Interview: 'Women need role models in general practice'

Medical Women's Federation president Dr Fiona Cornish tells Nick Bostock that general practice should be doing more for women.

'The notion,' says Medical Women's Federation (MWF) president Dr Fiona Cornish, 'that women will just filter through to the medical profession's top jobs is simply not true.'

Around half of the UK's current crop of GPs are women, and RCGP data show that closer to two thirds of trainee GPs are female.

But in London later this month, at the 2013 UK LMCs conference, GP leaders will once again find themselves discussing why women remain underrepresented in the profession's senior roles.

'We are still talking about it because women have been the majority of medical students for two decades now,' says Dr Cornish.

A lot of work has been done, she says, to analyse why it is that this has yet to translate into parity, let alone a majority, for women at the top. But the core reason is no real surprise.

Family life

'There are not a lot of barriers at the beginning,' says Dr Cornish. 'But when you start mixing career and family, it becomes more complicated. Women who have the capability to go for it get tangled up between family and leadership roles and you think: "I can manage the day job and the children, but I can't take on any more than that," so their career goes a bit flat.'

As a mother of four, Dr Cornish has first-hand experience of these pressures. Her aim as MWF president is to 'ensure women doctors are provided with the opportunities to combine a successful family life with an equally successful career'.

Women need more encouragement, she argues, to remain in the system in mid-career, to incorporate family into their lives as another element of a portfolio career, rather than dropping out of work.

The source of this encouragement may need to come from changes that are far outside the gift of general practice, however.

'Women have done pretty much all they can to change in terms of changing working patterns, and organisations have changed too,' says Dr Cornish.

'Some of that has happened, but the whole of society, ie men, has to accommodate these things - women still do way over 50% of childcare and domestic duties. You think: how can we get men to be more involved and part of it, so it's not always a burden falling on the women?'

Role models are important too. 'The GPC is heavily male - if you go there as a woman it is quite battering, you are very much in the minority. So women may not want to go somewhere that is so heavily male - you want people to listen because of what you say, not because you're a woman.

'We need critical mass, we need role models, and women have to help other women.'

The recent debate over Margaret Thatcher's legacy has been interesting, she says. 'She was a role model because she became prime minister. But she didn't really help other women - you have to encourage the next ones.'

Recent research by the RCGP suggests that the broadening role future GPs face - as NHS reforms make them increasingly responsible not just for individual clinical decisions, but for organising healthcare and working across professional groups - could change the selection criteria for the profession.

The findings suggest that teamworking and management skills may become more highly prized characteristics for future GPs. So how does the feminisation of the GP workforce fit with this need?

'I'm wary of generalisation,' says Dr Cornish, 'but women often can lead by consensus rather than just by being singleminded decision makers. In the new world of CCGs and working with social care teams, there is going to be a lot of multidisciplinary working.'

There is a suggestion too, that CCGs in England are beginning to buck the trend regarding women in senior posts. About a fifth of CCG clinical leads are women, as are about two fifths of accountable officers.

Although more needs to be done, these are positive signs, Dr Cornish says. However, growing pressure on the GP workforce could put the rise of women in the profession at risk.

Workload pressure

'I've never worked as hard as I do now,' says Dr Cornish. 'Workload is increasing to pretty unmanageable levels and the whole thing may go into meltdown. I don't think we can cope with the increasing number of consultations - it's rocketed in the past two to three years and there are GPs who are burning out.'

Rising workload and increased locum costs could make it harder for them to offer women with families the flexibility they need, she agrees.

Ultimately, however, practices considering cutting back on flexible working to reduce costs may need to take a step back and reconsider.

Women are increasingly the mainstay of the GP workforce - if the profession fails to adapt and ensure they are represented and welcomed at all levels, its future may be at risk.

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