Integrated GP Fellowship: Developing Specialism in primary care and Generalism in secondary care

Dr Elin Griffiths and Dr John Rees

Programme Directors for Carmarthen GP Speciality Training


Hywel Dda University Health Board



It is widely recognised that difficulties with recruitment and retention of GPs exist throughout the UK, but these problems have become especially critical in Health Boards covering large rural areas. Therefore, the foundation and concept for this project was to encourage recently qualified GPs to stay or work in Hywel Dda UHB as Integrated Fellows, working in both primary and secondary care during their fellowship year.

Image of a stethoscope on an open book

This would inevitably mean a greater integration of primary and secondary care resulting in:

Project Aims

A number of GP practices in Carmarthenshire are vulnerable, being unable to find replacement partners for retired colleagues and unable to recruit salaried doctors to work in their practices. Continued difficulties in this regard will inevitably result in those practices “handing back” control to the Health Board. This is known to produce financially inefficient health care, with no long-term ownership of the practice and with consequential sub-optimal patient care. The project aims to place Integrated Fellows in GP practices requiring support, to ensure the stability and sustainability of that practice.

In addition, and following discussion with Health Board managers, Fellows were also placed in secondary care placements where the Fellows themselves had special interests but also where HBs had greater need of provision, requiring medical support, and often dependent on expensive locum cover.

At the end of the fellowship year, Fellows would remain as partners/salaried GPs in their original practices. Fellows would also remain as Associate Specialists or GPs with a specialist interest (GPSI) in their secondary care placement.

A unique aspect of the fellowship is that the Fellows are mentored by two experienced clinicians who provide weekly support. Finally, the fellows are encouraged and financially supported to obtain a postgraduate qualification in their chosen secondary care speciality e.g. diabetes, dermatology or emergency care.


One of the main challenges of this project was to convince the major stakeholders (the Health Board) of the value and benefits of this project and how it would provide sustainable and long term health care to our local communities.

Good communication was fundamental throughout. Being civil and patient to all stakeholders, (of which there were many), was essential. Convincing hospital clinicians of the benefit of Fellows to their individual teams was crucial. Face to face meetings to develop trust between different factions made the exemplar sometimes challenging but always fun.

Key Outcomes

Two Integrated fellows have nearly completed the Bevan innovation. Another Fellow has recently started.

Image of a diabetic testing kit

We believe that all three fellowships follow the principle of prudent health care, ensuring patients are treated close to home and in their local communities. We are confident that the diabetic and dermatology fellowship will be further developed. This will enable these Fellows to visit primary care centres, allowing secondary care to concentrate on complex type 1 diabetic patients, and enable malignant skin lesions to be seen as a priority in hospitals.

Next Steps

We hope the Health Board will make the Integrated Care GP Fellow Scheme part of their programme for the transformation of clinical services within Hywel Dda. The movement of appropriate care out into the community, closer to the patient, is an area the GP Fellows can thrive in. We are hopeful that the scheme will become an integral part of the portfolio of posts advertised by health boards.

Workforce planning is an imperative part of providing the population with the NHS it deserves. Consequently this allows patients to have the right care closer to home, reduces inappropriate variation, uses doctors’ skills efficiently and crucially, puts the patient at the centre of their care.

Our Exemplar Experience

For us, the Bevan Exemplar experience has been both supportive and professionally stimulating. Keeping onward momentum and enthusiasm can be a challenge, especially during a pandemic however, becoming a Bevan Exemplar also gave us a timeline which was essential.

Bevan Exemplar Showcase 2021