish—www.fourteenfish.com/). However, some federations, alliances, and other organisations will pay for a newly qualified GP’s subscription to the post-CCT portfolio—either in full or in part. Newly qualified GPs should be encouraged to look at all of the different options. They all cover the same domains: they are required, as dictated by the GMC. However, the functionality varies, so trainees should be advised to consider their preference.
9. Support Trainees to Plan Their Journey
Post-assessment and newly qualified GPs should also think about where they hope to be in the next 5 years, and develop a 5-year plan. There are many options available to GPs post-CCT, both clinical and nonclinical, and often a mix of the two is possible. It can be useful for trainees to have an idea of where they want to go, whether along the traditional route of salaried GP and partnership, or whether they would prefer to build a portfolio. One of the most useful pieces of advice I was given at the end of my training was to spend the first few years honing my clinical skills and developing my confidence as a GP, and to only start to think about developing further skills once I was fully comfortable with the role. This may be something for the nearly qualified GP to reflect upon.
10. Promote Prioritisation of Emotional Health and Wellbeing
The COVID-19 pandemic has shone a light on the emotional health and wellbeing of the entire healthcare workforce. GPs are under significant stress due to unsustainable workloads, patient expectations, and long-term underfunding. Burnout is at an all-time high. It is vital that all GPs take steps to stay well, through maintaining a good work–life balance and ensuring that they exercise, get good-quality sleep, and eat well. Nearly qualified GPs should be encouraged to start fostering these habits early.
A wide range of sources of support is available to GPs (see Useful resources box). The RCGP provides useful signposting to resources on practitioner wellbeing, as does the BMA.
GPs are under significant pressure at present. However, they still need to inspire, energise, and support newly qualified members of the profession by helping them to make the transition from trainee to independent practitioner in a supportive environment. Trainees will then be better able to lay the foundations of a successful career—both for themselves and the patients they care for.
Dr Nicola Moerdyk
Clinical Lead: Coventry and Warwickshire Training Hub and Portfolio GP, South Warwickshire