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GPs buried under trusts' workload dump

What are younger GPs’ real career intentions?

A Pulse survey reveals that what we thought we knew about the new generation of GPs may not be correct. Anviksha Patel reports

It is widely thought that newly qualified GPs and other younger GPs are set for portfolio careers, spending less time in routine general practice. They are shunning partnerships and are more likely to retire early, the received wisdom goes.

This perception has found its way into policymakers’ decisions. NHS England has committed to make portfolio careers more attractive in a bid to attract younger GPs to the profession, as outlined in the interim workforce plan.1

In a bid to assess whether these assumptions are accurate, Pulse surveyed more than 900 GPs, placing them in five age groups:

  • Early career (23-35-year-olds) : 98 respondents 
  • Early-mid career (36-45-year-olds) : 292 respondents
  • Late-mid career (46-55-year-olds) : 311 respondents
  • Late career (56-65-year-olds) : 206 respondents
  • Late retirees (66+) : 28 respondents

Myth: younger GPs tend to favour ‘portfolio’ careers

Younger GPs on average are, in fact, working fewer hours outside of routine care – what would be considered ‘portfolio’ work – compared with older age groups. On average, GPs in the early career group work five hours a week outside routine in-hours GP care, compared with late career GPs, who do an average of 7.1 hours of portfolio or out-of-hours work.

And the early career GPs tend to work more hours in routine care than most of the other cohorts. Some suggest that this is because younger GPs are looking for normal, routine working in the early stages of their career. Dr Helen Egglestone, a GP trainee in County Durham, says this might in part be explained by training that involves ‘antisocial’ hospital shifts.

Dr Egglestone says: ‘As a GP trainee, I wonder if some newly qualified GPs are doing less non-routine working patterns as the shifts we have worked in hospital jobs when training can be extremely antisocial and very draining. I know some trainees I speak to are looking forward to having a little bit of normality within their work schedule, particularly at the start of their careers.’

GP trainee Dr Anthony James, who is a member of the RCGP associate in training committee, says: ‘For a large cohort of younger GPs, portfolio working is something that they are extremely interested in.’ However, the reality of pursuing portfolio work takes much longer, Dr James explains: ‘Young GPs still have a lot to learn about the realities of being a GP. From a non-clinical point of view, most need to learn a lot about basic finances – taxes, pensions, indemnity, how to set up with a locum agency etc.’

This view is borne out by the survey results. The cohort most likely to take on portfolio roles are the early-mid career GPs, who work an average of 7.4 hours a week outside of routine general practice.

These GPs – aged between 36 and 45 – said they have a better understanding of what they want from general practice. They said the balance of non-routine work suits family needs. One portfolio GP from Wessex says her role as an appraiser ‘reduces my stress levels and complaint levels. It’s probably the role that is keeping me in general practice. I’d very happily go into a completely non-clinical role if the opportunity arose’.

Myth: younger GPs don’t ever want to be partners

It’s indisputable that fewer early career GPs are partners. Pulse’s survey backs up official figures that show partners are likely to be further into their career. Interestingly, though, around 55% of early career GPs said they are or intend to become a partner in the future, with a further 20% saying they are undecided.

Former RCGP chair Professor Clare Gerada, an expert in GP burnout, said so few young GPs take on partnerships because that ‘we’ve told them what a bad thing it is’ and because of burdens like exorbitant premises costs.

GP trainee Dr Anthony James believes partnerships are not seen as compatible with the younger generation’s values. He says: ‘We value flexibility and variety more than previous generations and want jobs that can fit more neatly into the demands of the rest of our lives. GP partnership has not been sold as a job that fits in with millennial values.’

However, he says younger GPs may seek partnership when they are more confident – and it is clearer what type of model partners will operate within.

‘There have been a lot of changes even within the last six to 12 months. I think people feel uncertain whether partnerships will exist in the same way when they feel ready to take on the role.’

Myth: younger GPs more likely to retire early

More than half of respondents said they intend to stop practising before retirement age, and the early career GPs are only slightly more likely than most to retire early. The late-mid career GPs (in the 46-55 age bracket) were the only other cohort that were as likely to retire early.

An early career salaried GP from Bath says he could not ‘envisage’ being able to work till retirement age: ‘It is unsustainable.’ Another early career GP, from west Kent, adds: ‘The litigious climate is making the life of a GP impossible.’

According to Dr Nick Grundy, chair of grassroots campaign group GP Survival, all GPs are having problems with burnout and mistrust in the ‘shambles’ of Capita’s administration of NHS pensions. He says: ‘As such, people plan to get out as soon as they can – there is a feeling of betrayal by the system they work in.’

Conclusion: younger GPs have similar priorities to older ones

The results of this survey are broadly in line with Pulse’s 2017 poll of GP registrars2, which found 33% of GPs in training expected to be doing a GP role alongside another within five years of qualification. In that earlier survey, less than a fifth (19%) said they expected to be a partner within five years. On average, they wanted to work around 5.5 sessions a week.

What these latest figures show is that there isn’t much difference between the priorities of younger GPs and those of their older colleagues – certainly not those directly above them.

The early career GPs are less likely to be partners – but many plan to take on partnerships later in their careers. They are not working more hours outside primary care than older colleagues; they do tend to work fewer hours overall – but not by much. And they are very keen on retiring early – but so are almost all other age cohorts.

More than anything, younger GPs would like to see a decrease in workload and an increase in security around pensions. And they are certainly not alone in these demands

Methodology

The Pulse survey was launched in June 2019, collating responses using the SurveyMonkey tool. The 35 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to our readers via our website and email newsletter, with a prize draw for £300 of John Lewis vouchers as an incentive to complete it. We asked the respondents to state their age group. For ease of understanding, we labelled each group  - eg. early career (23-25- year-olds)

References

1 Interim NHS People Plan, June 2019. tinyurl.com/interim-people-plan

2 Pulse. Nearly 40% of trainees intend to take on partnerships within five years. August, 2017.tinyurl.com/pulse-registrar-survey

 

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Readers' comments (12)

  • David Banner

    Advertise for a partner 10-15 years ago? Loads of applicants
    Advertise for a partner 5-10 years ago? A few applicants
    Advertise for a partner last 5 years? No applicants

    Actions speak louder than words.

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  • In the current environment you’d be crazy to become a partner, either that or you’d have to be incredibly naive or ill informed. I say that as an ex-partner. The slight reduction in income as a sessional is more than compensated for by complete flexibility around when and where to work, holidays, lack of paperwork, lack of staff or premises or business to run, and ultimately just doing the job we actually trained to do. Continuity and sense of involvement is actually good as most locums gather a handful of practices that give the bulk of the work. To say it’s liberating would be an understatement.

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  • Early career GPs May feel that they don’t have enough gravitas to take on external roles rather than they don’t want to do them.
    Families significantly change career plans and realities - look at Ruth Davidson- no matter what the intentions. It’s real life.

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  • David Banner

    When I finished GP training 10 years ago there were very few partnerships on offer, it was either salaried or locum. Whilst a trainee in the north west, several of us didn't actually have a GP practice to do registrar year due to the sheer number of trainees . We were shoehorned in.

    Everyone knows post 2004 contract and the money grew, the partners at the time didn't want to give up any extra slices of cake.

    Two cliches come to mind

    Swings and roundabouts

    And

    You reap what you sow

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  • Agree we have all be rubber ducked by the boomers,well and truely.

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  • Q. What did the baby boomers do for us?
    A. Their parents fought ww2. They paid for it.

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  • Mandy Dingle completely and totally agree - GPs didn't want to take on more partners after the 2004 windfall - there were very few partnerships advertised, it was all salaried posts when I qualified so that's what my cohort took and what we came to expect. Then 10 years later when the money wasn't so good, people retired and the remaining partners started whining that no one wanted to be a partner anymore - well no you couldn't keep it to yourself in the good times and then expect us to share the burden when it got tough! If the partnership model is on the way out GPs are partly responsible for this.

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  • doctordog.

    The partnership model with the responsibility and earning ceiling may have its drawbacks, but it has nearly always been (much) better paid than salaried posts.

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  • David Banner

    Re Mandy Dingle

    You’re analysis is spot on. In 2004 practices replaced partners with salaried doctors for financial gain, so cannot complain now that partnerships have become toxic.

    But this wasn’t my point. Young GPs in this survey indicate they still are interested in partnerships, yet repeated adverts receive zero applicants. So clearly they’re not THAT interested.
    My assumption is that younger GPs are smart enough to realise that partnerships are an elephant trap of unlimited workload and liability, so won’t touch them with a barge pole, but are hoping that future reform may make them attractive again. Sadly, that day will never come so partnerships are on the road to inevitable extinction.

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  • Young Doctors, please dont start blaming older partners. The government set up the 2003/4 contract, because they didnt value or resprct GP's sufficiently. It cost them a lot of money which they have been since focussed on clawing back. That why general practice partnership is no longer financially viable, for the old Gp Partners, and why you young doctors rightly dont want to shore it up. Uncapped workload and falling cashflow, rising premises costs, with no repairs ever done, CQC keeping the bar high for premises/performance, GMC stick to hit you over the head when rare possibilities collide, and just blame doctors,I left partnership because I couldnt cope with the hopelessness of it, and I couldnt change it.
    111 was set up to prove you didnt need a medical degree to offer healthcare advice, so everything becomes cheaper. Sends lots of people to a&E or GP and overwhelm the system further.
    In most A&E you dont see a doctor, you see a clinical practitioner-cheaper. Lots of tests, mri etc and home, no need for medical skills, for most cases, the photo tells you the answer-usually!
    If they get it wrong, blame the few doctors left signing protocols and PGD.
    NON doctors are cheaper, the system only fails when you have driven all the doctors who carry the responsibility out of the system, and there is no-one to carry responsibility. Else it fails because too many errors. In GP we had an indemnity provider crisis, as clever accountants at mdu/mps realised they didnt want to pay the costs of rising claims. Government stepped in to make this wwork because they dont want healthcare provided by doctors, its too expensive. The new model if just better politically because its cheaper. doctors are just the washer squeezed between cost and quality, your lifeblood is being squeezed out of you.
    To end on a positive note, In New zealand, at Auckland University, the psychology department are looking at the need for compassion in healthcare, and suggest this can be best encouraged by the system having compassion for the workers. NHS england/GMC might best be reading this work, before they kill anymore doctors, and the system itself!!

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