By Gabriela Barzyk
So, you are thinking of General Practice (GP) as a career? This article covers what being a GP entails, different types of GPs, how to prepare for application during medical school, and details the application process and training pathway.
What is GP?
General Practice offers a varied workload – from seeing common presentations on a regular basis, to looking after patients with rare diseases. From doing medication reviews and referrals, to seeing a patient who presents with a serious condition for the very first time. Furthemore, seeing newborn babies and performing baby checks, doing asthma reviews, discussing family planning, dealing with chronic conditions, redirecting patients to support services, seeing patients in care homes and providing palliative care – each patient appointment brings a unique set of presentations and challenges making the work of GPs really exciting.
You are the first point of contact with healthcare for many patients, and each day may offer a different set of jobs and tasks as GP provides a mix of all other specialties. You will have the opportunity to utilise clinical skills daily while also having the opportunity to focus on your special interests or academic work.
You will develop long-term relationships with patients and their relatives – commonly treating entire families and multiple generations living in the area. You will be able to see patients progress overtime and manage their health with any health changes, while also considering wider aspects of their health.
Although you see patients independently during their appointments, you will be involved in a multidisciplinary team each day. Alongside the support of other GPs at the practice, you will communicate and work closely with nurses, physiotherapists, practice-based pharmacists, community mental health and social workers, and hospital based teams to name a few.
Day-day work
The working day of a GP may look differently each day due to the sheer variety of patients coming through the door.
In general, the day consists of morning and afternoon GP clinics which last for about 4-hours each and are made up of 10-minute appointments (some appointments may be longer) per patient. Between morning and afternoon clinics, you are likely to carry out administrative duties such as reviewing prescriptions, reading patient letters or attending practice meetings. You may also carry out community visits and see patients at their homes within this time. Each set of the half-day of clinic is called a “session” and a full-time GP may carry out about 8-9 sessions per week, although many opt to do fewer sessions each week, usually 4-6, and focus on other work such as teaching or academia.
Different GP types
You may have heard the terms “practice partner” or “portfolio GP” – here is a breakdown of what these are in relation to working as a GP:
Salaried GP is a permanent staff member at a GP practice. They run daily GP clinics and have a stable income. They are not involved in the managerial side of running a GP practice. On average, you earn £63,000-£90,000 per year*.
Locum GP takes up available shifts i.e. when the practice is short-staffed as a result of staff sickness or annual leave. They may also have a long-term position within the practice e.g. when covering a salaried GPs planned sabbatical or a maternity/paternity leave. Locum work offers more flexibility, however obtaining shifts may be more competitive depending on area of clinical work. On average, you earn £75-100 per hour*.
Portfolio GP has an additional role to their day-day GP work. This can include teaching, health consultancy, doing work in their area of special interest like carrying out small scale surgical procedures or gynaecology clinics at the practice site (GP with special interest)
Practice Partner is a GP who has ownership of the practice, allowing them to manage the day-day running of the practice. They make various managerial decisions and look after the finance of the practice, in addition to their day-day GP job. On average, you earn £110,000 -120,000 per year* depending on the practice business.
*Please note these are average earnings. GPs can have additional income from other work such as providing out-of-hours services, in addition to other opportunities listed below.
Other opportunities
Academic GP may be involved in various aspects of research while working as a GP. This may mean you dedicate a certain day of the week or a certain amount of working hours towards research work. For example, the National Institute for Health and Care Research (NIHR) offers 75% clinical/25% research and education fellowship posts.
Teaching as GP – you will have teaching opportunities in numerous aspects of GP work – from supervising medical students while running clinics to supporting new GP trainees (as a trainer, you will meet trainees on a daily basis and support them with their development). You may also teach at a local university or get involved in other aspects of teaching.
What to do – portfolio building during medical school
Having an extensive portfolio is not a requirement for a career as a GP. Good portfolio will showcase your abilities and help you to stand out when preparing for interviews (although not everyone undergoes an interview – see below). Beware that even though you may be set on one speciality, your mind may change over time. Setting good foundations throughout medical school will put you in a good position irrespective of whether you wanted to be a GP from the get-go or you decided to become a GP later down the line.
Anything you do is super worthwhile for your portfolio, remember – how your portfolio/CV comes across depends on how you apply your experiences. Not everything has to be related to GP in order for it to be of benefit to your application or beyond. The process can seem really daunting and there can be a lot of self-doubt and anxiety about what to do. Starting early and working efficiently means you can spread this work out making it more manageable. You do not have to do everything on the below list - pick and choose depending on where your interests lie.
Elements specific to GP:
GP Society at University – be involved on a committee, create a GP Society or be an active member. You can run various events related to GP training, teaching and special interests.
Essay prizes – various organisations offer GP-related essay writing opportunities. You can produce a few during your time at medical school.
Research. audits and publications – while on placement, you may come across interesting patient cases or get involved in an audit with the practice. You could present this at local meetings and conferences, or pursue further publications. Ask the GP you are shadowing or a practice manager for support - they may have a project in mind already!
You do not need to do tons of research to do well - try to find one good project to work on so you get a lot out of it i.e. a publication + presentation from it or multiple presentations covering different areas of your research.
Conferences – be involved in attending, or even presenting your own research at a conference such as Royal College of General Practitioners Annual Conference or Discover GP Conference. There are lots out there.
Potential things you can do during medical school:
1-4 Applicable as above in a non-GP-related capacity. Remember it’s about how you apply the experiences and what you gained from them!
Attend any speciality related events or courses
Awards – any recognition during medical school from your exam performance, awards from societies
Don’t forget the impact of your elective – you can apply lots from what you learn during this time into your applications
Leadership – apply for committee positions in university or external societies including local/ regional and national roles i.e. Regional Representative at WPMN or as a Student Council Member at the Royal Society of Medicine
Making an Application and its benefits
The application process takes place between November and January each year (as of 2022). Once an application is submitted around November/December time, candidates complete the MRSA exam in January– see details below.
Example application timeline
Application for GP training has lots of benefits:
- The competition ratios for applications across the local offices/deaneries are very reasonable in comparison to other specialties. https://gprecruitment.hee.nhs.uk/Recruitment/Competition-Ratios
- When applying, if you perform well in the MRSA, you may skip the interview stage altogether and proceed directly to ranking training location choices. In 2022, as appointment to a GP training programme will be determined entirely by the MSRA outcome
- When making an application you can rank by the vocational training scheme (VTS). These are small training groups (normally based around a hospital with an intake of 5-20 trainees per year), allowing you to apply for small geographical areas meaning you have lots of choice.
- No departmental training requirement – you go through the training programme without the need to complete specific specialities as part of their rotations. Teaching sessions cover a wide range of topics to subsidise any missing content as a result of this.
MRSA Entrance Exam
Entry to the training programme requires completion of the Multi-Speciality Recruitment Exams (MRSA), composed of a Clinical Problem-Solving paper (extended matching questions and single best answer across 97 questions, in 75 minutes as of June 2022) and a Professional Dilemmas paper (ranking and multiple-choice across 50 scenarios, in 95 minutes as of June 2022). This is a computer-based exam, usually taken at a Pearson Vue Examination Centre (same place as SJT exam for those sitting it at a centre, or as the Theory Test for driving licence). Beware, the MRSA is used by various specialities and requirements for different specialties change each year. For example, GP candidates were assessed and ranked solely on their MSRA performance during the 2022 recruitment window.
Achieving a total score of 550 for the Professional Dilemmas and Clinical Problem Solving papers (ranking in the top ~25-30 percentile of applicants), means you do not have to attend a face-to-face assessment at the Selection Centre. You will also be ranked first, ahead of applicants whose application is progressed following the Selection Centre, meaning that your chances of receiving an offer of training in one of your more preferred programmes or locations is increased.
Training Timeline
Upon graduation from medical school and completion of foundation years, the speciality recruitment takes place. With a successful application, you enter GP Speciality Training (GPST) which lasts three years. This includes 18 months spent in general practice, and 18 months spent in hospital – the rotations vary as there are no specific requirements for departmental training. Once complete, you become a registered GP and can choose to sub-specialise in various fields later in your career.
Examinations during training
Membership to the Royal College of General Practitioners (MRCGP) is completed once you enter the GP Training Programme. It consists of an Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA) and Workplace Based Assessment (WBPA). More information about this exam can be found here - https://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam.aspx
Closing remarks
We hope this whistle-stop tour of the GP training pathway provided you with some useful information. If you have any questions please contact WPMN or Gabriela directly.
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