Returning to general practice after a long break

by Lucy Henshall

After 18 months away from work, it is a daunting task to jump back on the carousel and be up to speed immediately – and support is few and far between

Location: England
Published: Thursday 15 April 2021
telemedicine, GPs, covid-19

Imagine you are a GP seeking to resume work, after 12 months or more away, and you do not have an ongoing job or specific workplace to return to. How would you pick up your stethoscope and GP career again? Who is out there willing to help you?

Up to two years away from the coalface is entirely possible without risk to Performers List status (technically eligible to 'just go back to work').

GPs occasionally plan time out, but for most the prolonged absence just 'happens'. Unexpected life events/illness, a geographic move, job loss – and six or even 18 months then flies by. Disconnection occurs rapidly and professional isolation is very damaging to self-worth and self-confidence in your GP abilities.

The newly revised HEE Return to Practice Scheme is still only pitched at the over two-year absence, despite strong lobbying. But how can we support GPs returning before that arbitrarily decided point in time?

Almost three years ago I set up Welcome back to work aiming to change how people viewed the whole issue of GPs resuming work in the zero to two year window. I wanted to focus on the perspective of the individuals, rather than starting from the needs of the system.

The 'how' we support differs with each GP, but the testimonials of all who have come to us prove we offer something previously unavailable, but highly successful and effective. A tailored return to work journey, exposure to opportunity and peers, with continuity of care and a clear recognition of the human condition right at its core. We are humans first, GPs second.

How many GP practices do you know that would make the time, show you the kindness, help reintegrate you into the swing of GP life, if you'd been away for 12 to 18 months, and who would do so without expecting anything at all in return?

No actual work from you, no payment for helping. No bursary is available to you either.

Struggling to write a list of names? This is not a dig at practices, drowning in workload and not resourced to offer this to their colleagues. Yet this kind of bespoke support is invaluable, common sense, and crucial to GP retention.

Would you even know who to approach to ask for such help? Locally, regionally or nationally?

For most individuals existing in this lonely space, the harsh reality is they have no 'home practice' or over-arching job contract in which to create an exploratory return to work.

Their individual story is unique but strong themes recur. Local statutory bodies, eg local medical committees and clinical commissioning groups, training Hubs, ICS, (expressing desire to 'recruit and retain' GPs), offer limited help and can lack insight into the lived experience of professional isolation.

All of the burden and responsibility is therefore left on the shoulders of the individual GP, to climb back onto a very fast-spinning primary care roundabout, totally unassisted.

There are, to use the title of my second paper for NHS England on this topic, 'More fences than gates' in the journey back to work.

From accessing clinical software to refresh skills, meaningful peer contact, and exposure to clinical environments as an observer simply to explore personal readiness for work. All lie beyond the reach of lone individuals. This is a massive uphill challenge and harder with health issues, geographic relocation, or experience of workplace mistreatment.

A GP needing reasonable adjustments for disability cannot even arrange an access to work assessment without a specific job. But what kind of job to seek, when personal work capacity an unknown within a new health reality? How to find someone willing to even offer a job after a prolonged time away? Where to begin?

The stark reality is that one in five of the population has a disability. GPs are no different to other humans, but where is the vocational rehabilitation programme within the NHS for GPs with disabilities?

In 2017, my paper 'Bridging the gap' was first submitted to NHS Employers, with suggestions regarding return to work support for individual GPs already well-qualified (eg, not 'retraining') and I contributed to the subsequent creation of the NHS England Local Retention Fund too, as an individually consulted contributor.

Sadly, I feel that, on the ground, little has changed since that funding stream was created despite it championing local flexibility as the aim. It morphed into a workforce agenda – not a way to reintegrate individual GPs.

What is needed, is a whole system, major cultural change. Supporting the GP workforce as a collection of individuals with normal human needs, and not just as a numeric headcount of service providers, medical drones. Better vocational rehabilitation of our profession and good proactive HR strategies for GPs within practices would be a healthy step towards sustainable and fulfilling careers.

Outside NHS life, major corporate bodies fund early, active rehabilitation of people whose careers stumble whether for health or other reasons and actively support a return to work. It makes good business sense to retain and support the return of already highly skilled staff.

Perhaps, therefore, the biggest contribution our profession can offer to those unexpectedly away from work is to proactively maintain professional and informal connections in a friendly, supportive and non-judgmental manner, fostering that vital sense of belonging while the individual is away or unsure of their future work aspirations. Individuals, GPs included, generally do know what support they need if someone reaches out to create that important conversation.

This blog can only offer a tiny window into our work but the stories of those who have accessed our support over the last three years are the most powerful, and we plan to create more films soon, to bring their experiences to life. For now, I hope that the undoubted success of our WB2W model will demonstrate those seemingly little things do matter, and to see similar support put in place across all four nations. Supporting our colleagues back to work costs infinitely less than the £500 000 it would cost the taxpayer purse to train one new GP from scratch.

My inbox is always open to interested parties for a conversation about WB2W and collaboration. Currently, we assist GPs across Suffolk, North East Essex, West Essex and Hertfordshire – at nil cost to individuals.

In the current climate what could be more important than looking after GPs properly, to help support and sustain their careers, and thus building a stronger workforce for the future?

Lucy Henshall is a Suffolk GP, East of England clinical lead for NHS Practitioner Health, nationally elected RCGP council member, sits on GPC’s education,training and workforce policy group, and is the founder of www.welcomebacktowork.co.uk. She can be contacted via twitter @DrLucyHenshall and via email at [email protected].