Roles apart
GP training opens up a world of opportunities. New Doctor tracks down two GPs who have taken drastically different career paths.
The portfolio GP
Dr Beth McCarron-Nash is a GP in Cornwall, and the first female UK GPC negotiator to be elected since 1991.
Seeing my patients keeps the rest of my role in perspective
What?
“GPs can work in a surgery as a partner, salaried GP or locum, work out-of-hours sessions, get involved with journalism or medical politics, become a GP with a special interest (GPwSI), pursue expedition medicine, work for a PCT, work in A&E or even work on a cruise ship. The world is your oyster, and that’s what I love about it. I work four clinical sessions each week. Seeing my patients keeps the rest of my role in perspective and reminds me why I became involved in medical politics in the first place.
"Last July I was elected as a UK Negotiator for the General Practitioners Committee (GPC) of the BMA. Two days each week, my role is to represent GPs at a national level, negotiating changes to the GMS contract and enhanced services with the NHS Executive, as well as representing GPs on professional issues, such as revalidation, GP training and practice accreditation. I was also the lead GP in the BMA Support Your Surgery campaign – 1.2 million people signed the petition in three weeks, protesting against proposals to implement polyclinics in England."
Why?
"I’ve always been interested in politics. As an undergraduate I spent my BSC module in the public health department. Since qualifying I have worked with directors of public health looking at the health of populations and health inequalities. When I lived near Leeds I worked for the PCT helping them implement the new contract, by going into practices and helping them improve their systems.
"I have recently moved home to Cornwall and am working as a GP locum. It is a rural area so a lot of care is managed within practices. Previously I was a partner in a large group practice, providing medical cover for the minor injuries unit and managing patients on an inpatient ward. I married someone in the RAF, whose job involved moving around the country, and general practice has enabled me to adapt to that lifestyle. Many GPs in the future may choose to work in a portfolio way, either like me by default, or by design."
Advice for new doctors
"If you have an interest in a certain area of general practice, try to pursue it. During your foundation training, look for extra-curricular skills which will broaden your experience and consider areas that you might be interested in for the future. If you are interested in medical politics get involved with the BMA, and join your junior doctors’ committee while working at hospital. Then, as a GP trainee, get involved in your local medical committee (LMC).
"From here GPs can be elected to the national GPC. It was from the GPC that I was elected as a national negotiator. In the future, new doctors should be aware of the perceived lack of partnership opportunities. Under the new contract, funding goes to practices who decide how to manage their workforce. In some cases when a partner leaves, due to funding uncertainties, many practices have decided to review the skill mix, and employed either more practice nurses or salaried GPs. We hope this situation starts to settle down for future GPs.
"Another issue is getting good quality training that matches educational needs. Some new GPs feel that they haven’t acquired all the skills they need within their three-year training. GPs need to make sure that they continue their education after qualification. My advice is to follow your gut instincts; if there is something you want to do, do it, even if it falls outside the national system.”
The sports medic
Dr Roger Brown works as a GP in Halifax and has been the club doctor to the Bradford Bulls Rugby League Club for the last six years.
What?
“Rugby league teams have six weeks off out of 52, so I work for them virtually all year round. It has become part of my life and a big part of what I do. I look after the first team (home and away), and I also cover all the home matches for the under-21s (ten matches), under-18s (ten matches) and under-16s (four matches).
"The match days vary – some play Friday evenings, some Sunday afternoons and others Saturday tea time. It follows Sky TV as they show a match on a Friday at 8pm and Saturday at 6pm and games will be changed to fit with those times – so you need to be flexible. If a player needs to see me in the week then the ground is only three miles away, so they will call me and come to my practice, where I will fit them in with my general practice commitments. If it’s two to three players who need to see me, I’ll pop into the club."
Just as you can become a registrar in general practice, you can become a registrar in sports medicine
Getting in
"I trained to be a sports medic at the University of Bath through a distance learning course. Different sports governing bodies have different rules and regulations – for example, I have a qualification (IMOFP COURSE) that allows me to enter the pitch at rugby league matches, but it is not recognised by the Rugby Union.
"Every two years I have to pass an exam to enable me to go onto the pitch. There is now a career route into sports medicine that wasn’t there when I started – just as you can become a registrar in general practice, you can become a registrar in sports medicine. A few NHS hospitals now have a sports and exercise department. Most jobs will require that you have completed a diploma in sports medicine."
Why?
"I’ve always been a keen sports person, playing sports, watching sports – you have to have an interest in sports to do this job. When I came here I used to watch the local rugby team with my wife, and the club doctor for Halifax. As he got older he asked if I’d like to cover a game. When he decided he wasn’t able to run on the pitch any more, I took over. So I got into it by chance really."
Hurdles
"There are definitely dilemmas. If a player said to me: “I don’t want the coach to know” – I wouldn’t tell the coach, but I would try to explain to the patient that it would be a good idea to tell the coach for this reason. But if he still didn’t want me to tell the coach, then I wouldn’t – it’s all down to good communication. If the players trust you they will follow your advice.
"Rugby league players are a breed of their own – they will always want to go back on the pitch, even if their arm was hanging off. The worst injuries I’ve dealt with are cervical spine injuries, but you can’t prevent tragedy can you?
"If a player has a torn cruciate ligament, they will be out for six months – there are no short cuts. Working as a sports doctor, you have to be careful about confidentiality. During matches, one of the commentary team will be hovering about; for example, Bill Arthur from Sky Sports – will ask: “Is it a shoulder injury, will he get back on?” I always respond in broad terms – you have to be careful not to give away too much."
Advice for new doctors
"In terms of job prospects, I negotiated the contract with the Bulls, I never signed an agreement and I receive the same pay as I did six years ago. I’m not doing it for the money. That said, it’s not an insignificant amount – I get paid a retainer, which is a monthly amount, then I get so much per game. It’s about a tenth of my GP salary.
"The sooner you pursue what you want to do, the better. Although there aren’t many full-time sports medicine jobs out there, as my dad’s friend used to say there is always room at the top – don’t worry about numbers, and if you want to do something, go for it. Study for your qualifications, maintain your PDP and make sure you have the appropriate indemnity.”