Professor Amanda Howe: Too bright for general practice?

Professor Amanda Howe is at the heart of the RCGP's efforts to expand the GP workforce. Neil Roberts reports.

In her second year at medical school, Professor Amanda Howe was told by her anatomy tutor that it would be a 'waste' for a 'bright girl like you' to become a GP.

Her laughter, looking back from her position today as incoming vice-chairwoman of the RCGP, suggests that the comment did not dampen her ambition.

She has been honorary secretary of the college since 2009 and will become the first female president of the World Organization of Family Doctors in 2016.

The implications of such attitudes, though - the idea that general practice is the poor relation of medical careers - is something Professor Howe thinks about regularly in her role at the college.

Under new chairwoman Dr Maureen Baker, she will lead on professional development, continuing her work as chairwoman of the RCGP workforce committee and as professor of primary care at Norwich Medical School.

The RCGP has been clear on the need for investment to recruit 10,000 additional GPs by 2022, and Professor Howe will be a key figure in trying to make that happen.

Supporting GPs

'Our work,' says Professor Howe, 'is about getting people into general practice, training them properly and then supporting them to do the job.'

But there has been some scepticism as to whether the extra 10,000 GPs will ever become a reality.

'The DH will need to put its money where its mouth is,' says Professor Howe. 'If there is no more money in the system, it will need to come out of specialties which are over-recruiting. You have to shut one pipeline to open the other.'

The college will continue lobbying systematically to convince ministers; demonstrating the problem, demonstrating that solving the problem is worth it, and using 'powers of persuasion', she says.

But in the end, she concedes, it will be a political decision for ministers. 'So I'll believe it when I see it.'

What the college has on its side, though, is the support of other stakeholders such as the Centre for Workforce Intelligence, she says.

Governments also have to invest more in training capacity, Professor Howe adds, to give GP trainers the time they need. Unlike consultants, GPs do not have the space in their job plans for training.

'We need to be saying that in a full-time, professional career, you've got to have the time for other roles, because that's what we need in the overall service.'

A large part of Professor Howe's focus is on how to attract medical students into the profession. Medical schools have promoted a positive image of general practice, she says.

Attracting students

'There have been, historically, cases of people badmouthing other disciplines; it's not professional. If general practice is valued and seen as a good career in medical schools, that makes a difference. If people are implying "You don't want to be a GP, you're a clever girl," that doesn't work.'

Despite the messages they might receive from the media or anatomy tutors, Professor Howe believes that once students experience general practice, they understand the attraction.

'I think when you're younger, you look at robotics or the genome, versus Mrs Bloggs and her bad leg,' she says. 'But I know when students meet Mrs Bloggs, they get it.'

But more needs to be done to educate students in the community. The college needs to keep working to play its part, going into medical schools, actively recruiting students and providing GP role models.

Professor Howe will also push for an increased number of well-supervised apprenticeship attachments for senior students and junior doctors.

'In the old days of training,' she explains, 'you were allowed to do everything, but you weren't always taught to do it. That wasn't very safe. Now it's a bit the other way: you're not allowed to do anything until you're qualified.'

Building the GP workforce

The RCGP says 10,000 extra GPs are needed by 2022, but what does Professor Howe believe will help to achieve this?

  • More investment in GP training.
  • Medical schools must recognise the value of general practice to attract students into GP roles.
  • Offer more medical students the chance to experience general practice first-hand.
  • Increase availability of supervised GP apprenticeship attachments for senior students and junior doctors.

Social upheaval

Professor Howe says the 'social upheaval' the country is experiencing also causes problems for the general practice workforce. She cites the new 'bedroom tax' as an example, which, she says, is bringing an extra three or four patients a week into her consulting room.

'We are where people come first when they are under pressure,' she says. Comparing the current period to her time working in Sheffield in the mid-1980s during the miners' strike, she says: 'It was the same then: blokes went out of work and women were doing two jobs for half the pay.

'It's a very turbulent time globally; it comes through our front door.'

The best way to prepare students for working in these difficult times, she explains, is to get them out into the community.

It is important, she says, to 'get them out to learn from patients, and about patients' lives'.

'The first time you see somebody who is very vulnerable, very needy, it is quite shocking, and you think "How do doctors work with somebody like that?". But when you teach a student to listen, respond and help, they see there is a role for that professional adviser, who is also going to do the health stuff.'

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