In celebration of GP education

Sanjiv Ahluwalia; Elizabeth Hughes; Mark Ashworth

doi:10.3399/bjgp19X701921

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In celebration of GP education
Gerald Michael

Published on: 06 April 2019
Expert medical generalism - ecological insights
Jon M. Dickson and Adam G. Hart

Published on: 02 April 2019
In celebration of GP education
Richard Albardiaz

Published on: 29 March 2019

Published on: (6 April 2019)

In celebration of GP education
Gerald Michael, Retired GP, Not applicable
As a retired almost career long trainer it was gratifying to read the article by Ahluwalia et al that in many parameters training practices did better than non-training practices. However, they report that there were lower levels of satisfaction with continuity of care....
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As a retired almost career long trainer it was gratifying to read the article by Ahluwalia et al that in many parameters training practices did better than non-training practices. However, they report that there were lower levels of satisfaction with continuity of care. The reasons for this are not given but one may be that practices are enlarging partly by amalgamations and by there being more part-time doctors. Added to this there may be two or more registrars and thus there is small chance of patients and doctors getting to know each other. Although with good notes and pre-consultations the harm can be lessened much of the allotted 10 minutes is taken up by a doctor having to read up all about the patient’s problem first. I have seen patients seen by different registrars in the same illness with no partner involvement.

Matters could be improved if practices take this problem seriously. I suggest that each large practice divides itself into notional firms. Each firm could have up to two principals and no more than one registrar. Each firm therefore has a maximum of three doctors. All the patients are allotted to a particular firm. Obviously, the patients would be allowed to choose a firm if they wished and there was availability.

You would finish up with all the advantages of large training practices with the added benefits of the patients and doctors knowing each other.

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Competing Interests: I was Dr Ahluwalia's trainer
Published on: (2 April 2019)

Expert medical generalism - ecological insights
Jon M. Dickson, GP and Senior Clinical Lecturer, The University of Sheffield
Other Contributors:
Adam G. Hart, Professor of Science Communication, University of Gloucestershire
The Five Year Forward View aims to recruit 3250 GP trainees annually in England.¹ Ahluwalia et ...
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The Five Year Forward View aims to recruit 3250 GP trainees annually in England.¹ Ahluwalia et al's² article led us to ask what is the ideal number of GPs in relation to secondary care doctors and could scientific insights from other disciplines be helpful in answering this question?

GPs are medical generalists³ with a broad knowledge base. Their expertise is not defined by focussing on a specific body system but by their ability to assess and manage conditions which affect any of the body’s systems. This skill-set means that they are able to deliver the majority of patient contacts in the National Health Service (NHS). General practice is a rapid turnover and high-capacity part of the health-system and contributes to its effectiveness, cost-effectiveness and resilience.⁴. In contrast, specialists’ knowledge and their focus on a single system allows effective management of conditions that are beyond the knowledge and skills of a GP. But specialists do not retain their generalist knowledge on their journey to specialism; as they learn new skills, they lose others. Generalists and specialists have distinct and complementary skill-sets and the health-system requires a balance of the two but the optimal ratio is unknown.

Social insects, for example ants, also have to manage the specialist-generalist problem. Ant colonies must organise complex work including nest building, foraging and defense. Evolution has produced effective and robust systems of work organisation including, in some species, the evolution of extreme physical specialisation producing morphologically distinct workers adapted for specific tasks but unable to perform other more generalist tasks e.g. soldier ants. Less extreme forms of specialisation also occur where workers specialise in specific tasks at specific times of their lives. These workers are specialised to a specific task but there remains considerable flexibility and they can revert to earlier tasks as conditions dictate. The resilience, dynamism and flexibility of ants organisational systems is a major contributor to their ecological success and the optimal balance between specialisation and generalisation are central to that success. Natural selection generates effective solutions to complex problems and ant-inspired solutions to delivery and scheduling problems are routinely used in industry e.g. Ant Colony Optimisation. We propose that ant organisation could yield valuable insights into optimisation of the specialist-generalist ratio in health care.

References

1. NHS England. General Practice Forward View, 2016. www.england.nhs.uk/gp/gpfv/ (accessed 26 Feb 2019).

2. Ahluwalia S, Hughes E, Ashworth M. In celebration of GP education. Br J Gen Pract 2019; 69(681): 174-175.

3. Hunter T. The expert medical generalist. Br J Gen Pract 2018; 68 (675): 495-496.

4. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Millbank Q 2005; 83(3):457–502.

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Competing Interests: None declared.
Published on: (29 March 2019)

In celebration of GP education
Richard Albardiaz, GP, GP appraiser, Northiam Surgery E Sussex
I would like to join in the celebrations of Ahluwalia, Hughes and Ashworth in support of GP education!

I would expand the upon the benefits for my peers. Being involved in teaching but also the associated peer group support and learning activities is essential for the maintenance of intrinsic motivation¹ and a lack of involvement a potential red flag for low motivation of colleagues.

But more importantly I would argue it is a key component of the reflection, renewal and reaffirmation of professionalism and professional values which protects us from burnout.²

Long may GP education be at the forefront of medical education.

References

1. Albardiaz R. Peer motivation - assessing and facilitating. Educ Prim Care 2017; 28(2): 119-21

2. Albardiaz R. Using the teaching of professionalism to medical students to inform appraisal and revalidation. Educ Prim Care 2012; 23(6): 440-2.

Competing Interests: None declared.