Being a GP in the UK and France

Dr Zara Bieler, a GP in Monmouthshire, Wales, spends part of each year working in France.

How did you start working for part of the year in France?

As a child, I spent many summers in France with my penpal, Maud. I became quite fluent in French.

My decision to head to France as a junior doctor was also motivated by affairs of the heart. I met my French husband-to-be while on holiday in France just after taking my finals.

I spent my junior house officer year in Belfast and once I had my GMC registration under my belt, I moved to France.

My husband had a vineyard in Provence and many letters and calls later, I was offered a six-month post in orthopaedics and A&E at Aix en Provence hospital.

I continued my training between France and London, finally presenting 18 months of French posts to the UK for validation. In 2003, I took the MRCGP examination.

How does your dual role work in day-to-day practice?

I first worked as a freelance GP in the Var area of Provence. We then sold the vineyard in 2005 and moved to a sheep farm on the Monmouthshire-Herefordshire border. Our first child was 13 months old at that point.

The cooler summers here were a relief, as was working in English for a change. Freelance GP work was plentiful in the English and Welsh practices in the area.

We bought a small property in the Vaucluse area of Provence and travelled there in the holidays. We then purchased a small vineyard near the house and as our little one became ready for nursery school, we hatched a plan: September to Christmas in France, January to August in Wales. And so the pattern continues.

I arrive in France for the start of school in September, help out with the grape harvest and then pick up some locum work with local village GPs. As January rolls around, we arrive back to the green of Wales.

Our daughters, aged three and eight, are bilingual and completely at ease with both cultures. My eldest now corrects my French.

I take advantage of my flexible schedule to teach English once a week to French children in the village school and vice versa in Wales.

We have to be organised, we keep track of how the children are coping with school, but at present, I can say the advantages far outweigh the disadvantages.

How does practice in the UK differ from working in France?

Many GPs in France work single handed. Some group practices exist, in towns. I have never met a practice manager or practice nurse there, and health visitors do not exist.

Nurses and physiotherapists work out of their own premises and patients make their own appointments. The doctor writes a referral, which is handed to the patient.

Specialists have their own offices and waiting lists are rare. There was open access to specialists until recently, but the government is bringing in more of a gatekeeper role.

GPs are paid on an item per service basis, so the patient will get out cash or a chequebook at the end of the consultation. You need to keep change in your top drawer.

Patients are refunded a percentage by the state and most have social insurance to cover the rest. Those on a low income or with certain chronic diseases are covered by the state.

The same applies to prescriptions as doctors are paid per consultation, so few offer repeat prescribing. Patients attend for repeats and expect a BP and general health check.

Access to testing is quick and easy. This is a relief, but can lead to over-consumption and patients arriving with a shopping list of tests.

What is your role in the Anglo French Medical Society?

Two years ago, I started teaching on the Anglo French Medical Society (AFMS) medical French weekend course, which has run for 20 years. This year I became its organiser.

The course runs once a year near Easter. All levels of French can be accommodated. Teaching is in small groups with a variety of styles and a relaxed atmosphere.

Participants come from all specialties. Tutors are a mix of doctors who have worked in France, language teachers and French medics.

There are talks by doctors with experience of working in France and plenty of opportunities to pick up practical information on everything from registering as a doctor in France to coping with referrals and emergencies.

How would you advise GPs thinking of working in France?

First, make yourself as comfortable with the French language as you can. The weekend course run by AFMS is ideal and there are other courses available. Practise by using Skype or conversational exchange with a French speaker, or better still, spend some time in France.

GPs in France earn less than in the UK, so you need to plan for that.

Sit in with a friendly GP to get an idea of how things work. Locuming at a group practice gives you the back-up of colleagues. Working as a GP in A&E is another good way to start, as there is a team around you.

The Anglo French Medical Society
The Anglo French Medical Society runs an annual weekend medical French course. This year's course takes place from 5-7 April 2013 and costs £175 for students and £375 for doctors and other professionals.

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