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GPs go forth

Matt, here's what you should really do about the workforce crisis

Dr Katie Musgrave

Mr Hancock, I understand you’re looking for 6,000 extra GPs. Since it’s February - still a fresh start and all that - I’ll do you a favour and list some suggestions that could help you achieve your goal.

Please view the workforce crisis a bit like one of your beloved tech startups - a significant early investment is needed, but with time, it will reap dividends.

1. Properly reward partners for the risks and responsibilities they carry

A partnership bonus scheme, recognising the value partners bring to the profession, would encourage the next generation of GPs to take on this commitment when times look uncertain.

The NHS depends on primary care, with the partnership model central to its sustainability. 

Partners should be rewarded with a bonus tied to the number of clinical sessions they work.  Maybe £1,000 per session rewarded annually, with incremental increases to reward longer term service. 

A £10,000 bonus wouldn’t be blinked at in other sectors. If being a locum remains as financially rewarding as being a partner, GPs will continue to leave the permanent workforce. 

2. Reward GPs who work the most clinical sessions

The Government needs to sort out the pensions taper debacle as a matter of urgency. 

However, alongside this, a ‘full time GP’ bonus scheme would be beneficial. 

Partners or salaried doctors who could show that they’ve reached a threshold of clinical commitments (perhaps eight regular clinical sessions per week over the previous year) could apply - similar to the clinical excellence awards offered to hospital consultants. 

We need to reward hard work in general practice, and better incentivise full-time work.  The tax system, pension, and loss of childcare benefits for incomes above £100,000 are all discouraging GPs from working full-time.  

3. Incentivise clinical work over managerial or educational roles

In an era where GPs in clinical practice are increasingly scarce, it’s perverse to offer managerial or educational roles which are paid at a ‘GP rate’. 

When the day job is so stressful, and alternative roles are similarly paid, are we surprised when there’s a rush for this type of work? 

Rates paid by the CCG, Health Education England, and other publicly funded bodies need to be markedly less than frontline clinical work -  I’d propose pay being capped at a maximum of 70% of the average GP sessional rate. 

These are experienced doctors who have much to offer. Why are we failing to offer them the roles that keep them in practice? 

4. Make better use of the workforce 

Rather than incentivising extra work that take GPs out of their surgeries, NHS England could incentivise extra sessions during the routine working day. 

Why not fund an equivalent of extended hours appointments that could be undertaken between 8am and 6pm?

These extra sessions could be protected against other demands (phone calls, visits, extra admin) and funded, at least in part, by NHSE. 

Call it ‘year round, relentless pressures’ sessions…They could be only on offer if taken on as an extra, but would be appealing to GPs if they were flexible, with a fixed and manageable workload.

5. Support practices to offer ‘flexible partner’ opportunities

Younger women in particular need to be encouraged to take up partnerships. 

It may be the case that women could negotiate more flexible roles as partners, but the truth is that not enough do. 

The perception (true or not) is that you can only work as a partner if you can commit to an 8am-7pm day. 

NHSE could financially support practices to offer a flexible partner role (perhaps during the first decade of raising a family). 

Drawings would be appropriately adjusted to reflect the hours undertaken.  By better supporting all sectors to take on partnerships, NHSE would help secure general practice for the future, and hopefully keeping women in the profession through the challenging years of child-rearing.

6. Create advisory roles for senior GPs

At any age, being a GP is demanding. But at the end of a career, workload is driving GPs towards early retirement.

These are experienced doctors who have much to offer. Why are we failing to offer them the roles that keep them in practice? 

A starting place could be a ‘buddy system’ with a flexible partner, where a GP looking to wind down might come in to do admin work first thing, then work a partly supervisory clinical session from, say, 3.30-6.30pm. 

We need to look at the people we have and design roles that they want to fulfil.  And support practices financially to sustain this.

 So there you have it, Matt. Some suggestions for bolstering the GP workforce. These ideas certainly aren’t rocket science - you could implement them all. 

Abandon Skype consultations, DNA profiling, and your apps - we must get the basics right and keep GPs seeing patients in their surgeries. 

Getting junior doctors to enter training is the least of your worries. Only by improving the utilisation of existing doctors, and their working conditions, will you retain the newly qualified GPs that come through. 

You urgently need to invest in general practice if you want the NHS to be standing at the end of your term.  And unless you take drastic measures, you will face a humiliating failure on your extra GPs pledge.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West

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Readers' comments (31)

  • The thing that I really hate about general practice is the patients valuing your opinion as precisely worthless.

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  • Currently actually seeing patients as a partner carries the most stress, the most medico-legal risk and is the least paid.
    Well said.
    I would also say that a GP partner patient list based system is the most efficient and effective way to manage health and social concerns as there is less buck passing around the NHS and social system. The problems are much more likely to be sorted.

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  • I agree. If only he’d listen to those of us doing the job instead of to those trying to tell us how it should be done

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  • Blinkered.... Where's the money coming from Katie? I don't recall a surplus at the Treasury now, do you?

    You happy to pay 10% more tax? 20%? With no guarantee it goes to the frontline?
    There's nothing stopping you giving more to the Treasury right now if you are. Put your money where your mouth is. But hey, it's always easier to spend someone else's money, ain't it?

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  • Matt is a socialist/communist. He would never advocate anything that would grant people more individual liberty because force and coercion are at the core of his political beliefs.

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  • Sorry, disagree with many of these. I'm nearing retirement age and would not want to be committed to admin in the morning and then 3.30-6.30 slot. we need GP representation at management meetings but need it to be properly paid to backfill the clinical session ( and some variation in role helps keep the GP in practice longer). Partnership does involve working late some days and if you wish less money for better hours that is the definition of a salaried doctor ( leaving all the unpleasant work to your colleagues is not what a partnership involves ) - it doesn't have to be every day. Unfortunately rewards for long service ie seniority have now been taken away. One major suggestion which would help would be to stop changing the funding/targets every year.. the new contract 2003 was supposed to take away all the claims for eg contraception, maternity care with a global sum trusting the GPs to do their work. It is worse now than ever chasing all the points and prizes to make sure the partners get paid (everyone else has guaranteed salary )

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  • christopher ho @0142

    What Kate is suggesting could easily be delivered with the money currently being wasted on PCNs. I have often thought about the same measures. The fact is that successive governments have wanted the partnership model to fail to enable HMOs to form. The DoH know all this but choose not to admit it.

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  • There are currently two models of GP running on parallel, dwindling partners struggling to deliver ever more stringent targets and specifications and Locums detached from reality. It is a myth to say that there are not enough GPs. There are enough but not doing enough core work. I don’t see accountants saying I won’t do tax returns but I’ll do VAT returns.

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  • CH,
    As usual an ideological rant.
    Apparently there's a spare £100 billion for a shiny new railway, not to mention a bridge to Ireland!
    He promised us an extra £350 million a week!
    We can go to war at the drop of a hat if it funds a politician's "Legacy"
    Stop spouting guff!

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  • What a con | GP Partner/Principal17 Feb 2020 12:

    - so.... Either you want the state to tail back 'other bits' of the NHS, and just spend more of the money on us.... And/Or as per our editor's position at 1 point, give us the money with no strings...
    Good luck! I'm sure you can convince the state, where so many others have failed...

    You're also basically ignoring the liberty to choose... Locums 'detached from reality'? No, they are simply following free market forces. Better rate of pay per time/responsibility? Why not?
    Not doing enough 'core work'? WHY do you think there are not enough doing or WANTING to do 'core work'? 'Core work' like fornightly nursing home visits in 2021 or whenever?

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