Balancing workload
I want to develop a portfolio career, but how I can ensure my practice does not suffer as a result of my taking on more work?
A so-called portfolio career is not something you just pull out of a bag because it may seem fashionable. You need to question whether you actually have an interest you wish to pursue. Are you looking for extra income? Do you want to enhance the practice or your own profile?
The answers to these questions then lead to where and when are you going to undertake these extra tasks. In short, this means will it be in the surgery during your ‘normal’ working hours or outside during your ‘spare’ time?
If the former, then you need to discuss your aspirations in detail with your partners, since whatever you are thinking of doing is bound to have an impact on your daily core NHS work as a GP. That really does not apply if you’ll be doing the work outside normal hours, so long as it does not affect the reputation of the practice – for example, performing as a pole dancer on a Friday night after evening surgery might be viewed in a negative way by your partners (and even some of your patients).
In summary, if you really do want to do something, go ahead and do it, but have some respect for your partners’ wishes. Having said that, the old adage ‘a change is as good as a rest’ can mean the effort of doing something different is a way of preventing burnout in a GP’s career.
Dr Jim Sherifi is a GP in Sudbury, Suffolk.
The day job has become so busy and intense that you need to add some variety to your working life, but falling income, rising demand and an ever-growing regulatory burden make taking time away from the main job almost impossible, especially as sessional GP cover is hard to find – even if the income from your alternative work covered the cost. And often it is no longer possible to agree with partners to reduce from, say, five to four days, because everyone is in the same boat and the old flexibilities are disappearing.
In the short term, your loyalty has to be to the day job. That is where the bulk of your earnings come from and if the practice implodes, not only will that income disappear, you will face all sorts of expenses as well, such as staff redundancy costs. Yet in the long term, your working life needs to be sustainable up to retirement age – which for younger GPs may well mean some time in their late 60s.
Realistically, then, you have two choices. Either park your ambitions for a year or two in the hope that the current workload will lessen, or find a like-minded colleague with whom you can jobshare. That may not give you exactly the amount of time for alternative work activities that you would like, but it will probably be acceptable to your partners. And it leaves control of the working week in the hands of you and your jobsharer.
Dr Harry Yoxall is the medical director of Somerset LMC.
Focus on: Becoming a portfolio GP
Getting your partners onboard
The partners at my practice are against me developing my career by taking on outside roles. How can I persuade them?
General practice is under attack and this is a clear example of siege mentality. The trick here is to illustrate to them how it could be in their interests for you to take on these outside roles. First, for everyone’s sanity – by taking on other roles, you’re much less likely to burn out and become a burden to everyone.
People work more efficiently and effectively when they’re motivated. Thwarting you will help no one. Not that you’re going to burn out – your wish to take on outside roles has demonstrated
a self-preservational work mentality. Conversely, your partners’ demonstration of a fixed mentality could mean they are more likely to burn out.
This isn’t about you persuading them not to be against you, it’s about you persuading them to follow you. You all need to get out more, outside of the daily routine of turning up to the same practice, the same consulting room, the same patients. For those on the edge of full burnout, like your partners, the drip-drip of this routine must be like water torture – they just don’t know it, yet.
Dr Richard Fieldhouse is CEO of the National Association of Sessional GPs and a locum in Chichester, West Sussex.
A portfolio career might have a positive effect on the individual GP and benefit the practice but I can understand why some practices, might have some concerns.
Your reduced sessions may mean reduced capacity. Will the practice have to employ a locum? If you have a named-GP system for continuity, there may be reduced access for your patients – although in my experience, they are happy to wait as long as they get to see you.
People may question your commitment to general practice. I know GPs of similar age to me who worked more sessions and who have resigned from partnerships. I believe it is because of my portfolio career that I have avoided burnout.
The deal-breaker is invariably how your portfolio work can benefit the practice. If your portfolio involves other clinical or academic disciplines, how will that benefit the practice in terms of income generation and CPD? If you are involved with the LMC or CCG, a source of intelligence can sometimes put your practice at an advantage.
Finally, consider how you manage your time and commitment across the components of a portfolio career. It works well if you have good discipline with time management and boundary setting.
Dr Richard Ma is a GP in Islington, north London.
Charging for your services
How can I work out what to charge for my services as a portfolio GP?
It is challenging to calculate what you are worth as a portfolio GP, as you will be pricing different services and skills in different markets at different times, and must avoid overpricing.
Portfolio GP practice derives some of its resilience from its lack of dependency on one market sector. In fact, medical report-writing (for example, for state benefit entitlement, medico-legal matters or occupational health), private cosmetic, managerial and political roles all feed from quite different markets with their own largely independent economies.
You must not, therefore, feel concerned or frustrated if your fees differ from job to job – don’t peg yourself to an abstract hourly rate. Your eggs are not in one basket, and this in itself has long-term value. You can mix employed and self-employed work to provide sickness and holiday benefits, and if self-employed income is non-superannuable, avoid some of the traps of recent pension taxation.
All these factors are significant, but it is also important to remember that the flexibility and mental resilience that you gain from not being financially dependent on one income stream is also valuable, as is the reduction in stress and the satisfaction that comes from being, to a large degree, in control of your workstreams.
Dr Stephen Bassett is a GPC sessional subcommittee member and a healthcare lawyer.
It is difficult to put a price on a scare resource – namely you.
I met a newly qualified GP recently who told me her proposed hourly rate and asked me what I thought of it. A pure benchmarking exercise told me that she was charging the local rate, but there are two key points here: I didn’t know how good she was clinically, and I wouldn’t be the one giving her the work.
It works the same for a portfolio GP; if you want to get premium rates then you will first need to build your personal reputation. There is no shortcut to achieving this, no matter which line of work you pursue.
Your personal rate will be established through a combination of talking to peers and negotiation with the employers looking to engage your services. This will help you find the pricing ‘zone’ – the tipping point at which you are not scaring off potential employers with your charges, but they would not pay any more if pressed to do so.
However, it’s important not to undersell yourself. If an employer isn’t prepared to pay your rates then be prepared to say no, even if you have no other offer to fall back on. Cutting your prices now could win you work in the short-term, but it could lead to problems in the longer term, when you might find it difficult to put fees back up.
James Gransby is a partner at MHA MacIntyre Hudson (Maidstone), a member of the Association of Independent Specialist Medical Accountants.
