GP Trainees Must Proactively Learn from Specialist Practitioners.

Why GP Trainees Must Seek Experience in Specialist-Managed Cases

Introduction

General practice is a diverse and dynamic field, requiring clinicians to manage a broad range of conditions. While some complex cases—such as ectopic pregnancy, asthma, and diabetes—are frequently managed by Advanced Nurse Practitioners (ANPs) or specialist practitioners in primary care, GP trainees still need to develop competencies in these areas. However, exposure to such cases during training can be limited. To build confidence and competence, GP trainees must actively seek learning opportunities, attend specialist clinics, and engage with multidisciplinary teams.

1. Understanding the GP’s Role in Specialist-Managed Cases.

In many primary care settings, ANPs, specialist nurses, and physician associates often take the lead in managing long-term conditions and acute presentations within their expertise. Despite this, GP trainees must not assume these cases are beyond their scope. As future independent practitioners, GPs remain accountable for safe oversight, escalation, and holistic patient management.

For example:

• Ectopic pregnancy – While Early Pregnancy Assessment Units (EPAUs) manage most cases, a GP must recognise red flags (e.g., abdominal pain, amenorrhoea, vaginal bleeding) and make urgent referrals.

• Asthma – Specialist respiratory nurses often lead asthma care, but GPs need to manage acute exacerbations, optimise long-term control, and conduct medication reviews.

• Diabetes – Diabetic specialist nurses provide structured care, but GPs must still assess for complications, lifestyle factors, and medication adjustments.

2. Limited Exposure in Training: The Need for Proactive Learning

Many GP trainees may not regularly encounter certain conditions in their day-to-day clinics due to practice structures, rota designs, or the reliance on specialist colleagues. This limited exposure means trainees must take an active role in building experience. Strategies include:

• Seeking out cases – Request to see patients with complex conditions or attend review appointments with specialist nurses.

• Joining specialist clinics – Observing and participating in diabetes, asthma, minor surgery, or women’s health clinics run by ANPs or consultants.

• Attending multidisciplinary meetings (MDTs) – Engaging in case discussions with district nurses, physiotherapists, and mental health teams to understand a broader management approach.

• Shadowing in secondary care – Spending time in EPAUs, diabetes clinics, or respiratory outpatient departments to enhance clinical understanding.

3. Developing Key Competencies for Independent Practice

Even when specialist colleagues manage certain conditions, GP trainees must still be competent in:

• Initial assessment and diagnosis – Recognising presentations that require urgent intervention or specialist referral.

• Emergency stabilisation – Knowing how to manage an asthma attack, initiate diabetes rescue therapy, or assess a deteriorating patient before escalation.

• Long-term management and follow-up – Understanding the role of GPs in ongoing care, including medication titration, screening for complications, and patient education.

• Safety netting and communication – Providing clear safety-netting advice and discussing shared care responsibilities with other professionals.

4. Exam and Career Readiness

The RCGP curriculum and SCA exam require GP trainees to demonstrate confidence in both acute and chronic disease management. Even if referrals are appropriate, trainees must show an understanding of diagnostic pathways, risk stratification, and holistic care principles. Proactively building experience will also benefit future career progression, whether in standard GP roles, portfolio careers, or extended roles in areas like women’s health or diabetes care.

Conclusion

GP trainees must recognise that even when ANPs or specialist practitioners lead on certain conditions, GPs remain responsible for holistic patient care. Since exposure to these cases can be limited in training, seeking out cases, attending specialist clinics, and engaging in multidisciplinary learning is essential. By doing so, GP trainees can develop the competence and confidence needed for independent practice, ensuring they are well-equipped to provide safe, effective, and patient-centred care in general practice.