Retraining as a GP - Dr Pritti Aggarwal

GP flexi partner in Southampton. Previously general surgery

Having qualified with a distinction at the turn of the millennium, I set out to become the next cutting-edge Professor of General Surgery. I quickly became frustrated at my plumbing position and saw the light at the end of the tunnel. Surgery was not for me as I felt my personal clinical skills were not maximised. However, I gained an immense appreciation for those positions and saw unimaginable pathology in a very deprived ethnic population. The experience was invaluable in growing professionally and personally. I was able to complete my MRCS and sidestepped into a general practice training scheme. I sat the MRCGP passing with distinction in 2005. I had found my niche and genuinely haven’t looked back.

The last 14 years as a General Practitioner (GP) has been a privilege in every respect. I am always overwhelmed by how integral our role as a GP is in our patients’ lives. Initially, I was a locum and experienced the unique breadth of general practice as independent businesses. I went on to be a partner for 6 years in a large suburban practice with a list size of 13,500 and an unusually high older population. With this territory came the complexity of long-term conditions, poly-pharmacy, social situations and challenging conversations where I totally thrived on consistently providing compassionate, holistic continuity of care for my patients. This is the bread and butter of a GP. I had great working relationships with my patients and colleagues alike and thoroughly enjoyed my role. I led for a number of locally enhanced services that we provided in our practice and was always looking for ways to improve things and influence primary care. I initiated teaching and training into the practice, starting with our own nurses, medical students and latterly, GP registrars. This refreshed and challenged our thinking. I explored my own learning gaining my PGCE in Medical Education and concluded that education was the key to the future.

We were pioneers in the use of Physician Associates (PA) to support our ever-increasing demand for on-the-day appointments. This was a huge learning curve for both the practice and myself in taking risks. Being a partner in a safe supported environment, I learnt to lead and grow personally, write business cases, look to improve patient care, maintain working relationships, remain optimistic in adverse situations and help maintain the team spirit. Having worked hard to help move the practice forward, I found myself at a point where I needed to question my work life balance. I could see an NHS changing faster than we could keep up and felt my good enough was no longer good enough for me. I was striving for excellence, which I could no longer deliver in the time I had. Add a young child into the equation and I realised something had to change. I resigned from the practice, leaving patients, staff and myself feeling very sombre.

I became a portfolio GP. I continued my GP sessional work, favouring long term contracts to ensure continuity. I also took on the role of Clinical Lead for our local Clinical Commissioning Group (CCG). The partnership of a Clinical Lead with a commissioning manager has been pivotal to the success in delivering evidence-based ideas to the implementation of streamlined pathways. There have been numerous achievements in this role but some standout highlights include the direct access to computed tomography of kidneys, ureters and bladder (CT KUB) for GP’s, single point of access for the DVT pathway and ensuring DOAC’s were on the prescribing pathway in light of the NICE guidance. As a result of the implementation of these simplified pathways, GPs are empowered to deliver better care to patients. Consequently, big savings to the health economy locally have been achieved. This was only possible through collaboration across providers, stakeholders and systems within the NHS. I feel my skills as a GP have immensely helped with sensitive communication and negotiations, developing ideas, understanding the process from a patients’ perspective and getting non-clinical leaders to listen and cooperate in the transformational process necessary to bring about change.

In April 2017, I was nominated by the membership to be a governing board member. That summer I worked up a GP-Consultant liaison programme, twinning GPs and consultants for half day exchanges with our local University Hospital trust and primary care. This was my attempt to get us doctors to appreciate the challenges that we all face in the current NHS. We celebrated and shared the learning from the exchanges. Revolutionarily this brought about simple local solutions to our frustrations and am now in discussions with NHS England to implement with the integrated care systems (ICSs) planned to improve the primary secondary interface.

Alongside these roles, I took on the Module Lead for Primary Medical Care (PMC) for year 3 medical students at the University of Southampton. Educating and promoting general practice was my dream role! I had the honour to help shape and deliver the new practice management curriculum (PMC). We introduced the use of virtual patients to deliver a core curriculum, altered the time scales so that students spend longer on general practice and introduced a PMC module prize for students in an effort to promote GP in its entirety. I have developed a wealth of knowledge on theoretical and practical aspects of educational practice and continue to expand this further. I have also developed an understanding on procedures of appeals and fitness to practice investigations. I now lead on the PMC BM4 (graduate programme) year 2 and the Faculty Development of GP teachers.

Last year I was nominated and recognised for my achievements to the community with the FRCGP. I have joined a modern innovative partnership as a flexi-portfolio partner on an unbelievable single session to maximise my life-work balance. Yes, definitely life-work balance, because my life is important to bring energy to work.

My many diverse roles have enabled me to maximise my time management, organisation and communication skills. I conscientiously thrive to deliver excellence whether that be on an individual patient level, with medical students or on an organisational level with the CCG and I look forward to my next challenge with great enthusiasm and hope to continue to inspire others on the rich and varied landscape that is General Practice.