The past five years have seen a steady increase in the number of women qualifying as doctors and this is mirrored by the increase in the number of female GPs.
General practice has been viewed as the ultimate family-friendly job and part-time working has become increasingly in demand and available, encouraged by the revamp of the retainer scheme in 1998 and the launch of the Flexible Career Scheme (FCS) in England in 2002.
The GP Returner Scheme was also launched. To bring back all those GPs who had taken time out and wanted to return to general practice. The majority were women with families who sought flexibility.
As an added incentive, the Golden Hello was offered to those who took up substantive posts of two or more years’ duration and with graded payments to encourage movement into under doctored areas.
Under the old GMS contract, there was little incentive for practices to offer part-time employment to GPs. However, the new GMS contract has removed the financial disincentives and a practice can use its budget to replace an out-going partner with salaried GPs.
The government states it has now achieved its aim of recruiting 2,000 new GPs and believes the issue of recruitment and retention within general practice is no longer a concern. But the figure of 2,000 new GPs is, in reality, inaccurate and over-inflated. The counting made no distinction between full-time and part-time working equivalents, nor did it distinguish between those Retainer Scheme GPs who transferred to the FCS from the retainer Scheme, or locums who joined the FCS.
The Wanless report in 2002 proposed that other less qualified healthcare workers could adequately perform much of the work of a GP.
This proposal has been adopted by many organisations. The effect has been that while the number of nurse practitioners/nurse prescribers, healthcare assistants and physicians’ assistants is growing, doctors who leave partnerships are not being wholly replaced.
As a result female GPs with caring responsibilities or who need to work part-time are currently at a disadvantage.
Many PCTs are in substantial deficit resulting in financial crisis. There is no new funding for the FCS (although PCTs must continue to fund those FCS GPs currently in post).
Implementation of financial priorities by the PCTs has resulted in refusals by some to fund locum reimbursement payments for maternity and sick leave locums and to claw back funds refusing to fund new GP retainees that the deaneries have approved.
The retainer scheme is, however, still alive and greatly appreciated by those doctors who require a protected post for a few years when they are unable to work full-time.
Some doctors may feel that the current lack of posts is a good reason to take a career break with their young families. They should think carefully before embarking on this course of action and should obtain reliable career guidance.
Never before has there been so much change in so little time; a plethora of new NICE guidance, Choose and Book, practice-based commissioning, changes to the quality and outcomes framework and the introduction of revalidation.
But returning to medicine after a career break may be harder than at first sight. Strapped-for-cash PCTs do not have funding for the returner scheme. Deaneries are experiencing the effects of restrictions and cuts to their budgets .
PCTs are also effecting a literal interpretation of the performers list regulations. If a doctor has not been working for more than two years they will need to be assessed and perhaps undergo a returner re-induction.
However, GPs are a well-trained and extremely knowledgeable group and highly respected by the community. Locuming, while only attractive to some GPs, is a potential solution. An advantage is that it may lead to finding a permanent post.
This is an increasingly competitive market and you will have to play the game. Take opportunities to meet people and network. Plan how you can learn new skills. Keep your CV up-to-date, be personable and do not allow your interview technique to lapse.
These are hard times and the way ahead may be fraught with difficulties. But we GPs are innovative. We must be ready to seize opportunities.
Many of us will thrive on new emerging possibilities. Use your contacts to ask for help and guidance and, most importantly, do not give up.
Dr Viney is a GP in north London. Dr Weeks is a GP in west London and chairman of the GPC Sessional GP subcommittee
Future career opportunities
- Part-time GPSI posts may offer new opportunities.
- Revalidation will inevitably cause some GPs to retire.
- The workforce will become more mobile.
- Partners’ profits will lessen.
- Practices will realise that partners bring different qualities to the workplace.
- Out-of-hours work will diversify and open up.
- APMS contracts are set to increase, creating new GP posts.