Abstract
New GPs are well trained and well placed to fulfil the requirements for revalidation. However, the current job market predicted 20–30% cuts in National Health Service (NHS) spending and the rethinking of how we provide care will bring radical changes to the workplace and workforce. Doctors will need resilience, flexibility and a clear personal action plan to stay safe and thrive in the new culture of General Practice. For example, as a newly qualified doctor, you may find yourself negotiating a difficult partnership, struggling to meet clinical demands or wondering about what direction your future career path should take. This is exactly the kind of thing that mentoring can help you to navigate.
Although there is no universal definition of mentoring, there is a long history of mentoring or coaching as it can be called, in different professions and countries (Rogers, 2004). In 1998, a UK report on mentoring for doctors proposed the following broad definition:
The process whereby an experienced, highly regarded, empathic individual (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning and personal and professional development (SCOPME).
There is much debate in the literature about the differences and similarities between coaching and mentoring. Mary Connor and Julia Pokora define them together as, ‘Coaching and mentoring are learning relationships which help people to take charge of their own development, to release their potential and to achieve results which they value’. (Connor and Pokora, 2007).
Why is this relevant to General Practice?
Research across the UK has shown mentoring, underpinned by change management and problem solving, to be highly beneficial in potentially enhancing a doctor's personal and professional life and ultimately patient care (Steven et al., 2008). The need for mentoring now is very clear. Doctors are working in a time of unprecedented change, from endless tinkering and policy initiatives by government, the recent uncertainty in the career structure following Medical Training Application System (MTAS) introduction, increasingly better informed and demanding patients and re-licensing and re-certification approaching (Abbasi, 2008). Furthermore, the structure of training has changed with trainees feeling less supported in more fluid teams with no clear support structures. This is before the upcoming financial reforms in the NHS as outlined in the Operating framework for the NHS in England 2010/2011 to save £20–30 billion in NHS funding over the next 3 years in England.
The London Deanery Mentoring Service
The London Deanery Mentoring Service was started in 2008 to train, assess and support the mentors, individually match mentee to mentor and fund doctors and dentists in training and in their first 2 years post-Certificate of Completion of Training and GP returners. The service has expanded to include all Staff and Associate Specialist Grade (SASG) doctors and is committed to provide the service to other London doctors who do not fall into these groups but can get funding from their trust or Primary Care Trust (PCT) or decide to self-fund. There are over 100 active mentors, all doctors and dentists themselves, seeing mentees and in March 2010, there were over 500 applications requesting mentoring.
An unexpected outcome of the evaluation of a similar service undertaken by Sheffield Hallam University in 2009 was that users of the service developed leadership skills. Since that time, the London Deanery has developed an emergent vision centred on helping already very good doctors to become great, on developing talent and leadership skills, in line with the Royal College of General Practitioners (RCGP) curriculum statement ‘Promoting learning about teaching, mentoring and clinical supervision’.
The principles underpinning the London Service are that mentoring should be a voluntary, confidential face-to-face interaction between mentee and mentor, confidential with mutually agreed boundaries at the start. Mentors cannot act as advocate or witness nor does the mentor write reports or references for the mentee. It is a dedicated time for reflection, during which the mentor ‘actively’ listens and challenges the mentee's thinking but does not give advice or problem solve for them. The mentee drives the agenda, benefiting from support as they work through their own strategies, resulting in increased self-confidence, professional confidence and job satisfaction.
Alongside the Mentoring Service, the London Deanery hopes to train PCT or Trust teams to mentor, map and facilitate mentoring networks across NHS London, liaising with local Trusts, Primary Care Organizations (PCOs) and Royal Colleges, who will increasingly provide the majority of the mentoring.
Outside London
The Strategic Health Authority (SHA) network usually has coaches for new leaders as it is in their strategic plan to grow clinical leaders and to enhance performance through coaching. Contact your local SHA and deanery and ask them if they already provide coaching and mentoring; many do. Some deaneries and SHAs have lists of coaches and mentors or have established mentoring schemes. Many are on the brink of starting a mentoring scheme and encouragement from you may reassure them that you want coaching and mentoring as doctors and clinical leaders of the future. We would recommend you contact your local deanery now to find out what is available in your area. The London Deanery is happy to advise local agencies on setting up a mentoring service.
Developing coaching and mentoring as a cultural norm in the NHS will help bring about increased trainee satisfaction, improved morale, reduced absence and clear vision for the future (Abbasi, 2008). Mentoring improves recruitment and retention of doctors, resulting in safer working and training environments. Below are some sound bites from the London Deanery evaluation forms:
Mentoring has given me peace of mind since I now have a plan to tackle areas where I have less confidence in my abilities.
Mentoring has enabled me to create personally targeted learning objectives.
Mentoring has refreshed the aims of my medical career.
Mentoring has helped me address issues in my personal life that have impacted my medical career and my personal well-being.
This has been a very useful and creative reflective space. It has allowed me to reflect on what is happening in our practice, what could and should change, and how to facilitate this. It has also helped me decide on aspects of my own career development.
We have been working on providing newly qualified GPs with access to career coaching by trained mentors to enable them to realize their potential at a time of great change in the NHS. It was Rahm Emmanuel from the Obama administration who, referring to the economic crisis, first said, ‘you never want a serious crisis to go to waste. … It is an opportunity to do things that you think you could not do before’. In this current climate of radical reform in health, we find ourselves in we strongly recommend trainees and newly qualified doctors utilize coaching and mentoring to release their potential. It will enhance your strategic planning and will be better than any course!