General practice - self-motivation to continue clinical work

Tell us about an incident/situation/feeling that gave you cause for reflection

Since leaving my partnership, I have not been as diligent in getting locums as I intended. There always seems to be something high priority in my educational and management roles that makes me put off getting my CV out to practices and locum sessions booked in.

I am worried that if I don’t get back into primary care clinical practice soon, I will start to lose confidence.

What made you stop and think?

I suddenly realised that three months had gone by without me doing a locum in clinical work (part of that was Christmas).

This was an internal area of disquiet, but what brought it up to conscious awareness was that I went on a mentoring course where I chose to raise this issue to discuss in a “mini-mentoring” session with another delegate. We looked at practical strategies to get over the barrier caused by moving into a new way of working – like working out what to charge and where to send my CV.

It only took 30 minutes but it was a really important and thought provoking discussion. I had not realised how much I was inhibited by having to set a price on my time and ask for money.

Tell us what you took away or learned from this experience?

I have realised how helpful it is to talk through things that seem difficult to get on with. I liked being introduced to some ideas about how to deal with procrastination – such as breaking the task down into bite sized chunks, and giving myself mini-rewards for achieving each stage.

How did it change your thinking or practice?

I have stopped allowing my fears about being a locum from stopping me any longer and I have started to take on locums in a variety of GP practices.

I have professionalised my locum work with a clear standard “service level agreement” with each practice.

I have joined the National Association of Sessional GPs.

Has it improved your practice and outcomes?

By getting back into clinical work, my confidence has been restored. I am getting more experiential learning to target my CPD, although I do have some learning needs that are entirely about this career change - such as learning new computer IT systems that we did not use in my practice.

Has it affected others?

I have shared my learning about how to deal with procrastination with some of my friends and colleagues and shared my findings on setting myself up as a locum GP with other new locums in my position (former partners with well-established links into one particular practice and team).

What top tips would you give to doctors in your specialty about how to get the most from reflection or thinking constructively about a particular problem?

• Build reflection into everyday practice. To get the most out of reflection, it needs to be something that is part of normal practice. Talking this feeling of disquiet through really helped me to work out why I was procrastinating, as it is not usually like me. I don’t think it matters whether reflection takes place alone or in a facilitated way but I do think that it is useful sometimes to take a few minutes to write something down that captures and names the feeling or problem or insight. A few good examples of reflective practice showing how I think about what I am doing as a doctor will keep my appraiser and my RO happy because they can see how I explore incidents that arise in my practice and react to them by making appropriate changes. On the other hand, I think it is essential not to waste time that could be spent with patients, or the leisure time that is so important for recharging the batteries, on a production line of documentation of reflection that becomes a burden or a chore. My appraiser has been very helpful in pointing out where I have been doing more than is needed, out of a misguided perfectionism.
• Use reflection to show how your practice is impacting on others. I am relieved to see the new guidance from the GMC and the Royal Colleges on decreasing the regulatory burden and increasing the emphasis on providing a few good quality examples of reflective practice. I aim to reflect on the most important things that I have learned every year and any significant changes that I have made to my practice. That way I can show how my CPD, and my review of my work and the feedback I get, has an impact on improving my patient care, relationships with colleagues or my own resilience.