These days, starting work in a GP partnership can be exciting, but possibly more daunting than it used to be, because of growing demands and uncertainties about the future of the NHS, as well as the GP's role.
This article considers a number of areas of importance when starting as a new GP partner, which need to be borne in mind to increase the chance for a successful start.
There will be considerable variations in the relevance of these reminders, depending on your background or previous experience and how the practice is set up to take you on and integrate you.
The information below is best used as a template or checklist to start from and to add to, before you begin in your new practice and as you go along thereafter.
It may be useful to revisit this outline on a regular basis, for example, at least monthly for the first three to six months of the partnership.
- Are you familiar with the practice surroundings, area, region, NHS infrastructure, out-of-hours settings, walk-in centres, specialist community clinics? Make sure that you have all of the relevant telephone numbers.
- Learn timings and distances to reach the local hospital, care homes and so on, and find out about any traffic bottlenecks in the area. When exploring the locality, consider using a bicycle rather than a car, to orientate yourself more quickly.
- Where will you park, shop, eat when at work?
- Join the CCG/NHS England/NHS Wales/LMC email lists.
- Familiarise yourself as soon as possible with where the practice emergency equipment and cupboard keys are kept, as well as any key codes and essential telephone numbers. Remember to protect any private details.
- If you have your own room, gradually declutter and shape your new working space to suit your requirements.
- Get to know the rhythms of information flow in the practice, such as the delivery and pick-up times for samples.
Clinical staff and patients
- Pay attention to and respect individual nuances, in particular, colleagues' work patterns and routines. Use coffee breaks or other opportunities to meet colleagues informally.
- Read the locum information pack (if available) to learn about referral pathways.
- Allow yourself two to three years to get to know your regular patient population.
- Be mindful of the risk of over-promising or showing off (clinically or emotionally) to patients as the newcomer.
- Explore the culture and the sometimes subtle expectations of individual patients and care homes, especially regarding interactions, for example, home visit requests, reassurance follow-up calls, your accessibility, the degree of personalised care, and consultations with a list with several problems. Identify ways in which you can adapt to this.
Other GP partners
- As a new partner, you will usually be joining a well-established team, with its functional (but sometimes dysfunctional) dynamics, formed over time, often complex and impossible to describe or explain. Note personalities, reputations, role hierarchies (whether open or not) and levels of experience. Typically, there will be a number of unwritten norms and rules for you to discover.
- Beware of readjustment outcomes in the partnership (old partner leaving, reshuffle of hierarchy, possible appearance of 'skeletons in the cupboard'), with potential for conflict.
- Take note of any signs of irritability, anger, fear, confusion or resentment (but also respect and admiration) among the partners and other members of the practice team.
- Avoid forming premature alliances with anyone and be mindful of anyone trying to ally with or against you.
- Define your duties and the practice's initial expectations of you. Take this at an easy pace at first, because the quantity and complexity of your tasks will usually grow with you. Ensure that workload is equally and fairly distributed from the start.
- Adopt and follow current practice procedures before you consider making any suggestions for substantial change. Even when people say they welcome change, they do not want it to happen overnight. Ensure you choose the right time, place and person or group to propose any changes to.
- Regularly gather, accept and implement feedback. Reflect on areas of difficulty or disagreement and consider options and possible compromises.
- Expect to make mistakes at first; acknowledge and learn from them so that ideally, they do not happen again.
- Adapt to the pace of the job in the new setting. Show initiative. Be punctual, but watch your amount of overtime - and that of your colleagues.
Dr Jacobi is a GP in York. Part two of this article looks at dealing with the practice team and personal development