Case study: Sarah is starting work at a new surgery after completing training 4 weeks ago. She trained on a UK vocational scheme, passing her assessments at the first attempt and kept an exemplary portfolio. Though a little nervous she is excited to be starting her new role. She meets Mike, a 43-year-old patient needing a medication review. Like many patients presenting in general practice he has multiple long-term health problems, but also several chronic symptoms that are not fully explained or described, including pain, fatigue, and low mood. Sarah is worried that she needs to investigate the causes of these symptoms. As a result of this consultation, she refers Mike for some blood tests and an ultrasound scan. Sarah increases one of Mike's medications to try and help with his pain. Meanwhile Sarah spends a lot of time during subsequent clinics and at home worrying about Mike's underlying health issues and what else could be causing them. This leads to further blood tests and a few referrals for specialist input. They meet several more times over the subsequent months and despite normal results Sarah keeps digging to find answers for both herself and Mike. His illness experience worsens - now because of the burden of investigation, Mike is finding it hard to continue work. Sarah is finding it increasingly frustrating to consult with Mike, as no apparent progress is being made and she is dreading their interactions. She worries Mike is not 'getting better' because of her inexperience. As a result of this and other personal factors she considers reducing her clinical hours as she no longer enjoys being at work. This, albeit fictitious, story may be familiar to newly qualified GPs. The Future Doctor Programme (Health Education England, 2020) sets out a vision for the skills doctors will need to support the NHS moving forwards and there is a strong focus on managing the complexity experienced with patients like Mike.
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