Read about the experiences of GPs returning to general practice in Scotland after spells working overseas or after a career break. Scottish GPs give first-hand accounts of work and life in urban, rural and remote practices across Scotland.
Dr David Hogg graduated from Glasgow Medical School in 2005 and, after completing his GP training in Ayrshire in 2010, he undertook a GP Rural Fellowship on the Isle of Arran, becoming a GP Partner in the island’s medical practice in 2013.
A member of the Arran Mountain Rescue, David was instrumental in setting up Arran Resilience, which brings together all the emergency services on the island. David publishes the highly popular ruralgp.com blog about life and work as a rural GP and is an active member of the Rural GP Association of Scotland.
“Combining the challenge of an incredibly diverse rural GP practice with the lifestyle appeal of living on a beautiful island is, for me, an unbeatable combination”
While studying at Glasgow Medical School I undertook a student elective in Stornaway on the Outer Hebrides and that first triggered my interest in rural practice. My FY1 was in Stirling, FY2 in Glasgow and GP training in Ayrshire - my GP placement was actually in Kilmarnock so a busy town practice. It was my GP trainer who said to me “go and have a look at Arran as an example of rural practice”.
In 2010 I started the Rural GP Fellowship in Arran and, five years down the line, I’m a partner in Arran Medical Group. The GP rural fellowship was the big enabler for me and I can’t praise it highly enough. It’s open to anyone who’s a qualified GP and wants a supported year to go and find out a bit more about rural practice - it’s aimed mostly at recently qualified GPs.
At Arran Medical Group, we’ve got 3 base surgeries, we operate another 3 branch surgeries on top of that and we also have the community hospital. Arran itself is about the same size as greater Glasgow. It takes about 2 hours to drive round it and we’ve got 5000 people here but it goes up to 25,000 in the summer so we cope with big changes of population.
“90% of what we do is general practice like anywhere else but the extra 10% totally stretches out these extremes”
The group has eight GPs and a team of 40 in total including practice nurses and admin teams to support all these sites. A typical week for me can involve being in Lamlash, a fairly busy, large village practice and then can take me up to Lochranza, with a population of 200 people. We open that place ourselves and you get the occasional deer peering in the window mid-consultation – it’s a unique place to work.
On-call work includes A&E, response for NHS24, dealing with up to 17 inpatients including a high dependency unit, police calls and any BASICS pre-hospital requests as well.
We’re highly supportive of the Rural GP Fellowship and provide taster weeks for GP trainees; we like to be positive about people coming over to take a look because we find it’s actually quite addictive once you’re here.
The medicine is really stimulating and there’s no shortage of interesting cases. 90% of what we do is general practice like anywhere else but the extra 10% totally stretches out these extremes. It’s why the Rural GP Fellowship is so good - when you’re a new GP you’re qualified in general practice but you’ve still got a lot of experience to get. Plus you’ve got these additional aspects of rural practice which keep the job quite stimulating – so it’s important to have a ‘wise owl’ to call upon! We take a lot of care to make sure our GP Fellows are supported. If they’re on-call, we’re always available to offer them advice and assistance.
Working as part of the team in Arran is very rewarding - there’s a lot of teams that we work in here. We are already integrating health with social care because we work so closely together anyway. We also work closely with our secondary care colleagues on the mainland so if we want to refer someone over acutely we tend to speak to a consultant. Our A&E colleagues in Crosshouse are supportive and the Emergency Medical Retrieval Service has revolutionised the treatment and transfer of critically ill patients in rural Scotland.
One of the biggest challenges is connectivity. There’s real impact on health now and we can demonstrate that – we have patients who can’t phone 999 because the landline’s down and they’ve got no mobile phone coverage. We are making progress with this and have set up ConnectArran, a campaign to try to improve connectivity and raise awareness of the real effect of the lack of connectivity.
We’re also looking into innovative ideas and GP is great for that - innovation in smaller groups is often easier. As a GP partnership we have lots of control over how we deliver services. We know the area well, and we get a lot of support from our patients, most of whom are understanding of the challenges of delivering rural healthcare. We find that it is really important to have this understanding and we take advice from our Patient Participation Group on a regular basis.
Student teaching is really important to me as is recruitment to general practice as a whole so I do a lot of things with that just now. I also have roles with the Rural GP Association Scotland, with RCGP Scottish Council and I take part in CPD events for BASICS Scotland – maintaining links with confreres in other parts of Scotland is important to reduce professional isolation, which can be an issue in remote and island practices. With email and video conferences, I can connect easily with colleagues on the mainland.
I have interests in emergency care so we’ve set up something called Arran Resilience to bring all the emergency teams together and I’m a member of Arran Mountain Rescue Team. It’s good fun! I like, whenever I can, to get out and about in the hills and to go sailing. I’m a keen photographer and there are some fantastic views here.
I think we should be optimistic about the future of general practice. We need to be very clear to government about the challenges that we have but also need to be very clear to students about how it’s still a very exciting and stimulating career. We certainly need to take innovation by the horns and make sure that we’re providing leadership for that but fundamentally, we’ll always be there as the primary contact for worried and anxious patients. I think that so long as we can keep that clear in our sights, everything else will then follow suit.
Arran Medical Group - http://www.arranmedical.co.uk/practice-info/doctors/
Rural GP - http://ruralgp.com/author/drhogg/
Follow Dr David Hogg in twitter - @davidrhogg
An Edinburgh GP talks about his return to General Practice in Edinburgh after five years working in Australia
I graduated in 2004 in Edinburgh. I did the old style JHO year and then a series of stand alone six month A&E posts with a view to doing A&E. I then got an A&E run through training scheme in Edinburgh but after a year had to re-apply through the MTAS scheme because that came in.
I was unsure about whether to continue long term with A&E so I applied for GP and A&E with a view to keeping an open mind. I got a GP post and continued with that because I was keen on the generalism but I didn’t fancy the long term commitment of working nights until I retire. I did my GP registrar year in Musselburgh.
When I finished, I then locumed for 13 months with a view to going to Australia because it fitted in with my wife’s training - she’s a doctor as well. We planned to go to Australia for one year and do some travelling on the way out, work for a year and then do some travelling on the way back and see it as an 18 month to 2-year period out and then come back and find something more permanent.
“The process of coming back to work in Scotland was much easier than I thought. I only had to complete a two week supervised placement. It was all a very smooth, quick process which I really appreciated”
However, before we knew it, I had spent five years as a General Practitioner in Australia, during which time my wife and I had a baby and, after she got towards the end of her maternity leave, we were at that tipping point where you either stay long term in Australia or move back.
Given we both have very close families, we decided to come back so they could play some part in the upbringing of our wee boy and so that we could help them as they get on a bit and become a bit more dependent.
The process of coming back to work in Scotland was easier than I thought. I was really unsure exactly what it would entail – I thought it might entail a retainer scheme that I would have to go on. I was pleasantly surprised when I only had to complete a two week supervised position.
Initially, I contacted the performers list and they referred me to NES who then referred me on to the Lothian Medical Director, Dr Nigel Williams. It was decided that, given I trained in Edinburgh and was familiar with the area, two weeks of supervised practice would suffice. It all came back pretty quickly; nothing had changed from when I was last working here.
At the end of the two weeks, it was all a very smooth, quick process which I really appreciated – Dr Williams asked the two GPs I spent time with if they had any concerns, they said no and I was on the performers list the next day. I’m very grateful because I was really keen to get back and working given that I’ve got dependents.
I had been working fulltime in a comparable healthcare system and had been doing CPD throughout in Australia so they had no real concerns. The induction was quite useful and reacquainted me with systems and processes.
Now I’m working exclusively as a locum in and around Edinburgh Looking to future, I would intend to ultimately settle down, get a partnership and stay in one place for the foreseeable future because I prefer to feel invested in that regard. I want to find a good team that fits in with the way that I work and I’m going to be quite patient in that. The purpose of locuming is very much to dip my toe in the water and see lots of different practices. I have also applied to LUCS (Lothian Unscheduled Care Service).
The climate has been a shock coming back to Scotland, but there are things that Australia really doesn’t have like the history, the proximity to Europe and all the cultural aspects of Edinburgh. The Edinburgh festival was on when we returned back so we came back at a really good time. Being so close to family was the main reason we came back and it is great to be nearer them. We’ve seen my family and my wife’s family a lot since we’ve been back and that’s been good.
Lothian Association of Sessional GPs - http://www.lasgp.org/
Dr John Dunn of Muirhouse Medical Group, who returned to general practice in Scotland after a stint as a GP in Australia and New Zealand, talks about his experiences as an inner-city GP.
Dr John Dunn graduated from Glasgow medical school in 1985 and did his GP training in Exeter before working for in Australia and New Zealand. He settled in Edinburgh, at Muirhouse Medical Practice in 1992 and remains a partner there today. He is actively involved in the teaching of medical students, foundation doctors and GP trainees and continues to be enthusiastic about general practice.
“I feel proud of the work we do in our practice. We make an enormous difference to people’s lives and while it’s often difficult to measure, it’s a job that makes me feel proud to be a GP.”
I trained in General Practice in Exeter and the GP at the time who was involved in that programme was a man who had been involved in GP training almost from its inception and that gave me a real enthusiasm for being involved in teaching and training. When my wife and I were in New Zealand and Australia, we did a lot of rural practice and that was interesting and enjoyable at the time but it concentrated our minds in the fact that we didn’t think that rural practice would be right for us.
“It’s a job that brings great fulfillment because you’re behaving in a way that’s consistent with your values; you’re doing something that’s worthwhile so it gives meaning, purpose, structure and direction to your life.”
I liked the idea of being in a bigger practice. So, when we came back to the UK in 1992, I was looking for a bigger practice, a training practice and a practice in a city. So, I looked at Muirhouse Medical Group in Edinburgh at the recommendation of a friend and found it had a commitment to team-working and ongoing education and professional development, a good building and facilities and good information systems. I think those four pillars are very important in forming a solid base for a practice to be able to flourish and that’s still the situation in the practice now.
“One of the biggest privileges of the job is you see so many people behaving with such extraordinary dignity and bravery in the face of the most awful circumstances.”
I work in an inner city practice with 7 partners and 5 other salaried doctors and we have a list size of 13,500 patients, one of the biggest in Edinburgh. It’s on the North West side of Edinburgh in a housing estate that was built in the 50s and 60s. The housing stock and local facilities have gradually improved but it would still be a disadvantaged practice. We are a practice that has a long tradition of being committed to education: we are involved in educating 2nd year medical students, 5th year medical students, foundation doctors and GP trainees.
For many years, we have also had an ongoing commitment to research in General Practice. It tends to be in areas relating to deprivation, in particular HIV infection in the 90s and other blood borne viruses more recently as well as other issues affecting deprived practices.
In our practice, we encourage the partners to do a variety of other things. One of the partners is involved in GP politics, one does research, two other partners are involved as GP trainers, one of the partners has a specialist interest in diabetes and I am very much involved in education. Some of the issues and challenges we currently face are the constant change, the increasing complexity, aging population, increasing expectations, all on a background of societal change.
That makes the job tough, and the resource we need more of is time. It’s a job that’s indifferent to how you’re feeling on the day you’re doing it - we deal with waves of human apprehension and sadness in ten minutes gaps and see lives that are messy and imperfect which is tough. But in a way, that’s one of the biggest privileges of the job - you see so many people behaving with such extraordinary dignity and bravery in the face of the most awful circumstances.
In my case, I have come across quite a few elderly people who as they become frailer and frailer, their spirit seems to get stronger and stronger to allow them to cope with that frailty but to continue to manage and flourish in their lives and that is truly inspiring. There is a paradox there - people talk about retiring and winding down, but I think that possibly when you get older, you need to become increasingly committed and wind up.
I think it’s an enormous privilege to be a GP. I feel proud of the work we do in our practice, I think that we make an enormous difference to people’s lives and it’s often difficult to measure but it’s a job that makes me feel proud, I’m proud to be a GP. It’s a job that brings great fulfillment because you’re behaving in a way that’s consistent with your values; you’re doing something that’s worthwhile so it gives meaning, purpose, structure and direction to your life. It’s a job that gives me great hope, you know – every day I go in thinking I hope I might be able to do something to help at least somebody today and most times I am.
I think, on the whole, my patients value what I’m trying to do and in my experience and in my observations of other people’s views of their GPs on the whole, we’re valued. In essence, you’ve got a job that pays well, that allows you to behave in a way that’s consistent with your values, that allows you to feel a certain sense of pride and fulfillment that can give you a feeling of hope and of being valued and I think most people would cut their arms off for that job. So I think that it’s a wonderful job to have.
In our practice, we encourage the partners to do other things, so one of the partners is involved in GP politics, one is very much involved in education, one does research, I’m involved in education, two other partners are involved as GP trainers, one of the partners has a specialist interest in diabetes so there is a variety of different things you can do if you’re a partner in our practice. I really enjoy being involved in teaching: I’m involved in teaching 2nd year medical students, 5th year medical students, foundation doctors and GP registrars. I enjoy the professional fellowship that you get from engaging with people who are training in medicine - that social interaction and the buzz of getting to know students and to know what they’re doing. You are constantly learning from them as well.
Muirhouse Medical Group - http://www.muirhousemedicalgroup.co.uk/
Read this first-hand account from a GP who returned to general practice in Dundee after a career break.
When I stopped working in 2011 to look after my young family, I thought I would never return to General Practice. My circumstances changed and, four years later, I have completed my NHS Education Scotland (NES) Returner post and I’m proud to be part of the Dundee GP workforce. Here is my story and I hope it may inspire some people who are considering the Returner Programme.
“I was initially daunted by the idea of returning to General Practice but, thanks to the structure of the Returner Programme, a helpful Postgraduate GP Director, efficient NES staff and my excellent supervisors, I have been guided and supported all the way.”
I qualified as a GP in 2005 in London. I was a GP in Birmingham for 7 years; then I took a break from medicine for family reasons. In 2013 I decided to return to work. Luckily in General Practice there are specific re-training posts. I had voluntarily erased my name from the GMC register so I applied to be re-instated. This was straightforward process though I did have to go to the GMC offices, which was a little daunting.
As I was living in England I was interviewed for the NHS England Induction and Retainer Scheme. I prepared for and passed an MCQ and Simulated Surgery and I was allocated a re-training practice and supervisor. However, before I started work I was faced with relocation due to my (medical) partner finding a Consultant job in Dundee. Determined to return to work, I looked up the NHS Education Scotland Returner Programme and contacted the local Director of Postgraduate General Practice Education.
Entry into the Scottish Returner programme didn’t involve examinations. I submitted information about myself and my experience to the Dean and we had an initial meeting. Following this I was offered a placement on the Returner Programme with a salary, to begin within 2 weeks if I wanted to. I was able to choose full-time or part-time working (I chose part-time) for 6 months. The Dean took information about my educational needs and preferences and recommended educational supervisors in a Dundee Practice. I met my supervisors and we arranged a suitable start date. There was a little waiting for Criminal Disclosure checking but other than that this process was uncomplicated. From the beginning I was made to feel like a welcome addition to the Dundee GP workforce.
The 6-month Returner post consisted of 3 stages. Initially there was an induction and I was integrated into the practice team and computer system and my supervisor helped me to identify learning needs. Then there was a period of beginning to see patients and complete the training requirements such as RCGP Personal Education Planning (PEP) and 360-degree appraisal.
Finally I was given a Trainer’s report and reference to apply to be on the Performers List. Throughout my post I had weekly formal tutorials and informal ad-hoc support from my supervisors. I did quite a lot of self-directed study and as my confidence grew I progressed from 20 minute appointments to 10 minute. I was also given Child Protection training and Resuscitation training. Initially I was very anxious about seeing patients but by the end of my 6-month post I had definitely improved.
This has been my first clinical post in Scotland. Dundee has been a welcoming place. I think a doctor’s salary could afford a good standard of living here. Scotland is clearly rich in culture, the arts, sports and nature and transport links are good. A big selling point for General Practice in Dundee is that most GPs do not have rigid practice boundaries. This encourages family members to stay registered with the same surgery despite moving within the city. Therefore, GPs can provide continuity with individual patients and families and understand the extended family and community context.
Overall I think GPs in Scotland have maintained their autonomy and we enjoy good access to investigations. The medical workforce of Dundee is a close-knit community with plenty of CPD opportunities including an active locum group and RCGP Women’s Doctors group. The highly rated Dundee Medical School provides opportunities to teach for GPs who are interested.
I am pleased to be a GP in Dundee and I would recommend the NES Returner Programme to people thinking of returning to General Practice after a career break or a break form the NHS. I was initially daunted by the idea of returning to General Practice but thanks to the structure of the Returner Scheme, a helpful Postgraduate GP Director, efficient NES staff and to my excellent supervisors I have been guided and supported all the way.