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Salaried, locum and partner, I’ve given them all a try over the course of my GP career and have enjoyed them all for different reasons.
The findings of the workload survey didn’t surprise me for a minute, however, because six weeks ago I left my partnership to head back to the world of locuming. This decision took a long time to come to and was done with a heavy heart. I believe fundamentally in the independent contractor model but the workload had become unmanageable and my stress levels were making me unwell.
I still feel guilty, like I have deserted the sinking ship, but self-preservation won in the end. I am also angry though. Angry that general practice has been pressurised to the point where myself and others have had to make this very difficult decision for the sake of our own health.
The desire to control workload was one of the main reasons for people choosing locum and salaried positions according to the survey. The contrast between my working life now as a locum and that of a day of a partner is stark. I now not only get to eat lunch, but it isn’t al desko while working through repeat scripts. I no longer watch tasks and messages building up during my morning surgery with an impending sense of doom. I am acutely aware, however, that in the same building there are GP partners who are struggling to get through their days and this knowledge tempers the enjoyment of my newly discovered reduced stress levels.
The perceived and very real challenges of partnership were sighted by salaried GPs as one of the reasons for those who wish to retain the continuity of care and surroundings of that position. It certainly is true, that partnership with the challenges of HR and business management, concerns re premises and reduced drawings seems less appealing now. As practices fall by the wayside, the concern with ‘last man-standing’ status is becoming acutely real. Who would want to be left liable for all the redundancies and costs by themselves? But, partnership offers its own rewards and there are some partners who are relishing the challenges that the situations are bringing, and others who are managing against the odds.
What is certainly true, is that the future is uncertain. If the independent contractor model is to continue, and that is surely the only way for GPs to remain true advocates for their patients, we need partners. How do we tempt the likes of me back? Reduce the financial and legal liabilities, scrap the ridiculous farce of the Care Quality Commission, foster bottom-up innovation, listen to us when we say we can’t do anymore work, allow workload capping by closing lists and give GPs, the most efficient part of the health service, the core funding to be able to run primary care properly with the staff we need and the workload we can manage.
Read the survey’s findings
Stephanie Degiorgio is a locum GP in Kent
Two weeks ago I left my salaried job and I am now taking a break from medicine full stop. My new found freedom and enjoyment is also tempered by guilt and the knowledge that friends and colleagues are struggling to stand still (my other half is a full time partner). Now I have some perspective I can see that as a profession we are too hard on ourselves - we take personal responsibility for all the ills and struggles our patients face whilst in the NHS system. But we are being asked to fly a plane with only 1 engine.
18 months ago I left my partnership for all the same reasons as Stephanie. At the time I had structure in my life but no work/life balance. In the first year I got balance but no structure as each day was different and there were days when I was not working. Now I have finally achieved structure and balance. I go to the gym every morning and feel great and work in the afternoon. My aim is to be home by 6 pm, something I had not done for over 5 years and towards the end of my time as a partner was hitting midnight on some evenings.
I think we all understand Stephanie's dicission. Work load, absurd bureaucracy and the final nail on the coffin CQC will be the death of General Practice. (Steve fields and Darzi are biggest reasons for the sorry state of general practice these days) GMS contact was based on a simple business model where you work for the patients and manage your service according to local needs.
But over the course of time bureaucrats, politicians and incompetent NHS managers have eroded the principle business model.
All this talk about forward view etc will not work until and unless GMS contract holders are allowed to operate as an independent businesses and there service costed properly.
When bureaucracy absorbs a major cunk of NHS budget how can NHS provide its primary objective of healthcare?
Yes, similar story. Two years since i left and i still feel the guilt for leaving what felt like a sinking ship and my patients, although this is tempered by absolute relief, being able to take holidays when my family are off, seeing my children in the morning and evening, controlling my work load and preserving my sanity. I try not to tell the partners at the practices i work at how much better life is for me, i don't want to rub it in and feel they are the brave ones for sticking with it. I just couldn't anymore. Maybe theres nothing wrong with the state of things? Maybe i just need more resilience training.
I am a 66 yo semi retired Inner City GP. I retired from my partnership aged 65 in February 2015, after 35 years in the same practice. I did love my work. I now do some OOH locum GP sessions, I really liked being a GP. But the bureaucracy , the nonsense of CQC and targets was increasingly irksome. In my last few years perhaps the worst stress was 'phone backs', with huge numbers of phone backs. The work of being a locum is certainly less stressful. When I worked as a partner I would finish surgeries at 6pm, but I would not leave the surgery until about 10pm, because of all the paperwork etc. As a locum I usually work 4pm to 8pm and I am home by 8.20 pm. But I do miss the continuity of care. I think the partner system of care is better for patients ,if they can get appointments. But it is difficult if not impossible to get new partners. It may well be a situation of last man or woman out please turn off the lights for General Practice in the UK.
I was a full time (8 session) partner for 14 years. Started work by 7.30 each morning, got home at 8 or 9 pm each evening, lunch while driving between visits. Despite these 13+ hour days I still always felt guilty for not doing more. Three months ago I dropped to be a 2 day salaried GP with minimal paperwork and no list. The rest of the week I locum in two or three nearby practices. Have taken a small pay cut, but boy has it been worth it. Am slowly de-stressing. Even patients are noticing the difference in my face. We need to start putting ourselves and our families first - burnt out and demoralised GPs are no good to anyone.
Happy in retirement , now, but I did all those things ...
Jeremy Hunt has been main recruiting sergeant for Australia and NZ .
I think you mean 'cited' not 'sighted' !
Very typical of what I've been through. Partnership liabilities are now too much to bear at a personal level. I agree that the potential financial liability of a sole partner of a practice being the last to leave is hugely underestimated - possibly 3 months of the annual turnover if a practice folds at best. I'm salaried and can easily go to locuming as a bargaining tool with my employers. Retirement is probably only 27 months away!
It's 9 months since I left my GP partnership at age 56 to be a freelance locum. Working 11.25 sessions a week while being paid for only 7 of them was unsustainable and affecting not only my health but my marriage. Since I left I haven't looked back. I'm getting home every night at 7pm, I'm enjoying my job and, believe it or not I'm making more money now than I was as a partner... without doing any evening or weekend work at all.
One way or another the independent contractor status us GP partnerships is going to end, either by being nationalised or by being taken over by private firms. Either way it's unlikely the premises will be bought out at anything like the figures those who have invested in them all these years were expecting - the over 50s' rush for the exit can only accelerate.