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GPs buried under trusts' workload dump

Trainees 'shun partnerships' in favour of locum work or emigration

Exclusive Just 6% of GPs in training practices say their registrar colleagues want to take partnership roles, due to concerns over pay and workload, a Pulse survey has revealed.

The survey of 253 GPs found that almost half of GPs have been told by their trainees that they want to into locum work, with 28% saying their trainees are looking to go abroad once they have completed their training.

GP trainers have said that there is a perception among registrars that locums earn more money than partners, without the extra stress and greater demands from various Government diktats.

GP trainee leaders said that this poll demonstrated that trainees were ‘acutely aware’ of the pressures facing general practice, but also demonstrated that locum or salaried work is increasingly being seen as a ‘positive career choice’.

There is currently little data on where trainees end up after finishing their programmes, although Wessex LMC carried out a survey this year of GPs in their region, which found that less than 50% of GPs being trained currently intend to join a practice when they finish training.

Pulse’s survey, which was carried out in July and was answered by 253 GPs working in training practices, revealed:

  • Only 6% said their trainees wanted to go into partnerships;
  • 49% said their trainees wanted to become locums;
  • 28% said their trainees wanted to go abroad
  • 30% said their trainees wanted to find a salaried post;
  • 4% said their trainees wanted to change career.

GPs have warned of a potential ‘brain drain’ of recruits to Australia, New Zealand and Canada, while Pulse has reported that practices are having to close because they cannot find anyone to become partners.

Dr Steven Colabella, a partner in central Manchester, said: ‘My interpretation of the general murmuring are that many feel the partnership profits have significantly decreased and more money can be made as a locum. 

‘The pressures and work load have increased that full-time is not possible for some doctors, making locum life more suitable.  The rumours of greener pastures in Australia or New Zealand (free houses, free cars, double the pay) makes them think about a year or two abroad.  How many will go, I’m not sure.’

Dr Alice Hodkinson, a GP in Essex, said: ‘It is the uncertainty about the job and seeing how we as partners are overworked and stressed. I don’t blame them at all for looking for more comfortable options. Mind you, I would still not be salaried. 

‘Also, we lost a partner to become a locum (again) because of uncertainties about the future of the practice and income. Locum income can be very high if you are prepared to travel.’

Dr Donna Tooth, chair of the GPC trainees subcommittee, said: ‘The results of this poll demonstrate that today’s trainees are acutely aware of the pressures facing general practice and are interested in a more diverse career path than past generations.  

‘The fact that eight out of ten are interested in being locums or salaried GPs does chime with other evidence that suggests there is a fundamental change going on within the GP workforce. For many, this is not just about the pressures of being a partner, but also the fact that many aspiring GPs regard being a locum or salaried GP as a positive career choice that offers the opportunity to focus on treating patients and maintaining their own worklife balance.’

This comes as the main political parties have committed to increasing the numbers of GPs being produced, with Labour leader Ed Miliband outling plans to put 8,000 more GPs into the system, while the Conservative Party has committed to training 5,000 new GPs a year by 2020.

Recent figures obtained by Pulse from HEE revealed that 12% of GP training positions were unfilled, and the survey of career intentions exacerbates the problems in long-term GP numbers.

Readers' comments (35)

  • this is due to bitterness of being exploited by the csa and a training scheme where the gp registrar is abused as a salaried/locum doctor. if older doctors are retiring why would you join a partnership when they hate it so much?!

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  • Sometimes adults also learn some good things from youngsters. We have a generation that has been in denial about the workload and it's time to appreciate that fresh GP Trainees seem to have their eyes and ears open and give them the credit for being shrewd and logical. They want a normal life/work balance and it's not too much to ask.

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  • None of this is surprising... being a GP partner in many cases does not make any sense financially or in terms of emotional well-being. Being a full-time partner has become incompatible with a healthy family life.

    It is all very sad but was very predictable. The focus has been on the options of those who can retire early or new entrant to the profession who emigrate or locum.

    The next group we'll have to worry about will be those in the middle of their careers who can't take it anymore also leave for locum work or other options.

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  • How do we persuade them to stay on ? Pay them more money .

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  • I completely agree with all this. I finished my training 3 years ago and I have been locuming since. There is lot more money you can earn as a locum. I have got good life balance. I can work extra hours when needed and I am able to take long holidays. There is no stress of paperwork, I don't need to start early morning and I'm usually done by 5pm. My earnings are good even though I take 3 months off in a year.

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  • With hundreds of practices at risk of closure why would anyone risk their home and their family security on partnership? It's not much fun being bankrupt.

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  • The constant rant about doctors joining partnerships has a whiff of the UKIP'ers about it - wishing for the past, not liking change. The good ole days! Primary Health is changing, Salaried GP's can get on with being doctors without having to worry about a leaking roof, interpreting and actioning the new diktats from DoH & NHS and the stability of a regular salary. Locum work offers flexibility, the chance to see whats out there, almost a 'try before you buy' without the responsibility or being tied down. Lets face it, Partnerships are hardly giving themselves good PR, its all misery and doom at the moment let alone from outside attacks. Who would want to become a partner? Perhaps if partnerships organised and sold itself better rather than the introspective kamikaze misery that partnership portrays itself as being at the moment it would be a bit more attractive?

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  • Comments at 10:42 & 11:18 summarise the key points. I was a full time GP Partner for 8 years on leaving the Forces after 16 years. It was, at times, the most miserable period of my career. I made the conscious decision to get my life back 2 years ago. I now freelance across 5 regular Practices. Never felt better & actually enjoying my job again.

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  • Una Coales. Retired NHS GP.

    I am surprised 30% still want to be salaried GPs. The recent Prop 46 debate in America is about the malpractice claims cap being allowed to quadruple! This will drive up healthcare costs and many physicians will not be able to carry on working as their premiums skyrocket.

    Already many salaried GPs in America are being forced to see patients in 8 minute slots and being told not to ask open ended questions, to speed up assembly line medicine to maximise profits.

    Why not think outside of the box? Talk to a local pharmacy, rent a consulting room and charge private consultation rates?

    Or consider emigrating to NYC. A 30 year old real estate broker is worth $20 million and another $30 million at age 37 as a real estate agent. Both started out as actors! Those who passed the CSA actor exam have the natural charm to sell real estate?

    One cannot work for a socialist healthcare system day in and day out without coming under the scrutiny of the GMC eventually. I doubt real estate agents have to live in fear or have to face onerous 5 yearly revalidation?

    One call to Head Medical and they sort out many of the necessary steps towards emigration to Australia.

    I just want Generation Y to look after themselves. Plan ahead so that one day you do not regret your career choices.

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  • Secure environments GP

    I am a Partner half the week, portfolio GP, Locum the other half - edging my bets !

    I don't at all think my situation is unique, but have worked at 50+ places across all of the Midlands (WiC's, OOH, Hospitals) in 18 months between leaving and joining another partnership, now settled again. It has given me some insights that I hadn't quite expected.

    It has been very sad seeing practices lack of capacity even when all GPs are at work, let alone those where doctors are off sick, burnout, practices where GPs have just emigrated (one where a GP had died).

    Sad to see patient's complain about their practice and the service they get, about having to see "just the locum" because it takes 3 weeks before they can see their usual doctor, some so upset that their GP has retired early, reduced their sessions etc

    To see it and live it, being able to lend an ear to Practice Managers and GPs, I have come away rather concerned frankly and frustrated seeing good caring doctors pushed passed their limit.

    I suppose I look to leaders - GPC, RCGP not seeming to have the disposition for the grandstand myself. Desperate times and we must all find a way to contribute, at least to improve our lot in each locality, groups of us meet and talk, make useful step forwards. Get out of our "Silo-mentality" working 12 hours a day in our practice Prisons.

    People like Dr Clare Gerada are few and far between with this same agenda of giving the opportunity to engage more GPs and wider practice teams.

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