Abstract
Over the last 12 months, I have had the unique experience of working as an ST4 Clinical Commissioning Fellow. This report will describe the role, what I achieved during this time, and why I would recommend it to other GP trainees.
I decided to apply for the post as I was unsure what direction I wanted my career to take, which is a typical dilemma for many ST3s at the end of their training. Many of us have ideas and aspirations, however, there is not always the guidance or structured learning programmes available to develop these interests. I have always been keen to understand the role of commissioning and how this impacts on the life of ordinary GPs.
The ST4 commissioning post was advertised via the local GP training scheme. The number and type of ST4 posts across the country vary between deaneries, and it is worth enquiring early in your ST3 year if such opportunities are planned. Once I had sent a covering letter outlining my reasons for applying for this role with my CV, I waited to see if I had been shortlisted. A couple of weeks later, I was invited to an interview. Part of the interview process required a presentation on the principles of commissioning and then to apply this to a clinical area. I chose obesity as it was a ‘hot topic’ and had several commissioning elements to its delivery both locally and nationally. I was very excited to be told that I was successful in securing the position.
The next stage of the process was planning and agreeing the structure of my working week. This required a meeting with my trainer and the ST4 commissioning lead from the GP training scheme. It was agreed that 2 days of the week would be in general practice, and the remainder would be spent working for the Clinical Commissioning Group (CCG). My existing practice agreed to continue to support me as an ST4 trainee, and my current trainer continued to be my educational supervisor. The educational supervision in the CCG role was less defined, but I found that the GPs working for the CCG were supportive in facilitating ePortfolio requirements.
This further year of training provided the chance to play an active role within the local CCG, enhancing my personal and professional development. The ST4 role meant I continued to work as a GP trainee, so was able to hone my skills in general practice with the support of a trainer within a training practice. This was important as many trainees feel that 18 months in general practice does not provide sufficient experience before you begin in the ‘real world’ after qualification.
The CCG role enabled me to experience a variety of different aspects of care, which included attending the health education board meetings; this provided the opportunity to gain an understanding of how the organisation is structured and how planning decisions are made. One of the core roles of the CCG experience was being involved in planning a variety of projects. For example, I was part of the musculoskeletal workforce planning team that was responsible for reviewing current service provision and comparing it with national standards as well as exploring user experiences of the service using patient focus groups. I also was given the opportunity to facilitate presentations for Health Education East of England at a regional event for educators.
I have learnt a great deal about how commissioning and the NHS works, and this has made me appreciate the decisions required for the delivery and implementation of primary care services at a regional and national level. One of the most memorable and enjoyable experiences was a public speaking / presenting course, it really made me aware of what my strengths were, as well as showing me how I could develop my skills in a public domain.
This period of extended training has also enabled me to become a Quality Improvement Fellow and work closely with the Kings Fund. The Kings Fund introduced our team to concepts and ideas that changed our way of working within the team and ultimately improved care for the patients. Part of their approach is to work on a quality improvement project that is sufficiently complex that it can potentially lead to a post-graduate certificate qualification in quality improvement. This does sound daunting, but the project (I chose health promotion and obesity) was a vehicle that encouraged me to consider audit principles. The opportunity to work towards a post-graduate qualification has been the highlight of this post.
Working in primary care and for the CCG has provided an enriching experience with great variety, however, you do need to be organised, particularly in ensuring that you complete clinical tasks at the practice and fulfil the expectations of the CCG and project work.
There was a requirement during the 12 months to continue adding entries to the ePortfolio on a regular basis. These entries captured both clinical and commissioning experiences.
The ST4 role continues to evolve following trainee feedback and if you are considering applying for this role, I would suggest that you speak to trainees who have completed this process. Overall, I would strongly recommend this experience to any ST3 wishing to further their understanding on commissioning and those wishing to develop leadership qualities. The additional 12 months has allowed me to consolidate my knowledge base as a GP. It has also provided an understanding of the role of the GP within the wider professional environment and an insight into the allocation of health resources. I feel I am now better equipped for life as a GP.