Rediscovering the joy of general practice

DR JONES had been a GP for more than 30 years. Turning 60 gave her the impetus to evaluate her life and career – and she didn’t like what she concluded.

Working in a busy practice in the centre of a large town in the south of England has its compensations but Dr Jones’ soul-searching prompted her to an admission she hadn’t previously contemplated: she wasn’t actually enjoying herself anymore.

Frankly, she felt she was going through the motions. Being a senior partner in the practice meant she was forever tangled up in red tape. She had virtually forgotten why she had become a GP in the first place: she wanted to help people, pure and simple.

Her practice had grown significantly in recent years. She had more older patients than ever before, and though dealing with comorbidity has always been part and parcel of general practice she was frustrated that she simply couldn’t give each patient the time she felt they deserved.

Furthermore, Dr Jones lived in a village a few miles from town and her daily commute had become something she dreaded to such an extent that to avoid the congestion she would often go to work very early and she invariably worked well into the evening. It’s little wonder that she felt permanently tired.

Does any of that sound familiar? Dr Jones is, of course, an imaginary character but she’s exactly the kind of GP whose life and work have been transformed as a result of an initiative operating in some of the more remote parts of Scotland.

Rural reinvigoration

The Scottish Rural Medicine Collaborative (SRMC) was set up with Scottish Government funding in 2016 to address long-standing GP recruitment and retention challenges in remote and rural parts of the country. The collaboration recently widened its remit to embrace other disciplines involved in general practice multi-disciplinary teams, but the bulk of its work has focused on GP recruitment and retention.

The SRMC instigated a range of projects to promote remote and rural general practice but few have taken off quite like the ‘Rediscover the Joy of General Practice’ initiative. Initially involving four regional health authorities – Shetland, Orkney, Highland and Western Isles – the ‘Joy’ scheme, as some call it, was designed to provide GP cover for practices, using flexible work placements, where continuity of care has been difficult due to a shortage of GPs.

GP hit squads

The idea was to recruit GPs to work in rural communities on short-term placements, typically of one to four weeks at a time. They would be contracted to work for several months a year and would form rural support teams – effectively hit squads of GPs who could provide cover in practices with staffing issues.

Although GPs like Dr Jones weren’t specifically targeted, the SRMC suspected that the scheme would be attractive to doctors like her: GPs towards the end of their careers, or perhaps even recently retired, who were looking for a new and interesting challenge in some of the most beautiful parts of the country. The belief was that the scheme might just provide a fresh opportunity for GPs to reconnect with a more rewarding experience of general practice.

If there were any doubts that the scheme would be popular, they were quickly dispelled. The first pilot was launched in 2019, resulting in around 30 GPs from throughout the UK being recruited. In 2020, as the first Covid-19 lockdown started, a similar number were recruited to form a second rural support team.

Today, many GP practices that would otherwise have had to rely heavily – and expensively – on locums to provide cover now benefit from the services of experienced ‘Joy’ GPs who relish the fresh challenge of working in a new environment without the hassle or commitments associated with managing a practice.

Highland GP Dr Charlie Siderfin, the collaborative’s GP adviser, said: “Working in remote and rural areas isn’t necessarily for everybody but ‘Rediscover the Joy’ is undoubtedly making it a much more attractive proposition. We have found that many GPs are looking for a new and rewarding career experience that helps them to develop professionally as part of a network of like-minded doctors supporting practices with recruitment difficulties.”

In the scheme, which is administered independently of the SRMC, the GPs can choose their placements, work in one practice or across several and take as many placements as suits them. They are able to come together as a team through a social media messaging group and regular video-conference meetings, designed to provide mutual support, share learning and drive quality improvement.

Time and space

A real-life example of our Dr Jones is Cameron Wilson, who had been in the same inner-city general practice for 33 years, much of the time as senior partner. At age 62, he didn't feel burnt out but “maybe just a bit jaded,” he said. And then, towards the end of 2021, he saw an advert for vacancies under the ‘Rediscover the Joy of General Practice’ initiative.

As a Scot living and working in England, the prospect of practising in a beautiful part of Scotland without the responsibilities associated with being a partner appealed to him greatly. And so he retired from his busy practice in Preston, Lancashire, and sought to rediscover some of the lost joy of general practice.

He hasn’t looked back. As a ‘Joy’ GP, Dr Wilson has had four placements, all in small relatively isolated communities in the rugged far north and west of Scotland.

“It’s been great for me,” he said. “It’s good from a medical point of view as I can now give much more time to patients than I did before. I am working in a fabulous part of the world and I feel I am part of a team in which everyone – the admin staff, other GPs and colleagues and the diverse and interesting bunch of other ‘Joy’ GPs – is pulling in the same direction.

“It’s been a real eye-opener really. To be honest, I didn’t know just how jaded I had become until I joined this scheme.”

Firefighting

He's not alone. In 2018 and at the age of 62, Dr Peter Glennon retired from the practice in Stafford where he had cared for patients for 32 years. He was looking forward to a leisurely life, enjoying cycling, reading, birdwatching and long walks in the country. And then he came across an advert for the ‘Rediscover the Joy’ scheme.

It read: “Are you looking for a new challenge, a change from your current routine? We are looking for experienced GPs to help us achieve excellence in remote and rural healthcare. Would you like to have the time to address your patients’ needs, providing holistic care within a team which knows their patients and community well? Are you interested in delivering modern, high-quality, evidence-based, realistic medicine in the context of traditional family general practice values?”

Today, Dr Glennon believes successfully applying to be a ‘Joy’ GP is one of the best things he has done.

He explained: “As a partner in a busy urban practice, my burden of work was impossible. I was forever firefighting and never able to get on top of things. The stress levels were alarmingly high. I just couldn’t switch off after work.

“Now, though, after a few years on the ‘Joy’ scheme, I feel revitalised clinically. I’m back to doing good old-fashioned general practice work. I’ve been able to cherry-pick the practices I want to work in, and my work/life balance is how it should be. I love it.”