My typical working week is a mixture of locum stints at practices and other self-employed sessional work.
This would not suit every GP but there may come a time when the freelance lifestyle beckons even the most committed GP principal. This is how my career changed.
New Year 1996
Aged 33, I had my life planned out for the next 30 years. I had just returned from West Africa where my husband, a mechanic, and I had been doing mission work in Cameroon.
I thought I would spend two years in full-time partnership, then have children when I would go part-time at the practice and, possibly, increase my hours again when the children hit their teenage years.
New Year 2006
At age 43 I found myself reflecting on 10 years as a partner. Now a GP trainer and, unexpectedly, lead partner at my practice, I was suffering with depression and not seeing enough of my seven-year-old daughter. I was also part-way through an LMC-sponsored leadership course.
The final blows came within weeks of each other. First, my health insurer refused to quote mental health-related cover for me. Foolishly I had stopped paying the premiums while in Africa, and I did not reinstate the policy before I became ill.
But it was the final leadership course session that changed my life. It made me realise that my situation was untenable. I then found and paid for individual lifestyle coaching.
While visiting New Zealand, my decision was finally made: I had to resign. A year went past. I had freedom, but what was I going to do next? I had a letter from the PCT congratulating me on my retirement, but my husband and I knew I had to work: a mechanic has little earning power compared with a GP.
Initially, I continued doing GP appraisals and my regular sessions for the out-of-hours service.
We knew we should stay in Bedford, close to my recently widowed mother. I emailed my CV to just five carefully-chosen local practices. Within minutes there was a reply offering me work.
New Year 2011
Now 48, I pondered on my life as a portfolio GP of nearly four years' standing. I was not depressed and my portfolio GP role had evolved.
I was working five sessions a week on average as a locum, mainly in school term-time. This work - clinical, sexual health and, as I have maintained my trainer status, teaching GP registrars - is almost exclusively at two practices. I have given up out-of-hours work.
For one to two sessions a week I do other things. I continue to appraise, I teach Cambridge medical students and do prescribing work for a local GP commissioning group.
What have I learned since I left my partnership?
Within weeks of resigning I realised I still really enjoyed clinical work and teaching, but disliked paperwork and I was definitely not a manager.
I had considered becoming a GPSI in women's health but discovered that there is more to general practice than gynaecology. My interest in it was inevitable as the only female doctor with six male partners.
As for the pros and cons of portfolio work, I think they vary according to the individual.
The main pro has been structuring my time, taking time off when I want, going on holiday when it suits my family and doing the parts of medicine I enjoy - clinical and teaching work.
This has been possible as I have stayed in an area where I am well known. I did struggle when doing sessions at a practice on the Bedfordshire/Cambridgeshire border that referred patients to three hospitals with different path cards, consultants and so forth.
I acknowledge portfolio working would be more difficult for a young GP in an area unfamiliar to them.
My list of cons is longer but still acceptable. The most major is 'no work, no pay' - particularly no sick pay. This hit me big time in 2008 when I was diagnosed with breast cancer.
Thanks to the generosity of the Village Medical Centre and London Road Health Centre practices in Bedford (who provided me with QOF paperwork and teaching sessions during my chemotherapy) and those Bedford GPs who changed their appraisal times and venues to suit me, I coped.
Having no manager to sort out my tax and NHS superannuation has also been a challenge.
The National Association of Sessional GPs offers some excellent help and I would encourage any portfolio, locum or salaried GP to become a member.
Knowing how much to charge practices and other employers is difficult. GP locums are reluctant to talk about their rates, so it is hard to find out what the going rate for an experienced local GP is without pricing myself out of the market.
My cri de coeur is the difficulty communicating with colleagues and keeping up to date particularly with local information. Not having an NHSmail address can be a huge disadvantage.
GP consortia need to sort this out. Personally, the issues surrounding revalidation and audit have not been a problem but being an appraiser and trainer gives me a huge advantage.
New Year 2020
What shall I be doing in 2020 when I am 58? Probably I will still be a portfolio GP. I definitely would not be salaried as it is much too restricting.
Would I be a GP partner again? Maybe. But it would take a lot for me to give up the freedom I have gained.
- Dr Wilson is a sessional GP based in Bedford