Concerns over the recruitment of GPs is nothing new. It seems that every few years, concern grows that the increasing number of GPs fast approaching retirement age will not be replaced by new trainees. Similarly, there is periodic concern that fewer trainee doctors are not interested in becoming GPs.
Recently, these concerns have been coupled with an increasing sense that where GP vacancies are in place, it is becoming more difficult to find anyone willing to take on a partnership to replace them.
And an increasing number of vacancies are being advertised as either partnered or salaried positions, if a partner cannot be found to fill a slot.
As the era of the single-handed partner GP practice seems to be at an end, does this mean there will be a new generation of practices staffed at a clinician level solely by salaried GPs?
Shadow health secretary Andy Burnham recently said he believes general practice should shift to becoming a principally salaried profession, with GPs predominately working as employees of large health and social care organisations.
His view is echoed by Colin Tate, practice director of the Range Medical Centre in Whalley Range, central Manchester and director of primary care at Manchester Primary Care Ltd, a GP provider organisation working across the city (pictured below).
“I believe that if primary care is provided in more of a trust style setup, where the GPs are not responsible for the business side of the organisation they work for, they feel more comfortable [entering the profession]. Trainees can see that GPs have a lot of boxes to tick, whereas if they work in a hospital the management is there to do that for them,” says Mr Tate.
Practice managers point to the changing culture of medical schools, which now urge students to consider their own work-life balance in a way not done with previous generations of doctors.
“There is a growth in the GP that wants a portfolio career, to do research, academic work or clinical commissioning group (CCG) work. There are some exceptions, but to be a full-time GP just isn’t as popular as it used to be,” says sole partner and practice manager at Bridges Medical Practice, Val Hempsey (see Box).
“GPs used to become partners because that was the option that was available to them,” says Mr Tate, whose own practice GP positions are 50/50 salaried and partner.
“The situation at our practice has evolved as it is now easier to get people recruited to salaried positions. Fewer GPs are now willing to run a small business, to potentially put their own house on the line, when it is harder to make that decision financially viable, particularly in deprived areas. Trainees like to come to areas like central Manchester because they get to see a lot of different pathologies. But when it comes to getting a job for life, they want to wipe the sweat off their brow and go somewhere less pressing.”
Ms Hempsey adds that with what she calls the “glory days” of primary care behind them, a number of GP partners have also seen their income fall considerably in a bid to keep struggling practices afloat.
“Salaried GPs do not have to do that,” she points out. “Many partners are choosing to take retirement now, rather than facing financial difficulties later.”
Anecdotal evidence increasingly suggests that partnerships are often vacant for months at a time, perhaps over a year, even in the kind of leafy suburbs it would once have been assumed would have no problems attracting new clinicians. Practice managers spoken to for this article reported that vacancies were often unfilled for over a year, in areas where they would have previously been “snapped up”.
It should not be assumed, however, that having partnered GPs in your practice means all its commitments will be hassle-free.
“More and more GPs are reducing their hours, either going part time or not doing evenings, not doing weekends. The status of GP partnerships varies tremendously from practice to practice but partners were always expected, in return for a share of the profits and an opportunity to pump prime the issues that were important to their practice, to work their socks off,” says John Doherty, strategic director at the Waterfoot Group of Doctors in east Lancashire and chair of East Lancashire Practice Managers.
“Now there is more of a drive towards having a work-life balance. And that means it is less attractive to new recruits.”
While they do not have the responsibility of running a business, they also do not have the automatic right to be involved in how that business is run. While this may be an attraction for some – Mr Tate estimates that around 10% of incoming GPs are not interested in settling down in one location – Mr Doherty is concerned that the number of GPs taking retirement or cutting down their working hours is leading to a loss of valuable experience.
“If we lose that kind of experience at the level where key decisions are being taken – and if all the positions are salaried – who is making the decisions? Having all salaried positions can lead to less continuity for patients.”
However, it should not be assumed that GP trainees have been replaced by a generation of future doctors who are unwilling to commit to one patient population.
“When you have a turnover of salaried GPs, there can be real issues over their expectations, where they treat the work as a locum would,
with no sense of commitment,” says Mr Tate.
“They won’t go the extra mile. When something extra has to be done, partners will roll their sleeves up and get on with it. But salaried GPs won’t always do that; they are employees and won’t do extra, without getting something in return.”
The key to preventing such scenarios, says Mr Tate and others, is to get salaried GPs involved.
“Try and involve them in all business decisions, clinical meetings, strategy setting for the future. Ask them to take leadership, to develop a service as they see fit. A lot of salaried GPs wouldn’t get the opportunity to do that. It can be difficult to get them engaged but being a salaried GP can mean a long term commitment, a job for life.” l