Case study summary
There is no more important job in modern Britain than that of the family doctor. With a growing and ageing population, GPs have to deal with more complex health problems – and as a result, their job is more challenging than ever before. Find out how the GP Forward View is changing the profession.
While many medical students avoid general practice, others are embracing careers as family doctors and finding the many benefits of the profession.
At a time when general practice is reeling from ever-increasing workload, rising patient expectations and burgeoning bureaucracy, it comes as no surprise that medical students are avoiding the profession in favour of secondary care specialties, leading to staff shortages.
It is, therefore, refreshing to meet Dr Maslah Amin – one of a rare breed of doctors who decided to switch to general practice after he was due to start training as an interventional radiologist. A graduate from the University of Sheffield and national medical director’s clinical fellow at Health Education England (HEE), Amin is working with HEE on its Nothing General about General Practice campaign, encouraging young doctors to choose a career as a family doctor.
He believes there is an image problem afflicting general practice, which may partly explain why medical graduates don’t choose this specialty. “We were mostly taught in a secondary care setting by older consultants with traditional views,” he says. “The education wasn’t focused on general practice, nor were there many GP placements or GP educators, so a lot of us graduated from medical school without having an informed perception of general practice, and instead thought of it as a second rate specialty.”
Amin says he chose general practice not for what it is today, but for what it will be in the future. “When I see its future in 10 years from now, I see a big multidisciplinary community hospital with many allied healthcare professionals such as pharmacists, nurses, physiotherapists, healthcare assistants and doctors working together as a team,” he explains. “With more care services being provided through primary care in the future, I see general practice as the most important specialty and the best way to help patients.” A statement many would agree with.
The General Practice Forward View, launched earlier this year, said there is no more important job in modern Britain than that of the family doctor. With a growing and ageing population, GPs have to deal with more complex health problems – and as a result, their job is more challenging than ever before.
As modern healthcare moves away from the hospital to the community, it is now widely acknowledged that sustainable primary care is essential for a sustainable NHS.
An extra £2.4bn a year has been earmarked for GP services by 2020-21 – increasing the spending from £9.6bn in 2015-16 to more than £12bn by 2020-21. A portion of this fund will also be used to expand the workforce and hire 5,000 additional doctors in general practice (along with 5,000 other professionals) by 2020.
Students should be made aware about the opportunities general practice offers, says Amin. “It gives you great flexibility with your career … you can have a specialist interest, combining specialism with generalism, you can go down the leadership path, take up medical education, get involved in other academia such as research or be a pure clinician.
“It’s the flexibility and variety which makes general practice stand out. For our generation, the retirement age is probably going to be in the 70s, and general practice gives you the chance to reinvent your career and work in a team, which is important for young people. There is enough in general practice to keep me going for another 50 years, I don’t feel other specialties offer as much opportunity.”
While some doctors don’t relish management roles, for Amin, it was the leadership potential that attracted him to general practice. “I’m the sort of person that if I see a system not working, I want to improve it. And with GPs now in charge of commissioning, there is scope to lead the integration of patient care and to also promote innovation for our modern NHS.”
Mentorship also plays a vital role. “I met my GP role models during my clinical fellowship at HEE – eight years after starting medical school. Working with them first-hand made me appreciate the breadth of experience general practice can offer and motivated me to become a GP. If I had met them earlier, I would probably be a senior GP trainee by now.”
Amin is talking about his mentors – Prof Sheona MacLeod, postgraduate dean and chair of HEE’s postgraduate deans and Prof Simon Gregory, the regional director and dean of education and quality in Midlands and east at HEE and HEE’s GP lead. MacLeod agrees that mentorship is much more important than previously realised: “Our trainee doctors value personal input, they want us to share not just knowledge but our stories too.”
She says HEE is working with medical schools to make students appreciate how rewarding general practice can be as a career. “It gives you the ability to develop your talents the way you want and yet have a work-life balance. You can have a challenging job and still have time for your family. This is a very positive message for young people.”
Gregory adds that mentoring “someone like Maslah who is incredibly bright and caring” can be equally rewarding. “It is not a one-way relationship,” he says.
Interestingly, both MacLeod and Gregory say GP trainees are often surprised to discover how stimulating general practice is. They emphasise the need to raise the profile of family doctors among the wider public and introduce flexible recruitment procedures and training.
Besides working with medical schools, HEE is collaborating with local authorities to encourage sixth formers to explore the option of GP work placements. In addition, efforts are being made to broaden the talent pool to include trainees from diverse backgrounds. Amin says people from BME backgrounds have traditionally faced issues with career progression, and initially he had encountered some scepticism as well.
“Actually, lack of diversity isn’t just a race or gender issue but a class one,” he adds, pointing out that medicine is still considered an elitist career, not known for attracting many working class people. If young people from BME backgrounds can relate to me and realise they can do what I’m doing, then that makes me happy. Medicine is challenging, but if you have the talent, right support and discipline, you can do it.
“Being a GP and trying to solve patients’ problems is a privilege. You can’t change the world but you can change someone’s world.”