Strengthening links between GP training and academic primary care

General practitioners can rightly be proud of their vocational training; in many respects GP education has led the way in postgraduate medical training in the UK and around the world. We are also right to be proud about academic primary care; in terms of research outputs and undergraduate education, its influence is substantial and growing. What is puzzling is why these two gems of general practice – GP training and academic primary care – often have so little to do with each other. There are, of course, some excellent academic training schemes for the minority of GP trainees who want to focus on academic primary care – but how can the majority benefit from the key academic skills and attitudes? We, like others, have noticed some scepticism from colleagues about the value of an academic slant on mainstream GP training.[1] But as directors of a new training scheme embedded within an academic department of primary care, we think a closer relationship between the two could bring real benefits for general practice and for tomorrow’s GPs. In this article we will set out what we think those benefits might be and outline our vision for GP training rooted in a culture of scholarship.

Perhaps the shyness we have noticed between academic primary care and GP training is down to the separate ways the two fields evolved.GP Training developed through the College of General Practitioners in the 1960s and 1970s, whereas academic primary care sprang up in the late 1940s and 1950s in medical schools. The Association of University Teachers of General Practice was established in 1972 – eventually becoming the Society for Academic Primary Care in 2000.[2] Whatever the history, for the future we think a closer relationship between the two could bring mutual benefits. It could help with recruitment to general practice for example – we know that there is still a widespread view amongst students that general practice is lower in both intellectual stimulation and prestige when compared to hospital specialties.[3] Working with primary care academics whose research is influencing national or international practice; glimpsing the bigger, often global picture of primary care; and tasting the excitement of using research to answer questions that really matter in daily practice – those things can be inspirational, even if you don’t want to be an academic. All GPs need basic academic skills too. The General Medical Council and the Royal College of General Practitioners (RCGP) highlight teaching skills as an important part of training, but many GP trainees would like to be more involved and to have more formal feedback and training in how to teach.[4] Close links with academic units offer both expertise in teacher training, and the opportunities to teach undergraduates. It is also vital that our GPs of the future are equipped to deliver patient care that’s underpinned by the best available evidence; and don’t drown in a sea of information. Although much of modern clinical practice is shaped by evidence-based guidelines, they are only as good as the evidence on which they are based. GPs need to be able to search for relevant literature, critically appraise it, explain it clearly to patients or colleagues, and learn to apply it in practice. There’s a bigger picture here too. As the influential RCGP report ‘The 2022 GP’ states:

the NHS will greatly benefit from developing approaches to care that facilitate educational activity and research in practice. This is important for a wide range of reasons, including evidence-based service improvement, redesign, planning and commissioning; development of integrated care; establishment of a positive learning climate in teams; and data management and informatics.[5]

Our GP Training Scheme at Imperial began in 2012, and we have sought to embed a vibrant academic culture within it from the start. Being based in an academic department of primary care has really helped. Our trainees attend their weekly teaching in an inspirational environment within a thriving research community. As programme directors, we took an active role in promoting and celebrating this aspect of our scheme’s identity. We also hoped to act as role models to our trainees, by sharing our own experiences of writing, research and clinical leadership.

We were clear on the importance of building specific academic opportunities into the scheme. We developed new Innovative Training Posts with organisations such as the Kings Fund, the BMJ, the BJGP and our own academic department of primary care and public health. These posts, which all of our trainees have the opportunity to undertake in ST1/ST2, have been incredibly popular. The trainees in these posts have learned new research and writing skills and achieved numerous publications and blog posts (https://goo.gl/nzUOaA) which they have proudly shared with their peers. As PDs, we have provided individual mentoring and guidance to our trainees in helping them to shape and develop their ideas, backed up by medical writing workshops. We are also currently developing new academically focussed workshops, such as one on evidence-based practice, which we aim to share across NW London. We are encouraging our trainees, whether academic or not, to attend relevant academic conferences such as SAPC, RCGP conference, and ASME and AMEE meetings.

Alongside these non-clinical academic opportunities, we have created two local flagship academic practices to support local research, teaching and innovations in healthcare delivery. Crucially, this has allowed several trainees to maintain their academic skills and knowledge after they have completed their training. For example, one is a Darzi Fellow in a local Clinical Commissioning Group leading on service redesign and children’s services in a deprived area, and another is redesigning diabetic services to be delivered out of a hub practice.

The scheme is only four years old and we know we have a lot more to do and learn. These are just a few practical examples of how academic primary care could seep more deeply into the training of future GPs. We would love to hear about others’ experiences or ideas. Academic general practice has brought prestige to general practice in the UK and around the world; it has also shaped clinical practice and health policy. In a rapidly changing primary care landscape, couldn’t we create more such opportunities for our GP trainees as we prepare them for the future careers they say they want – varied, prestigious, intellectually challenging, flexible, and full of exciting possibilities? And perhaps with more trainees and trainers engaging with the academic primary care world, GP academia might feel more relevant and less like an ‘ivory tower’ to those on the frontline.

Graham Easton, Martin Block and Samia Hasan
Imperial College, London
[email protected]

Acknowledgements

The Department of Primary Care & Public Health at Imperial College London is grateful for support from the NW London NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC).