Representing Early Career General Practitioners:
ADiscussion Paper for LMC’s Consideration
Background
The following motion was passed at the 2014 Conference of LMCs, mandating GPC to act:
That Conference appreciates that experience is required for the effective running of GPC and values the contributions of its more experienced members. This conference is however concerned by the lack of recently qualified GPC members. Conference therefore calls on GPC to:
(i)Explore options for increasing the number of newly qualified GP members on GPC
(ii)Put mechanisms in place to train and nurture the future leaders of general practice
Introduction
Representation Subcommittee has suggested the term ‘Early Career GPs’ be used to define those GPs within seven years of their Certificate of Completion of Training. Such individuals may hold any contractual status, however it could be argued that their specific needs; interests; aspirations and assumptions vary significantly compared with their more experienced peers, due to the healthcare environment in which they completed their GP training, and the workforce demographic and economic landscape they now find themselves practising in.
GPC very much supports and welcomes opinion from GPs starting out in their careers. Their views may surprise and challenge, and their make-up reflects a different demographic to that most likely to be reflected in the individual membership of the GPC. (This in itself may be a matter for further discussion and debate). Meanwhile, GPC has a responsibility to represent Early Career GPs and their particular interests and concerns to the best of its ability.
As per the mandate from the above motion passed at the 2014 Conference of LMCs, Katie Bramall-Stainer produced an extended paper for GPC’s Representation Subcommittee for further discussion. This paper, intended for LMCs, seeks to present a number of options to consider and invites further discussion and debate of how GPC may be able to put mechanisms in place to train and nurture the future leaders of general practice.
Representativeness of GPC
How many Early Career GPs are there on GPC?
Out of the eligible 74 voting qualified GP members of 2015/16, six elected members of the committee joined the GMC’s GP Register subsequent to 31 March 2006. Of these:One (out of 43)is from a geographical constituency (CCT 2010); one (out of 8) was elected from the Conference of LMCs (CCT 2008); three (out of 10) of these were elected from the ARM (CCTs 2008, 2014, 2014) and one is a representative from another body (CCT 2013).
Broadly speaking, how representative is this of the profession as a whole?
As of 5 February 2015, according to the GMC List of Registered Medical Practitioners:
-65,108 doctors on the GP register, of whom 60,132 have a license to practise
-From 2008-2014 there were 8467new additions to the GP register
-We can broadly assume that a maximum of 14% of GPs are within this cohort in the UK
-By contrast 8.1% of the GPC voting membership isan Early Career GP.
Is this the only issue around representativeness affecting the make-up of GPC?
Far from it: The GP register is 50.2% male and 49.8% female. Out of the 74 elected voting members of GPC UK, 20 are female (27% of the committee). To accurately reflect the wider profession in terms of gender make-up, GPC would need an extra 16.8 female voting members compared with the status quo. Representation Subcommittee is cognisant of past motions to Conference on this very issue.
Can the Early Career cohortbe considered an ‘under-represented group’?
Whilst a broader reflection of representativeness may be welcomed among the make-up of the committee, this is not a problem unique to GPC, and the complexities of this debate are outside the remit of this paper as to whether we should seek to balance proportionate over appropriate representation. Women, BME and sessional GPs all may have a case to argue alongside the defined cohort and may contribute to the options taken forward in due course. We need to be sensitive to the various factions and their respective interests within the profession while balancing the size, function and effectiveness of GPC in serving its constituents and LMCs.
Options for increasing the number of Early Career GP members on GPC
Directly elected representation onto the GPC
- Via Conference of LMCs
(i)Ring-fencing of an existing Conference of LMCs elected seat to GPC UK for a GP who has gained their CCT in the preceding seven years from the start of Conference for the duration of one session
And/or
(ii)Creation of a new Conference of LMCs elected seat to GPC UK for a GP who has gained their CCT in the preceding seven years from the start of Conference for the duration of one session
- Via ARM
(i)Ring-fencing of an existing ARMelected seat to GPC UK for a GP who has gained their CCT in the preceding seven years from the start of ARM for the duration of one session
And/or
(ii)Creation of a new ARM elected seat to GPC UK for a GP who has gained their CCT in the preceding seven years from the start of ARM for the duration of one session
- Via a co-option of an ‘under-represented group’
(i)Addition of one or more voting seats onto GPC, specifically open to UK GP CCT holders within the preceding seven years from the start of ARM for the duration of one session
Of these three options, Representation Subcommittee felt that option 1 would be the easiest and most appropriate to implement.
Conference may wish to further foster new grass root input by creating the caveat that the successful individual in each of these scenarios, as in the case of the ‘seventh seat’, will not have been a previous member of GPC. However, to be present at the Conference of LMCs, the elected individual will already be active within GP medico-politics, and the ability to be able to contest the election again at the end of the given session would be within the spirit of the motion to ‘train and nurture future leaders of general practice’.
Representation Subcommittee also wondered if there would be a role for an individual Early Career GP to be nominated by their LMC to stand for this ring-fenced seat. It would be expected that this path would encourage LMCs to engage and encourage younger membership, leading to younger delegates standing for election. This leads us onto the second part of this discussion paper:
Proposed mechanisms to train and nurture future leaders of general practice
Historically over the past decade, new young GP members of GPC have primarily come from either the existing committee structures as trainee representatives or from the Junior Members Forum.
The route onto GPC directly from LMC involvement is the path least travelled, yet the route best placed to focus on the nurturing of future leaders with a lasting effect on succession and a democratic accountability. Arguably there is a need to urgently foster development and education surrounding the management side of practice to deliver future sustainability and resilience in this cohort of GPs. LMCs are established; respected; stable and locally based organisations waiting, and no doubt willing, to take on this role.
There are a number of potential options for mechanisms to help nurture and train future leaders of our profession. This list is not intended to be exhaustive but it is hoped will foster further discussion around the subject that delegates can feedback on:
- Focused Support and Development
LMC nominated Early Career GPs could be linked in to a wider national LMC network that would potentially include executive officers and experienced senior LMC officers from around the UK as members and mentors, as well as the GPC secretariat, to share common issues and concerns affecting their peers providing support and development.
The representatives themselves would be linked in to their local GPC geographical reps either informally or formally through the BMA mentorship programme. In time, it would be hoped that they may apply to the GPC visitor scheme, or assist with local VTS teaching and raise LMC awareness amongst trainees and their peers.
- Ring-fenced Visitor Scheme
This option would involve Representation Subcommittee formally reviewing our visiting arrangements and ring-fencing a number of visitors to be from within the identified cohort. This could be advertised via social media, various BMA communication pathways, LMCs or via direct contact with the office.
- LMC Mentor Scheme for Geographical GPC Representatives
This option would involve creating guidance for the 43 geographical LMC representatives to identify anEarly Career member from among their LMC to personally invite to the visitor’s scheme to maximise attendance and foster a mentoring process through the acknowledged BMA mentorship programme.
- Engagement drive with local VTS teaching
This would see LMCs provide at least one annual single education session to its constituent vocational training schemes, with central support materials produced by GPC if requested. It would be expected that each GPC member would volunteer to do this in addition to senior LMC officers. LMC offices would contact local programme directors in advance of the new VTS year to arrange specific teaching, and feedback would be sought – both from the trainees present and from the LMCs to see how many would take up this recommendation to offer such a session (acknowledging that many already do). Recruitment into LMC trainee positions would be an additional advantage to these sessions, and wider publicity regarding the pastoral importance and role of the LMC post-CCT.
- Qualitative workforce experience
Early Career GPs are often quoted as being ‘hard to reach’ or ‘hard to engage’. As a representative organisation we need to think differently with regard to this particular group who are often disparate, sessional and may not have forged established links of support to help them through arguably the most vulnerable years of their career. These doctors thrive on communicating and peer led support via social media rather than within yet another BMA committee structure. Established online communities of GPs are already in existence with hundreds of regular commentators and contributors.
-Could we seek a voluntary reference group from within this online community or ones like it?
-Could an online Social Media forum or Twitter page be a way forward that the BMA could develop?
-Have we examined the lessons learned by the RCGP in their First5 format which has been established now for >5 years?
-Could our own GP Trainees Subcommittee, Sessional GPC or Education, Training and Workforce subcommittee inform this workstream?
-How could your LMC improve engagement with current local trainees?
-Does your LMC offer educational sessions to the local VTS?
-Do you have GP Trainee seats on your LMC?
-Would you consider an LMC seat ring fenced for an Early Career GP?
GP Future
As a simple experiment, I set up a Facebook page called ‘GP Future’ inviting ST3s and those within 5 years of CCT to join a closed group whose remit was defined thus:
‘GP Future's aim is to find out from grass root GPs, finding their feet within the profession, of what they want from their future, their NHS, their job, their work-life balance and their options. The views herein will be used to influence thinking to help guide the Representation Subcommittee of the General Practitioners Committee of the BMA. All views will be treated as anonymous and all platforms for debate will be afforded respect and right to reply. There are no wrong answers or bad ideas here - it's a chance for fresh thinking and a fresh approach. Thanks so much for your input and actually choosing to make a difference.’
Currently there are in excess of 150 members with a number of developing debates including the future of UKGP; workload issues; membership data (geographic spread and contractual status); the future of the partnership model; who employed GPs would prefer to be employed by; LMC engagement as an early career GP and as a trainee.
This was a very simple exercise with surprisingly effective results and serves to demonstrate that engagement is possible and simple if we actively seek out these doctors’ opinions rather than waiting for them to approach us.
Summary
The key point of this discussion paper is the importance in finding motivated and opinionated young newly qualified GPs and marrying them up to their LMCs. We do ourselves a huge disservice by potentially neglecting this cohort.
We need to actively recruit, engage and develop the future leaders of our profession them, rather than despair at their apparent apathy. Perhaps they do not believe GPC/their LMC speaks for them? Perhaps they are not even aware of what GPC/their LMC does or could do for them?
We have a responsibility in aligning these doctors with their local support structures. Part of this debate involves futureproofing UKGP and we should make no apology for this.
Join the debate
Email your contributions, ideas and suggestions to by 30th June 2015.
Katie Bramall-Stainer, Deputy Chair GPC Representation Subcommittee
March 2015