Getting to grips with the non-clinical side of general practice

Business and leadership skills shouldn’t have to be something doctors learn along the way

When I was growing up, I assumed that the adults in the room had it all figured out. Parents, teachers, the consultant leading the ward round; they all knew exactly what they were doing. There was great comfort and safety in the feeling that there was someone who was competent and in charge.

However, as that generation that I looked up to settles into cosy retirement and people around my age are now becoming consultants and even the Taoiseach or the Minister for Finance, I realised that we’re all just winging it. There is no magic day where you look around and suddenly feel like a grown-up. Although I may now have a mortgage and a pension and an accountant, there are days when I feel no more grown up than the day I finished school.

This feeling of fumbling your way through adulthood extends into your medical career as you step into more senior leadership roles. Medical school and postgraduate training teach us how to be doctors, but can leave you remarkably lacking in the many other non-clinical knowledge and skills it requires to do your job well.

I remember when I was a GP registrar, one of our trainers remarked that only 10 per cent of their brain power was spent dealing with clinical challenges – managerial issues took up the other 90 per cent of their mental load.

Hearing this blew my mind. How could it only be 10 per cent when, at the time, 100 per cent of my brain was overwhelmed by the guidelines, the nuances, the uncertainty of general practice? But now, as I set out with my own GMS [general medical services] list and partnership I know exactly what that feels like. Generally, after a few years, patients start to follow patterns, you click automatically into the hormone replacement therapy consultation, urinary tract infection, the mental health crisis, and so on. Although each patient is unique, the story and management steps are generally more or less the same.

However, there is a whole professional mindset and knowledge base required for modern general practice that we expect doctors to acquire by osmosis. Subjects such as accounts, employment law, and leadership are as integral as knowing how to treat diabetes.

But we have no formal training in any of these subjects. Not only do we find ourselves clinically responsible for the patient in front of us, but we are also responsible for the staff we work with and lead, the financial viability of the practice, and the ethos of the service we want to deliver to those in our care.

When I went to medical school I did it with the intention of becoming a doctor – I definitely didn’t want to be a small business owner. Certainly, it was something that put me off the idea of general practice and traditional partnership structures for a long time.

Recently, it was reported that only 59 doctors have signed up to new GMS lists nationally in the last five years. It is not surprising that many of my peers are opting for part-time assistant roles or portfolio careers, with special interests in fields such as occupational health or aesthetics, if they do not feel fully equipped and supported to enter a traditional general practice model.

I’m not saying that every GP should do an MBA or have that level of business knowledge. But it would be useful to have a little more guidance. I remember the subject of taking on a GMS list was touched upon very briefly one afternoon at GP training and I know that the ICGP Network of Establishing GPs does its best to provide support to new GPs. I feel that this should start earlier – throughout training and even at undergraduate level. Business and leadership skills shouldn’t be something you learn along the way, as nearly all of us, whether we become consultants or GPs, ultimately end up leading a team in some way or another.

But perhaps, as in life, no amount of training can ever really teach you to be ready; you can only learn to do something by doing it. When you become the adult in the room you realise that those who went before you never had it all figured out, they had just been doing it longer.