We recognise that making a decision about which specialty to pursue may not be easy at any stage of your career. Sometimes conflicting advice or negative perceptions and comments you hear about general practice may be off putting.
We’re here to help. If you have any feedback, questions you’d like answered or would like to speak to a trainee or GP to hear first-hand what it’s like to train or work in practice email email@example.com.
Increasingly, GPs are taking on roles that are beyond the scope of GP training and the MRCGP that require additional qualifications. But there’s no standard route to becoming a Portfolio or extended role GP. The opportunity to work flexibly and develop areas of clinical interest is one of the great benefits of shaping your own career. Some specialty areas of work will have more structured degree courses or diploma requirements, with others it may be experience.
With the support of NHS England, the Royal College of General Practitioners (RCGP) has developed a new generic framework to support the accreditation of GPs with Extended Roles (GPwER). An accreditation service for GPwERs in Dermatology and Skin Surgery, has been launched on a one year trial basis initially. The Dermatology and Skin Surgery guidelines have been updated in collaboration with the British Association of Dermatologists (BAD) and Primary Care Dermatology Society (PCDS) and replace the 2011 Department of Health Guidelines for General Practitioners with Special Interest (GPwSI).
It is possible to pursue postgraduate qualifications during your training, such as a masters. You can apply for a full time out of programme experience. There are some post-qualification (i.e. ST4) fellowships that offer funded courses (the choice of subject will vary) but this depends on location. Academic Clinical Fellowships (ACFs) offer opportunities that may help support a portfolio career.
These fellowships are usually offered by Health Education England through your local office/deanery or CCGs
While a majority of trainees work on a full-time basis, the less than full time (LTFT) and out of programme (OOP) options are becoming more popular with an increasing number of trainees keen on pursuing roles as portfolio GPs.
Less than full time training (LTFT)
Deaneries, through their Postgraduate Medical Education departments, have a commitment to help all doctors recognise and achieve their full potential through career development. It is also supportive of those with health problems and caring roles and responsibilities to help make sure training can be completed. Local administrators will need to be informed of applications requiring the approval of the Training Programme Director (TPD) and the Head of School.
You can find the eligibility criteria in A Reference Guide for Postgraduate Specialty Training in the UK guidance (Page 30).
Out of Programme (OOP)
Trainees may opt to take some time out of training to develop professionally, get involved in research opportunities or get clinical expertise in areas not provided by their training programme. All requests need to be agreed by the Head of School in advance, so trainees are advised to discuss their proposals as early as possible. All applications will require support from your Training Programme Director (TPD) and are considered competitively by a panel that look at the benefits to the trainee’s career and GP practice in the NHS as well as other criteria.
You can find the eligibility criteria in A Reference Guide for Postgraduate Specialty Training in the UK guidance (Page 36).
The competency based selection process allows applicants to demonstrate their abilities and suitability for GP training.
There are a number of selection centres based across the country. Dates and locations are posted on the Recruitment section of website.
Candidates work through three, 10 minute scenarios known as objective structured clinical examinations (OSCE). These are friendly non-intrusive observations using role play scenarios with a patient, colleague, carer or a relative for example, with a written exercise to assess prioritisation skills. The exercises test four main areas around communication skills, conceptual thinking and problem solving, empathy and sensitivity and professional integrity. There is more information in the 'Guidance for Applicants' with sample questions available online.
Most GPs are independent contractors, either running the business on their own or in partnership with others. As with all other independent NHS contractors, GPs are responsible for running the business affairs of the practice, providing adequate premises and infrastructure to provide safe patient services and employ and train practice staff.
Over recent years there has been a steady increase in the number of large partnerships resulting in the consolidation and growth of a number of GP patient lists. In turn, the traditional staff roles have expanded and developed to meet the needs of the practice. It does mean that there’s plenty of scope for GPs who are interested in the business aspect of running a practice with the ability to make local changes.
It is true that a number of trainees take the opportunity to travel and work abroad after and between foundation and specialty training. Historically most of these doctors tend to return to the UK. Some GP trainees defer their start date for up to a year (minimum deferment of three months) knowing they have a job to come home to. There are also a number of Global Health Fellowships available.
This can vary between education providers but all offer the minimum of 1 year GP full-time and 6 months which may include another specialty. Trainees will do a four or six month GP post in either ST1 or ST2, and then 12 months of GP in ST3.
You will have a dedicated GP educational supervisor who will provide support throughout training with regular contact during the months in ‘non GP’ posts. There are protected education sessions with your peer group during the 3-year training programme.
Not all GP rotations have A&E posts but most acute specialty posts in hospital will involve some on-call commitment as part of their rota. There may be an opportunity at recruitment to select your preferred rotations, usually based on previous clinical experience. It’s important to look at individual schemes and get in touch with your intended local office/deanery to discuss ahead of your application. Many education providers allocate trainees their preferred choice of speciality jobs in hospital.
When successful applicants are offered their area for training, there may be a chance to select rotations.
Each GP practice and its patient list is unique. General practice is all about teamwork. As a GP you will be working closely with other doctors in the practice, along with the wider primary care team which may include nurses, health visitors, mental health workers, physiotherapists and clinical pharmacists. Most practices hold regular multi-disciplinary meetings as well as frequent educational sessions. Days are varied and many GPs develop special interests or a portfolio career undertaking additional work in a range of different community settings.
As a GP trainee you are well supported from day one with someone to ask questions to during surgeries. During your ST3 year, you will have a minimum of 3 sessions of education each week. You will be well supported on a daily basis with debrief sessions after surgeries and home visits.
The majority of patients with coughs and colds tend to treat themselves or can be seen by other practice staff. General practice is a world of infinite variety. Patients will continue to present with a range of symptoms. Some are due to simple illness but many are medically complex and require a high level of skill to not only manage pathology but to see the patient in the context of their lives, their family, home environment and personal beliefs.
To give you a better idea. In a single 3-hour surgery, it’s possible to see an array of different presentations – a child with a high fever and acute otitis media, a bereaved widow with a pathological grief reaction, a woman with newly presenting breast cancer, a manual worker with a rotator cuff injury, an elderly man with a new onset AF… any number of conditions can walk through that door and although it’s a big challenge for any clinician, it’s a stimulating and greatly rewarding experience. Later on the same day, you could find yourself performing minor surgery procedures or be the lead GP running the diabetes clinic, attending a CCG Board meeting or safeguarding case conference. Opportunities for sub-specialism are endless and you will never be bored!
There are over 270 NICE and 150 SIGN guidance documents (for England and Scotland respectively) almost all with a primary care element as well as other national and local guidelines. GPs practice evidenced based medicine. Knowing where to find and how to implement the most relevant and up to date guidance is a skill and the art of general practice is applying the knowledge and facts to individual circumstances to deliver holistic patient care. Increasingly this means dealing with a combination of preventative care, acute illness and multiple long term conditions. British general practice is known for providing a leading source of knowledge and research into patient lives, in cities towns and villages. Academic general practice involving GP trainees and post-CCT fellows contributes many articles to the BMA, British Journal of General Practice and other international journals.
Most patients value the personal relationship with ‘their GP’ which brings your working life added rewards right from the beginning of your career.
You will be well supported and receive one to one supervision to enable you to acquire the necessary knowledge and skills to diagnose and manage the diverse conditions encountered in general practice. You'll gain confidence through review and observation, as you learn the natural history patterns of disease. Supervision continues during your ‘out of hours’ training too.
Many practices have now moved to a range of appointments up to 20 minutes long. Doctors in training will start with longer appointment times and fewer patients in each clinical session. In many cases, GPs and practices have ongoing relationships and continuity of records which means it is not necessarily a 10-minute consultation but more often one in a series.
Practices continually review their access and provision of appointments and trainee GPs are encouraged to take part in this process. Some problems are easily managed within a shorter appointment time.
Research has shown that although many patients do research their symptoms and treatment options online, they usually make an appointment with a GP - who they trust, to interpret the findings.
Patients value that personal relationship which delivers an additional reward for you, right from the beginning of your career.
In general practice, particularly in training, it’s recognised that maintaining a healthy work/life balance is part of being an effective clinician. Although working full time in practice will suit many qualified GPs, others may prefer the flexibility of a varied portfolio career. This means not all your weekly sessions have to be worked in practice. You may choose to spend time in other clinical, education or leadership roles or pursuing other commitments and interests.
Education providers or your supervisor may offer further insight into some of these roles during training. You can email firstname.lastname@example.org outlining your particular area of interest. We can match your request and put you in contact with a portfolio or special interest GP who may give you a better idea of how they went about it.
Don’t forget to contact us if you have any other questions you’d like answered
Updated January 2020