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Part-time working offers general practice a glimmer of hope

Editor's blog

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I often get asked by other trade journalists what it’s like working with GPs and I always say it’s great. GPs are among the most outspoken, passionate, dynamic and innovative people I have met.

These qualities should be perfectly suited to the general practice model. Implemented correctly, the model encourages innovative thinkers while allowing the freedom to speak out as advocates for patients when things go wrong (ideal for us journalists).

The problem is that in recent years, far too much has gone wrong, so GPs’ other qualities are often stifled. It’s almost impossible to innovate when you’re working 14-hour days and battling burnout.

It’s for this reason – among others – that many GPs are deciding to work part time in general practice, as our cover feature this month shows. In reality, these GPs are not traditional part-time workers – the current demands of general practice mean they can end up working just as much as full-time staff in other professions, and they often have other healthcare roles outside of general practice.

Recruitment messages are highlighting the flexibility of general practice

But what they are trying to do is bring a semblance of control back into their lives.

There are two obvious problems with this part-time revolution. The first is that continuity of care inevitably suffers. It is basic logic that patients are less likely to see the same GP if that GP is there less often. But this is not insurmountable.

As Dr Zoe Norris explains eloquently this month, it may simply be a case of adapting continuity of care: writing more comprehensive clinical notes and clear plans, only providing guaranteed continuity to those with certain conditions, and so on. Patients may have to adapt as well, but something has to give.

The other problem with the move to part-time working is far more obvious and far trickier – it increases pressure on those who still work full time. To this, there is no easy answer. In the short term, there is a faint silver lining for full-timers under the cosh – a part-time colleague is better than one who is burnt out and on long-term sick leave. As the case studies in our cover feature show, this is the stark choice many GPs face.

In the long term, though, I believe the move towards part-time working could be the saviour of general practice. Because those outspoken, passionate, dynamic and innovative medical graduates will be the ones who most drawn to portfolio work, flexible hours and the ability to shape their own careers.

As regular readers will know, I rarely praise NHS England and Health Education England’s recruitment efforts, but I think they’re finally getting the message about attracting the next generation of GPs. Gone is selling dreams about GPs signing off patients to go skydiving (if you don’t remember this, go to pulsetoday.co.uk/skydiving for a guaranteed laugh). Instead, we have messages about the flexibility and innovation inherent in general practice, so it’s no surprise that last month saw a record influx of graduates. At this rate the sheer numbers of new GPs could well offset their part-time hours.

This is in no way diminishing the problems faced by GPs in the current climate. But it may just be that the kids are alright.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

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Readers' comments (11)

  • Only in socialism would you allow for and actually promote the fact that your workers are LESS productive, and use that as a selling point.

    You have to remember - EACH new GP, regardless of whether they plan to be full-time, part-time, or LEAVE immediately after training, incurs a significant training cost. However, our 'employer' clearly has no interest in getting as much bang for our buck, by trying to encourage full-time working and retention, since its not spending its money, but ours.

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  • And how are they being less productive? If a 6 session partner is still working around 40 hours a week it might sound 'Daily Mail bad' on paper, but in the real world it is still very productive.

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  • More head in the sand from you Angus. Wake up. From the other articles less than 10% of new GPs want to be partners. And if you think part time partners, who are less invested in a surgery than full time partners, are happy to continue to work unpaid, unappreciated overtime, think again. A 6 session partner working 40hrs/wk might fit your definition of productive, but its not as productive as a happy and appreciated 10 session partner working 50hrs a week is it?

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  • So what is your solution? all I see in your posts is NHS criticism, which in some parts is warranted, but I don't see much in the way of constructive idea.
    How would you run a health service so that it provides a fair return to the taxpayer.
    If I could just point you to the Commonwealth Fund reports which point to the NHS being the most efficient and fair health system in the world (and I agree not necessarily the best)then I am interested in how you would make it more efficient? is there another country's health system you would prefer?

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  • I've offered plenty of suggestions. Keep in mind the NHS ideal of universal access at point of 'NEED'. And universal access does not necessarily imply that the financial responsibility of access is taken away from the individual either. To deal with your point about the Commonwealth Fund report - as with all things, the devil is in the detail. How did they define 'efficient and fair'? Any conflict of interests with the CF? I would agree that the NHS is one of the 'best'. We are a developed country after all, we train a lot of our own staff (not enough in my opinion) and the NHS receives HUNDREDS OF BILLIONS of taxpayer funds annually. I would be surprised if it was NOT amongst the most efficient, even with the wastage and misuse of it. It seems that the coalface workforce don't think much of it though, as doctors are clearly voting with their feet. I like Singapore's system, which is purely emergency treatment cover only, and partial subsidization of insurance, but I would be willing to go a little further and cover primary care access too (and SOME prescriptions).

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  • Commonwealth fund- google it and have a look. They are an American charity set up over a hundred years ago to try and improve quality of healthcare and access to healthcare in the US. They do a regular international comparison rating - their criteria are given, In 2017 OK finished bottom and UK top of an 11 developed country comparison (Australia 2nd, Netherlands 3rd).
    I agree as you say that NHS is one of the best, and that we do need more staff- who need to be treated fairly in terms of workload so we do not put them off from staying as is currently happening.
    The NHS received £125 billion in 2017/2018 which was 9.9% of GDP compared to USA which was 16.7%.
    I am glad you think it is one of the most efficient despite the wastage- more the reason not to change it wholesale.
    If we only funded emergency care like Singapore how do we fund the rest given private insurance shows itself to be a highly inefficient alternative to tax which excludes a lot of people who can't afford it?

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  • correction to above- 'US finished bottom and UK top'...

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  • Well the changes I propose are pretty much drastic, if not wholesale. Also, percentage of GDP takes into account a lot of other factors i.e. how the economy is doing, population numbers if calculated per capita, etc. I know of the Commonwealth Fund, but obviously not the underlying politics behind the organisation. And despite their conclusions, you don't see the USA rushing to our health system do you? Wonder why? The answer to your question about Singapore is you don't. Private insurance might be 'inefficient' (depending on how you define it), but you don't punish the whole for the few. The end result? A thriving economy as as many people who can strive, do so, and minimal state intervention.

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  • You worry about those who can't afford it? Guess what, altruism is healthy and encouraged, familial responsibility is high, insurance policies can be shared in families, you rarely see any horror stories of a lack of access to healthcare.

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  • Yes I do actually worry about those who genuinely can't afford it.
    Silly me. I must be in the wrong job.

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