Podcast | Oh, you’re a GP locum; the rise of the portfolio GP

18th December 2018 by NASGP

Podcast | Oh, you’re a GP locum; the rise of the portfolio GP

Zoe Neill had begun to feel trapped as a GP partner. She describes her journey, and speaks to Richard Fieldhouse in our latest podcast.

Time was when the look of disappointment from a GP colleague would have got me down. “I was a full-time partner for 9 years,” I would proffer, but they had already moved on to someone far more erudite and accomplished: someone who hadn’t failed.

Oh, you’re a GP locum…

But this time the disappointment has a different vibe; “Why aren’t you staying? Can’t you see me next time? You’ve really listened.”

Over the last four years, my GP identity has shifted and morphed, and is very different from when I was first shoved out of the sausage machine of training, a straight arrow through hospital medicine, then a salaried post, then a partner.

On January 3rd 2015, I arrived in a new practice as a newly fledged GP locum, arriving 30 minutes before my first ever locum surgery so that I could teach myself EMIS web. (I do like a steep learning curve!)

Since then, through a variety of planned and not-so-planned happenstance encounters, I’m now a fully-fledged portfolio GP.

My latest appraisal lasted 4 hours (I know…) as my appraiser needed to clarify just what on Earth I had been doing since partnership. His questions got me thinking about how the confines of general practice offer both comfort and isolation.

Now, when I do a locum session, it’s like putting on last year’s winter coat, or sitting in an old chair (usually one in which the levers no longer work). It feels familiar, but uncomfortable if I sit too long.

In the real world, people have one job for a while and then move on. One of my university contemporaries (not a medic), gets twitchy after just 18 months. This is apparently normal. She has ‘catch-ups over coffee’ and within a few weeks is ensconced in a shinier, better-paid and higher-flying role in a area vaguely related to the previous one. No-one seems to mind that she knows nothing when she arrives and in fact she is fêted for her ‘fresh approach’.

When I first started out, my now-deceased GP told me he’d been ‘sitting behind this desk for 35 years’. At 17, I just thought he was being melodramatic. 25 years later, I realise that he was being honest, perhaps even requesting rescue!

Medicine offers some veritable treats when it comes to steep learning curves, with a change of scene every 4-6 months during training. Until it doesn’t. And then comes the slowly dawning realisation that you could stay in the same seat, even in the same chair, until the day you retire.

In 2014, before one afternoon surgery, I worked out I’d got 28 more years to go if I was to stick with the NHS pension retirement age of 68. I stared out through the bars on my consulting room window. I was fast approaching 40, and with every good cliché about mid-life crises, ‘something had to be done’.

Add to that a good dose of burnout, some child-induced sleep deprivation, and a smattering of anxiety and depression, and there was only one way forward.

One of the things GPs say to me now is that it must’ve taken some courage to leave. At the time, it felt instead like it was the only way to survive. Having met other GPs who have fled partnerships, we huddle together as survivors, not pioneers. It is no coincidence that the Doctors.net forum about such matters is called The Lifeboat.

Which brings me on to the incredible support that I have had since that day in 2014. I returned to sessional GP meetings locally, and signed up to the NASGP again, and found my new tribe. I found locums in practice broom cupboards, delighted to have fled their partnerships, enjoying their new-found freedom and autonomy, even if life wasn’t anywhere near perfect. I joined Yorkshire Medical Chambers in 2016, and found myself surrounded by an amazingly diverse and accomplished group of people who just happened to also be GPs.

In early 2018, I had lunch with a GP friend, Angela Goyal, and out of that discussion came the plan to bring those broom cupboard discussions together. Angela and her events company, Inspired Medics, ran with the idea, so that in May 2018 170 GPs of all stripes gathered in Leeds for a day to talk about what else they could do. It was the first event of its kind, bringing GPs with very diverse interests (snowboarding, tech, education, coaching, politics, functional medicine to name a few) into the same space.

The air was electric, the conversations non-stop. It was the first time in many years I had felt a buzz about being a GP.

Since then, I’ve heard more stories about how GPs have taken courageous steps into the unknown to try new things.

What happens to us when we get our own room? I am not sure it’s all good. Beau Lotto’s book Deviate – The Science of Seeing Differently advocates that we need to question our assumptions from time to time. Ask why, really ask why, we’re doing what we’re doing. He urges us to travel and explore, not necessarily geographically, in order to think more creatively.

I think being a sessional GP, a locum, a portfolio GP can be about exploration and discovery. What’s next for you?

This article first appeared in The Sessional GP magazine.

"I am all set up and running on LocumDeck. I'm very impressed by how efficient and smooth it seems."

Dr Paula Zukowski, GP, Norwich

Dr Paula Zukowski, GP, Norwich

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