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Four options for a portfolio career

Considering branching out and developing a portfolio career? Dr Steve Leung runs through some of the main options.

A portfolio career for a GP is defined as pursuing more than one area of work, with one usually outside the traditional general practice setting. There are a wide range of income streams you could pursue as a supplement to your partnership or main salaried work.

You might be interested in a portfolio career to get better variety or fulfilment in your work, pursue a particular kind of medicine – such as police work – or perhaps because there is a lack of suitable salaried opportunities in your area.

 

Preparing for a portfolio career

If you are considering a portfolio career, it is important to first ask yourself what you are trying to get out of it. What's your motivation: variety, flexibility, ambition or salary? Whichever of these four is your driving motivation, you need to consider all four when pursuing a portfolio career.

When thinking of going down this path, a common limiting factor is your financial considerations.

What is the minimum income you would be happy with? Some work pays better than others – for example, conducting an appraisal could earn £500-600, whereas writing might not pay at all, especially when you are starting out.

Another area to consider is your current work commitments. It is worth having a discussion with your partners or current employer about your desire to develop a portfolio career, and it may be that they will support your professional development if your interest helps them.

Teaching, GPSI and medical politics work often fall into this category, and it is not unusual for practices to release partners for sessions in exchange for money earned to be paid into the practice.

Salaried GPs may need to negotiate a reduction in clinical sessions, but always check your contract of employment and make sure you give the required notice period.

Once you have decided what you want to do, you need to work out a financial plan. Make a list of your monthly outgoings and make sure your plan will support your financial commitments.

Make a list of the costs in the first year, including training and any new equipment you'll need, and decide how you will pay for them. Account for cashflow – which might be patchy or untimely for freelance work, for example – and decide how much of a ‘cushion' you'll need.

There are many potential careers for a GP to expand into, from the traditional areas of teaching, writing and clinical governance to the new world of commissioning, blogging and running a website or podcast series.

Here are four options to get you started.

1 Clinical governance and judging fitness to practise

Who it would suit

These kinds of roles primarily suit GPs who want to drive up standards of medical care for the whole NHS. You will need to be able to assimilate and analyse complex information, and be able to make sound decisions without bias.

What it involves

There are lots of strands to clinical governance, such as being an appraiser or doing audits for your out-of-hours services. You could also work as a medical panellist at GMC fitness to practise hearings.

As a panel you hear evidence on cases where a doctor's fitness to practise has been questioned, make findings of fact, decide whether their fitness to practise is impaired, and decide what sanction, if any, should be imposed.

You will receive induction training and be required to attend annual refreshers.

What it can lead to

You will get an abundance of networking opportunities with other lay and medical panel members, who are usually very highly qualified. In a clinical governance role, I met several tribunal judges who opened my eyes to opportunities available for GPs in other kinds of tribunal.

Experience in working for a national regulatory body can be also be relevant when applying for senior positions such as medical directorships.

Best thing

Working with doctors and non-medical panellists to protect patients, uphold standards in the profession and maintain public confidence in the profession.

Worst thing

Some cases can be complex and stressful, demanding a lot of time and attention,

and there is no natural career progression.

Time commitment

Medical panellists are expected to commit to a minimum of 20 days each year, usually in blocks of five to 10 days. Some hearings last for only one day, but others run for several weeks or months. Panellists who are not based in the area where the hearing centre is located will need to stay in local hotels.

Remuneration

There is a daily fee of £310 or GPs may claim up to £430 a day to cover locum costs. Panellists can also claim reasonable travel, hotel accommodation and subsistence expenses.

How to get started

The GMC recruits panellists for fitness to practise hearings from time to time and will be doing so this summer.

Posts are normally advertised in the BMJ and on the GMC website (gmc-uk.org). This summer, the GMC's adjudication will transfer to the Medical Practitioners Tribunal Service. For local governance roles, try contacting your local PCT, out-of-hours service or walk-in centre.

2 Teaching and training

Who it would suit

This role appeals to GPs who are patient and enjoy sharing knowledge – whether on academic topics or practical subjects such as consultation skills.

It would not suit those who are disorganised, impatient or can't support the range of learning styles you'll find at this level of education.

What it involves

I teach GP registrars at the out-of-hours service and run some sessions at the local deanery. The out-of-hours sessions – including interactive teaching and ward rounds – take about two and a half hours each week although sometimes I need to prepare beforehand; much of this counts towards personal development goals for appraisal and revalidation. You can often learn about new guidelines from registrars on the job, too.

What it could lead to

You develop your workplace as a training practice, and the more academically inclined can consider a career in medical education. Talk to your local medical school and deanery for opportunities to further your career.

Best thing

Seeing trainees develop skills and confidence, particularly in areas such as communication and consultation skills.

Worst thing

Teaching requires co-operation on both sides, and when pupils are uninterested in your lessons it can be very demoralising.

Time commitment

For an out-of-hours trainer, hours vary. For a GP tutor at a university, it tends to be one or two sessions per week. GP trainers usually build this work into full-time practice and training days, and the role can be split with a colleague at your practice.

Remuneration

Usually £200-£350 per session at a university or deanery. Our local out-of-hours provider pays a £23 per hour supplement on top of normal rates for supervising registrars – quite lucrative.

How to get started

Contact your local medical school and ask about teaching opportunities for GPs. You can also try talking to academics already working in schools of primary care at local universities.

3 Writing and blogging

Who it would suit

Writing suits GPs who would like flexible work, and who have ideas or opinions they would like to share with others, or who have been told they write well. It can be lonely and time consuming work, so if you find it hard to commit to deadlines or motivate yourself it may not be an ideal choice.

What it involves

Building a contact book, establishing yourself and getting regular commissions. Most people start by blogging, which develops writing and editing skills, pinpoints the areas you're interested in and provides a good writing sample for prospective editors.

What it could lead to

Unpaid work and blogging can lead to paid opportunities, and a regular column can lead to book deals.

Best thing

Feature articles in national publications can get you publicity and build your profile.

Worst thing

It can take hours to write an article, often for no monetary return.

Time commitment

Very flexible if you're a blogger; writing a book is a serious commitment, and working as a consultant or columnist to a magazine might take a day a week. Dr Keith Hopcroft, Pulse's GP adviser, works one day a week in the magazine's office.

Remuneration

Online writing rarely pays, but you can get up to 50p per word for a feature commission. If you get a book deal you might earn about 10% in royalties. If you self-publish a book through Amazon you could earn up to 70%, although you may have to hire editorial professionals to help you prepare the manuscript.

How to get started

You can set up a blog using free websites – the two most popular are wordpress.com or blogspot.com, or wordpress.org if you want to host your own blog. Contact publications and journals you'd like to work for, and seek tips from published authors and bloggers whose work you enjoy.

4 Setting up a business

Who it would suit

GPs who are driven, passionate and entrepreneurial are likely to find setting up a business easiest. It would not suit people who need or would rather have job security and a stable income.

What it involves

There are opportunities all around the NHS to improve inefficient services and systems. When I worked as a locum I saw how inefficient and expensive it was to book GPs through agencies. Colleagues and local practices gave me their ideas about how the problems could be solved. Having worked as both a locum and an employer and with knowledge of web development from other businesses, I was able to come up with a solution.

What it can lead to

In my case, rLocums.com is now a successful business, and we are rolling it out across the country. I sometimes get asked about my exit strategy – mainly, whether I'll sell up – but it's too early to say. I have already been approached to expand the service into other sectors and I'm pleased to say the work still excites me.

Best thing

When you run your own business you are your own boss, with the freedom to work how and when you like. You can pursue your own ideas and ambitions, with potentially unlimited rewards, while improving services at the same time.

Worst thing

You will make mistakes, it can be very time consuming, you can lose out financially and there's no guarantee you'll succeed even if your initial idea is a good one.

Time commitment

This varies depending on what you are trying to do and who you are doing it with. It took about three months to set up rLocums.com and a further six months to get running smoothly. It still takes me 10 hours a week to run the site – and setting it up was incredibly time consuming.

Remuneration

The money depends on the profitability of your business and your cut, if you are building your business with a partner. A successful business can generate revenues far in excess of a full-time partner – but it is also not unusual for businesses to make a loss in their first year. I had access to savings and that capital really helped me in the initial development phase of the website. I no longer have to worry about generating an income to pay the bills, though I still do locum and do out-of-hours work to ensure I am not de-skilled.

How to get started

Start thinking of potential solutions that would improve the NHS, while running as a profitable business at the same time. If you lack the resources for a start-up – such as IT or finance skills – consider outsourcing or finding a like-minded partner who does have them.

Formalise your idea by writing a business plan – if you get stuck along the way, identify experienced people who can help.

Dr Steve Leung is a GP in Leicester and medical director of rLocums.com

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