Why I chose GP - with Dr Nishma Manek

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26 Apr 2022

26 Apr 2022 • by RCGP

When and what made you decide you wanted to be a GP?

As a medical student, Dr Iona Heath (past President of the RCGP) said something to me that really struck a chord: ‘in the hospital, diseases stay and people come and go, and in general practice people stay, and diseases come and go’. That really sums up the essence of general practice for me.

What I love most about GP is being a part of people’s stories, even if it’s just listening to them. And sometimes you can help to shape those stories, 30 or 40 of them every day. No story is the same, and neither is your role in it. I don’t know many professions you can say that about. It’s such a privilege.

For me, general practice also feels like one of the last bastions of clinical medicine. That challenge of dealing with uncertainty, having few tools at your disposal, formulating a plan for undifferentiated presentations, choosing a treatment pathway that’s tailored to the whole person in front of you - that feels like real medicine to me.

Finally, the degree of flexibility to shape your own career and control your own destiny in GP shouldn’t be underestimated. This isn’t something I fully appreciated at the start, but has become more and more important to me as time has gone on.

What was your biggest influence in becoming a GP?

I was lucky enough to come across some amazing GPs as a medical student. GPs like Iona Heath, David Haslam, Colin Hunter and Nigel Mathers always struck me as being really happy in their careers, and were all also improving population health on a wider scale in various roles alongside general practice.

I spent a week with Colin Hunter as a 3rd year medical student in his practice in Aberdeen. I remember going with him to see a newborn baby at home, and reminiscing with the mother about how he’d done the same for her 20 years ago. From there we went to certify the death of one of his oldest patients, where he was welcomed in like one of the family.

I found those relationships so touching, and it stayed with me ever since. Over time I realised how important that was for me in the profession I chose, and I couldn’t find any other specialty that offered that in quite the same way.

What is the best piece of advice you would give to someone considering general practice?

After medical school, a GP placement isn’t compulsory (I wish it was!) If you haven’t done it since then, I would recommend contacting a practice and spending some time there. You want to go in with your eyes open about the rewards and the challenges.

At the same time, keep in mind that exposure to one or two practices won’t be truly reflective. Just as hospital placements can vary hugely in terms of the hospital or consultant you’re with, I’ve found my enjoyment of GP can vary depending on the practice or team I’m with. Unfortunately, as most of us will have less exposure to primary care than secondary care before choosing our specialties, it can be easy to make decisions based on very few experiences.

But it’s worth remembering one of the other great things about general practice - further down the line, you’ll have the autonomy to choose the type of practice, partners, and patient population that you really want to work with. You can shape your career in general practice in a way that I think is unparalleled.

What is the most challenging part of your job?

With all the pressures on primary care, the most challenging part is feeling constrained by how much you can give to your patients, in terms of your time and the resources in the system. It can feel particularly frustrating when you want to help, but there are so many factors impacting on health that feel out of your control- like the social determinants of their health, and the availability of social care.

But I suspect those in other specialties have similar frustrations. I also think that, although we hear quite a lot of negativity about general practice in the press, it has ridden through waves of difficulties in the past - and come through it. I hope with some of the new models of general practice emerging (such as working in larger groups of practices), we might be able to tackle some of these challenges.

What do you think the future of general practice holds?

Having spent the last year working at NHS England, where I was closer to the policy and politics of general practice than ever before, I’m much more aware of the pressures on primary care. But I’m also cautiously optimistic about the future. History has taught us that enormous challenges also bring with them huge opportunities to improve.

I think the role of the GP will start to look different in my career. We’ll be working in much bigger teams that consistently include other professionals, like pharmacists and physician associates.

I think the trend we’re seeing with GP practices working at scale is also going to continue. I hope it will help us to build better relationships with the acute sector, the third sector, and other services so that we can really help our patients with the wider determinants of their health.

The only thing we can guarantee we’ll have in the NHS is constant change. But I’m positive about the future, and I think being a GP offers fantastic opportunities to shape what that future looks like. And that’s a privilege.

About the writer

Dr Nishma Manek is a general practitioner at Trumpington St Medical Practice in Cambridge. She studied at Imperial College London and her special interests are healthcare for the homeless, leadership and teaching.