GPs are returning to practice – but held up by red tape

Pamela Martin answered the ‘urgent’ call to return to general practice. She says the process for bringing GPs back needs to be streamlined, and that long-term lessons can be learned from the crisis
Location: UK
Published: Monday 27 April 2020
medical bag

I worked as a GP partner in a London practice for 30 years.

Since I left the practice three years ago, I have not considered myself to be ‘retired’. For me, that conjures up a spacious, reflective time based on a lot of leisure and not many commitments. I was initially exhausted by my work and badly in need of recovery. I did enjoy the increase in space and leisure, and in particular the freedom from an alarm clock. I didn’t want to put myself under any pressure at all but was busy as a carer for my increasingly needy parents. I learnt to be a medically experienced help seeker and advocate for them.

I remained interested in medicine, reading the BMJ and British Journal of General Practice much more than when I was in practice. I continued my three-year term on the BMA GPs committee, and remained co-opted as a local medical committee observer. I became facilitator for two peer-support groups of young GPs, and was working on building up mentorship availability locally. I admitted to myself all the things I had loved about being a GP, and that I did miss using my clinical skills… but not enough to want to go back to any work I had previously done.

And then came COVID-19. I remembered swine flu and knew this was so much worse. It was what we initially feared swine flu would be. I assumed lessons would have been learned, and the national pandemic plan would kick into action.

I only came off the Performers List in February last year, and received the lovely letter sent to all my cohort of leavers on 24 March jointly from BMA, Royal College of GPs, NHSEI (NHS England and NHS Improvement).

It said: ‘Wherever you can help, your NHS needs you… as a qualified and experienced GP your colleagues and local community are in urgent need of your support... not only about clinically treating patients, there is also a need to provide a calm presence… your expertise can help in so many ways… it doesn’t have to be in frontline care… we aim to approve your application within 24 hours.’

This was promising. I was happy to respond to the ‘call-up’. I have recovered, am alert and interested and of course love to be appreciated and useful – to make a difference. I have my clinical skills. They don’t magically wither. I have my knowledge: it doesn’t dissolve after a given time and all clinicians need updates. I have years of remote consultation experience. I was a GP trainer.

Like everybody I had plans for the spring and summer, nice ones. But they were obviously out of the window and working for the COVID-19 111 response team would replace them, since that was where the need was greatest, although in time the backlog of work may mean that the need shifts to supporting practices.

I expected to be part of the workforce within a week of the efficient GMC process to restore my licence on 27 March. Alas, I was only put back on the Performers List on 21 April. So many colleagues are desperately frustrated like me, stalled at some point in the process. Now there are further stages to go through to get ‘on-boarded’ and rostered. The experience of many of my colleagues has been that these have been chaotically slow, although no doubt many people have been working very hard. Clearly a piece of the pandemic workforce plan that had not been given sufficiently detailed thought in advance.

At this rate I won’t be able to work until a month after my relicensing – me and so many others. And this despite a situation where sick people are redirected back to the 111 website and we are told there is a desperate shortage of clinicians in the service, and NHSEI has taken out TV adverts asking for more returners.

But we will not give up. Well, some might, but there is such a strong feeling among returners of wanting to do something in the NHS, despite its faults. Looking forward it is worth considering what the implications are.

GPC has started compiling ‘things that have happened because of COVID-19 that we should keep afterwards’. One thing that should be on this list is how to harness the energy of the returners for the future.

For me, this must include trying to keep in the workforce experienced doctors who are in danger of taking away their skills. The Royal College of GPs’ Later Career and Retired Members Committee has been working on this. It needs to be done by offering a role that suits. It could be continuing support for nursing homes, educational work, commissioning work, home visiting work, rolling out good practice in an area of special interest – and many other ideas returners can themselves suggest.

How lovely it would be if appraisers could discuss a menu with any doctor considering reducing or ending their clinical commitment. Why can’t this be a routine question in appraisals? And could the revalidation process not be modified where needed to keep this cohort being useful? With primary care networks struggling to recruit to their mandated roles why can’t funding be used to keep experienced doctors in work who would otherwise leave?

This pandemic has shown the value of having a flexible workforce in reserve, and we could remain even more useful going forward.