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The changing face of general practice in Northern Ireland--Portfolio GP's. Interview by Claire T Lundy.

The traditional role of the GP in their consulting room serving the local population throughout the working week is no longer the only option for doctors interested in general practice in the United Kingdom. I met with Dr Finbar McGrady one of the new breed of ‘Portfolio GP's’ to find out more about his diverse role as clinical academic and general practitioner. 
 
 
Dr McGrady trained at Queen's University Belfast, graduating in 1999. Following his Preregistration House Officer year he headed for sunny Australia to consolidate his training by taking up a post in emergency medicine and general surgery. At that time he was strongly considering a career in general practice. 
 
C: Finbar, how did you plan your GP training? 
 
 
 
F: I met with the Postgraduate General Practice Dean Dr McKnight who gave me guidance on specialities which would prove useful. I worked in Craigavon Area Hospital where I did Paediatrics and Obstetrics and Gynaecology. I then did General medicine in Newry. The experience gained in these hospitals provided insight to the workings in secondary care and helped develop my clinical skills. There was good consultant support for GP trainees and exposure to common conditions. Following this I considered my options for registrar training. I had always been interested in teaching and was keen to combine this with clinical medicine. The research registrar post in Dunluce Health Centre seemed an ideal way of completing my training and acquiring further experience of research and medical education. These two year posts have been running for seven years now and are funded by the Research and development office and the (then) Northern Ireland council for postgraduate medical and dental education (NICPMDE). Dr Keith Steele was my supervisor / trainer. Part of the time was spent in clinical practice and the rest setting up and completing a research project. My study on the physical activity habits of GPs in Northern Ireland has led to my completing an MPhil. 
 
 
 
C: What qualifications did you need to complete your training? 
 
 
 
F: During my registrar post I completed my summative assessment in general practice and my MRCGP exam. GP trainees are also encouraged to obtain diplomas in various specialities. This is a fairly common path for GP's in Northern Ireland; however the process is currently undergoing some changes. 
 
 
 
C: You now work as a ‘Portfolio GP’ what exactly does this entail? 
 
 
 
F: Many GP's are now choosing to work part-time in a couple of different jobs. My post as part-time clinical academic in Dunluce health centre is closely affiliated to medical education and came about due to changes in funding following the expansion of Queens medical school. I also work part-time in a rural GP practice and have regular out of hours commitments. The interface between hospital and community care is becoming increasingly blurred, with more and more chronically ill patients being cared for in the community. The variety of work is refreshing and I find that it brings a sense of clinical reality to my role as an educator. 
 
 
 
C: Tell me more about your role as a clinical academic? 
 
 
 
F: This job reflects the changing role of GP's in medical student education. I also teach clinical skills to first and second year students. I help with the organisation and delivery of the Science in Society and Medicine module to first year students and facilitate tutorials during it. I am also closely involved in developing the fourth year assessment process in general practice and have examined in the final medical exam and clinical skills exams. Clinical skills sessions in general practice now begin in first year. Students cover areas such as history taking and examination and start to see patients for the first time in the community environment. In my experience students really enjoy these sessions. They value the protected nature of small group teaching with an experienced clinician. 
 
 
 
C: What career development opportunities are there for portfolio GP's? 
 
 
 
F: Recent studies have shown that more GPs are opting to work part time; this can be either as a salaried (i.e. employed by a practice to perform a set number of sessions) or as a partner within a practice. The new general medical service contract has facilitated this flexibility. This then provides the opportunity for them to do other work. Many GP's are gaining specialist knowledge in a particular field and are increasingly involved in the triage of patients through to a particular hospital service. (Also known as GPwSI [GP with specialist interest]) There is huge scope for career development in fields such as orthopaedics, dermatology and sports medicine, with many GP's now taking additional qualifications in these areas. It is likely that the role of GPs will continue to grow in providing clinical teaching for medical students, and with the advent of ‘Modernising Medical Careers’, in the future substantially more doctors will get to benefit from experience in general practice during their early medical careers. I personally enjoy clinical teaching and would hope to continue this as my area of interest. 
 
 
 
C: Any insider tips for a young doctor considering becoming a GP? 
 
 
 
F: I think most would agree that certain attributes are essential as a general practitioner: good communication skills, genuine caring for your patients, clinical competence, ability to problem solve and effective management skills. If you have all these skills you are likely to really enjoy working in general practice. I would recommend being a portfolio GP; it allows choice and variety in your working life and delivers opportunities to develop new skills.