35. Academic General Practice


	THIS CHAPTER encompasses the following: Working in an undergraduate department of general practice; Working with postgraduates with the Regional Adviser in general practice; Involvement in research relevant to general practice; Sources of Funding for Research. Undergraduate General Practice Theoretically, there is no reason why non-principals cannot become involved in teaching in this area. University departments are independent of regional Health Authorities/Boards, so a doctor’s ‘status’ is irrelevant. The first step, is to make contact with your local medical school, expressing an interest. A basic requirement is completion of vocational training, but achievement of several ‘milestones’ will help further your case. Stability. To make a worthwhile commitment, you need to be in the area for at least five years - ‘nomadic’ non-principals need not apply; MRCGP is desirable. Research. Having a track-record in general practice research shows a proven interest in academic practice; Training practice affiliation. Participating as the training partner’s deputy, in the registrar’s tutorials, provides both teaching experience and a respected known referee. Remuneration is less than pay for direct patient contact - even at locum rates. However, this is improving, with the advent of Service Increment For Teaching (SIFT) funds. At present, a GP having a medical student sit in, is paid £12.50 per session/student. SIFT will double this figure. Working within the department in tutorials with up to eight students, will theoretically pay £200 per morning. However, most University departments take on GPs as clinical senior lecturers, with a part-time academic contract, paying considerably less. Figures vary depending on the staffing grade of each individual lecturer. Benefits are therefore not related to pay. Any doctor entering undergraduate general practice teaching does so on a self-motivating basis. One aspect may be that of ‘escaping’ patients and the stresses they generate. Also, being part of the future of general practice by nurturing medical students will appeal to many. Teaching has its own stresses, but to a certain extent these are controllable and not demand-driven. The advent of teaching-quality assessment cycles (every six years) has increased the macho-culture within University departments, by necessitating ‘proof’ that set standards of teaching are being met. As with the rest of general practice, undergraduate teaching has entered an interesting period of change. The GMC paper, ‘Tomorrow’s Doctors’, will ensure increased teaching of medical students within the community, by ‘real’ GPs. University departments are moving away from employing full-time lecturers towards part-time and sessional ones. The time is ripe for more GPs - including non-principals - to enter this stimulating and rewarding field. Postgraduate General Practice The former Regional Adviser - now the Director of Postgraduate General Practice Education - works with the Postgraduate Dean and associate advisers, the ‘bottom rung’ of the ladder being course organisers on vocational training schemes and GP principal trainers. At present, there is no formal way in which a non-principal can be involved in postgraduate teaching in general practice. This is due to the requirements in place for getting a foot on the training ‘ladder’. The absolute bar to non-principals, is the need for a minimum of five years as a principal, coupled with the practice itself being an integral part of the equation. Virtually all GP tutors are principals. After that, the next step towards becoming an associate/assistant adviser in general practice is by being a trainer within a training practice - thus showing a commitment to teaching. Of course, being a trainer means attending a training course and possession of the MRCGP. Some doctors’ (those with a particular interest in teaching) involvement is more central, i.e. within the department of general practice as a course organiser, but this is the exception rather than the rule. Having attained these ‘milestones’, sessional-based remuneration can be good. The non-principal can become involved in this structure on an informal (unpaid!) basis, primarily by working within a training practice and contributing to the education of the registrar. For most non-principals’ contact with the Director of Postgraduate General Practice Education will be for careers advice. Hopefully, it will not be in his role as helping to design the education input needs of doctors falling foul of the re-accreditation process. Research in General Practice This is an area where non-principals can be actively involved in projects with potential for changing clinical practice. First, you need an idea, one which considers a question relevant to the ‘coal-face’ of general practice - preferably one with an outcome that could save money! Funding for your research efforts is available from various sources, sometimes in considerable amounts and asking a worthwhile question is essential for access to this. Before approaching any potential funding source, make contact with your local University department of general practice. This is an invaluable source of help and advice - not least by way of helping you draw up the protocol for your research project. Armed with your protocol, you can go looking for funding sources. These can be Health Authorities/Boards, Public Health Departments, local Trusts, Health Education Authorities, the RCGP and even government departments. Some of these bodies make funding available only to doctors working within the NHS. It is all a question of knowing who best to approach, something the local department of general practice and the RCGP’s National Research Adviser can advise upon (see below). Funding is not simply a matter of the nuts and bolts of the research, but also covers your time. However, you will need to prove how much your time is worth and this often means (on a practical footing) that you must be practice-based. GPs are sometimes asked to provide practice accounts as proof. Remuneration is not a reason for getting into research. The most effective way of becoming involved in research is to secure a part-time training research fellowship via one of the funding sources, particularly the RCGP fellowships. Providing you are a Member or Fellow of the College, you can apply and non-principals are not excluded. The College fellowships provide training in research methods and are linked to a university department of general practice. They also support GPs working for a higher degree. As is usually the case, evidence of previous interest in research - a track record - is a bonus when applying. The RCGP also awards research grants via the Scientific Foundation Board. These grants are primarily for short term research projects and do not fund the GP’s time. Benefits to the individual involved in research are by way of personal development. Good research projects are concerned with promoting better clinical practice. Even if you become involved for only a single project, chances are you will become a better clinician for it - this is precisely the idea behind research fellowships. Of course, really useful projects have an impact not only on personal practice, but on the general practice as a whole. By becoming involved in research, you can play a part in shaping the future of that practice and, by being published, achieve immortality! What more incentive could you want? Acknowledgements Thanks for helpful information during the preparation of this chapter go to: Dr. Digby Thomas, Academic Co-ordinator for general practice teaching and Dr. Ross Taylor, Senior Lecturer, Department of General Practice at Aberdeen University, Dr. Mike Taylor, Director of Postgraduate General Practice Education (Regional Adviser) at Aberdeen University and Fenny Green, at the Royal College of General Practitioners. Sources of funding and advice Regional Research and Development (R&D) programmes, contact the Regional Director of R&D. See Useful contacts for Regional NHS Offices' details. Local bodies: University Departments of General Practice, Health Authorities, LMCs, RCGP Faculties. Medical Research Council 20, Park Crescent London, W1N 4AL. Telephone: 0171 636 5422. BMA Board of Science and Education BMA House, Tavistock Square, London, WC1H 9JP. Telephone: 0171 387 4499. Association of Medical Charities 29-35 Farringdon Road, London, EC1M 3JB. Telephone: 0171 404 6454. The RCGP Research Network ensures that advice and guidance is available to both new and more experienced researchers. One way of achieving this is through the College’s National Research Adviser who provides advice and guidance on research matters in general practice. This service is free to members. The Adviser will discuss ideas with people who are at the early planning stages of a project. Through this post the College is able to encourage GPs to undertake research within general practice. The RCGP Scientific Foundation Board awards grants for research projects which are specific to general medical practice. Applications are not restricted to practising general practitioners although priority will be accorded to practising general practitioners and members of primary health care teams. It mostly funds small scale research projects and pilot projects. The Board meets three times a year, usually in January, May and October, to consider applications for grants of over £1,000. The closing dates for these meetings is two months prior to the meeting. The exact closing dates may be obtained from the Clerk to the Board at the College. Applications for grants of up to £1,000 can be considered at any time of the year and it is usually possible to confirm whether the application has been approved within one month of its receipt. Further information RCGP Information Sheet No. 12, Research in General Practice. Howie JGR 1989: Research in General Practice. Chapman & Hall.