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First PCNs hire GPs in ‘portfolio’ roles to work across networks


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Exclusive PCNs have begun hiring salaried GPs to work across their member practices in ‘portfolio’ roles, representing the next stage in their development, Pulse has learned.

PCN clinical directors said they are using funding streams such at the investment and impact fund (IIF) to directly hire salaried GP as it’s not possible to hire GPs via the additional roles reimbursement scheme (ARRS).

NHS England has been promoting PCNs as providers of primary care, and networks hiring GPs to work across their practices is the latest indication that they are becoming increasingly prominent.

In some cases, these salaried GPs are being hired to provide acute care across the networks.

Dr Brigid Joughin, GP clinical director for Outer West Newcastle PCN, said that her network is hiring a salaried GP to help address on-the-day presentations, in instances where staff hired through ARRS cannot.

Joughin explained that while the ARRS roles do help, they have not changed ‘demand coming through the door every day’ which ultimately falls to GPs.

She said: ‘To try and overcome this, I applied for a GP fellowship role who would work across practices and that will be salaried within the PCN.

‘We’re now applying for a second role – because we’re so short – who will do a couple of sessions in a few practices and will also teach medical students.’

She added that her PCN is planning a ‘PCN acute service’, which will see patients who present on-the-day with urgent needs directed to a hub staffed by these salaried GPs.

Central North Leeds PCN advertised for ‘the first PCN salaried GP’ to work across practices in Leeds LMC’s February newsletter.

The bulletin said:  ‘This role will involve education and support for all members of the team along with undergraduate/postgraduate trainees as required. 

‘You will spend up to 25% of your week supporting colleagues, improving pathways and contributing to service design. The remainder will be working clinically within the seven PCN member practices as the need arises.’

In Doncaster South PCN, clinical director Dr David Coleman told Pulse PCN that while none of the practices in Doncaster employ a salaried GP to work for the PCN, ‘it is possible – not through ARRS but with some of the other funding e.g. IIF, Covid vaccination funds, various other funding streams.’

He said: ‘A salaried GP could help with care home work, lead on health inequalities, cancer etc. Our PCN does some research so this could be another target area. They could also provide relief for practices in the PCN as part of a business continuity plan. 

‘By creating a portfolio of work and combining with adequate supervision and possibly some leadership training opportunities, it could be quite an attractive work opportunity.’

Similarly, Dr Jeremy Carter, clinical director of Herne Bay PCN in Kent, flagged that such a role might be attractive given that portfolio GPs are ‘becoming more commonplace’.

He said: ‘GPs who might want to do some core general practice GMS clinics, but might also have a special interest in frailty or learning disabilities could work across the PCN in that format.’

It comes as a recent report warned PCNs lack ‘clear purpose’ and adequate funding.

NHS England is yet to clarify what funding PCNs will receive for delivering the new PCN extended hours scheme.

Health secretary Sajid Javid admitted in November that the Government is not on track to deliver its election manifesto pledge to recruit 6,000 additional FTE GPs by 2025.

READERS' COMMENTS [9]

Vinci Ho 23 March, 2022 9:52 am

There is a conceptual caveat in here :
(1) Instead of being available in a ready-to-use pot of money in ARRS ( additional roles reimbursement scheme) every financial year , the practices need to chase after QOF like targets to obtain the Impact and Investment Funds (IIFs) .
(2) Hence , if your performance was not good enough ( involving a lot Read Codes , temples and actual additional workload ) , the money for these additional salaried GPs would be compromised.
In other words , the IIFs are no longer just for rewarding the work you put in for achieving these IIF parameters ( arguably the new QOFs) .
(3) Using the IIF money to employ additional salaried GPs ( by all means , if that really ultimately reduces overall workload for GPs and practices) is , instead , a desperate compensatory measure , in my opinion . Perhaps , it is similar , in a way , to the last resort of letting hospitals to employ all GPs in practices .
At the end , it simply does not answer the question why ARRS is so obsessively inflexible as far as how the money can be spent . May be , or just may be , one can see a different picture if ARRS can be used to employ more salaried GPs for the network .
Of course , even better , that ‘modified’ ARRS money can go directly to individual practices.

gregory rose 23 March, 2022 11:24 am

This is nothing more than practices deciding to create a job share role across a group of practices. Could have been done before PCNs but more likely now practices have a framework to talk. It goes against the concept that GP work could be delegated to the ARRS roles and “transforming” general practice. This is just practices employing a salaried GP using practice finance to do so. IF is practice money. It is also far from guaranteed.

This is typical GPs papering over the cracks stuff which hides the fact the wall is actually falling down.

Darren Tymens 23 March, 2022 11:33 am

CDs who are doing this are colluding with NHSE in bringing about the end of the practice-based contractor model, and ushering in the era of the salaried GP – with all of the loss of autonomy, self-respect and professional status this entails.
It is the wrong solution to an artificially-induced problem (by DOH/NHSE and commissioners) that is really someone else’s problem to fix (DOH/NHSE and commissioners) – there may be short term benefits (a handful of extra patients get seen) but in the medium term this will lead to the NHS replacing existing services with a cheap and uncheerful ‘McGP’ service, with loss of continuity, poor quality and expensive care, and an absence of any job satisfaction.
Some of us will work part-time in it out of a sense of charity, but I think most of us will seek to replicate the continuity of care, and the high quality patient-centred care we always have but in a newly-generated private sector. At least we will be able to set our own terms and conditions under those circumstances.
I am sure the CDs doing this are enjoying the positive attention of the local commissioners – this is because you are doing exactly what they want. But whatever future you think you have as ‘system leaders’ will not emerge (as they don’t really want GPs leading anything), and you will come to regret the role you played in the denigration of your profession.

Darren Tymens 23 March, 2022 11:40 am

A correction to my post above – when I say ‘the era of the salaried GP’ I mean ‘the era of an entirely salaried service’. I appreciate that the service is around 50% salaried now: but the majority are employed by their peers, which is a significant difference as it involves personal choice and the ability to negotiate terms and conditions with colleagues who understand the job. This is an important right we need to hang on to. I also understand that many of our salaried colleagues are not employed on good contracts and not treated well by partners – this also has to change, but it is within our power as a profession to do so. DOI: I am a partner, and I believe in the partnership model. We employ salaried doctors, but endeavor to treat them well. I understand why salaried posts are attractive to a significant number of people, but still prefer partnership to be something everyone can access as I think it is still the best and most effective way of delivering long-term care to a community.

David jenkins 23 March, 2022 12:23 pm

in rural south wales we found a way round this a long time ago. it’s called “talking”. most gp’s don’t regard the practice down the road as the “competition” – more like a slightly different shop, with slightly different clients, and slightly different products. one practice has a GPSI dermatologist, a few miles away there is a GPSI cardiologist etc. if you think they have something you need access to, then ring them up and ask !

i retired from my single handed, rural, dispensing practice in 2007, after i had a dvt in my right arm, and a Hb of 5%; the health authority denied me any help, so i either walked, or i died.

i now do locums a couple of days a week. if i can’t help a practice who contacts me i suggest dr’s A, B, or C. and they do the same for me. usually things sort themselves out. any practice who doesn’t treat colleagues well very soon finds out it doesn’t pay.

if a practice takes the piss, and treats you as a second class citizen, i won’t go back – but in 15years it hasn’t happened yet.

we’re all on the same boat. it might be a shitty, rather unsafe boat, with an idiot as a captain, and a company who don’t give a toss about their staff, but quarelling and arguing amongst yourselves won’t improve that !

Andrew Jackson 23 March, 2022 12:31 pm

when is the profession going to be asked if this is the system they want to work in?

Patrufini Duffy 23 March, 2022 2:14 pm

Basically, opt out of the PCN. Down the road, you actually will lose. With no voice.

Dave Haddock 23 March, 2022 6:39 pm

Do making care worse for patients, and the job worse for doctors.
A triumph, congratulations to all involved.

Simon Ruffle 23 March, 2022 7:11 pm

Are these monies recurring?
‘To teach medical students’ Bailing out deaneries and HEE. And how does that improve patient care?
I appreciate the clever ways of using any investment into primary care, I really do, but all the time we make it work with employing staff with scheme that can be withdrawn we are taking a huge gamble with financial and legal risks down the line.
The only way to improve patient care and practices wellbeing is to fund the core properly.
Too many vested interests in each of the bolt on bits.
I’m sure I could now make a portfolio career without exposing myself to risk or actually doing the job I’m trained to do and probable quite good at according to revalidation appraisal and my patients.