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Independents' Day

Where have the jobs gone?

Anna Hodgekiss

The GP registrars of 2006 told the BMA's recent 'GPs to be' conference they want flexibility. They want to locum, take salaried posts and try a practice and an area out before committing to a partnership.

But as figures gathered by Pulse show, the reality is that they have little choice in the matter. The number of advertised partnerships has plummeted – and so has the number of salaried GP positions.

An analysis of the BMJ's careers section shows 256 partnership jobs were advertised online and in print between January and July 2006. This compares with 761 for the same period last year and 859 in 2004.

Of those 256 partnerships, one in five was also available as a salaried post.

The number of salaried jobs has dropped equally dramatically. Some 907 salaried roles were advertised in the first six months of last year. In 2006, the figure dropped to 328.

Government figures released earlier this month bear out the findings. GP vacancies in England per 100,000 patients halved from 1.4 to 0.7 in 2005.

So where have all the GP jobs gone?

Dr Colin Hunter, a GP in Aberdeen and former national GP co-ordinator for primary care, says the drought in partnerships is purely down to new GP contracts.

'Times have changed,' he says. 'The number of GP principals in a practice no longer matters because practices get the global sum.

'Consequently, there is more financial incentive than ever from a practice perspective to employ salaried GPs.'

Dr Robin Fox, a GP partner in Bicester, Oxfordshire, agrees. 'The pervasive incentive to take on another partner has definitely gone.'

He says competition for partnerships has become increasingly fierce in the four years since he completed his VTS.

'My practice is still very partner-led, but many surgeries employ larger nursing teams since the introduction of QOF.

'Doctors aren't always great at doing the QOF-like activities, and it's often more efficient to employ a nurse practitioner to triage patients.'

While the number of practice nurses employed by GPs has gone up since the new contract, the rise of 830 nurses, around 6 per cent, does not appear to account for the sharp drop in GP vacancies. Indeed, latest figures show the number of nurse vacancies fell slightly in 2005.

One factor in the decline in salaried GP posts is likely to be PCT recruitment freezes and mergers.

Dr Laurence Buckman, GPC deputy chair, says another is that practices are stretching their existing resources further.

'In light of this year's pay deal, I think these figures are a reaction to the contract,' he says. 'GPs are looking at alternative ways of doing the work themselves rather than recruiting another doctor.'

One benefit to emerge is that if you do want a partner or salaried colleague, it is far easier to find one. Department of Health figures released last month found the number of GP vacancies in England left unfilled for more than three months more than halved in the past year, falling from 2.4 per cent to 1.1 per cent.

What it means, though, is that competition for principal and salaried jobs is intense. GPs who have a good level of experience gained by locuming will be at a distinct advantage.

Dr Alex Smallwood, deputy chair of the GPC registrars subcommittee, is due to become a GP this August.

'All jobs – and partnership jobs in particular – are going to be hotly contested, so it's a case of trying to make yourself stand out from the 69 other candidates,' he says.

'Those people who show how they can benefit the practice with specialist skills to develop enhanced services and practice-based commissioning are in with the best chance.'

Dr Smallwood adds that even though many newly-qualified GPs are not immediately aiming to settle into a partnership or salaried post, most do have this as their long-term goal.

'A lot of people aren't that keen [to settle down] at first because they want to flit around and get to know different practices, but the idea grows on them 12 months down the line.

'The problem is that people are increasingly finding there are few partnerships to be

had, which is causing growing anxiety.'

Both registrars and principals agree that the downward trend in partnerships is likely to continue for as long as it remains in existing partners' interests to maximise their share of the practice.

But the present dearth of salaried positions is not expected to continue. 'As private firms continue to mop up the opportunities going out to tender, I can see many more GPs working in salaried roles in this sector,' Dr Smallwood says.

'A combination of salaried and locum work is also likely, as registrars in particular try and build up experience.'

For GPs who want the greater control and rewards of being a partner, practices in hard-pressed urban areas that have always found recruitment difficult are most likely to provide the opportunities.

Elsewhere, newly qualified GPs and those looking to move on will have to bide their time and develop the skills to give themselves the best chance when a job comes along.

'The days of being guaranteed the exact job you want are over,' Dr Smallwood says. 'But there are still opportunities for the most proactive people.'

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