Intended for healthcare professionals

Career Focus

A GP returner—five years on

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7457.s18 (Published 10 July 2004) Cite this as: BMJ 2004;329:s18
  1. Lesley Morrison, principal general practitioner
  1. Teviot Medical Practice, Hawick TD9 9DTlesley{at}ljmorrison.fsnet.co.uk

Long live the four Rs: recruitment, retention, refreshment, and reflection. That was the philosophy of the general practitioner (GP) returners' scheme sponsored by the London Initiative Zone Educational Incentives programme, which I joined in 1998. I worked as a returner in a busy, demanding inner city London practice with an experienced, committed, and motivated trainer. Five years into being a GP principal, I am even more aware of its great value than I was then, and I would support anyone wanting to take advantage of the now established Department of Health scheme.

In the 1970s

I initially trained in general practice in the late 1970s but was daunted by the long term and rather inflexible commitment which a partnership seemed to demand. I was aware that I would soon be thinking about starting a family and so I chose to work as a GP assistant. I enjoyed the work and at the same time developed a fascination for community medicine (as it was then), which I felt would complement and enhance my understanding of primary care. I joined a training scheme and was eventually appointed part time consultant in women's health with public health and clinical responsibility.

Returning to general practice

When our last child started school, I felt that it was the right time to pull together the threads of my experience as a doctor and a parent and return to general practice. My main problem was a lack of confidence in my clinical skills, particularly prescribing. I was hovering on the sidelines, unsure how to make a start, when I spotted the returners' scheme advertised in BMJ Careers. It offered six months' full time or ten months' part time refresher posts for GPs who were vocationally trained but had been out of clinical practice for some time.

An attractive option?

It seemed such an attractive option that I imagined scores of GPs, especially women with similar career patterns to mine, crawling out of the woodwork to apply. In fact, sadly, there were few applicants. I was appointed to a part time post and was made very welcome. I was an extra pair of hands and I brought a training grant one and a half times that for a registrar. My (male) trainer appreciated my experience in women's health, and I quickly felt a member of the team. What my trainer found hard to accept, however, was that when I said I did not feel confident in prescribing—for example, asthma medication—I was not exaggerating.

Differing training needs

My ease in relating to patients and colleagues belied my lack of confidence in disease management and prescribing. Instead of asking for tutorials on dealing with violent patients, I wanted to talk about diabetic treatments that had come into fashion since I last treated a diabetic patient. It was clear in the weekly vocational training scheme afternoons that I had different training needs from the GP registrars. We developed a symbiotic relationship in which I came to feel comfortable asking what to them, fresh out of hospital medicine, were basic clinical questions. Subsequently, the returner trainers realised that it might have been more appropriate to include a series of introductory clinical lectures in our training programme.

At the end of the year we made a family decision to move north. The packing cases were on the floor when I opened BMJ Careers and saw an advertisement for a part time GP principal post in a town 20 miles from where we were going to live. We moved, arriving in an April snowstorm, and I was interviewed and got the job a week later.

Inner city to... Hawick?

Initially, I felt guilty about using inner city training money to prepare myself for a rural post. I was reassured by my trainers that this guilt was unnecessary because I was still working in general practice. As it turns out, the vacant housing in Hawick now attracts large numbers of families from Glasgow, and so there is effectively an inner city population among the leafy reaches of the Borders. I admit that I still miss the cosmopolitan life of working in London. The hum of Kurdish conversation which came from the Islington waiting room and the hum of the Teerie (the local Hawick vernacular) are discernibly different. Both, though, are interesting in different ways.

Fresh eyes

Do I regret stepping out of general practice for several years? Mixed feelings. But I have certainly returned with fresh eyes, new insights, and a commitment and enthusiasm which may have faded had I tried to combine the job with raising a young family. Was the returners' scheme useful? Invaluable.

I feel that I now have a specific contribution to make to my practice as a result of becoming a partner relatively late in my career. All nine of us (we are a big practice) bring different skills, aptitudes, and personalities. Just as celebrating difference is an underlying ethic of working in a multicultural environment, it is also at the heart of all general practice. And perhaps that has been the most important insight I have gained.

Footnotes