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Doctors at Work Podcast.

Episode #77

What’s a career in General Practice like? With Ranj Sagoo

Mat Daniel


Ranj tells me that General Practice in an exciting specialty with wide variety of conditions and interactions. Good communication skills and teamwork are important, as is an ability to manage uncertainty. We discuss the many different ways that GPs can work, including portfolio careers. I love the way his Practice has created structures that enable staff to connect and get support from each other.

Dr Ranj Sagoo is a UK trained and GMC licenced doctor of over 15 years’ experience. He gained his medical degree (MBCHB) at Leicester University in 2006 after which he trained in Orthopaedics and Surgery before becoming a GP in 2013 obtaining Membership of the Royal College of General Practitioners (MRCGP).

Early in his GP career he developed an interest in Dermatology and completed the Cardiff Diploma of Practical Dermatology, followed by the Cardiff Certificate in Dermoscopy. Combining this with his surgical skills Dr Ranj developed an expertise in diagnosing and managing chronic skin conditions, diagnosing skin lesions and performing skin surgery.

As he progressed in his career Dr Ranj felt that there was so much more that we can do to help people not only manage their health problems but prevent them from occurring. Dr Ranj has a firm belief that we are in control of our health and those people that struggle with their health have the power within them to regain that control. We are not destined to develop certain conditions because they are in the family, nor should people feel restricted by their health problems as they are very reversible.

Dr Ranj began to look at health as a complex interaction of multiple contexts of life. Core to his belief is seeing the person as a whole and not the illness that they present with. Developing a deeper understanding of the person, their values, purpose and their circumstances, holds the key to helping them with their health problems.

He began to explore the psychology of health behaviour and the drivers of motivation to change. Dr Ranj developed an awareness of the need for a more holistic approach to health and wellbeing. He developed a fascination with lifestyle and nutritional approaches to health and wellbeing. He has since become certified in counselling, a Professional Coach and NLP Practitioner accredited by the Association of Professional Coaches (APC) and European Association of Neurolinguistic Programming (EANLP). Dr Ranj has also achieved the Level 3 Award for Nutritional Intervention in Exercise, Wellbeing and Weight Management with the Association for Nutrition (AfN) and completed the Diploma of Lifestyle Medicine with the British Society of Lifestyle Medicine (BSLM) and is a Certified Lifestyle Medicine Physician.

With his Health & Wellbeing programs, Dr Ranj helps clients achieve their health goals by bringing together his wealth of knowledge in conventional, nutritional and lifestyle medicine. Using his skills in counselling, coaching and NLP he helps clients make deep discovery, find alignment with their values and make sustainable life-long change. A true journey to creating a healthier and happier life, not only for the client but their family and loved ones through transferable learning.

Outside of medicine, Dr Ranj is an Award-winning Fine Art wildlife artist, having won the 2022 BritishContemporary.Art ‘Artist of the Year’ award. He is also keen on sports and fitness and enjoys playing football, tennis, and kickboxing. As well as this Dr Ranj enjoys travelling and exploring different cultures and cuisines with his family.

You can find him at, Instagram @drranj_healthcoach; Youtube @drranj_healthcoach;; and The mindful Mixtape Podcast is at instagram @the.mindfulmixtape.podcast an

Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors careers. It’s part of my mission to help doctors create successful and meaningful careers. Today we’re having a discussion about general practice. Now Ranj tells me that general practice is an exciting specialty with a wide variety of conditions and interactions.

Good communication skills and teamwork are essential as is an ability to manage uncertainty. We discussed the many different ways that GPs can work, including portfolio careers. And I love the way his practice has created structures that enable staff to connect and get support from each other.

Welcome, Ranj. Tell me a little bit about yourself.

Ranj: Hi Mat. Uh, thank you for having me on. Um, so I’m a GP, um, I’ve been a GP now for the past 11 years. Um, I work as, I’m a GP partner, uh, in a practice, uh, with, with three other partners. [00:01:00] Um, and I, uh, as well as being a GP partner, I’m a medical student tutor, um, uh, FY2 and a GP trainer, GP registrar trainer.

Um, and I also do, uh, some other, uh, some other areas of interest like lifestyle medicine, uh, minor surgery and dermatology.

Mat: Thank you. And the topic for us today is about a career in general practice. So tell me what’s general practice like?

Ranj: Uh, general practice is, is, is, is very interesting. Um, it’s. I think for me, the key things I really enjoy about it are the variety, the continuity of care that you get in general practice, and also the main thing I like about general practice is kind of going on from continuity is that relationship building.

Um, so you build relationships with your, with your patients because, you know, you might see them from the time they’re born all the [00:02:00] way, you know, throughout their lives. And I think that’s, that’s a really, really interesting. For me.

Mat: And how did you get interested in general practice initially?

Ranj: Yeah, I mean, it’s been an interesting journey for me because after medical school I, I thought I wanted to go into orthopedics.

Um, so I did train as an orthopedic doctor for, um, for a couple of years. But I found, um, a couple of things. It was, a lot of it was to do with work life balance. Um, um, and I. Yeah, so that that kind of took me to thinking about, you know, other areas and other careers. And I think the, again, with general practice, it was one, the variety.

Um, secondly, the, um, you know, sort of that, that continuity of care and just being able to control kind of, you know, my, my, my plan for my future and, and, and kind of the variety of work that I wanted to do. I think that those are really important aspects. So, um, and then kind of getting into [00:03:00] general practice, I’ve found that I can do that and it’s been a really good experience ever since.

Um, so, you know, I have a number of different roles as I, as I mentioned earlier, um, and, and it kind of varies throughout my working week. So it keeps it really interesting for me.

Mat: I wonder if we could maybe kind of start somebody’s career journey from the beginning. So there’s somebody who may be an F1 or F2 listening and contemplating that.

So how does one get into general practice training?

Ranj: Um, so after, well, obviously whilst you’re training as you’re, uh, doing your foundation training, obviously you have to apply for general practice, um, training, um, and, and, and obviously we, we have a lot of, We have FY2s that rotate through general practice and I’m, like I said, I’m a foundation trainee, uh, trainer.

Um, and, you know, it’s, it, I always think it’s nice to get that general practice, um, rotation in, in foundation years because I’ve found a lot of trainees actually who haven’t, who’ve come through, who weren’t [00:04:00] thinking about general practice actually, um, you know, start to, start to think about it because they, they get, you know, They get to really enjoy it.

Um, and, uh, it’s a, it’s a training program like, you know, any of the medical or surgical training programs that they have to apply for, um, and go through, um, the, uh, sort of the, the interview process, uh, for general practice training. Uh, and the general practice training is a, is a three year training program.


Mat: what kind of skills, um, Does one need in order to get into general

Ranj: practice? Um, I think the biggest skill is, is communication, being able to, you know, to, to talk to people, um, and kind of that building a rapport, building a relationship. I think that’s, that’s vital in, in general practice. Um, I always talk to trainees when we’re, when we’re, when we’re doing tutorials and things, especially when they first come into their, their FY2 rotation.[00:05:00]

I always say in general practice. You have to kind of get comfortable with uncertainty. Um, we, we, we see a lot of complex patients, um, and everybody that kind of comes through the door, you’re always having to think about what could potentially be going on with these patients. And you have to be able to take certain, um, you know, certain, certain degree of uncertainty into, uh, into account.

You have to be comfortable with the decisions that you make. Um, so, but I think that’s a, it’s, it’s, it’s a very kind of interesting and challenging part of general, but it also makes it really, um, um, Really satisfying when you, when, and fulfilling when you’re doing the job.

Mat: So I’m wondering, I mean, what, um, what kind of a person is comfortable or how, how would a foundation doctor know that, that this is for them or that it’s not for them?

Or how, how would you develop this ability to, [00:06:00] to manage uncertainty?

Ranj: Um, so really good question. I think it’s, it only it comes with experience. And I think it also comes with having good support and training from the beginning. And that’s again, something that we really focus on in our, in our practice as a, as a training practice.

Um, I, again, something I tell my, my FY2 trainees is that you’ll hear, this is learning experience for you. Um, you know, I always, I think a lot of people like to kind of make that differentiation between a foundation trainee and a GP trainee. Because obviously they’re learning, their training is different.

They’re training to become GPs. Whereas the foundation trainees are kind of building their, you know, their knowledge and expertise from, you know, from a very early level. So I think that’s, that’s a big part of where it comes from. It comes from kind of the groundwork that you build in and then you’re kind of, you’re building your experience on top of that.

So. [00:07:00] Having that good support structure around you, you know, your supervisor, you know, knowing who to go to, because in the early stages, you know, the foundation trainees are going to need a lot of support. And, you know, we ensure that we’ve got that support kind of built in so that they can debrief after each patient, they can, um, you know, um, come to us for support with, um, you know, if, if, if they’re stuck or, or they, they need some, um, some further guidance.

And so I think it’s having that in, in the beginning is, is really important. And then, um, It’s one of those things kind of an we’re all still, we all still deal with it, you know, yourself, you, you know, you probably deal with lot uncertainty, uh, day to day and, and we still do. And also having support kind of ongoing doesn’t mean like when you finish your GP training and you’re a GP that you don’t need any support anymore.

We, we, we’ve kind of, uh, we’ve always had this ethos within our practice of we’re, [00:08:00] we’re all here to support one another. Um, so we. Kind of make sure that we can talk to one another. We always, we’ve always had this kind of open door policy at work where we can talk to, talk to one another about. about, um, uh, clinical cases or, uh, or even if we just need some, uh, you know, some support for ourselves.

Um, a really funny one is, um, myself and my, one of my, my partners, um, our, uh, our rooms are at the end of the corridor and they’re kind of opposite one another. And, um, in between clinics, we leave our doors open so we can just chat in between. And we find that’s really helpful because we could just share, just share, uh, comments and, and ask each other questions.

Um, but it just kind of, uh, you know, just kind of illustrates that we have this, this kind of very open policy that we can ask no questions, a silly question. We can ask any questions. And I think that there’s helped to kind of, [00:09:00] um, You know, support you when you’re in this kind of uncertain environment that we work in.

Mat: I’m interested in how you talked about supporting and connecting with each other. Um, you know, my impression would be that being a GP may be quite lonely because it’s just you and the patient and it’s perhaps a very different set up to somebody who is, 24 seven as part of the multidisciplinary team.

Sure. So I can see how those connections are really important. So, and you know, that idea that there’s a physical proximity, that’s really important. I mean, what, what else have you seen that works well to help create those kinds of connections with each other in that support mechanism?

Ranj: Yeah, absolutely. I mean, I was lucky that, um, from the beginning when I trained, cause this was my actual training practice as a GP trainer and I’ve been here ever since.

And I think that’s one of the things that might. trainer and the partners who were there before me kind of instilled into me and that kind of ethos we’ve tried to maintain within the practice of kind of, [00:10:00] it’s an open, you know, everyone’s doors always open. You can always ask a question, you know, nobody, you know, nobody knows kind of more than anybody else.

So I think that that’s kind of always, always been a, kind of a key thing for me. Um, so I think that works in kind of, you know, having this supporting environment. Um, other things that have worked, um, again, we have a a regular clinical meeting, um, kind of in the middle of the day where it’s only kind of half an hour long, but anybody can bring clinical cases or things they need to discuss.

And we just sit in one of our rooms and we just have a kind of an open discussion so that that works really well. Um, and even, um, And then we have certain other sort of meetings during, um, you know, during the week or the month where, you know, other clinical staff like nurses or even sort of, you know, whole team admin team meetings, um, we, you know, we can get [00:11:00] together and we can have discussions.

But like I said, you know, day to day, we We are very open. Um, and, um, and that’s the kind of environment that we like to encourage is, um, you know, making sure that we can, um, all talk to each other. I think something that’s, that’s really helped as well is we have a kind of a morning huddle. Um, so quarter past eight in the morning, we all meet in reception and the, the duty doctor for the day just does a very brief overview of, you know, who’s here, anybody missing?

Is there any, does that mean, you know, if somebody is off sick, do we need to cover just little things like that? What kind of meetings are going on in the day? Is there anything else that’s happening? And it just kind of brings everyone together.

Mat: So it sounds like that, that, that what you created is actually very similar to model to what many of us in hospital work, which is that, you know, you might meet together in the morning or you see each other at lunchtime and, you know, and every now and then you have an MDT, you know, slash [00:12:00] discussion slash conversation, you know, an opportunity to discuss.

The difficult challenges that we might face as individuals as well as the patients.

Ranj: Yeah, yeah, I think we’ve tried to because you’re absolutely right. It can be a very lonely environment. If you’re in your office all day, you know, you’ve done your morning clinic. Then you do your admin in the day and you go on a couple of home visits and then you do your afternoon.

You can go a whole day without seeing anybody talking to anybody. And, you know, if you did that consistently, it does start to become very isolated. Um, And, you know, sometimes, and it still can happen on occasions where like you’ve just been so busy that you’ve just done, you’ve got through your day and then, you know, before you know it, it’s the next day.

Um, and, but we have to, but we’ve tried to kind of, kind of safeguard against that to try and make sure that that’s not happening.

Mat: It’s interesting because in many ways it’s actually if I think of me, you know, when I do clinic Well, I go to clinic and I just sit in [00:13:00] clinic and I see patients and it’s just me, you know I don’t sometimes I have a nurse that that brings patients in but So it’s actually, it’s perhaps, maybe it’s not as different as, as I thought that it might be, um, particularly sort of with, with all of those common junctions.

I’m, I’m interested in, in, in how different practices work and what the career opportunities are, because I know that, you know, you said you’re a GP partner, you’ve outlined the philosophy of your practice, but there’ll be people, some people will be, Salary GPs or the retainer scheme, although I think that’s, that’s finishing.

So you can tell me about that. Some people will work for consortia, some people work for private companies. So, you know, when you, when you qualify as a GP, um, there’s probably quite an exciting opportunity cause there’s all of these different ways that you can have a career, you know, maybe with an EMT surgeon.

Well, I’m only, I’m going to work in a hospital or I’m going to work in a hospital, that’s it, you know, I can work in a big hospital or a small hospital. That’s my choice. It sounds like in general practice, you’re very lucky [00:14:00] because there’s quite a wide range of choices as to where a newly qualified GP can go.

Ranj: Yeah, yeah, you’re absolutely right. And, and, you know, there are so many different avenues to explore. And I think, again, that’s kind of one of the reasons why I was attracted to general practice because, you know, I, I like to have kind of variety. Um, and yeah, you’re right. I mean, I, I, after I, qualified as a GP.

Um, the, the, my, my training practice took me on as a salary GP, as part time. Um, it was mainly because I wanted to try salary GP, but I also wanted to see what, what locuming was like. Um, but I quickly found that actually locuming was quite isolating. Um, and whereas, you know, being part of a team and, you know, being, Going to a regular practice, um, you know, with, with what felt like, you know, my own team around me, um, [00:15:00] was, was kind of more of what I wanted.

And it was kind of also because of that continuity of care and being able to build relationships, which is really important to me. Um, yeah, I mean, for me personally, I didn’t particularly like locuming. Like I said, it was quite isolating because I was working through a locum agency. And there are different types of locums.

You can have long term locums when you’re doing, you know, a six month or a maternity cover or something like that where, you know, you can build that sort of continuity. But when, when you’re working for an agency, you, you could be going to one surgery in the morning, a different surgery in the afternoon, um, you know, places you’ve probably never been before, people you’ve never met before, you don’t know how different things work in the practice.

So yeah, it wasn’t particularly worth for me that, that route, but it might be for, for other people. Um, you know, that’s why, you know, being able to, to try these different things is, is, It’s quite a luxury actually in general practice.

Mat: So locumming [00:16:00] is that, that, you know, you go and you do a session and then, then you disappear.

So, I mean, what are the advantages of, of doing locums? Um,

Ranj: it’s the, the advantages are again, if you like having that sort of variety where you can, it’s kind of, you don’t mind talking in different places. Um, it’s, it’s, it’s, and kind of the type of work you tend to get is not so much the um, the complex patients you may get.

It’s more kind of same day acute stuff, um, that you may, you may be seeing. So if you like that kind of work, and also it doesn’t come with the responsibility of all the admin work and, you know, practice related work that you that you might have, um, as either, you know, especially as a partner, but as a salaried GP, because, um, when you’re a salaried GP, you are more part of the practice.

So depending on what, you know, what kind of relationship you have with the, with the partners and the practice, you might be involved in a lot more of the, um, [00:17:00] uh, you know, sort of the day to day work, um, you know, like, you know, sort of cloth work or, or the, um, work that might be available, like, um, you know, some of our salaried doctors do, uh, depending on their interests, uh, coil and implant clinics, minor surgery clinics, uh, women’s health, other things like that.

Mat: What, what’s the difference between a salaried doctor and a GP partner?

Ranj: Um, so salaried GP, uh, salaried GPs kind of work for the practice, so they’re employed by the practice. Um, obviously a partner is a person who, who owns the the partnership, um, to supply that, um, VMS contract.

Mat: So that’s the thing that, um, always, um, appealed to me is, is, you know, the idea of being a partner, because one of the things that may be in hospital, I always think, well, you know, if I wanted to buy some different paper, The, the, that’s like a six month process of, of procurement.

I [00:18:00] have to form, put the business case together, um, you know, demonstrate a need, do a risk assessment, and then I get to spend 20 pounds. I always imagined, you know, as a GP partner, you know, that must be fantastic because if you say our practice needs this, you just make a decision and, and you make it happen.

So that, that’s, I I love the, the freedom that, that,

Ranj: that brings. I think you’re right. Absolutely. I think that’s what appealed to me as well is having that autonomy of being able to make decisions doesn’t mean doesn’t always mean they get made faster because obviously there are still, um, sort of things you have to kind of navigate and you have to do within certain rules.

But it does still come with that level of autonomy where you can kind of make decisions. personal experience from our practice, we’ve always tried to be, um, kind of a leading practice. So whenever [00:19:00] things, um, you know, kind of a coming into, um, kind of into trend, we like to try and kind of move and move things along quite quickly.

Um, so, um, as an example, things like, um, Sort of developing a triage system. Um, there’s something that we, we implemented quite, uh, quite early, um, and that’s kind of become, you know, quite the norm now for, for practices to kind of triage, uh, the sort of acute patients and things like that. So. What’s

Mat: the downside of being a GP partner?

Ranj: Um, there’s a lot of obviously extra work in the background, a lot of admin work. Um, obviously there’s so many more pressures now within, within general practice and, um, we see a lot of strains on, on kind of costs and things as well. So it’s something that we’re always having to, um, to factor in. Um, there’s general practice is, is changing.

The landscape of general practice is changing now with the, [00:20:00] um, you know, with PCNs coming in, uh, primary care networks, um, where obviously there’s a, there’s a lot more influence now by the primary care network on how on how we deliver our services and how we integrate primary care staff with our staff as well.

So there’s, there’s a lot to kind of factor in.

Mat: Um, and what about the, the, the other models, you know, we talked about you can be a locum, you can be salaried, you can be partner, but what about, you know, online company, private GP services, um, private companies that, that, that run. services. What, tell

Ranj: me about those.

Yeah, I mean, it’s, I think it stemmed from the fact that obviously there’s so much demand for health services now, especially, you know, general practices, that first, first port of call is always the, the GP. Um, and I think it’s just, You know, trying to find new ways of being able to access, you know, general practice services.

Um, [00:21:00] and obviously through the pandemic, um, obviously we had to adapt some of the ways that we were working. So initially there was, um, you know, very little to no face to face, a lot of it was telephone work, a lot of video calling, um, and we, we quite quickly moved when it was safe to back to. pretty much fully face to face.

Um, but there are benefits in some circumstances. Me personally, I’ve always been a, you know, sort of person that’s preferred face to face. You know, I always think that patient doctor interaction Should be on a face-to-face, uh, level. Um, it doesn’t mean that certain things don’t work, don’t work well. I mean things, uh, I mean like teledermatology is a, is a brilliant example of something that can be done through pictures and videos and things, but maybe not so much video.

But, you know, definitely pictures do work really well and especially with, [00:22:00] um, you know, especially if you can do oscopy as well, then that’s, and, and, you know, there are, um, teledermatology. services between primary and secondary care, which is really, really good. It’s really, really helped the system. Um, in terms of kind of remote, um, sort of private companies doing, uh, sort of remote DP services again,

it’s there and it, and it, it, it does work, but there are obviously some downsides to it in that, um, I think it works mainly more for acute problems. So if someone’s got it. chest infection, water, uh, you know, water infection, something like that, then, you know, it’s an easy access way to, you know, get some antibiotics if it’s needed.

Again, it’s that thing of not being able to clinically assess the patient that, you know, that, that does, you know, create, um, the difficulty, but if it, if it, you know, if it helps [00:23:00] somebody get quick access where they can’t get it in primary care, then hopefully it’s

Mat: helped them. I hope you’re enjoying the show.

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Now on with the show

It’s interesting if I think I looked at it. I think I thought I had the chest infection and And the limitations were the, the, you know, the, the app, I can’t remember what the app was, but says, you know, we’d need to see you for this and this and the time that I looked through the list, sort of thought, okay, so what, I mean, what could you offer me remotely?

Sort of in that sense, yeah, um, as, as opposed to, you know, my normal GP practice, we’re probably same as yours. Everything’s face to [00:24:00] face, um, and, um, and sometimes, you know, I might, I might not want it face to face, but it is, so, so it’s quite interesting. Um, and I think that the, there’s, there’s quite a lot of, um, new, new ways of working sort of again, you know, if I think of, of, of my experience, you know, both as a patient, as a secondary care clinicians, sort of in terms of the roles of nurses, the roles of allied health professional, sort of pharmacist, it sounds like there’s quite an exciting landscape when there’s lots and lots of innovation.

that’s happening in terms of how care is delivered.

Ranj: Yeah, absolutely. You’re right. And that’s what I mentioned earlier about primary care networks and, um, all of these new roles now filtering into general practice. And now we, as well, why the primary care networks, we have clinical pharmacists, nurse practitioners, paramedics, um, health coaches, social prescribers, all part of the primary care.

team. And, um, so like I said, it’s a, [00:25:00] it’s a developing landscape and it’s, it’s how we kind of integrate, um, you know, all of these different people into, into the, into practice. Um, and, and, you know, we’ve had some really good experiences so far. We have a, we have a couple of paramedics working with us, um, to provide brilliant acute services, uh, you know, so they see a lot of the, day to day acute patients.

Um, it basically means freeing up time for, for ourselves and salaried GPs to see some of the more complex problems. Um, so it’s, it’s how we use these roles kind of in the most beneficial way.

Mat: And it sounds like a really exciting space to be, you know, if you’re a GP who loves innovation, who loves thinking outside the box, you know, has different perspective, you know, it sounds like a great place to be, you know, somebody who’s really keen on innovating.

So, you know, one of the things that I wonder. And this isn’t just general practice, maybe this is all of us, if, if, if all of us as [00:26:00] doctors, um, give some of the straightforward routine tasks to non doctors, then what we’re left with is the complex. stuff. Um, now, you know, you might argue that, you know, well, that’s what we’re there for.

Um, I suppose that the flip side is, is are we set to work like that? So, you know, maybe if I think that if you have 10 minutes appointment and the assumption is that nine out of 10 are going to be kids with ear infections that just need some antibiotics, then, you know, that’s fine. But if you have 10 minute appointments and nine out of 10 are people with multiple comorbidities with multiple problems that have just been discharged from hospital then you kind of think well hold on a second this is taking a lot longer than a child with with a sore throat or you know somebody with with a toenail rash.


Ranj: you’re absolutely right and we did have to and we have as well looked at the system um because yes there is. So we are seeing a lot more of the, uh, you know, the, [00:27:00] the chronic, more complex, um, cases. So actually our routine appointments now are 15 minutes. Um, so we, so we’ve adapted that, but we still have same day acute appointments because you do need to keep that balance.

You know, if we’re all seeing just chronic complex patients all day, that’s quickly going to lead to, you know, sort of stress and burnout on our, let’s say there has to be a bit of a balance, I think.

Mat: So it’s, it’s, it sounds like you, your practice is, um, Very forward thinking. Um, I’m interested in sort of you mentioned that, that, you know, you do a bit of skin surgery and sort of, and you do coaching and I’m, and I’m interested in sort of how, how did you go from being, you know, a GP that’s a standard GP, how did you branch out into these things?


Ranj: I think it’s just always. For me, I’m always on this journey of kind of wanting to learn more and being able, it kind of stems from being able to do more for, for my patients. Um, so I see dermatology [00:28:00] was something we hardly ever get taught in medical school and then in your early years in training.

And obviously in general practice, we We see so much dermatology. I mean, same, same with orthopedics and, you know, musculoskeletal problems. Um, luckily, obviously I had a couple of years of extra training in orthopedics, which has helped. Um, so again, so I do, you know, sort of a lot of joint injections and things in practice.

Uh, but dermatology was something I became really interested in because we see so many different things and

being able to, to treat those things yourself, um, Without always having to refer to secondary care and especially obviously now we know how, you know, overwhelmed in a dermatology services can be, um, is, is, is really helpful. So being so, I did the Cardiff diploma in dermatology and then I did the Demoscopy course as well.

Um, so it’s, it’s [00:29:00] nice to be able to. You know, be able to sort of see patients with skin problems, manage, you know, majority of skin problems myself, um, look at skin lesions as well, being able to reassure a lot of patients who have, you know, benign skin lesions and, and hopefully take some pressure off secondary care for not referring in things that don’t need to be seen.

Although a lot, you know, there are these, I mentioned teledermatology, we have advice and guidance now from dermatologists. So there’s a really good support now from secondary care. dermatology. But I also, what’s also been nice about doing the dermatology myself is that within the practice, um, you know, I, it’s again, I’m able to support my colleagues.

Uh, so when they have patients that they, they’re not sure about with, with skin related issues, they can bring them to me. And likewise, you know, um, it’s nice working in the practice where everybody has Um, you know, different interests, um, which, you know, so I can go to one of my colleagues who’s got an interest [00:30:00] in women’s health or a colleague who’s got an interest in diabetes.

So again, it’s that kind of that supportive, collaborative, uh, working, which I think, you know, we’ve kind of fostered in our practice.

Mat: So that, you know, the, the career. Aspect of it. So, you know this you identify an interest or a need And a willingness to self develop and then, you know, you do some training and you can skill yourself And then now you have the skills to deliver that and then how how do you how do you incorporate that then into?

into your GP

Ranj: work? Um, so I mean, it’s, yeah, so the dermatology, that’s obviously been incorporated quite easily in terms of, um, you know, what I can help with day to day and what patients I can, I can see and manage. Um, the lifestyle medicine has been a really interesting journey. And again, a lot of that for me is stemmed from the kind of the feeling of there must be so much more we can do for patients.

Um, you know, from a root cause level, [00:31:00] I think. It’s always, I’ve always had that feeling of we were a little bit too reactive, you know, kind of waiting until somebody’s either developed diabetes or, you know, had a heart attack or a stroke, and then we’re really trying to push lifestyle. Actually, we should be doing that a lot, a lot earlier on.

Um, and it kind of got me down the lines of thinking, well, if you know, What we, you know, what we currently do when we’re talking to patients and telling them, you know, we should be doing this. These are the things we should be eating. That doesn’t really work for most people, you know, just telling somebody you should be doing something doesn’t make them change those behaviors, which is why I kind of developed this interest in in coaching.

Um, because it’s all about helping people, empowering people to develop those behavior changes, those habits for themselves, seeing you know, why it’s important for themselves in order to, to, to [00:32:00] develop those changes. That’s been a bit harder to incorporate into general practice again. biggest reason is obviously not having, you know, significant amount of time with patients to, um, you know, incorporate this into, um, uh, you know, into, into your consultations because it’s, it’s having deep discussions with people.

Um, but you can, you can do it. So, you know, I’ve, You can start to do small, small amounts of it with, with patients in within conflict conversations. Um, so yeah, so that’s something I have started to integrate now. Um, and hopefully, like we said as well with the PCNs, bringing in health coaches, so there are health coaches who can then, um, you know, kind of, expand on that for us.

So if we can start the conversations, then hopefully, you know, that’s something that we can, we can work collaboratively together with the health coaches.

Mat: So if I think again, the, the, [00:33:00] the career, you know, sort of somebody listening and thinking, okay, you know, what, what’s my career as a GP going to be like, so you can do all of these things that interest you and you identify a need, you have the skills, and then some of that very nicely.

just fits into your everyday general practice work, but, but there will be other bits that don’t neatly fit into your general practice work. And it’s then a question of creating opportunities where you can be doing more of those, um, kind of things, not, not as a GP doing GP work, but as a GP doing, um, non GP work.

Is that, is that sort of a

Ranj: fair summary? Yeah, absolutely. Yeah. I mean, yeah, you’re, you’re absolutely right. So there’s a lot, like you say, does fit into general practice, but then there’s a lot, if you do develop the specialist skills, so obviously there are GPs now with extended roles in, you know, cardiology, dermatology, um, and then you can work outside of, of the, you know, general practice within community.

clinics like community dermatology clinics or community cardiology [00:34:00] clinics. Um, and that’s in closer collaboration with secondary care. Uh, so there are a lot of opportunities and obviously there is the private sector as well, but you can take your special, special, um, interest skills into the other thing

Mat: that, um, I wonder if I could just.

talk a little bit about is the leadership opportunities, because I think one of the things that I see where I am, you know, our, our integrated care system is kind of burgeoning and exploding. And there are lots and lots of GPs that I see that are working in senior leadership role doing really, really exciting stuff.

And I suppose the other thing also for us is the medical school because I think the medical school is really interested in. In having GPs, much more than ENT surgeons. Yeah. Because, you know, cause like I know about this much of medicine. So I think, so I think they’re much more interested in having GPs than they are in having an ENT surgeon.

Ranj: Yeah. I mean, again, yes, it’s, um, you know, there are [00:35:00] loads of opportunities for GPs to get involved, especially, um, from, you know, the ICB point of view, there’s lots of GPs that do work within the ICBs. Um, or the OCCGs if you like. So yeah, there’s a lot of potential. And obviously I think knowing sort of the primary care side of things, understanding how primary care works and how it integrates with secondary care is very useful if you’re going into those kinds of leadership roles.

Um, and, uh, and obviously it’s, yeah, it’s, it’s. If it’s, if it’s kind of leadership in that sense, you know, uh, is something that interests you then, then there are plenty of opportunities for it.

Mat: What kind of attributes do you need to be a really good GP?

Ranj: What kind of attributes? Um,

I think from, from kind of my perspective, I think it’s, [00:36:00] it’s always, it’s always good to have patience. Um, so being, you know, kind of calm and patient is, is, is always helpful. Um, being able to. Again, like we said earlier, sort of communication, um, is really important. Um, you know, being able to listen, listen is probably the most, listening is probably the most important aspect.

Um, so I want to talk about listening is active listening. Um, and that’s where you really. start to build rapport with patients. You know, when patients feel that they’re actually being heard, that makes a huge difference. Um, and, and that’s where you’re, you’re going to be able to do your best work as well as a clinician.

You know, once you’ve, once you actually hear what the problem is, once you understand, You know, the sort of the patient on a more holistic sense, and not just the problem that’s facing you, but actually what’s happening for that patient in [00:37:00] their lives. And you can understand a bit more and start to think about how to help patients.

So yeah, so being a good active listener, being patient and calm under pressure. Because we’re all, we’re all working under pressure and just being able to sort of be calm and kind of think and focus clearly. Uh, under pressure is, is really helpful. Uh, again, like I said, you know, being able to, um, work in a team, um, although a lot of the work is, can be isolated, but, you know, being able to work as a team and being able to

kind of be humble and know when you need some support and need, need some guidance, you know, it’s, it’s completely okay. You know, me as a, as a GP partner of company now, um, eight or nine years, I’m really happy to hold my hand up and ask a colleague, um, or even when I’m with a trainee and we’re doing, you know, [00:38:00] I’m sort of observing a trainee doing a joint consultation.

I thought, you know, I might say at the end, you know, I forgot about that. You know, that’s something that’s, that was really interesting that came up. So you’re just being able to, you know, say that, that was a learning need for me, or I don’t quite know this. And, you know, do you mind helping me with this?

Yeah, I think those are really important attributes

Mat: Um, what are some of the challenging aspects of the job?

Ranj: Um, yeah, I think the biggest challenges is sort of the, the, the, the pressure, the workload pressure, um, that’s probably the biggest one. Um, you know, day to day as a GP in itself. So, you know, the pressure of, um, you know, clinics and the amount of, um, demand there is for general practice services, but also the complexity, the increasing complexity of, you know, of patient need now, um, does put a lot of demand.

on you and a lot of, you know, [00:39:00] sort of stress and strain on you. Um, so, so that’s, that’s quite a big challenge. Um, and again, like I said, we’ve, we’ve tried to put things in to try and reduce as much of that as possible. Um, other challenges, uh, as a, you know, as a partner, there’s obviously the, um, running the sort of the, the business aspect of general practice is, is getting a lot tougher as well.

Um, you know, increasing, um, strains on, you know, costs and things like that. And also, you know, hiring staff, there’s, there is a big staff turnover because of, you know, things like the pressures of working. So sometimes you do lose staff and trying to get new staff can be a difficult one as well. So that’s a part of it.

You know, those are those are some. challenges.

Mat: And what are the best aspects of the job?

Ranj: Um, for me, it is, it is the teamwork. The team I work with is amazing. Um, and, and like I said, that’s, [00:40:00] you know, hopefully a culture within our practice that we, we, you know, we’re going to continue and we’ll always be part of the practice.

Um, so yeah, the teamwork, the, obviously the patience, um, even though they might be complex, even though they might be challenging, you know, being able to help somebody is, is always rewarding. Um, so, you know, I love that aspect of the job. Um, and, and it’s the, you know, the variety and the relationships that you build, you know, you see so many different things, you know, you might add, but.

And that’s what keeps it interesting, you know, you might have a, um, you know, a throat infection on patient and, you know, an MI walk in the next one. So it really does kind of keep you on your toes. So this is, you know, so that, you know, That’s something that you kind of thrive in. I think, I think that’s a nice pressure to have.

Um, and like I said, you know, the, um, sort of the, uh, the relationships you [00:41:00] build, the continuity of care, um, you know, patients that you see over time, how they’ve changed, especially when you’ve, you know, you’re working with somebody and you’re trying to implement new changes and you see, you know, the, the, the diabetic who’s completely reversed their diabetes all the lifestyle changes that they’ve made and, and, you know, they’re, they’re, they’re feeling so much better now that, you know, those are really, really rewarding aspects of the job.

Mat: And then maybe my final question, what would be your top tips for somebody considering general practice or for doctors at work in general?

Ranj: Um, okay. Top tips would be, um, if you’re considering general practice, um, I think it is an amazing, uh, an amazing career, a really fulfilling career. Um, it, It is about, um, you know, if you, if, if you really do like that, you know, the challenge of some uncertainty and also the variety of work, I think, [00:42:00] you know, that’s, um, yeah, it’s, it’s kind of a really, really good career.

Um, um, what was I going to say?

Top tips. Other top tips would be, um, obviously the important thing is to always be, um, sort of kind of kind to yourself and compassionate with yourself. It’s, it’s a career that, um, you know, can take its toll or whichever form of medicine, um, you kind of go into. So it’s always having that awareness of, of yourself and being able to know when, you know, you might be under a bit of stress and strain and, and, um, you know, being able to try and seek advice and help, um, where you need it.

I think that’s always an important part of it, whichever, whichever career path you go down. Um, so I think that that’s really important. And that’s for all, for all doctors, you know, there’s, there is a lot of stress and strain, there is a lot of demand on all [00:43:00] parts of the system. So we need to be able to look after ourselves and, and, you know, that’s another area where.

You know, it’s okay to, to, to reach out for help. And I think that’s an important message that, you know, we, you know, a lot to send out to everybody that, you know, it’s okay to ask for help. We’ve all needed it at some point. Um, and, and, and, you know, there are people out there to help and support you. Um, the top tips is obviously.

Enjoy the career that you’re, that you’re going into. Um, and there’s, there’s no reason why you can’t explore different careers like, you know, like I did, um, to find out what actually fit for me, what actually was, you know, really gave me the sort of the motivation and the passion to, um, you know, to, to, to kind of deliver the kind of care that I wanted that, that worked, that kind of fit with my values in, in serving people.[00:44:00]

Mat: Wonderful. Thank you very much,

Ranj: Ranj. Brilliant. Thank you, Mat. Thanks for having me.

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