Dr Mary-Rose Shears

GP Partner and Primary Care Dean Health Education England, south London

As both a Primary Care Dean and a GP partner in a practice, I am involved in recruiting, training and retaining the workforce over multiple practices within an area (south London) as well as working clinical sessions at my practice.  I talk to many doctors at all stages of their careers about being a GP. I’d like to share a little insight.

Working in a practice, where I enjoy the company of others in the team is very important to me. I work in a large practice with a workforce of at least 60, including GPs, nurses, managers, receptionists, and other roles, such as first contact practitioners and district nurses. We tend to communicate with each other in person, via instant messenger or over the phone throughout the day. I always make time for coffee or lunch to meet with my colleagues, chat and share news.

I have my own list of patients to ring or see face to face. Admin tasks are varied and are important for good patient care. I deal with letters from different specialities and community services as well as letters from patients themselves.  At the end of a busy clinical day, sifting through a list of docman (our letters from the hospital) can feel tedious, so our practice is always looking at what measures we can take to work more effectively. This can mean training up administrative staff to help with the more straightforward letters, which is interesting for them too.

Then there’s the test results I’ve initiated.  I routinely go through my patients’ medicine lists and chronic disease records.  As a partner in the practice, I have responsibility for particular clinical or non-clinical areas of work and focus on updates around this activity.  For example, as CQC lead, I need to be aware of all the regular guidance, make sure I read the email updates and distil this information to my colleagues and teams.  Importantly I need to keep up to date with the requirements for my clinical work and management responsibilities, by attending courses, reading and learning from my colleagues.  

As a GP partner, I work a 12-hour day. In our practice, a full-time partner works 4 long days, although many of us work variations on this, often combining our GP role with other special interests. Many of our GPs have special interests - cardiology, dermatology, public health and medical education for example. All the GP partners take on a specific responsibility for clinical or management areas, such as diabetes, respiratory, palliative care, safeguarding, finance, etc, so there’s always plenty of scope to develop a range of interests and skills which does help to maintain our resilience and ignore the current very negative media headlines! 

There’s no denying, it has been a tough time throughout the stages of the Covid-19 pandemic. We’ve adapted and changed how we work and are trying to deal with the huge backlog in all sectors of health care. The waiting time for an appointment at our surgery has increased, as has the length of time for an outpatient appointment, booked surgery etc.  We’re aware of the significant unmet needs arising from the pandemic when patients wanted to avoid giving us any extra work. These factors along with remote working during the lockdowns, has undoubtedly led to later diagnoses of significant conditions, such as cancers and chronic disease.  We’ve all noticed an increase in the number of complaints and negative comments directed towards our staff. We wanted to address this and have begun by placing a statement on our website that describes our current workload (managing on average 4000 incoming calls to the practice each week) so that patients can better understand and work with us. My job as a partner is to help support our staff and their wellbeing.

I’ve noticed more doctors are asking me whether GPs will move to more virtual and less face-to-face consultations in the future. Currently nearly all our initial contacts with patients are over the telephone other than those who can’t manage phones, such as deaf or very frail people.  Having spoken to the patient, the GP will decide if an appointment in person is necessary. I’ve personally found that approximately ¾ of my patient contacts can be managed over the telephone and around a ¼ need to be seen. Over more recent years, we have noticed that patients are gradually becoming more familiar and happier to see other members of the primary care team, such as first contact practitioners and social prescribers. I appreciate working with and supporting our multidisciplinary teams.  As GPs we have close and direct input around how we manage our workload and utilise practice teams so that we’re able to provide the best care for our patients.

I have been speaking to doctors who are keen on the idea but struggling to decide if GP is right for them – it’s a big decision to make whether you’re in your foundation years or thinking about a move later on in your specialty training or even hospital career.  

I’d like to leave you with this thought. As a Primary Care Dean, I can tell you there’s a lot to do and know about training and workforce planning. As a GP, I have the benefit of generalist training, a holistic approach to my patients and an understanding of the health needs of our communities.  Yes, its hard work and there are often difficult decisions to make but the rewards are there as well.

I’m proud to say I’ve been a GP for 32 years and would recommend you make some enquires, take a look for yourself, and get in touch with your Health Education Local Office/Deanery.

And for those of you who are curious about educator roles including Primary Care Deans, details are on the Health Education England website.