Our content editor Anna Francis talks to Dr Mary Favier about her position as President of the Irish College of General Practitioners and the initiatives she’s working on within general practice.
Anna Francis: Hi Mary, can you tell me a bit more about how you became the President of the ICGP and what attracted you to the position?
Mary Favier: I've been involved with the college for a very long time in a variety of roles. I started out doing the membership exams and then I actually joined the college as the first Educational Fellow on what was called the Quality in Practice Program, writing educational materials for GPs.
I did that for four years and then I took up various representative roles in the college, including chair of the Education Committee. I've been a Council representative for many years, and from there it was suggested to me that I run for president. The process involves becoming vice president first by election, then becoming president for a year, and after this you're the immediate past president; so it is actually a three-year appointment.
AF: So now you're in the position of president, what are your aims and objectives for the year ahead?
MF: Firstly, I want to work on strengthening the communication pathways that exist between the central college board and executive, the faculties that are the representative structures beneath that and the members. The college is going through an inevitable process of change. At 30 years old we first had the original pioneers who set up the college and it was very much part of their life. Then we were in a settler phase where people got used to it and sort of took it for granted. And now we have a whole new generation who may only know the college in relation to exam structures, assessments and competency testing. I want to try and encourage them to see the college as part of their lifelong general practice journey, throughout their career, whether that’s in terms of education, membership benefits, collegiality or professionalism.
Secondly, a lot of GPs feel the significant impact of Medical Council complaints that come in, even though many of them turn out to be relatively minor – some are even frivolous. But the full weight of the investigation process has to take place, however minor. So, if you look at the fact that there are approximately 3,500 general practitioners in Ireland, with about 27 million consultations a year, there are about 400 general practice complaints. But, of those 400 complaints, only two or three go through to an actual fitness to practise inquiry.
That’s a lot of activity for a very small amount of significant concern, and GPs get very upset about this and it can be very stressful. So, we're now working with the Medical Council to look at whether there are better ways this could be managed. The first principle is that we must protect the patients, and the Medical Council primarily exists to protect their safety. Yet GPs feel that there must be a better way, as many patients aren't satisfied with the way their complaints get resolved, because it's very binary – it's all or nothing. Often, they just want to be heard. So that's a project I’ve been working on with Dr Rita Doyle, who's the president of the Medical Council and who is actually a former president of the ICGP.
Another thing I want to look at is the issue of planetary health and the impact of climate change on health. What is the role of a general practitioner in trying to address some of these issues: how does climate change affect our work and what is the role of planetary health in the health of our patients?
AF: You’ve helped set up the Termination of Pregnancy service in general practice and you’re a member of the ‘southern taskgroup on abortion and reproductive topics’ (START) group – can you tell me a bit more about that?
MF: One of the things I've long been active in is the area of reproductive health, working as an advocate for women in changing the law around the repealing of the Eighth Amendment. I’ve recently been involved with the college, helping to draw up interim clinical guidance so that GPs could be trained for what was a new and entirely novel service, and I’ve been involved in the START GP group, which helped provide that training. I’ve been working with START and the director of women's health in the ICGP to support GP providers who wanted to be ready for the first of January this year, and we're very pleased with how successful it’s been.
Following this, we’re focussing on the provision of free contraception – we don’t actually have a universal coverage contraception service that people are entitled to, so we're working on that. Hopefully this will come to fruition in the next six months – it's just gone out to government-organised public consultation.
AF: You sound like you have quite a lot on your plate – what sort of challenges do you think you might see in the year ahead?
MF: Well I’m currently busy working at my general practice in Cork – I work in an area of high urban deprivation. Our practice is part of the Deep End group, which started in Scotland and is an initiative there, and now here, for groups of GPs who work in areas of high deprivation, both urban and rural, to get together to support each other, but also to look at all the research about what the particular needs and attributes are for that type of practice. We are aware of them in our own practices in terms of lower health literacy, more complex needs, multi-morbidity occurring at a much earlier age and psychosocial stressors that may be more significant.
AF: So what's your favourite thing about working in general practice?
MF: I think the variety – it’s the aspect of ‘the cradle to the grave’ and the fact that you know these people who are your patients and you follow them on their life and health journey, sometimes through their entire lives. I've been in my practice now for over 20 years. I’ve been a GP for nearly 30 years and that's a privilege. You never know what's going to come through the door on any day and what attitudes, knowledge or skills you will need, and I really like that.
For example, this morning I went through everything from a hospital discharge of a patient who presented with ketoacidosis to an early psychosis presentation; from a snotty-nosed child to the contraceptive needs of a perimenopausal woman.
AF: What do you do to relax and why do you think it's so important to make sure you have a good work/life balance?
MF: I think it’s key to have a good work/life balance because you’d never stick it out otherwise. I have two teenage children who have just gone to college, so I had spent a lot of time running around after them. But I also love to garden. Spinning class is my exercise and I will spin until I drop. It’s important to leave your ‘to do’ list in your work inbox and keep the balance. And a big element of it is that you should try and practise what you preach in terms of the life advice we give to patients.
AF: In terms of your role on the MPS Council, what drew you to that and what has it done for you?
MF: That's one of those serendipitous opportunities. I met Tim Hegan, a former GP, when I was working in Australia doing GP locum work many moons ago and he got in touch when he was later working for Medical Protection at a senior level. I hadn’t spoken to him for 15 years, maybe longer, and he contacted me saying he had come across my name in a medical article and would I consider applying for the job on the MPS Council. I applied and interviewed and got it – which is extraordinary since I didn't really quite understand what I was getting myself into.
The role was so interesting, and I learned so much – it has really informed my work. I now write medical reports for some of the Medical Protection cases, sometimes for other indemnity organisations and occasionally for plaintiffs. I like that type of work – it’s a nice cerebral break from the face-to-face aspect of daily general practice. There are very few bad or incompetent general practitioners and it’s usually the classic Swiss cheese effect that Medical Protection talks about, when the little risk holes all line up in a straight line and the bullet of harm goes straight through and hits the patient.
We all have those potential situations and there's very rarely a case that I would look at or examine when I wouldn't think that it could have happened to me. It’s provided me with very useful learning points in terms of safety in our practice and significant event auditing, and we now talk about ‘near hits’ rather than ‘near misses’. I now do day release teaching with GP trainees, looking at medical risk management, how medicolegal cases are constructed and run, why certain Medical Council cases occur and how the trainees might protect themselves against complaints and litigation.
For most of us, this centres around good notes – record keeping is everything. The majority of cases that I deal with involve competent GPs whose notes let them down a bit, and you're left with just their word against the plaintiff’s. If I could suggest one thing for doctors to always try to improve it would be their records and note keeping.