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Become a partner? Not if I can help it

As a GP in training, I read with interest the recent articles detailing the return of ‘golden hellos’ to certain practices that can’t seem to recruit partners. These incentives are anything from £5,000-£20,000, should the partner remain for a requisite time period. Will anyone really be won over by an extra £1,250 approximately a year after tax? Ultimately, it’s going to be less of a bind, doing a couple of locum shifts. I’d see it as a nice bonus at best, but it’s hardly a golden ticket.

There is a shortage of GPs, which means there is always going to be some sort of work available. As more senior GPs take their retirement early in wake of the changes to our pension scheme (among other things), the number of vacancies will only increase and so there will be that much more choice for those left. That, in turn, means that those looking to recruit must compete against one another, and we’ll see more cases of golden handshakes, golden handcuffs and the like.

I don’t plan on applying for a partnership when I complete my training. There are several reasons for this. Firstly, I’d like to try working for different practices. This seems to be what the majority of newlyqualified GPs do. It makes good sense to know that the practice you’re committing to is where you want to remain. Secondly, there is more scope for working part-time, or to a particular working pattern which lets me put the children to bed at least a few nights a week. Thirdly, and this is true for a lot of doctors, my partner is also a doctor, albeit a hospital doctor. We must both fit our careers in, and as there are that many more jobs in primary than secondary care, we will be more governed geographically by her place of work than by mine. Fourthly, from what I gather there is almost no benefit, financially at least, in becoming a partner. Coupled with the additional pressures and workload this brings, it’s easy to see why most people aren’t jumping in with both feet.  And finally, there is the consideration of relocating overseas. Many of my friends have done this; most go for the experience but end up staying as they have found so much more job satisfaction and work-life balance. There was a time when talking about relocating overseas would give me a pang of guilt; the National Health Service is very close to my heart, and I think we should all be proud to work for the values it embodies.

Unfortunately, the NHS is no longer an ideal employer, and thinking of it in purely careerist terms, , that pang of guilt I feel about emigrating goes away quite quickly. When I substitute ‘NHS’ for, to pick a random example, Tesco, things start to sound pretty unappealing. For example, ’Tesco staff told no pay rise for three years’ sounds entirely unacceptable. Why, then, would people still work for such a company? Increasingly they are not. Doctors are leaving the NHS for greener pastures at all stages of their careers. A significant number of the people I qualified with have left medicine altogether, and not for glamorous careers elsewhere. I know of consultants leaving to become photographers, or personal trainers. And now, of course, there are a lot of doctors preparing to take early retirement.  Clearly, the NHS is no longer an attractive employer.

I’m not sure I know how to fix the situation. Recruit more doctors? Retain the ones we’ve got?

Certainly, any form of golden handshake would probably need to start on the first day of medical school to have any meaningful sort of effect. The military use it as a recruitment tool - perhaps the NHS needs to as well. Only when there are enough people staying in the NHS will there be enough people to recruit from. But only by changing the way the NHS treats its staff will people stay in the long term. Doctors are not volunteers and the NHS is no charity - most obviously, charities still provide their employees with pay rises.

If nothing happens to improve things then the situation will continue its downward spiral. Shortfalls will put more stress on those in post, who will in turn look to get out for their own sake, be it by going abroad, switching careers or retiring. With such uncertainty, it is not surprising that few people want to commit to partnerships.

Ultimately there may be few things that can be done to attract new partners, but I think any prospective surgery would need to be supportive and caring. It may sound twee, but getting on with the people you work with and the culture at your surgery make a big difference to any GP’s morale. People don’t mind hard work, provided that they feel valued. (That, and a big fat cash incentive.)

Dr Tim Cassford is a GPST1 in Chichester.

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Readers' comments (66)

  • I think you summarise the thoughts of GP Trainees very well.

    I do think that this mode of thinking is dangerous and self destructive.

    Shortages in GP's in many areas is not leading to more locum use or better pay packages - there is no money for it. What is happening is that several CCG's are now employing Nurse practitioners or recruiting A&E nurses for triage type work.

    The danger is we'll have a group of GP partners controlling primary care and a low paid salaried gp/ nurse based workforce underneath them.

    I think this will be disastrous as well but it is happening.

    We need to re invigorate medical training with some professionalism

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  • Anonymous - "Dangerous & Sefl destructive". Accurate description.

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  • Una Coales

    With more medical schools places cropping up and more closures of NHS hospitals, there will be fewer hospitals to complete FY and specialty training. The prospect of our young medical students may well be a £84k-£100k government student loan debt and unemployment as they try to scramble for an FY hospital placement!

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  • The NHS was built on a bedrock of moral duty, with a sense that Drs/nurses etc are all "in it together" with the patients best interests the priority, doing the best we can with limited resources.

    Unfortunately this moral duty has been taken beyond its limit by politicians, by strangling finances and resources, creating warring factions within specialities, needless regulation and subsequent litigation, and selling off the juicy bits to private companies.

    This has created the mentality displayed by the author, and I don't disagree with it.

    It's each man/woman for himself - there is no collective responsibility anymore. It's the sad truth.

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  • The NHS is a s*** contracted and employer.

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  • This comment has been moderated.

  • I mean The NHS is s s*** contractor/employer !!!

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  • This comment has been moderated.

  • I can recommend life as a freelance GP within your local chambers. Bookings and paperwork all done for you. Just turn and concentrate on the clinical stuff. Take as many holidays as you wish or work hard and earn plenty. Partnership does not seem an attractive option at the moment.

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  • A lot of what you say does reflect the general consensus in primary care at the moment. I would say one thing though, that it's important to retain the ones (GPs) we have, that's you. It's me too. We are the future of the NHS. it's also true that many practices will either merge, federate of work harder to avoid too many locum costs.
    Furthermore, I would have to question your work ethic/reasons for entering general practice. It seems the good old reasons of wanting the satisfaction of continuity of care in a community that you become well known and respected in are sadly become a thing of the past. People would rather 'get on with the clinical work'. I'm afraid someone has to take responsibility, the work is there to be done, that's what being a GP is all about. Holistic care isn't just seeing the patients, it's everything else, the paperwork, the meetings with fellow GPs, CCGs, federations, other healthcare workers. No matter how arduous it may seem, this is the job we need to do. We simply can't have a situation where your mindset is adopted by all present and prospective GPs. The system would come down for sure, as right now, as the RCGP quite rightly states, it's 'teetering on the edge'.
    Work your firstfive on various practices, locum, get a fe, then get yourself a partnership you are happy with. This is the only way you will end up really making a difference to a community you serve consistently rather than providing a geographically sporadic, intermittent care. Good luck for the future.

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  • I am a Locum and turned down three offers of partnership recently.
    I wouldnt touch it with a barge pole !
    I agree that GP partnership is the backbone of community medice.
    However, I dont blame any younger GP for not getting involved with partnership at the moment.
    Ethics doesnt come into it.
    They could possibly end up in debt,burnt out etc etc etc.
    It is about time GPs woke -up, they have only theirselves to blame.
    Years of greedy partners using salaried doctors.
    The devide and rule debacle of the splitting of the pesnion system into the under and over fifty year olds.
    There is no backbone within the profession.
    GPs are not changing anything.
    It is about time we all woke up !

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  • I quite agree with James Weems.

    I am a relatively new partner of 4 years and despite this I have become the 2nd oldest GP in my practice. People who knows me might be surprised (as I always talk about money) but financial gain or work life balance is not the only reason I'm a partner. For me, it is about making a small difference to patients & families I have come to form a professional relationship with, and ability to decide my own practice. Yes, the latter is being strangled by DoH but still, I get to decide what I do and how I do it to satisfy DoH contract. Although I feel less respected by both the authorities and my patients then when I was a junior doctor in hospital, partnership has given me a sense of satisfaction. I'm not being ethical - stating what floats my boat.

    Reading the article, I get a sense of very well informed registrar who has spent time considering his future. Unfortunately it doesn't always make a better partner - I have seen several registrars who feels they deserve more but are unprepared to do more then clinical work or do work which has no direct benefits to them. We know in business, sometimes you'll have to give before you can take......

    p.s. I'd feel sorry for those who choose to do locum if partnership model collapses. They'd have hard time getting onto managerial post in a big organization when there are competing against plenty of ex-partners with existing skills and knowledge. Most of them will also have extra skills (e.g. teaching, chairing federation, IT lead, GPWSI etc etc)

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