Diversify your GP career

General practice allows you to combine clinical practice with other interests such as politics, research, and medical education. Or, perhaps you wish to develop an extended role by providing an additional specialist service in your community, or go further afield in a wide range of clinical areas from cardiology, dermatology, and minor surgery to mental and sexual health.

Developing a portfolio career

"Portfolio GP" is a term which commonly describes a GP who holds multiple roles. Most GPs will have a primary clinical role - as locum, salaried or partner GP - and it's becoming common to see members taking on additional roles alongside this to diversify their skills and experiences.

Hosted by Dr Sophie Lumley, a First5 salaried GP and Training Programme Director in Shropshire, the GP+ Careers podcast is a series of short interviews with a standardised format. It's designed to point people in the right direction and showcase what’s possible. Sophie will ask a series of questions to each of her guests about what their role entails, how they got into it, and any top tips they have for those considering a similar path.

You can look forward to the release of a new podcast episode each month, available exclusively here and through all main podcast platforms. Browse this page to explore and listen.

Latest episode: GP+ Working in Secure Environments and substance misuse

Have you ever wondered what it would be like to work in a secure environment as a GP? Are you interested in managing and treating patients often with complex needs?

Working in a secure environment such as a prison, secure psychiatric facility, or immigration centre as a GP can be highly rewarding, but also present challenges. Often those living in secure environments have complex healthcare needs that extend beyond general medical care. These include managing additional considerations such as patient vulnerability, mental health disorders, and substance abuse issues.

In this month’s episode we hear from Dr Juli McCulloch, a First5 GP working in secure environments and secondary care addiction services. Juli provides valuable insights into working in a high security prison, how her personal interest attracted her to the role, and the benefits of pursuing this specialist interest.

For someone like me coming out of ST3 that was a bit of an anxious type, working in secure environments has really boosted my confidence. Running towards that fear instead of avoiding it has really helped going into those more difficult patient interactions.

Top tips

Research the different types of secure environments

There are a range of secure environments you can work in as a GP, including open prisons, higher security units, immigration detention centres, and more. Juli works in a high security men's prison, but she urges you to consider the type of secure environments near to you that interest you.

The job can be rewarding, but emotionally demanding

Patients in these environments tend to have more complex needs and have experienced more trauma, often resulting in more mental health and substance use concerns. You need to consider how to care for yourself and your emotional resilience as well. Juli mixes prison shifts with a varied work week within a portfolio career to protect herself from burnout.

Contacts are key

Juli highlighted that she secured an interview for her other role in substance misuse through her GP partner colleague, who had a contact in the local addiction services. Connect with GPs already working in secure environments to gain first-hand accounts of their experiences. You can join online forums, and seek out mentorship opportunities in this area. She found this route much easier and more informative than searching for job adverts and listed vacancies.

Preserve human dignity and provide empathy

It’s important to always approach individuals in secure environments with empathy and respect, recognising their vulnerability. Juli states that a simple, human connection can make a significant difference in their experience and wellbeing.

Same but different

Juli highlights that she was not required to complete any additional qualifications to work in the prison environment. Although the structure and environment are different, a lot of the day-to-day clinical work is exactly the same as that of your community GP clinics. This includes chronic disease management, triaging patients, prescriptions for the pharmacists, and dealing with queries from the nurses. In Juli’s experience, she also sees fewer patients per shift, allowing you to spend more time if the patient needs it.

GP+ Appraisal

A medical appraisal is the opportunity to reflect on your work with a trusted peer. Completing your yearly appraisal is one of the essential requirements to be recommended for revalidation by the GMC.

An appraiser in general practice is someone who has been trained to conduct annual appraisals for other GPs. The main role of appraiser is to meet with the GP to facilitate reflection on clinical work, challenges, achievements and assessing the GPs portfolio evidencing their CPD, quality improvement and feedback from both colleagues and patients over the last year.

The appraisal role involves working closely with your senior appraiser and GP colleagues in a constructive, supportive environment to ultimately improve patient outcomes.

In this month’s episode our host Dr Sophie Lumley is joined by Dr Nicky Wilson, a GP appraiser since 2018. Nicky outlines her career journey so far, the skills required to be appraiser, benefits of the role and much more.

A highlight of the role for me is when I have my own appraisal, and I’ve had feedback from appraisees saying things like ‘the best appraiser I’ve had’ it makes me really pleased that I have delivered a positive appraisal and revalidation experience for that GP.

Top tips

Build a career to suit you

The role offers flexibility in terms of how many appraisals you want to take on each year (usually 22 to 24) and these can be done at a time that suits you and your appraisee. You also need to consider the time dedicated both before the appraisal for preparation and the write-up afterwards in your overall time commitment.

Seek inspiration from others

Nicky enjoys finding out what others are doing as part of their personal development plans (PDP) and is often inspired by their ideas for innovative practice and new ways of working. Some of these ideas may inspire you to make improvements in your own GP practice.

Reach out to your local networks

If you want to become an appraiser, Nicky advises that you reach out to your local appraiser team about recruitment opportunities and the application process. If you aren’t successful the first time – don’t give up! Ask for feedback and apply again.

Consult with your colleagues

As an appraiser, Nicky states she was assigned a senior appraiser who she could seek advice from. She also attends small group meetings facilitated by experienced appraisers, where they come together to talk about new guidance on appraisals and revalidation, difficult cases, etc.

Consider brushing up on your soft skills

Nicky suggests coaching or mentoring training can help bring out the soft skills beneficial when applying to be an appraiser. These include empathy, good listening skills, and providing constructive feedback to others.

GP+ Genomics

Genomics in general practice refers to the integration of genomic information and testing into primary care. This allows GPs to use a patient's genetic information to guide diagnosis, prevention, and treatment decisions.

Examples include:

• Predictive testing for genetic conditions (e.g. BRCA genes for breast cancer risk)
• Pharmacogenomics, which helps determine how a patient might respond to certain medications.

Becoming a GP with a special interest in genomics offers a variety of benefits to you and your patients such as specialized expertise, enhanced career satisfaction and earlier detection and prevention of genetic predispositions for patients.

In this month's episode we are pleased to be joined by Dr Will Evans, a salaried GP in Leeds and a GP with a special interest in genetics with the Yorkshire regional genetic service. Will tells Sophie how he got into the field, what his typical work week looks like, benefits of the role, and how you can get involved in genomics within primary care.

Genomics - GP+ Careers podcast

One benefit of the role for me is having that extra time to be able to delve into the histories and examine patients more thoroughly. A lot of the things you identify and skills you develop are really useful elements I found that I can apply in primary care.

Top tips

Explore the world of genomics

There are several great resources to familiarise yourself with genomics. Will recommends looking at Health Education England (HEE) website for genomics educational resources, particularly the GeNotes resource. Other excellent resources include the RCGP genomics toolkit.

Join the Primary Care Special Interest Group

If you are interested in finding out more about how you can be involved with Genomics, Will recommends joining the Primary Care Interest Group that Will is a member of. This has a number of GPs but also community pharmacists from across the country with differing interests and roles and is a great place to find out about opportunities and connect with like-minded peers.

Carve a diverse career path

With the growing integration of genomics in healthcare, GPs with expertise in this area are likely to be in higher demand. There is a range of opportunities to work in specialized clinics, academic settings or policy-making roles related to genetics.

Drive progress through innovative practice

Be part of the cutting edge of healthcare, applying the latest advancements in genetics to clinical practice. Will has been involved in several transformational projects, such as improving care coordination of patients with rare genetic diagnoses as they transition from paediatric to adult services.

Set clear boundaries

Like with any special interest, when you are working in that area for one day (for example), there can be a risk that work falls in other days when you aren't doing that role. Will suggests that you define your week quite carefully and protect your time - set clear boundaries and stick to them for the best work-life balance.

GP+ Learning disabilities

According to Mencap, a learning disability is a “reduced intellectual ability and difficulty with everyday activities for example household tasks, managing money – which affects someone for their whole life”. 

It is important not to confuse this with a learning difficulty such as dyslexia, which unlike a learning disability, does not affect someone’s intellect.  

GPs have an important role to play to ensure that people with learning disabilities have accessible healthcare and annual health checks to prevent illness. Explore how you can start your portfolio career as a GP with a special interest in learning disabilities.

This month we are joined by Dr Ayesha Mahmud, a salaried GP, TPD, ICB lead and Faculty Education Lead with a special interest in Learning Disabilities and Autism. Ayesha describes how her GP career path changed due to her passion for advocating for patients with learning disabilities. She also outlines her achievements within this area of work and highlights of the role.

Learning disabilities - GP+ Careers podcast

Even if I can make a little difference and provide reasonable adjustments for patients, that is so rewarding and makes it worth the effort and time.

Top tips

You can always change direction of travel

Ayesha previously had a background in surgery and had planned on developing Minor Surgery as an area of specialist interest. She changed to learning disabilities as it was a passion of hers with a personal meaning to drive change.

Find your tribe

Ayesha recommends exploring the RCGP Special Interest Group for Learning Disabilities. Here, you can connect with others who share your special interest, expand your networks and opportunities, and learn from each other.

Raise awareness of your work

If you are working to improve the quality of patient care for those with learning disabilities, it is important to raise awareness of this as it can lead to more joined-up thinking and improved patient outcomes.

Expand your knowledge

Ayesha highly recommends the RCGP One Day Essentials courses for different topics, which are now free to members to book.

Small changes can be rewarding

Implementing small changes in your practice can be hugely beneficial to patients. Ayesha provides an example of this: her GP practice has an alert system set up for a patient on the learning disability register, so the receptionist is notified and can try to make reasonable adjustments for them such as a longer appointment time.