There has to be an alternative

You’ve no doubt heard in the press about GP partners resigning from their partnerships mid-career to become locums, and more GPs applying for licenses to practice overseas in countries like Australia and Canada.You’ve no doubt heard in the press about GP partners resigning from their partnerships mid-career to become locums, and more GPs applying for licenses to practice overseas in countries like Australia and Canada.

The reasons given seem to centre around rising workload, caused both by increased demands across the NHS, and also increased bureaucracy through devices like QOF and enhanced services, with more and more hoops to jump through to chase ever-decreasing rewards. Then, on top of this, an economic decline, with reducing income and a pension scheme that seems to be slowly fading in value. Add to this the pressure of patient complaints and litigation cases and the stress of revalidation, we begin to have in this country a toxic mix of circumstances which are leaving many GPs exhausted, unhappy and even hopeless about their career.

For many, early retirement seems the only escape from the hamster-wheel of endless effort. And now the Government threatens not only to add out of hours back to the workload of individual practices, but also longer hours and night-time responsibility too.

So what are the alternatives? Looking through previous editions of the NASGP Newsletter over the years, you’ll have noticed that we’re obviously huge advocates of working as a sessional GP as a completely viable and long-term alternative to the partnership model.

Salaried posts have all the benefits of professional stability, with the guarantee of income, but just less control. There are downsides of course, with many examples of employers taking advantage of their salaried GPs.

And around twice as many GPs choose to work freelance. The majority work completely independently, managing all aspects of their business; others choose to work through agencies, but perhaps the most exciting development for locum GPs has been the emergence of locum chambers. Andrew Noble works both as a part time partner and a locum. On returning to freelance work when moving back to Yorkshire in 2009 he founded the Yorkshire Medical Chambers and now has over 40 other locums working with him in teams under the umbrella of the chambers: "I get to see general practice from all angles as a partner and as a locum, I certainly find our chambers GPs much more relaxed and settled in their work as our model has enabled them to concentrate on being clinicians, without all the distractions of running all the non-clinical aspects of being a GP, whether that was a partnership or as an independent locum. Their chambers groups offer excellent support, as well as all the support from senior members of the team”

What seems, though, to be on many GPs’ minds at the moment is working in countries like Australia. Conscious of this a GP from Oxford took early retirement, travelled around Australia meeting GPs and other medical professionals prior to setting up, with his business partner, a chartered accountant, the International Medical Careers Consultancy to support GPs in making the transition from working in the UK to Australia: “Working abroad, GPs can broaden their career prospects, earn a sizeable income, have a lot of fun, escape QOF, league tables and English winter, even if just for a year or two. If you did your GP training in the UK, and especially if you hold MRCGP, the doors to working overseas may well be open for you.”

One British GP who went out to Australia to work and ended up staying is Martin Panter. "The move from the UK to Australia is one I have never ever regretted! In Australia, General Practice can be whatever you wish it to be from simple, uncomplicated city practice with referrals for anything one might choose, to country practice where one can follow one's heart’s desire for obstetrics, anaesthetics, simple procedures such as gastroscopy or colposcopy, together with any surgical procedure that one is trained for. There are still many rural communities without a doctor and local councils will go to great lengths and expense to acquire one. As a country GP in Queensland, I really could not have had a more satisfying or interesting professional life. If you have the opportunity to go to work in Australia, the will and the ability to work hard, and you love medicine, I would grab it with both hands!"

General Practice is a great career, but its monopolistic interpretation within the NHS as ‘partnership-or-bust’ model is clearly no longer viable, and GPs of all ages and experience are turning more and more to models of general practice which far better avoid the malignancy of incipient burnout of which we’re all otherwise at risk.


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