General practice is facing a workforce crisis. It has been widely reported that the NHS is struggling to retain GPs and to recruit GPs willing to become partners.
But, with a ‘record number’ of doctors now in GP training, will this mark a turn in the tide for general practice?
The answer is most likely not, according to a new survey by think tank The King’s Fund which asked trainee GPs what their career plans are for the next ten years.
The survey of 729 GP trainees found that only 37% of respondents see themselves as a GP partner in ten years’ time, while just 22% plan ‘to work in full-time clinical general practice’ one year after qualifying.
Almost 50% say they intend to work part-time as a GP in the first year post-qualifying, while a further 26% say they plan to have a portfolio career with additional responsibilities alongside their GP work.
So, how can the NHS recruit and retain GPs and GP partners? What needs to be done to change the minds of GP trainees?
Partnership model
Val Hempsey, practice manager at Bridges Medical Practice in Gateshead, says GPs are leaving general practice because they ‘are not seeing the positive side of GP practice, like independent contractor status and being in a sense their own boss’.
She explains that one of the main obstacles to finding and retaining GP partners is that many practices are in negative equity with their buildings.
‘To be a partner, you have to buy into the building. It’s a big commitment to make. If you become a teacher in a school, you don’t have to buy into the school. And if you’re a consultant in the hospital, you don’t own a little bit of the hospital. It’s just general practice that has that,’ Ms Hempsey says.
In July this year, the Government launched a review into the partnership model, to look at reducing premises liabilities and see how the model can better support flexible working and portfolio careers.
The Government and NHS England say they are ‘serious’ about reforming the model, despite previous suggestions that it should be scrapped altogether.
Steve Williams, co-chair of the Practice Management Network and a former practice manager, says that while it might not be about removing partnerships altogether, the ‘traditional partnership model may no longer be fully appropriate’.
‘One simple solution is to listen to what the next generation of GPs want and start to plan for the changes that will be necessary to support primary care in the future,’ Mr Williams says.
Workload issues
The King’s Fund study suggests that the most common reason for GPs not working full-time and moving away from general practice is the ‘intensity of the working day’, followed by ‘long working hours’.
Professor Helen Stokes-Lampard, chair of the Royal College of GPs (RCGP) says it is ‘not a surprise’ that more GP trainees are planning to either work part time or opt for portfolio careers.
‘The intense resource and workforce pressures facing general practice at the moment mean that full time working as a GP is often regarded as untenable,’ says Professor Stokes-Lampard.
The RCGP is calling for an additional £2.5bn a year for the NHS, to ensure that practices get the resources they need to deliver good patient care.
Sheinaz Stansfield, practice manager at Oxford Terrace and Rawling Road Medical Group in Gateshead, says the first step to greater retention is for general practice ‘to be a better alternative for doctors to work in’.
‘Three of our GPs have recently chosen to go work abroad or to go and work in A&E or a hub because those are more preferable options for them – they get paid more and they have less work,’ she says.
Ms Stansfield suggests that general practice needs to be properly resourced, but also offer mentorship, ensure that indemnity fees are paid and support portfolio careers moving forward.
‘Working full-time doing ten minute appointments is so hard these days. So give people opportunities to actually develop portfolio careers.
‘They might not be a partner, but give them opportunities to develop leadership skills and support them to work outside the practice so they’ve got variety in their work and feel fulfilled in what they’re doing,’ she says.
