As I near the end of my hospital training and look forward to my final year training in general practice I have been reflecting on my time in medicine.
There was a point in my career when I questioned my decision to become a doctor. Returning to a hospital setting as part of my training this year has confirmed that my decision to leave hospital medicine and carve out a career within general practice was the right one.
My time in hospitals has made me aware of some of the issues of these rotations during GP training.
Service provision instead of training
Speaking to my colleagues at work and during VTS sessions it is clear that, on the whole, we feel less like trainees but more like service providers.
This may be because of the available posts - some trainees have to work in a specialty that they may have significant experience in again because these specialties need more doctors.
In some cases, GP trainees may also spend more time in certain departments or wards, while specialty trainees seem to spend more time in clinics, theatre or receiving specialist training sessions. Some of this may be appropriate if this is the trainee's chosen specialty, but more often than not GP trainees' learning is put on the backburner in preference for specialty training.
One example is that GP trainees miss out on certain opportunities so trainees from hospital specialties can ‘meet their competencies’ and take part in specialist training sessions. Meanwhile, the half-day VTS session can be seen as an inconvenience in some hospital posts – I have been told: ‘you don’t have to meet 100% attendance’ or ‘you can’t go, it is too busy’. Surely this is an important learning opportunity for doctors and should be seen as such?
As a doctor I am aware that I provide a service and am happy to do so. However, as a doctor in training I have always felt that there is very little time for me to actually be trained. Instead there are rushed and cancelled teaching sessions and times when trainees miss teaching because they have to cope with the never-ending list of clinical duties.
I think spending more time within general practice will be more beneficial for me than working in certain specialist areas. Although it may be difficult given the current state of the NHS, it should be possible to ensure that GP trainees are working in areas that will directly benefit them as future GPs. Alternatively I think there is a strong case for completing all GP training within general practice.
Denigration of general practice
Like most medical students I did not seriously consider general practice as a career. A big factor was the general perception that general practice was not an attractive or exciting career. A decade later and, although things are changing, there still remains a poor view of general practice among other specialty trainees and consultants.
A personal example of this is when, during a team huddle, the sister in charge asked if there were any staffing issues that day, a specialty registrar commented ‘well, we have two GP trainees’. The sister was quick to jump to our defence, but that was the view of another doctor.
On the other hand I have met many trainees in other specialties who feel general practice is a great career and wish they had chosen it.
Problems with flexible working
From speaking to colleagues, it seems that the majority of GP trainees (and newly-qualified GPs) are aiming to work less than eight clinical sessions a week and have more of a portfolio career.
However, in hospital medicine it is very much the opposite. Less than full time (LTFT) working or working adjusted hours is less accepted. When colleagues in hospitals work different patterns this often places a strain on the rest of the workforce, mainly because of a lack of staffing and a failure to institute appropriate measures to enable LTFT training/working.
Evidence shows that when doctors work part time this allows them to better enjoy their job and boosts morale. I have seen how miserable, overworked and stressed hospital doctors (and some full time GPs) are and how this disseminates from senior to junior staff.
Many GP surgeries have shown that when there are a number of partners and salaried GPs all working together in a less than full time capacity, it can work and work well. I think that hospitals can learn much from this; the workload can be shared evenly, ensuring patients receive excellent care and access to doctors with a range of skills and specialties, while allowing adequate time for a healthy work-life balance for doctors.
I personally believe that the future of GP training lies within general practice itself and not in the use of GP trainees to provide a service within the hospital. I think that if things do not change soon more GP trainees will not complete training and there will be even more issues with recruitment of GP trainees over the coming years.
For now, I am most looking forward to the teaching I will receive, the close-knit team working and the opportunity to really get to know my patients, and provide them with the best care I can, in general practice.
- Dr Baptiste is a ST2 GP trainee in Romford, Essex