General practice is your oyster

by Paula Wright

There is a huge diversity of roles for GPs, including many that you might not have considered

Location: UK
Published: Thursday 18 August 2022
Paula wright

As a new cohort of colleagues joins us in primary care, it is a good time to reflect on the diversity of opportunities within their reach.

It could feel like a gloomy time to be qualifying as a GP. However, the specialty is far more diverse than you are likely to have been prepared for in your vocational training scheme.

And even if your scheme has been enlightened enough to consider that working as anything other than a partner is acceptable, chances are you haven't had much exposure to colleagues working in substantially different roles to those which take place in traditional practices (partner, salaried, locum in practice).

This is an area the BMA sessional GPs committee has invested some energy and thought about in the last two years.

We have differing professional priorities in different stages of our careers. These might include the need for strong support from peers and mentors, and opportunities to have an established caseload.

Alternatively, the priorities might be the need for flexibility to fit around responsibilities towards dependents (children and elderly relatives), flexibility to accommodate travel, or another portfolio whether it is clinical (such as a GP with special interests in dermatology, or sports medicine) or a non-clinical role for example in education, medical politics, leadership or entrepreneurship.

For any new role, one would be wise to speak to more than one person currently carrying out that role to get a feel for the opportunities and pitfalls these present. One would want to embark on these innovative roles with a clear idea of ‘what good looks like’ for that role.

This goes beyond contractual terms, to support mechanisms, culture, risk management, status, opportunities for career development and so on. Our newly published toolkit on roles outside of traditional general practice does exactly that so that when you explore such vacancies you know what to ask and what to expect.

A recent report by the think tank Policy Exchange proposes a GP service operated by hospital trusts and media coverage has been very negative about the impact of this on the GP partnership model.

Our guidance on working for a trust-run practice draws from the experience of GPs who work in well-established practices which are run by trusts and covers the pitfalls and opportunities of such roles.

There has also been a huge expansion of digital providers of primary care and understanding how these roles can vary is important for job fulfilment, skill mix, performer's list status and pension. Our guidance takes you through the key issues.

Urgent care has been another well-established portfolio which has expanded significantly, now encompassing not just out-of-hours work, but walk-in centres and 111 work. We have also published guidance on these roles and a blog on 111 work.

The CCAS (COVID Clinical Assessment Service) recruited nearly 2,000 clinicians in a matter of months and has provided a rewarding and flexible way for flexible GPs to contribute to the pandemic effort. As a result of this, we developed zero hours GP guidance. Although CCAS has now been wound down you can read about the experience of working on the service.

Another non-traditional role which has been around for a while is the mobile salaried post where you might be employed by a federation, clinical commissioning group or primary care trust to work across several practices. This blog explains the key questions to ask when applying for this kind of role.

We know there is much dissatisfaction with many GP posts and inexperienced GPs are particularly vulnerable to situations where they feel unsupported, with some ultimately feeling so unhappy that they choose to walk away.

Isolation compounds the self-doubt of not knowing whether difficulties are down to inexperience, ‘lack of resilience’ or whether they are due to an unsatisfactory work environment. We have also developed a guide setting out 'what good like' in terms of working conditions for salaried GPs and employers.

If you are working within more traditional roles remember we have extensive guidance on salaried roles and locum work in our salaried and locum handbooks. Significant central funding has been used to push the rollout of flexible pools (or locum banks).

These pose significant risks to the autonomy that locums seek. To avoid being trapped in bogus self-employment, I would recommend you read our blog on digital locum banks.

In the last couple of years, we have held webinars about changing roles during the pandemic and about the diversity of the job market post-pandemic as well as maternity breaks and the GP retention scheme. These are all valuable resources when considering the range of options available to you.

We are planning to look at terms and conditions for non-clinical roles as we are aware of many roles in the NHS where there is no entitlement to basic benefits like maternity, sickness, or pension despite being roles in which a regular sessional commitment is required.

Paula Wright is a member of the BMA sessional GPs committee