The GP retention scheme inclusivity reset

by Paula Wright

A rebalancing of the GP retention scheme hopes to address workload concerns and gender disparity

Location: England
Published: Thursday 18 March 2021
GP at desk

The GP retention scheme was launched in 2017 to replace the previous GP retainer scheme which had been around in various iterations since 1969.

There was a recognition that retention initiatives were as important as ever but that they needed to adapt to changes in the workforce and the employment market.

Opportunities for salaried GP roles and part-time working have increased significantly with almost 45% of salaried GPs working four sessions or less. Despite this, the ninth GP Worklife survey shows that nearly 20% of under 50-year-old salaried GPs are still intending to leave within five years and a higher percentage of those over 50.

We also know GPs working fewer sessions per week work significantly longer sessions which suggests simply cutting down a full-time blueprint to part-time does not deliver the desired work-life balance, boundaries or control which is sought.

Furthermore, in many cases, this is probably exacerbating a gender pay gap as it means lower average hourly rates of pay for those GPs (usually women) on reduced sessions.

There are two leavers' peaks, one mid-career for female GPs which is attributed to caring responsibilities and a later one, for GPs over 50 affecting both genders, but more so male GPs, which is thought to be owing to a mixture of burn out and the development of a second portfolio, as well as the fiscal disincentives of the NHS pension scheme for high earners.

The relaunched GP retention scheme has specifically targeted these issues in permitting doctors to maintain a substantial second portfolio. The relaunched scheme has attracted considerable interest and brought in older GPs (12% are aged between 60 and 64). The gender split has also changed with the male members rising to 18%.

The eligibility criteria for the scheme recognises that part-time working is widely available and so the applicant must demonstrate that their needs for flexibility go beyond what is normally provided within a part-time salaried role.

The applicant must be at risk of leaving the workforce and require additional educational support. The latter might be due to loss of confidence, low volume working, professional isolation, or being newly qualified.

The scheme has brought significantly improved funding for both practice and the doctor. For approximately £4k of funding per employed session, the practice must be able to provide mentoring and an individualised job plan with a realistic workload based on that doctor's experience and needs (not just the needs of the practice and the blueprint of other doctors working there).

The HEE (Health Education England) lead will scrutinise this aspect of the job plan to ensure it provides protected time for mentoring, CPD and participation in the wider team activities (like MDT meetings for which there is contractual provision separate and additional to the CPD entitlement).

The HEE lead is also responsible throughout the scheme, for ensuring that the doctor is still eligible and also that the post meets its objectives and continues to provide the necessary balance of clinical work, CPD mentoring and so on. Another feature of the relaunched scheme is the option of working as few as 30 weeks a year which is valuable for those who need extended breaks for example to do voluntary work abroad or project-based work. Also, retained GPs are now permitted to take on unlimited GP or non-GP work outside of the scheme including locum work (more on this in the misconceptions document linked below).

On the 24 of February, we held a webinar on the scheme which included speakers from NHS England, HEE, myself and three current retained GPs. We were delighted that 380 people attended, with more than 200 questions through the chat. We have recently published a document on common misconceptions about the scheme to supplement existing guidance and FAQs.

Paula Wright is a sessional GPs committee member