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.