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For every doctor, choosing which specialty to do is one of the biggest, and hardest, decisions we make. Often this decision is based off hearsay, and snatched conversations from older peers, with very little evidence-based decision making in the process. This can inevitably lead to making the wrong choices. Sign up here (register) to access our training navigator and review bank to find the rotation you want!
Today… rounding off our general practice week is, as promised, Dr Helen Stokes-Lampard! The current chair of the Royal College of General Practitioners.
- Name: Helen Stokes-Lampard
- FRCGP 2010
- PhD Medicine (University of Birmingham) 2010
- MSc (Primary Care Research Methods, University of Birmingham) 2003
- MRCGP (Merit) 2002
- LOC(IUT) 2002
- DRCOG (RCOG) 1998
- DFSRH (RCOG) 2000
- MBBS (London) 1996
- Years in the NHS: 21
She topped the listed of the most influential GPs in 2016 by Pulse magazine and is one year into her term as Chair of the RCGP. Introducing Dr Helen Stokes-Lampard and her insights into GP training and what the future holds. Although she initially started down the path of Obstetrics and Gynaecology, she decided to switch careers and pursue General Practice. Today she explains how she changed specialties, her top tips for junior doctors considering this field and how she expects training to change in the coming years.
First and foremost – congratulations on becoming the RCGP Chair! Could you tell me a little about your path to becoming the Chair of the RCGP?
- I’ve always been a person who’s been interested in making a difference at an organisational level, so in my sixth form college I set up a branch of the NUS. When I was in medical school I got involved in student politics where I was BMA rep and then the Student Union president. By the time I graduated I knew that my interests were more in terms of professional standards, so I knew that I was more likely to be more interested in working with the Royal College rather than the trades union route. But I didn’t think too much about it at the time, I started my career in Obs and Gynae but then several years later moved across into General Practice. It was when I was in training practice that one of the GPs suggested that I go along to a regional college meeting, where I quickly appreciated the opportunities and networking on offer, and I became a representative locally, then a trainee rep nationally. I eventually became Honorary Treasurer of the Royal College of GPs and that really opened my eyes to the potential of being in such a high profile position in terms of the doors it can open and the influence you can genuinely have on policy making. I never planned to be the Chair of the College, it was a by-product of my desire to help make a difference and improve the quality of life for GPs, GP trainees and patients.
What are your main responsibilities as Chair? How do you balance your clinical practice with your leadership responsibilities?
- The Chair of our College is like the President of the other medical royal colleges. We also have a President which is a ceremonial role – think of the Queen and the Prime Minister, I’d be the Prime Minister!
- The Chair sets the policy, political and strategic direction of the organisation, is the public voice and media face of things, chairs the most important committees, including our Council, and is where the buck stops!
Do you still have a clinical practice alongside this?
- I’m still a partner at my surgery, although I’m usually only there one day a week because of my other commitments.
You initially contemplated an OBGY career, what was your motivation for choosing specialities?
- The first thing is that I started off in Gynae because that is what I’d always thought I’d wanted to do, partly because the only experience I had as a teenager of medicine was shaped by family and friends. I’m fit and well, and like most people in medical school I didn’t have much personal experience in healthcare. You get influenced by what you’re exposed to. I’d gone into medical school with that and nothing that happened in medical school dissuaded me from Obs and Gynae, and I liked the thought that it was medical and surgical. I enjoyed nearly all of my placements in medical school. After I qualified there was no reason really not to continue with that path but there was a problem with OBGY training placements in the 1990s – as there was nowhere to go! We were told there would be no training progression for 5 years. Also, my husband had an awful accident and that changes your life perspective completely. I think I just wanted a change because I was frustrated, so my husband changed job because he felt he needed to, and I followed him to the Midlands. I intended to do public health because I wanted to do the most good for the most people. On my way to do public health, I’d signed up for an academic GP training initiative and I absolutely loved it. The balance, and diversity of general practice was fantastic and I felt at home, so I stayed.
- Although it was never plan A, I think general practice was always in the picture. One of my top tips for people is don’t be afraid to let serendipity influence your career. It is so easy to get stuck in one rut and one pathway and not look for any other opportunities. What’s interesting is the number of people at my level have had unusual career pathways. It also means when I speak to colleagues in other specialities, I speak from a slightly different position from somebody who has never walked a mile in their shoes.
A lot of people in training at the minute don’t know what to do and end up taking an F3 year!
- I love the concept of broad-based training – a really good way of getting a good grounding from several places is to travel and spend some time abroad. I’m also frustrated for trainees that at the moment, it is fairly difficult for trainees to swap between disciplines, although we are working very hard to ensure that it gets more straightforward and there is a better accreditation of prior learning. This should hopefully make it easier to transfer across and shift from one speciality to another.
What would your advice be to other junior doctors who aren’t sure about the specialty they wish to pursue?
- First of all you need to think about what has made you happy from what you’ve seen so far. Also think back to medical school and what stimulated you – get to know yourself.
- If you need quick solutions and quick answers then a speciality like a surgical speciality or A&E might suit you better. If you like problem solving and a huge diversity then general medicine and general practice are amazing. I would caution this though, if you can’t handle uncertainty then don’t do general practice! It’s not for the faint hearted in terms of handling uncertainty. If you need black and white answers then it’s not for you. You’re seeing the first presentation of completely undifferentiated disease. Therefore, when somebody walks through the door, the entire spectrum of medicine is a possibility. From that first moment, you’re narrowing down the options all the time and that’s really stimulating intellectually. Sometimes it’s pretty straightforward and sometimes it’s potentially bizarre! It is easy to forget, that when you see a patient in hospital they’ve had a whole range of tests and been seen by several colleagues already, just how much filtering they’ve undergone already. The pre-test probabilities change massively every step along that journey.
- The level of responsibility gets high very quickly, but you do also get to go on a journey with the patient and get to know them well. This all adds another dimension to being a clinician.
Could you share with us your most difficult moment?
- I guess there a couple of things – certainly in the days when I was a medical house officer, which was back before the European working time directive. I just remember being so fatigued and I couldn’t eat or sleep, barely functioning. Knowing that was horrible and I made a decision at that point that I would never do a general medical rotation in a hospital, which was actually crazy because it was nothing to do with aptitude or interest in the job – the job was actually very interesting but it was purely the rota and the timetabling. I’m grateful trainees never experience that now. It was a bizarre way of making a decision.
- Making the decision to transition from one speciality to another felt quite isolating because nowadays it’s a lot easier to talk about these kind of things and find colleagues who’ve gone through it. At that time I just felt really alone and I was grateful for a really supportive consultant who just normalised it, whereas for me it was difficult.
Having a good team around you is so important – it can make a bad rotation seem like a great rotation can’t it?
- Absolutely! Team working is a huge part of medicine. I always say to the medical students that the people you make best friends with in these years in medical school will be your best friends for life. They’ll be the people you go back to for whatever help and advice you need.
- I think you’ve genuinely got to be good with people, not just good with medical problems. General practice really is fine balancing act between the physical, social and psychological aspect of a patient’s life and if you’re not interested in all three then I think it makes it harder to do general practice well. It is hard work, whichever bit of medicine you’re in. You’ve got to be good with uncertainty, interested in people widely and also be good in teams because general practice is a team sport, we work with the widest range of healthcare professionals of any discipline. Understanding their world and their language, and how to use them best to get the best healthcare for our patients is really important.
What is your take on the current decline in partnerships and rise in salaried GPs, do you think this will continue?
- I think it is reaching the peak in terms of the proportion. The balance may have a bit further to go before it levels again, but we are seeing quite a number of trainees say well actually I do want some control and it is quite attractive. I do think that the structure of general practice is changing around us, so the organisations they go into are likely to be bigger organisations overall. Some people are scared of going into partnerships because of financial risk or feeling tied in, whereas when you go into a bigger organisation you won’t feel that as much. I know that some of the newer ways of working are making it easier to recruit partners. I think the partnership model has been fantastically creative for the NHS, but for some newer doctors who don’t want to take on some elements of being a partner, such as managerial responsibilities, the salaried posts can be a good option to consolidate your clinical skills. Some people aren’t interested in the management side of things and that’s fine! You don’t want to force people into something they’re not interested in or not good at.
GP services are facing huge pressures right now, what would you say to junior doctors who are worried that this may affect their training?
- I think we need our medical trainees more than ever in general practice. The best bit of general practice training is that there is always tons of exposure to clinical practice. In hospital training when service is stretched, you get less exposure to the learning opportunities, whereas in general practice when service is stretched you actually get more Most general practice trainees report having an excellent experience and really love the fantastic training as it tends to be very personalised. I don’t want trainees to be put off by what they see as a stressed training environment – the pendulum is shifting back and things are gradually improving. The NHS needs the next generation to be the architects of change to help shift the landscape and modernise general practice, so I think it’s a great opportunity.
Another concern of many trainees is that general practice doesn’t offer the same research and academic opportunities in comparison to hospital specialties. What are your thoughts on this? What would your advice be for doctors who would like to pursue academia?
- There are myriad of ways of getting involved in research and there are different levels of it. There is the ‘full monty’ which is academic general practice, which is my background. Or you can be in general practice but do research occasionally – these practices will be signed up to work with a local research university to do data searches with their patients and offered research opportunities. The next tier would be actively getting involved with research yourself, perhaps by accessing data and putting it into a national study. Another way would be to do your own research as a practice – coming up with the idea yourself and doing small scale pilots. The next tier is a full academic post where you have a substantive post with the university, where you will get involved with the hands-on side of research. There’s quite a range – I remind my trainees that we all train as scientists first before the art of doctoring comes onboard. To be really good doctors in the end we need this overlay of compassion with a background of science.
You’ve reached the top of the GP ladder – and where do you go from here?
- Going back to my practice and being a partner at the end of this post. I am a professor at the University of Birmingham, and I am taking a secondment from this role while I am Chair of the College. Someone else is doing it now and doing an excellent job. Once I step down as Chair, I’ll see what the university can offer me and see what other exciting opportunities comes up. There certainly isn’t another role for me at the College I can think of – let them get some fresh blood in, it’s good for an organisation to have a clean break when there’s a change at the top. Some previous heads of the college have gone on to do:
- Director of NICE
- Head of General Practice arm of CQC
- Head of NHS London
- Often people find that this opens doors for them but I’m not looking for those doors just yet.
Great, you’ve been very helpful and informative – thanks very much for speaking to us!