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A very condensed overview about: GPs in England

update 2025 03 29 Owen Yang

This post is an ongoingly improving, condensed description of what GPs are. This is aimed to be highly over-simplified, and aimed for the widest audience within and across medical fields, beyond medical fields, and internationally. Please contact me @0wenyan9 or 0wen.yan9@gmail.com if you have something to say.

GP practices are private contractors under NHS rules
GP practices (or medical centres) are where GPs work. GPs provide primary care services, seeing patients at the frontline and treat if they can, or refer patients to hospitals or other services under NHS contracts. This means GPs generally do not do things that is not paid for by the NHS, or do not do things that are not allowed under the NHS contract. The also implies referrals to the hospital are only made when it is necessary. Practice owners run the GP practice as a business under NHS contracts and rules, but where contracts and rules do not dictate they are otherwise free to operate the practice in their own ways. They can decide how long an appointment is or who has the priority to be seen, as long as these operations jointly fulfil the NHS requirement to take care of the population. GPs largely fall into three categories: owners ('GP partners'), those who are hired to work for the owners ('Salaried GP'), or or those who work odd hours just like replacement teachers in the schools ('Locum GPs').

GP practices are the first contact of all NHS patients
GPs practices are supposed to be the main first contact of each patient in the NHS, but reasonably patient can also contact emergency services directly, especially during hours when the practice is closed. There are other direct-contact services but these are designed as exceptions, such as sexual health clinic and abortion services. Each patient also has a named GP where they are supposed to make this first contact, but in reality this is operated at the practice-basis, which means all GPs in that practice can be the first contact. GPs also oversee whatever has happened to a patient across the healthcare system. When someone is referred to the hospital, most of them have an appointment with a consultant specialist, or admitted to the hospital under the care of a consultant specialist, such as a consultant surgeon or a consultant cardiologist. The hospital services feedback to the GP what has happened so that the GP can keep updated and oversee the patient's care across different specialties. A consultant specialist can follow up the patient when they see fit, but can also stop following up and 'discharge' the patient form their service. This means the patient can no longer contact the hospital service directly and has to go through the first contacts, the GPs.

GPs as nannies
The 'primary care' is not limited to internal medicine, but all ages and problems. This includes gynaecology, musculoskeletal medicine, skin rashes, and mental health. However, most GP practices are only offices, drugs and dressings. If someone takes blood, the blood sample will need to be sent to the hospitals, and the results will require days to come back. An X ray will need to be requested, and wait for days or weeks to see the report. GPs nowadays only see the reports and do not have access to X ray images. In addition of the usual medical care, a significant time is also used for safety, safeguarding, and end-of-life care. Sometimes it can be a bit like nannies, especially when the patient is not keen to their own health but the GPs are under the NHS responsibility to chase patients.

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NHS GP registrar self-development ideas

update 2025 03 27 Owen Yang

This post is an ongoingly updated list about ideas that might be helpful for those who would like to arrange structured activites during their protected learning time, such as tutorials, independent learning, or self-directed learning time. I think you will agree that my ideas are aiming to be just slightly out of our comfort zone, but not too much. Please contact me @0wenyan9 or 0wen.yan9@gmail.com if your idea is within this bittersweet zone and would like to share it.

Tutorial time: see one, do one

It is not uncommon and quite convenient to use tutorial time to be observed by ES and complete assessments. However, I would like to argue that in our GP training, we do not have enough time seeing other doctors, or even our ESs to see patients, and seeing others seeing patients can be equally educational.

I suggest you could push for the idea of see one, do one, instead of purely being observed and given comments. When I did my research degree my interest was behavioural psychology, and if I learned anything it would be that words are less useful than we think it is. Unfortunately compared to my home country, the UK, the NHS, and the GP training are more obsessed with words, but this is another argument to make. My point is at least we will learn more by diversifying our learning activity, through not only being observed but alos seeing how other doctors prioritise their values in their consultations. I learned a lot of tricks from my ESs that she does not know she has.

Tutorial time: a walk around the neighbourhood

Many of us work overtime and struggle to finish all admin work on time, and as far as I know most do not have time to see the catchment area that we serve. During one sunny day I boldly suggested to my ES that we can walk around the neighbourhood to see what is out there. She kindly agreed.

This is a village-town and I personally feel like to 'show myself around' the neighbourhood and subtly imply that I am a new doctor in the practice. I have a good past of my life being trained in social science and my version of a community work should be purposeless: for me the most efficient way of understanding a community is get the footprint, do the miles, spend the time. No agenda. When there is time, I also tend to entice my fellow GP registrars to come with me to have a walk during the elusive lunch braak.

If your are not a natural social scientist like me, I suggest you can justify your walk by doing some forced activity, such as actively introduce yourself to the shop fronts (it helps if you buy something), or draw a map of the neighbourhood area during or after your walk.

Tip for reflection: I personally think this activity should automatimcally make a strong case for 'population health' in the clinical experience group and 'community orientation' in our capabilities, but unfortunately in my experience ESs and TPDs tend not to trust themselves to interpret this and would like to seek comfort by knowing they fit the descriptors. We will need to strategically reflect this to make it easy for them. So be mindful if you need a reflection from this, and show you have demonstrates understanding of how the characteristics of the local population shapes the provision of care in the setting in which the doctor is working.

Turorial time: listen to recorded remote conversations

Credit to TPD Dr. Jennifer Barnes who shared her idea to my ES.

To my understanding all remote consultations are recorded, and your ES (or CS) in the practice is very likely to have access to these recordings. During tutorial times we pulled out either 'interesting' or random consultations, listened to them together, and discussed about it.

This can be used as one of the CAT activities.