The transition from GP trainee to independent practice

Practical advice for GP registrars approaching the end of their training. By Dr Pipin Singh.

A young female GP typing on a  laptop

Completing your GP training is a significant moment. All those years of postgraduate study, RCGP requirements and clinical rotations finally pay off.

This will feel like an even great achievement given the difficulties the pandemic will have thrown at you during training with so many changes to the college requirements and introduction of new assessments. Are you now fully prepared for independent practice?

Final months of ST3

The final months of ST3 training is a challenging time. Multiple workplace-based assessments to complete, potentially the RCA and numerous college requirements in order to be ready for your annual review of competence progression (ARCP), which in ST3 is likely to be two months before completion of training.

In addition to this, it is important to remain focused on how to prepare for independent practice. Your trainer will also be able to guide you with respect to this.

Start thinking about your career options post acquiring your CCT as early as possible. The beauty of general practice is that you have multiple options available to you due to the current climate and the extremely wide variety of skills you will have acquired throughout your career.

If you have completed the bulk of your assessments and exam requirements and find you still have a few months left in training, use this time constructively to actively seek out possible jobs.

Options for newly-qualified GPs

These are just some of the options available as a career:

  • Partnership
  • Salaried roles
  • Locum work
  • A fellowship role – funding has lead to an increased number of fellowship roles, some may be available in specific areas such as mental health or frailty work.
  • GP trainer (normally requires practice experience first)
  • Out of hours general practice
  • Media work
  • Writing for mainstream general practice magazines
  • Undergraduate teaching
  • Postgraduate teaching
  • Prison medicine
  • Police surgeon
  • CCG management or clinical roles
  • Acquiring a special interest
  • Medico-legal roles
  • Sessional work within accident and emergency or specialities such as diabetes
  • Cosmetic procedures
  • Sports medicine
  • Occupational health
  • Private medical work e.g healthchecks, medicals

This is not an exhaustive list and portfolio careers are becoming an increasingly common part of general practice.

Read more: Career options for newly-qualified GPs

Practical tips

1. Ensure you apply for your CCT (certificate of completion of training) on time. You will not be able to practise without it.  You will be told when you can apply and this will be dictated by the outcome of your final ACRP review.

2. Prepare an electronic file with relevant documents, either in a cloud or on a memory stick (whichever works for you). The following items will be mandatory for most jobs:

  • GMC certificate
  • Certificate of completion of training
  • Immunisation status - Hep B status +/- MMR status, COVID vaccintions
  • Medical indemnity certificate.
  • Up-to-date CV with recent references.

Other scanned documents worth including, that may or may not be required include

  • Proof of address (e.g council tax bill or scanned copy of driving license)
  • University certificate
  • DBS check
  • Child and adult safeguarding training certificate
  • Equality and Diversity training certificate
  • CPR training certificate

Having these readily available will potentially save you a lot of time.

3. Attend a GP update course once a year. Certain CCGs provide these locally although there are recognised national courses also. These are generally advertised in mainstream GP media and provide valuable updates and useful summaries of new evidence.

4. Write a CV. Think about what will make you stand out. It will be worthwhile asking your trainer and practice manager to provide you with some feedback on this.

5. Sign up to a local locums agency as soon as possible if appropriate to your needs.

6. The RCGP normally hold First 5 and AiT (associates in training) regular monthly remote meetings. These often include educational lectures and will count towards your appraisal. Find out when these occur and try and get on the mailing list. These are often advertised on local Facebook groups.

7. Think about documenting learning as you go along. The best way to do this is to keep a file on your smartphone, tablet or laptop that is common to all devices. Note down a few learning/reflective points at the end of each learning event. This will save a lot of time later on when preparing for your appraisal. Although appraisal at present is light touch, it is not clear if and when this may go back to the way it was so try and stay on top of your CPD requirements.

8. If you plan to locum, remember you are now self-employed. Firstly find a good accountant as quickly as possible. Document ALL your work whether clinical or non clinical on a spreadsheet regularly. 

Make yourself aware of tax deadlines and discuss with your accountant how much money you will need to put aside for tax, pension and national insurance contributions. This can be complicated, however a good accountant will be able to help you with this and also guide you as to where you can save money.

It may be in your best interests to set up as a limited company. Your accountant of financial adviser will be best to advise you about this.

How else can you prepare yourself?

The most difficult part of the transition from registrar to GP will be the lack of support that comes with being independent, particularly if you begin working as a locum.

Due to the fast pace of the job, you may rarely have an opportunity to ask clinical questions of your day-to-day colleagues and in fact may rarely see them.

Setting up a young practitioners group and agreeing to meet on a regular basis is very useful and gives you an opportunity to share and discuss complex cases, summarise new guidelines and anything else you may find useful during your day to day work.

This may be friends or colleagues from your GP training groups, or a group you prepared the RCA with. The pandemic has likely increased isolation further, so staying in touch with colleagues has never been important as now given how the delivery of healthcare has changed over the last two years.

Ensure the contents of the meeting are noted down during or after the meeting with some relevant learning points. This should be social alongside providing educational value.

Ongoing CPD

Part of being a doctor is the passion for lifelong learning. Your appraisal will require you to complete 50 hours annually of learning (CPD credits) so think about how you will achieve this.

This becomes more tricky when taken out of the training environment.  The appraisal and revalidation process should be discussed in your final placement with your trainer and your PDP generated prior to completion of training.

Your trainer should be able to guide you as to when your first appraisal will be and you will normally be notified about this and who will be doing it by your local appraisals team.

Ensure this is SMART (specific, measureable, achievable, relevant, timed) . Familiarise yourself with the appropriate documentation you will be completing for you appraisal e.g MAG form or Clarity.

More than ever, recognise your strengths and how you can use these. Ensure you maintain a good work/life balance and be alert to where you maybe exhibiting signs of stress or burnout. This has become an increasingly recognised condition within our profession with help available if needed.

  • Dr Singh is a GP trainer in Northumberland

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