General Practice - working as a salaried GP

Salaried GP/ Maternity Locum
 
My name is Paul Di-Stefano and I’m a 29 year old GP in St Leonards in East Sussex. I’m currently working at a 3 ½ partner practice in a medium sized surgery on the edge of town, with approximately 6000 patients. As a maternity locum I work the same 8 session (4 whole day) week as the GP I am covering for a 6 month period.  I qualified from the local Hastings VTS in August 2011 and had a 2 month recovery after elective spinal surgery. I then started work as a salaried GP in nearby Bexhill for 8 sessions per week. After a 3 month period the opportunity to take on a locum post meant an increase in pay, the possibility of partnership at the end, and a move to an area with a diverse population. I have recently completed my diabetes LES training and look to undertake the role of GP lead in diabetes over the coming months.
 
Why GP in KSS?

I grew up in East Sussex and have always enjoyed the variety of the scenery and population. I trained at Bart’s and The London with a view to returning southwards one day. Soon after commencing my clinical years I decided that GP would provide me with a broad and rewarding career, with a well established training programme and rapid career progression. The opportunity to specialise would also allow for me to develop interests, and keep up my continuing professional development.  I spent time away from the south and worked my foundation years in Yorkshire, where I chose general practice as a rotation in Foundation Year 2. This good experience reinforced my decision to undertake GP training. I had missed Sussex and chose to return to the Hastings VTS. Here I received a very broad and balanced set of rotations.
 
Staying local to my VTS has meant that I already have a head start in knowing the 2 local hospitals and the nearest tertiary referral centres. I know who to send particular problems to and it is always good to be able to put a face to the names of consultant teams. I would recommend choosing a VTS location with at least a passing interest in staying local for these reasons. It can also mean that job opportunities after training become apparent much sooner.
 
Kent, Surrey and Sussex have a wide range of opportunities for a trainee and future career. The local population is very varied from city centres such as in Brighton and Medway, through smaller towns to small villages. The area is generally well connected and you can easily travel between London, the coast and beyond to Europe by ferry and train, and Gatwick and Heathrow are nearby. Brighton serves as a tertiary referral centre as well as south London hospitals. In my time training I have worked with trainees on both KSS and London Deanery schemes, as well as students from GKT and Brighton & Sussex medical schools. 
 
My role

As a maternity locum I am in a practice without personal lists. This contrasted to my salaried position where I held a personal list of 1600. Locally there are a variety of practice set ups. In my current post I start morning surgery at 08.30, and try to clear my blood results and other admin work before surgery. The morning surgery is 2 hours but usually there are a few extras added at the end for emergencies. Following this there may be 1 or 2 home visits. Afternoon surgery starts at 15.30 so there is good time in the middle of the day to make referrals, read letters and attend to prescription requests. Afternoon surgery also last 2 hours and may be longer if on call until 18.30. After which the telephone calls are directed to the out of hours GP service. Specialist clinics are run through the week but every Friday afternoon, everyone in the practice runs a coronary heart disease specialist clinic, another chance to specialise. Saturday mornings cover a couple of hours of pre booked appointments – reserved for medicals and for those people who work in the week and cannot attend normal surgeries. I work a Saturday every 4 weeks and they feel quite relaxed. As they finish by about 11.00 the rest of the weekend is yours. My day off is Wednesday – so usually I don’t have to work more than 2 days in a row. It sounds easy but general practice can be mentally and physically tiring so you need the catch-up time to rest and get on with finances and housekeeping.
 
Although mentally demanding seeing up to 20 patients in a row in 10 minute slots, every consultation is different in its own way. The variety keeps me interested and on my toes. You never know what you’ll be seeing next. There is an established quarterly local GP teaching seminar with guest speakers. In addition to this there is a local young GP group where consultants can give us updates in the latest research and guidance, as well as answering questions on a small group basis most months. The local young GP cohort is friendly and sociable, and I count many of them as friends as well as colleagues.
 
Advice

If you are thinking about general practice as a career I cannot recommend it more highly. Soon after entering Foundation Year 1 you are faced with choosing Foundation Year 2 placements. A large number of these thankfully contain general practice. I would recommend trying to get the rotation as early as possible. This will help to make up your mind and give you experience to use in your application process. The entrance exams involve a lot of general practice focused questions and role play so the experience is very useful. Once on a vocational training scheme you are centred on 1 hospital generally for 3 years. It allows you time to make a home for longer than 1 year, find a partner or even start a family. I met my wife on the training scheme and we are looking to raise a family locally. I recommend visiting the area in which you apply. Find the area that suits you best as you may very well end up staying.  

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