First5®—a UK initiative relevant to the global general practice community

Abstract

In 2009, the Royal College of General Practitioners (RCGP) in the UK created the First5® initiative to support new GPs through the first years of independent practice. For new GPs, finishing training and taking the first steps into a career in family medicine is an exciting but also challenging time. The RCGP and fellow Wonca organizations are well placed to support young colleagues through this transition period. The First5® initiative is based around five key pillars, which help to support new GPs by ensuring they are well represented, supported and encouraged by their member organization. Peer support, mentoring, career guidance, revalidation and tailored continuing professional development are just some aspects of the programme. This article describes the origins and key components of the concept then explores the progress which has been made to date. The challenges faced by new practitioners are not unique to the UK, or indeed to general practice, and we hope that the First5® initiative will inspire colleagues across Europe and around the world.

Key words::

• General practice
• family medicine
• education
• representation
• support
• Wonca

KEY MESSAGE:

• The RCGP First5^® initiative is empowering new GPs by supporting their professional development and allowing their voice to be heard.

Introduction

First5^® is an initiative that has been developed by the Royal College of General Practitioners (RCGP) in the UK since 2009 and aims to support new general practitioners (GPs)—also known as family physicians—from the time of completion of training through the first five years of independent practice (1). First5^® is about empowering the next generation of new GPs, encouraging their energy and enthusiasm and equipping them with the skills needed to lead the profession in the years ahead. The concept seems to have captured the essence of what being a new GP is all about and given an identity to this somewhat lost tribe.

The idea of supporting new GPs through the crucial early years is relevant to Wonca member organizations across the world. Healthcare systems across Europe differ in terms of size, organization and funding, but evidence has shown that primary care is fundamental to cost effective healthcare (2). Supporting new GPs to be able to manage patients to a high standard and lead the profession is fundamental to countries across Europe now and for the future. Some other organizations, such as the Vasco da Gama movement in Europe, recognize and embrace the new generation of GP, as well as trainees.

This paper describes the UK experience of setting up the First5^® programme and is hopefully significant to many fellow Wonca organizations. So, where did First5^® start from, what did we want to achieve and how far have we got?

Starting Out

Challenges

Becoming a new GP can be both exciting and terrifying. In the UK, general practice has the shortest training period yet the largest curriculum of any specialty. Training is at a high standard and trainees are well supported by their trainer and local education provider. After three years, the new GP can join the world of the independent practitioner. The UK and England in particular, is seeing big changes in its healthcare system (3,4). The landscape that trainees saw when deciding to enter general practice, may be very different to that which they find on completing their training. Traditionally, new GPs aspired to become partners (profit sharing owners of the business) in a practice but the availability of this form of employment has significantly declined in recent years. It is more common for new GPs to work as salaried employees or locum in several practices (5). The general practice workforce has become increasingly female and the desire to work part-time to combine career and family life is increasing (6). A recent review of training in the UK recommended that the length of general practice training should increase from three to five years, but this is yet to be realized (7). In the past, higher professional education (HPE) funding from central government provided an opportunity for newly qualified GPs to undertake further training in the first two years after qualification, but this provision has largely disappeared (8). The GP trainees committee at RCGP recognized these challenges and realized that as a UK wide organization, and member of Wonca, the College was well placed to support new GPs through the early years of their career and beyond.

The First5^® concept and aims

The trainees committee developed the concept of First5^® as a way for the College to support new GPs from completion of training through the first five years of independent practice. The concept was originally described by five key pillars (1), which are listed again here to explain the foundations that the First5^® programme has been built on since 2009.

Connecting with college—promoting a sense of belonging and appropriate representation for the First5^® cohort within the college. For the past 60 years, the RCGP has worked to promote high quality standards in general practice, in the UK and around the world. The influence of the College, however, depends on both the number and engagement of its members. Traditionally, a large proportion of committee members within RCGP have been more senior members of the profession with new GPs being under-represented. The First5^® initiative called for a move towards greater representation for those members at the start of their careers.

Facilitating networks—encouraging peer support and mentoring through the development of local networks using the RCGP structure. GPs who have recently completed training can feel isolated and may initially be under confident in their new role outside of the supportive training environment. Understanding that others may have similar feelings and worries can be reassuring and establishing processes for mentoring and small group learning to support new GPs through the challenging early years was an important aim for the First5^® initiative (9).

Supporting revalidation—offering support through revalidation for those in the first five years after training. The UK will see the introduction of revalidation for medical practitioners in 2012. This is a system where all doctors will be required to demonstrate they meet a minimum standard required to practice every five years. New GPs are more likely to be undertaking work in short-term salaried positions or as locum doctors so may find gathering the evidence for revalidation more challenging than GPs in more established posts. The First5^® initiative aims to support new GPs through the revalidation process.

Career mentorship—highlighting the opportunities a career in general practice offers and helping new GPs get the most out of being a GP. A career in general practice offers a huge range of opportunities. From choosing whether to work in an inner city, suburban or rural location to developing a special interest in a clinical area to spending time in education and research, no medical career offers a greater variety. The First5^® initiative aims to support new GPs by providing information about career opportunities in both the UK and internationally, drawing on the wealth of expertise which exists within the College.

Continuing professional development (CPD)—identifying areas of CPD, which members in the first five years feel are not well provided and developing materials that will address their learning needs. Continuing Professional Development (CPD) is an essential part of general practice, which ensures GPs improve their knowledge and skills throughout a professional lifetime. At the end of training, trainees should be competent in most areas of clinical practice but can lack confidence in areas such as leadership or practice management. The First5^® CPD project, started in 2009, aimed to identify the educational needs of new GPs and develop tailored learning materials specifically for this cohort.

First5^® Progress to Date

The First5^® paper describing the concept and action plan was fully supported by RCGP Council (the decision making body at the College) in November 2009. Over the past three years, the First5^® team has worked to make the concept a reality. Fellow Wonca organizations could consider a similar strategy to support the needs of their new general practitioners or family doctors. It has been vital to work across College departments to achieve the aims of the First5^® project and to avoid creating silos or duplicating work. We have worked collaboratively with many departments within our organization (including research, education, curriculum development, centre for commissioning, marketing and public relations) to get the First5^® initiative off the ground.

Connecting and networking

It is important that new GPs feel a part of, and are supported by their member organizations. Colleges should represent members at all career stages at both a local and national level. The First5^® initiative has used existing RCGP structures to provide a voice for new GPs and also used innovative methods to communicate with the new GP membership. We have also written widely about the First5^® concept to ensure the vision is clear and consistent.

Local. We have created a network of First5^® leads in each of the RCGP regions (also called ‘faculties’) across the UK. These are First5^® GPs keen to promote the concept and vision locally. Each faculty lead is a member of the RCGP Faculty Board in their region and provides new GPs with a voice at a local level. Faculty boards are responsible for appointing the First5^® faculty lead using their usual processes. Each faculty lead is also a member of the First5^® discussion forum; a closed online group, which allows discussion about all matters relevant to new GPs. Senior College officers, including the Chair of RCGP, are on the discussion forum meaning the voice of new GPs is really heard at the highest level. We held the inaugural First5^® faculty leads meeting in May 2011 at the College headquarters in London and the leads met up again at the annual RCGP conference. However, we continue to communicate electronically on a daily basis via the online discussion forum. Many leads have organized First5^® networking events, which provide an opportunity for members to get together and potentially form First5^® CPD groups. Faculties are able to bid for funding from a reserve held at RCGP specifically allocated to support networking activities.

National. We have requested an allocated First5^® seat on the Council (the national decision making body of RCGP) as currently new GP members are underrepresented. Three First5^® members stood for national election to the RCGP Council this year and one candidate was successful. Many, many Council members, however, have been supportive of the First5^® concept and while we do not yet have an official First5^® seat on the Council, the concept and vision does seem to be well supported at the highest level through existing Council members.

Communicating

It is vital that any membership organization has effective communication with its members for both listening to members views and conveying important information about the latest developments. This is particularly important for new GPs and we needed to embrace innovative ways of engaging the new generation of GPs.

First5^® e-newsletter and social networking. The First5^® team was amongst the first at RCGP to embrace social networking. We regularly post on our Facebook group (RCGP First5) and tweet about issues of relevance to First5^® (@RCGPfirst5). We also have a monthly e-newsletter, which goes to all First5^® members. The e-newsletter is in the format of the five pillars and discusses latest advances in the First5^® initiative and welcomes members to join the latest debate on our Facebook page.

Annual conference. The RCGP annual conference in 2010 provided an excellent forum to launch the First5^® initiative. The 2011 conference saw a large First5^® presence with designated First5^® sessions and a First5^® social event. We held a fascinating debate about the ‘Lack of Partnership Opportunities for New GPs,’ which included a debating team for and against the motion involving senior college officers and new GPs. In the discussion, many audience members started their questions with ‘I am a First5^® GP from舰.’ suggesting the concept has given an identity to this group, which they clearly welcome. We also held a First5^® Leadership taster session and a ‘First5^® to last5’ CPD workshop looking at the educational needs of GPs across their life cycle.

Continuing professional development

The First5^® Continuing Professional Development (CPD) project started in December 2009. The main objectives were to identify the CPD needs of First5^® GPs, develop materials to support their needs and ensure collaborative working across the College, which would benefit First5^® members. This is the area of most progress so far in the First5^® initiative.

Here, we describe a few key areas that fellow Wonca organizations may wish to consider if setting up their own new GP CPD support programme.

Identifying areas of CPD need. The first objective was to identify the learning needs of new GPs, which were not well addressed by existing CPD provision. This information was gathered from a variety of sources including a literature review (10), survey of the new GPs membership (11), discussion via the First5^® online forum and social media channels. The main areas of CPD need were found to be practice management, leadership, work-life balance and becoming a partner. First5^® GPs wanted to learn in a variety of formats including courses, small groups, online learning and using reading materials. There was also a need to support the formation and organization of CPD groups. We also tried to align with other areas of work in the College, which included Commissioning and Child Health.

Developing CPD. The second objective was to develop CPD materials to support the learning needs of First5^® GPs. In the survey, First5^® highlighted that they want CPD material in a variety of formats. We have, therefore, developed ideas for CPD materials around face-to-face courses, peer group learning, educational articles and a practice based development initiative. The format of First5^® courses has been developed and piloted to ensure they meet the specific needs of First5^® GPs. The courses all involve a single facilitator running a one- to two-day course for around 30 First5^® delegates. The main challenge has been preventing private competitors using the First5^® name and College infrastructure to support and market their courses. The name First5^® has now been trademarked by RCGP to prevent this.

New GPs often miss the support enjoyed during the GP training scheme. Being part of a small group, which meets regularly, can be an excellent source of peer support and provide a valuable forum for educational activity. We wrote a guide to provide a framework for forming and running a CPD group (12). The guide includes forms for planning and recording educational activity, which can be printed out for the appraisal folder or uploaded as an attachment to the revalidation e-portfolio. We are now developing online materials to support First5^® CPD groups.

InnovAiT, the RCGP journal originally designed for GP trainees in the UK, is also a valuable resource for CPD activity, which now remains available to GPs after training.

Conclusion

The RCGP First5^® initiative is empowering new GPs by supporting their professional development and allowing their voice to be heard. The term ‘First5^®’ is being used in the language of the whole general practice community suggesting a valuable identity for new GPs. New GPs in Europe and around the world have a lot to offer their practices, Wonca organizations and the wider healthcare community and their energy and enthusiasm should be encouraged by all those who care about the future of healthcare.

Declaration of interest: Dr Clare Taylor chaired the AiT Committee 2008–09 and wrote the First5^® paper, which was endorsed by RCGP Council November 2009. She is currently First5^® Clinical Lead at RCGP. Dr James Parsons originated the name First5^® and the Five Pillars. Professor Nigel Sparrow is the Chair of the Professional Development Board at the RCGP overseeing the First5^® CPD project. Dr Clare Gerada is Chair of RCGP Council. Dr Colin Hunter is Honorary Secretary of RCGP and a member of the First5^® Discussion Forum. Professor Amanda Howe is Honorary Secretary of RCGP. First5^® is an RCGP Trademark.