When considering a career in general practice many students ask if they can be a specialist as well. They are surprised to learn that many GPs are specialists, not least specialists in primary care. Many of us did other things before we became GPs and have continued to develop those skills in practice. My specialism is being a medical teacher and trainer.
There are lots of opportunities to specialise both inside your practice and outside. Inside the practice it could be running the diabetes service, being the lead for child and adult safeguarding, giving joint injections or looking after minor surgery.
Outside the practice there are many hospital posts available as clinical assistants and the chance to train further in one particular field, for example, endoscopy. There are also occupational health opportunities with local businesses (I was the doctor for a well-known maker of pressure cookers and also lawnmowers) or being a sports club doctor. In my previous GP practice one of the partners was the club doctor to a now premiership football club.
Why is a special interest important?
A special interest is good for your personal development and the practice as you bring a new skill, which may reduce referrals outside. Also, when you pursue your specialist interest it is something that takes you away from day-to-day consulting, keeping you refreshed and stimulated, so when you return to seeing your usual patients you are recharged.
Forty years or more as a GP is a long time and it is good to keep learning and updating in this way. Your partners may be pleased as it could generate extra income to the practice as well as the extra interest in the benefits it creates, such as being able to watch your local football team on a Saturday.
It is important not take on something outside of your competence. In a hospital post there will be access to a consultant for advice and feedback. This may not be so easy in your GP practice so it is important to access any courses or relevant training that is available and, where you take on an activity such as running the diabetes clinic, to audit your work regularly.
Whatever you do, obtaining feedback is essential. It is also important to let your medical defence organisation know to ensure that you are adequately covered.
Medical education is an area where GPs can develop a special interest. This can be as an undergraduate university teacher, either by having students in your practice or having a university post as well to provide teaching in-house.
For postgraduate teaching you can become a GP trainer for foundation year two doctors or GP registrars, or look for a leadership role with what were called the deaneries, now Health Education England. This could be as a vocational training scheme course organiser now called training programme director or a post as an area director overseeing such schemes. In both there are relatively defined career pathways.
You could also become a GP appraiser and work with local colleagues.
Extended roles and appraisal
In terms of revalidation, having a special interest means having what is referred to as an ‘extended role’. To demonstrate that you are keeping up to date in that role you should keep supporting information in your appraisal portfolio.
It is the job of your NHS GP appraiser to check that you are keeping up to date as both a GP and in your extended role. However, this job is made easier if the organisation you work for conducts its own appraisals and these can be put in your portfolio. This also may help in accessing funding for training.
For some extended roles, it may be necessary to gain further qualifications. For example, as a premier league football club doctor there would be an expectation to have a diploma or masters degree in sports medicine, or it could be basic life support training if you are working as a first responder in a rural area. If something goes wrong you need to be accountable, not least to your medical defence organisation.
With a 40-year career the world is your oyster. You can be a generalist and specialist combined.
- Professor Charlton is a GP near Solihull and Professor of Primary Care Education, University of Nottingham