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Matt, here’s what you should really do about the workforce crisis

Mr Hancock, I understand you’re looking for 6,000 extra GPs. Since it’s February – still a fresh start and all that – I’ll do you a favour and list some suggestions that could help you achieve your goal.

Please view the workforce crisis a bit like one of your beloved tech startups – a significant early investment is needed, but with time, it will reap dividends.

1. Properly reward partners for the risks and responsibilities they carry

A partnership bonus scheme, recognising the value partners bring to the profession, would encourage the next generation of GPs to take on this commitment when times look uncertain.

The NHS depends on primary care, with the partnership model central to its sustainability. 

Partners should be rewarded with a bonus tied to the number of clinical sessions they work.  Maybe £1,000 per session rewarded annually, with incremental increases to reward longer term service. 

A £10,000 bonus wouldn’t be blinked at in other sectors. If being a locum remains as financially rewarding as being a partner, GPs will continue to leave the permanent workforce. 

2. Reward GPs who work the most clinical sessions

The Government needs to sort out the pensions taper debacle as a matter of urgency. 

However, alongside this, a ‘full time GP’ bonus scheme would be beneficial. 

Partners or salaried doctors who could show that they’ve reached a threshold of clinical commitments (perhaps eight regular clinical sessions per week over the previous year) could apply – similar to the clinical excellence awards offered to hospital consultants. 

We need to reward hard work in general practice, and better incentivise full-time work.  The tax system, pension, and loss of childcare benefits for incomes above £100,000 are all discouraging GPs from working full-time.  

3. Incentivise clinical work over managerial or educational roles

In an era where GPs in clinical practice are increasingly scarce, it’s perverse to offer managerial or educational roles which are paid at a ‘GP rate’. 

When the day job is so stressful, and alternative roles are similarly paid, are we surprised when there’s a rush for this type of work? 

Rates paid by the CCG, Health Education England, and other publicly funded bodies need to be markedly less than frontline clinical work –  I’d propose pay being capped at a maximum of 70% of the average GP sessional rate. 

These are experienced doctors who have much to offer. Why are we failing to offer them the roles that keep them in practice? 

4. Make better use of the workforce 

Rather than incentivising extra work that take GPs out of their surgeries, NHS England could incentivise extra sessions during the routine working day. 

Why not fund an equivalent of extended hours appointments that could be undertaken between 8am and 6pm?

These extra sessions could be protected against other demands (phone calls, visits, extra admin) and funded, at least in part, by NHSE. 

Call it ‘year round, relentless pressures’ sessions…They could be only on offer if taken on as an extra, but would be appealing to GPs if they were flexible, with a fixed and manageable workload.

5. Support practices to offer ‘flexible partner’ opportunities

Younger women in particular need to be encouraged to take up partnerships. 

It may be the case that women could negotiate more flexible roles as partners, but the truth is that not enough do. 

The perception (true or not) is that you can only work as a partner if you can commit to an 8am-7pm day. 

NHSE could financially support practices to offer a flexible partner role (perhaps during the first decade of raising a family). 

Drawings would be appropriately adjusted to reflect the hours undertaken.  By better supporting all sectors to take on partnerships, NHSE would help secure general practice for the future, and hopefully keeping women in the profession through the challenging years of child-rearing.

6. Create advisory roles for senior GPs

At any age, being a GP is demanding. But at the end of a career, workload is driving GPs towards early retirement.

These are experienced doctors who have much to offer. Why are we failing to offer them the roles that keep them in practice? 

A starting place could be a ‘buddy system’ with a flexible partner, where a GP looking to wind down might come in to do admin work first thing, then work a partly supervisory clinical session from, say, 3.30-6.30pm. 

We need to look at the people we have and design roles that they want to fulfil.  And support practices financially to sustain this.

 So there you have it, Matt. Some suggestions for bolstering the GP workforce. These ideas certainly aren’t rocket science – you could implement them all. 

Abandon Skype consultations, DNA profiling, and your apps – we must get the basics right and keep GPs seeing patients in their surgeries. 

Getting junior doctors to enter training is the least of your worries. Only by improving the utilisation of existing doctors, and their working conditions, will you retain the newly qualified GPs that come through. 

You urgently need to invest in general practice if you want the NHS to be standing at the end of your term.  And unless you take drastic measures, you will face a humiliating failure on your extra GPs pledge.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West