Diversify your GP career

General practice allows you to combine clinical practice with other interests such as politics, research, and medical education. Or, perhaps you wish to develop an extended role by providing an additional specialist service in your community, or go further afield in a wide range of clinical areas from cardiology, dermatology, and minor surgery to mental and sexual health.

Developing a portfolio career

"Portfolio GP" is a term which commonly describes a GP who holds multiple roles. Most GPs will have a primary clinical role - as locum, salaried or partner GP - and it's becoming common to see members taking on additional roles alongside this to diversify their skills and experiences.

Hosted by Dr Sophie Lumley, a First5 salaried GP and Training Programme Director in Shropshire, the GP+ Careers podcast is a series of short interviews with a standardised format. It's designed to point people in the right direction and showcase what’s possible. Sophie will ask a series of questions to each of her guests about what their role entails, how they got into it, and any top tips they have for those considering a similar path.

You can look forward to the release of a new podcast episode each month, available exclusively here and through all main podcast platforms. Browse this page to explore and listen.

Latest episode: GP+ Minor Ops

Minor operations (minor ops) refers to small-scale, low complexity surgical procedures that can be safely and effectively performed in outpatient or primary care settings. Examples of minor ops include ingrown toenail surgery, skin biopsies, excision of skin lesions (skin tags, moles, cysts) and more. These are performed by a GP who has additional training, skills, or experience in performing minor surgical procedures. These GPs typically offer procedures that would otherwise be done in hospital outpatient departments, helping to reduce waiting times and improve access to care in the community.

This month, we hear from Dr Pim Dhahan, a GP in Birmingham with a special interest in minor surgery. He shares his journey into minor operations, emphasising the importance of accredited courses and hands on experience gained through observation and supervised practice. He also outlines several benefits of the role such as providing a practical and engaging alternative to GP work and reducing hospital wait times.

Patients do really appreciate the work we do... they're always very thankful about coming in and having something done, something removed that's really irritated them or they've been worried about for a little while.

Top tips

Observe and get involved in your local area

If your practice already offers minor surgery, Pim suggests that you go and attend a session to see what is involved. If your practice does not perform minor operations, find out who does within your local Primary Care Network (PCN) and see if you can observe them. Observing others will help you determine if you truly have an interest and will enjoy this type of work.

Complete an accredited course

To carry out minor procedures in practice, you must first complete an accredited course. Look for courses run by the RCGP or through the Association of Surgeons in Primary Care. Pim, for instance, used his study budget to do the RCGP minor surgery course. These courses may include a small assessment, potentially involving practical elements like removing a paintball pellet from pig skin or assessing your suturing skills.

Gain hands-on experience with supervision

After completing an accredited course, do not immediately start performing procedures on your own. Pim advises you sit in with or assist someone who already performs minor surgery so they can observe you and ensure you are comfortable. Start by performing small procedures with a supervisor to build your confidence, then gradually move to doing them independently. It is important to build up your portfolio of accreditation and experience.

Explore funding opportunities

If you are a GP trainee and interested in minor ops, consider using your study budget to attend RCGP-accredited courses. However, if you are an established salaried doctor or partner, present a case to your practice. Highlight that minor surgery is beneficial for patients and can bring in funding that will surpass the cost of the course itself.

Commit to regular practice and continuous auditing

Minor surgery is a skill that needs to be performed regularly to maintain proficiency. Continuously audit your work, checking for complications like infections, and assessing the accuracy of your diagnoses. Pim noted that he gets about 70% of his differentials correct, which is acceptable as long as no cancers are accidentally removed.

GP+ Academic

An academic GP refers to a GP who is involved in not only clinical practice but also academic activities such as research and teaching. They play a key role in primary care in advancing evidence-based practice and therefore better outcomes for patients in the future.

In this episode, Sophie speaks with Dr Tom Purchase, a First5 GP and a Health and Care Research Wales NIHR Doctoral Fellow at Cardiff University. Tom describes his career journey into his doctoral fellowship, where to look and how to secure some funding opportunities, and the benefits of the role.

A highlight for me over the last few years has been that on two occasions I've been able to go to Geneva to support work with the World Health Organization. I got to meet world experts in patient safety, attend a global expert consultation, and see how global issues are prioritised. It was a really valuable and enjoyable experience and something I don’t think I’d have done working purely clinically.

Top tips

Be curious and ask questions

Tom’s journey began by simply asking a GP colleague what she was doing in her academic GP role. Don’t underestimate the power of curiosity and conversation, as most people are happy to share their experiences and may connect you with others or current projects.

Seek early opportunities even without prior research experience

You don’t need formal research qualifications to start. Tom didn’t have any before his postgraduate certificate. He built experience by joining projects, showing interest, and asking how he could get involved. Take initiative and look for small roles on existing studies.

Apply for small-scale research funding early on

Start small and go from there. Tom received a grant from the RCGP Scientific Foundation Board which is perfect for early-career GPs wanting to trial an idea. These short-term grants help you develop a track record and build your portfolio for larger funding later (e.g. National Institute for Health and care Research, Health and Care Research Wales etc).

Be aware of the challenges

The role is not without some challenges such as:

• Job security: Early academic roles are often fixed term.
• Financial hit (initially): Academic salaries may be lower than full-time clinical GP work.
• Juggling roles: You need flexibility and resilience to balance deadlines with clinical responsibilities and personal life.

Appreciate the benefits – variety, impact and autonomy

Academic GP work brings a number of benefits such as:

• Variety: Every week can be different, for example, teaching, research, and conferences.
• Autonomy: You can shape your projects and personal development based on your interests.
• Wider impact: Your research can change policy or clinical practice nationally or globally.

Tom’s experiences even led him to the WHO in Geneva—a unique opportunity to contribute to global health initiatives.

Master organisation and time management

Academic work can involve different demands to clinical work, including project planning, literature reviews, participant recruitment, writing, and meeting deadlines. Being organised and managing your own time becomes a crucial skill.

GP+ Humanitarian Health

In this episode, Sophie is joined by Dr Hareen De Silva who has a special interest in Humanitarian and Global Health. Hareen describes how he got into the field, how you can find out if it is the right role for you physically, emotionally and morally and the benefits and downsides of the role.

A highlight of the role for me was when I was working in Gaza and we were vaccinating children against polio and they were watching and laughing. It was at that point I realised I hadn't seen a child laugh for about four weeks and I become emotional thinking about it….to see laughs and smiles during probably the worst time they will experience. That is one small moment that stays with me and keeps me going back to deploy in various countries.

Top Tips

Gain relevant clinical experience and skills

Broaden Your Clinical Scope: Try and gain experience in areas often neglected in high-income settings but critical in humanitarian contexts. Just because you may deploy as a GP you may have to step into other situations. Hareen has gained skills over his career. Some of these can be obtained free or paid. Consider using your GP training study budget.

Emergency Medicine: ACLS, PALS certifications - paid for by CADUS.

Trauma Care: Even basic trauma stabilisation

• Have a look at cheap/free courses organised by a UK charity called CitizenAid that have a free app to download.

Mental Health: Basic psychological first aid (PFA) and recognition/referral of common mental health conditions.

• There are websites such as Coursera that offer free certification in PFA

Procedural Skills: Minor surgery, suturing, wound care, basic fracture management, IV insertion.

Resource-Limited Settings: Consider volunteering locally within the UK using your skills. Crisis at Christmas is where he started volunteering and then locally in homeless healthcare clinic in Doncaster. The UK Government website has a database of opportunities.

Understand the Humanitarian Aid sector

Research organisations: There are so many organisations that you could work with. Each has their own individual identity. CADUS is different to other organisations Hareen has worked with. When you interview for a position, make sure your personal values line up with those of the organisation.

Humanitarian principles: Stress the importance of understanding and committing to the core humanitarian principles: humanity, impartiality, neutrality, and independence.

Contextual awareness: Stay informed about global crises, geopolitical situations, and the specific health challenges in different regions. ReliefWeb has a jobs board and collates information from all around the world.

Networking: Connect with doctors already working in the field. LinkedIn, professional associations, and humanitarian aid conferences are good avenues. Hareen is happy to take on mentees via RCGP Mentoring.

Realistic expectations: Prepare for challenging conditions, long hours, emotional toll, and potential ethical dilemmas. This work is not for those with a saviour complex.

Essential training and qualifications

Specific humanitarian training:

• Pre-deployment courses: There are plenty of free online resources to help you understand the basics. DisasterReady is a free online resource which Hareen uses every year to increase his knowledge.
• Tropical medicine/public health diplomas: These are highly relevant and often required or preferred by some organisations. But think about the financial impact on yourself before paying for courses. Will it help you get a volunteer position or a paid job.

Language Skills: Proficiency in languages other than English (especially French, Spanish, Arabic) can be a significant asset and sometimes a requirement for specific deployments. Even just having a few phrases will help to generate rapport with beneficiaries of the project.

Security Training: Consider something like a HEAT (Hostile Environment Awareness Training) Course. CADUS offers a free course. The United Nations also has a free course called BSAFE.

Practical steps to get started

Initial deployments: Your first deployment might not be your "dream" assignment. Starting with shorter deployments or less complex contexts can be a good way to gain experience. Be warned that the smaller organisations may ask you to cover your travel and accommodation costs. Please do not be exploited for voluntourism type projects.

Application process: Be prepared for a rigorous application process, including interviews, assessments, and background checks.

Financial planning: Humanitarian work, especially early on, may not be highly paid. It is advisable to have some financial stability or savings.

Health and wellness: Stress the importance of maintaining their own physical and mental health during and between deployments.

Long lasting effects: Hareen has deployed to multiple conflict zones and now has to apply for visas to travel to countries as a tourist. He also holds two passports to avoid questions at the border - one for work and one for tourism. Consider where you want to travel in the future as some countries do not allow travel if you have been to another country.

It may not be for everyone

You may realise it is not for you, and that is fine. Within the UK we have so many health inequalities and this is how Dr De Silva's humanitarian career started. Consider joining the RCGP Health Equity SIG working group and contribute locally.

GP+ Lifestyle Medicine

The British Society of Lifestyle Medicine (BSLM) define Lifestyle Medicine as 'evidence-based, clinical care that supports behaviour change through person-centred techniques to improve mental wellbeing, social connection, healthy eating, physical activity, sleep and minimisation of harmful substances and behaviours'. It's important to understand that there are socioeconomic determinants of health and health inequity, and often people don’t have much choice or influence in the situation they find themselves in.

It was not about the choices people make, but the options they had to choose from.

Lifestyle medicine focuses on preventing, treating and even reversing chronic diseases through evidence-based lifestyle interventions rather than relying primarily on medication. General Practitioners are uniquely positioned to make an impact on their patients through lifestyle medicine interventions.

It's amazing if you pursue your interests and passions where things can go. General Practice has that flexibility that allows us to pursue areas we are interested in. If there's one thing people can take away from this podcast, it's that enthusiasm goes a long way.

Top Tips

This month, Sophie interviews Dr Callum Leese, a First5 GP based in Aberfeldy, Scotland with an extended role in Lifestyle Medicine. Callum shares his journey into the field and signposts to a number of helpful resources if you are interested in finding out more in this area.

If you think Lifestyle Medicine could be the right fit for you, here are some top tips to help you find out more:

Connect with other Lifestyle Medicine Professionals

The BSLM is the primary professional body for lifestyle medicine. Callum suggests the BSLM is a great place to start to build those connections through their in-person events, online webinars and networking at the BSLM annual conference.

Research if there are any local lifestyle medicine groups and if not, why not initiate one with like-minded colleagues. Callum set up the 'Healthiest Town Aberfeldy' initiative with colleagues to inspire change and address some of the social determinants of health to inspire healthier lifestyles.

Start small and strategic

Figure out what aspect(s) of lifestyle medicine interests you and begin with part time or low commitment roles alongside clinical practice. For example, Callum led on some group patient consultations in his practice for conditions such as diabetes and prostate cancer. This helps him to remain energized and enthusiastic about his role trying out different styles of delivering patient care.

Research funding opportunities

Callum suggests look at your local deanery first for potential funding opportunities in lifestyle medicine. If you are a GP registrar, consider the study budget to cover some lifestyle medicine courses such as the BSLM Core Accreditation in Lifestyle Medicine or Red Whale. Callum had previously secured funding from the Claire Wand Fund for some courses in the past. He suggested also checking out NHS Trust charities as his 'The Movement Prescription' podcast was part funded to support these ideas.

Learn more about Lifestyle medicine initiatives

Spend time to do some community mapping in your local area. Callum suggests becoming familiar with existing initiatives and help to shape and support initiatives that already exist. If you identify a gap, thing about what you can do but try not to reinvent the wheel.