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GPs buried under trusts' workload dump

Flexible career scheme GPs

left in

the lurch

The flexible career scheme was the Government's answer to the GP shortage but after three years funding abruptly stopped, leaving many GPs in the lurch – Dr Victoria Weeks explains

Last October saw the precipitous and possibly catastrophic cessation in funding for the flexible career scheme – leaving no real alternative for GPs who had been planning to sign up.

The scheme was a Department of Health initiative, launched in 2002 to ease the recruitment and retention crisis. Over the last few years there has been a shift in the makeup of the medical workforce, with more female medical graduates than ever before, and more women are entering general practice.

An increasing number of GPs want to achieve a work-life balance, develop different strands to their career, and want to work part-time either because of family commitments or other interests such as specialist training, teaching, management, medical politics and academic general practice. The portfolio GP is here to stay.

The flexible career scheme was very successful in increasing GP numbers, and for the department, was a significant factor in attaining their GP target numbers. For the majority of the salaried GPs on the scheme, it was successful because of its principles and aims and because it did what it said on the packet.

By providing substantive part-time posts and demonstrating, particularly to practices, the advantages of part-time flexible working, with so many being employed using the scheme's model contract, it also encouraged protected time for educational supervision and continuing professional development. This was crucial, as sessional GPs have always had difficulties maintaining competency and continuing their medical education.

The scheme attracted a range of GPs, such as returners, retainers who wanted to work more than four sessions a week and develop their skills further, locums who wanted to develop a stable practice base, GP partners wanting to retire or downsize their commitment and others such as educationalists or academic GPs who wanted to maintain a commitment to general practice. Up until then there was no real niche for these GPs.

Then the funding was stopped.

Funding fiasco

The full impact of this is only now becoming fully apparent. There has been a common misconception that the monies for practice reimbursements for the flexible careers scheme (and the retainer scheme for that matter) are funded directly by deaneries.

Deaneries administer the schemes and are responsible for quality assurance, but do not deal with the reimbursements made to practices. This money comes from non-ring fenced PCT funds.

The scheme is therefore competing with every other scheme the PCTs, with their large deficits, already have to fund.

The first and obvious casualty was new flexible career GP placements. Several GPs who were applying to the scheme, either as retired partners, or GP returners, found themselves without the post they had planned their career around.

GPs currently in post should continue to be funded – but any problems over reimbursements should be raised with the LMC.

Another, but less obvious casualty, has been the creative way that deaneries and some PCTs have used the existence of this scheme to support other schemes, for example the returner scheme, or recruitment initiatives, and to develop infrastructure and invest in those skills of administration, management and leadership.

This has resulted in fragmentation and loss, with obvious implications for the future.

The loss of funding for the scheme should be viewed in the wider context of the current financial climate in the NHS. As usual, it is the soft unprotected target of GP education and support for recruitment and retention initiatives that takes a broadside hit.

What other options are there?

The retainer scheme has always served a different purpose in retaining and developing the skills of its GPs within the workforce. It is no substitute for the flexible career scheme, and is also, in some PCT areas, experiencing difficulties.

Salaried options, without a scheme, or partnerships should be considered as alternatives. But there is a tremendous pressure on partnership placements, and, as with salaried options, I am currently hearing widespread complaints that in some areas there are no jobs on offer.

I can only hope the foundations of part-time flexible working and protected time for continuing professional development laid in the flexible career scheme, and by using the salaried model contract, will help to provide a basis for continuing good employment practices – especially as we are seeing the rise of APMS and private companies as the employers of the future.

It is important that any GP is aware of what their options are, and is part of a support mechanism (whether that is a self-

directed learning group, an independent GP group), and maintains membership of their professional organisations, including the BMA and LMC.

Vicky Weeks is in her second year of a three-year flexible career scheme – she works four sessions a week at a surgery in Southall and is a GP tutor at London Deanery North West with responsibility for flexible career scheme and retainer scheme GPs, and she chairs the GPC's sessional GPs' subcommittee

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