I've been reflecting recently on how underemployment and unemployment among GPs comes in waves and how little that reality is acknowledged by those who simply say: ‘just move.’

I qualified as a GP in 2008, based in London. I was desperate to become a partner, but opportunities were scarce. Salaried posts were fiercely competitive, and I ended up cobbling together work. At one point I was clocking over 11 sessions a week across salaried, locum and out of hours shifts. I had a problem saying ‘no’ when OOH coordinators rang begging for cover.

Eventually, my partner was offered a role at Edinburgh University and we moved to Scotland. Partnership opportunities there were more plentiful at the time, and I landed the job I truly wanted. I stayed for ten years. It was hard going at times, but I relished it.

In 2022, we moved to Sheffield and the landscape had shifted entirely. By autumn 2024, locum work had dried up and competition for salaried posts had driven rates through the floor. I was scraping around trying to find work that would pay the bills and fit alongside my portfolio: a clinical advisor role for a charity and growing responsibilities within the BMA.

And throughout all of this, I kept hearing the same refrain: ‘Doctors just need to move. Commute further. You can't expect to work on your doorstep. Other people in other careers don't.’ It sounds so simple, doesn't it?

Here's the reality. Many of us start medical school at 18 or 19. A five- or six-year degree takes us to 23 to 25. Two years of foundation training brings us to 27. Three years of GP VTS and we are 28 to 30 before we even qualify. By that point, life has happened. Partners have careers of their own, and this is where it gets complicated.

Many of us are partnered with other medics, often in secondary care roles tied to specific hospitals in specific cities. We cannot simply pack up and follow us to wherever a GP post has appeared. And for those whose partners work outside medicine, they too are often well established in roles they cannot easily abandon.

Children have arrived by this stage too, and not just as babies. Many of us qualify with children already settled in local schools, with friendships, routines and roots. Uprooting them to chase a salaried post in a different city is simply not an option.

Elderly relatives need care. Childcare does not allow drop-offs before 8am or pick-ups after 6pm, so how do you add an hour's commute each way to a contract that runs from 8am to 6.30pm?

And even setting all of that aside, the jobs themselves do not always justify the upheaval. A growing number of salaried GP posts are short term and fixed, particularly those funded through ARRS and similar schemes. Moving your entire family to a new city for a post that may not exist in 12 months is not a career move, it is a gamble. Stability matters, and when it is not on offer, the call to ‘just move’ rings particularly hollow.

And many of us are women. The image of the male family GP with a wife at home managing the household so he could focus on his work and up sticks to wherever the job was is long gone. The profession has changed, but the expectations placed on us when people say ‘just move’ have not kept up.

Nor has the job itself kept pace with what is being asked of us. We were once well respected and the work, while demanding, was more manageable. Yes, we worked nights and weekends, but we could admit a patient to start an ACE inhibitor rather than trialling four antihypertensive agents before we are even permitted to involve a cardiologist. The complexity has grown enormously, and the support structures have not.

All of this is relevant  when we talk about workforce planning. But all is not lost.

There are real opportunities emerging. The new CAIP funding in England and new investment in Scotland create genuine scope to develop GP roles and employment. More deprived and rural areas may benefit most, but practices in city centres need to start thinking creatively too, about how existing contracts can be made to work for modern GPs.

Could a slightly later start to the workday and earlier finish make a longer commute more feasible? Of course, core hours will need to be covered across the practice but one day of an early start or a late finish per week vs every day makes it more manageable. Small changes in how we structure and advertise roles could make a significant difference.

The ‘just move’ brigade is missing the point. What we actually need is smarter, more flexible thinking about job design, about what a realistic job plan looks like, and about what it means to recruit and retain GPs in the world as it actually is, not as it was 50 years ago.

If any of this resonates with you, the BMA's sessional GPs committee is here to help. Whether you are struggling to find work, unsure of your rights, or just need someone in your corner, know that you are not alone and know your rights. Get in touch with us, and share this if it speaks to your experience.

Amy Small is co-chair of the sessional GPs committee