My fruity answer to ulcers
Dr Vicky Weeks explains why there's never been a better time to become a portfolio GP
‘GPs want – and need – to be able to balance their careers with their family life and other interests'
The news item in Pulse said it all1 – women make up 80 per cent of the net increase in GPs since last year, with 60 per cent of registrars now being women, and one GP in four now working part-time.
Between 25 to 33 per cent of the workforce in any one PCT area will be sessional GPs.
Increasingly, working in the surgery is being seen as only one element of a GP's career development and there is a growing acceptance of the concept of the portfolio GP.
For example, credence has been given to the GP who may want to do a proportion of clinical work, but also wishes to develop a special interest in a clinical specialty, or in medical politics, or as an educationalist.
But what are the factors that have recently made becoming a part-time GP an increasingly attractive and viable option?
In the last few years there have been major and fundamental changes to the organisation of general practice, with more far-reaching changes yet to come.
These will significantly impact on the provision of GMS and open the gateway for more GPs seeking a flexible career.
The most recent influence on the way we work in general practice was the introduction of the new contract in April 2004.
Not only did it herald a radical revision of general practice organisation and funding, it also provided the catalyst for practices
to review their internal organisational structures.
Practices started to look at the range of patient services they could offer, the systems they needed and the skill mix necessary in order to provide these services effectively and efficiently.
They also began looking at the new options open to them, including employing a salaried GP in order to complement their team. The new contract also provided for out-of-hours to be provided separately.
With the new contract came the model terms and conditions of service for a salaried GP employed by a GMS practice or PCT, which were published as part of the supporting documentation.
Under the NHS (GMS contracts) regulations 2004, the contractor may only offer employment to a GP on terms and conditions that are no less favourable than those contained in the model.
Hence, from 1 April 2004, all GMS practices and PCTs offering employment to a salaried GP must do so using the model terms and conditions of service.
For the first time the contract provides a definition of what should be regarded as full-time – that is, 37.5 hours or nine sessions per week.
It also provides for at least four hours a week, on an annualised basis, of protected time for activities related to professional development, and appropriate time for part-time GPs.
Not only that, at last we get protected time for continuing professional development, set out in the job plan.
It replaces the old Dickensian system, under which continuing professional development was a triple whammy – you did it in your own time, funded it yourself out of taxed income, and had to pay for additional childcare.
Of fundamental significance is that, for the first time, all previous NHS service is recognised for the purpose of assessing the period of continuous employment under the salaried GP model contract (and this includes work as a locum).
This enables salaried GPs to become eligible for maternity leave payments, and to qualify for sickness benefit payments, where previously this most probably would not have been the case.
Improving Working Lives2 plays a significant part in how we think about our careers. GPs want – and need – to be able to balance their careers with their family life and other interests.
Work patterns are changing, influenced by the increasing mobility of the GP workforce.
The majority of doctors now qualifying and working as GPs are female. But male GPs also are increasingly wanting to work in the surgery less than full-time, so that they are free to develop other medical-related interests.
No going back
For some, the springboard to the development of this style of career has been working as a salaried GP, because it provides the means to manage that crucial work/life balance.
Whatever the future holds, GPs will continue to need a flexibile approach to their career pathway, whether this might be as a partner, a locum or as a salaried GP.
Each career option has its part to play in allowing an individual to build a rewarding career in general practice.
Vicky Weeks is embarking on her second year as a flexible career scheme GP; she works four sessions a week at a surgery in Southall, Middlesex, and is also GP tutor at the London deanery, north-west section, with responsibility for flexible career scheme and retainer scheme GPs – she chairs the GPC's sessional-GP subcommittee
1 Pulse, 4 June, Pg 12 www.nhsemployers.org/ EmployerExcellence/ improving_working_lives.asp