The Government’s flagship 7 day access policy is in the news once again with a mixed response as to its efficacy. Official evaluation showed that A&E admissions were reduced by 3% and said the scheme was set to be extended. However, CCG leaders in Yorkshire have scrapped the pilot scheme citing poor take-up of weekend appointments as one of the main reasons for abandoning the scheme. A joint report by the Patients Association and the Royal College of Emergency Medicine has found that same-day GP appointments do not stop patients from choosing to attend A&E instead. Meanwhile, according to research by the financial regulator for the NHS in England, a third of patients find it difficult to get an appointment. Although a smaller YouGov poll found apparent public support for 7 day access.
One of the biggest stories this month was Jeremy Hunt’s ‘New Deal’ for GP which has prompted a backlash from GPs and a petition with nearly 3000 signatures. Remarkably, Mr Hunt has also called for GPs to move away from the mentality of clocking off at 7pm.
Staffing in General Practice is still a cause for concern with promises of 5,000 more GPs and 5,000 support staff including 1,000 physician associates by 2020. Although the Government has since distanced itself from the pledge for 5,000 extra GPs. In Leicester, the CCG is spending £600,000 to bring over 10 US-trained Physician Associates to work in local practices. Recruiters have said more foreign GPs are essential in order to meet this target. Whilst regulations were changed this year to allow GP training applicants who failed the Stage 2 exam in the first round to re-apply in the second round. The Welsh Government is investing £34million into GP recruitment whilst the Scottish Government has announced that a new £50million fund for GP recruitment and retention is to be spread over 3 years, replacing a one year £40million fund.
Also in the news has been practice closures. One doctor explains why she and her colleague were forced to resign from their practice after a replacement for the retiring partners could not be found. A practice in Brighton was closed with no warning, following a CQC inspection, leaving nearly 10,000 patients to use local walk-in facilities. The entire patient list was subsequently transfered to one neighbouring practice. In Essex, a third sector provider has been commissioned by NHS ENgland to take on an APMS contract for 12 months after all partners at the GP practice resigned. Meanwhile a practice in London has been saved from closure by local campaigners who persuaded NHS England to use locums to keep the practice open whilst looking for a new provider to run the practice. Jeremy Hunt has agreed to shadow a GP at a practice in Tower Hamlets, but Limehouse Practice is facing a funding crisis and may close before he gets there.
The RCGP has called for an immediate halt to CQC inspections as it emerges that nearly half of GP practices spend more than 20 staff hours to prepare for them.
A pilot scheme in Glasgow is to offer 30 minute appointments to its most vulnerable patients with researchers from the University of Glasgow measuring the impact on hospital admissions.
The Government’s flagship 7 day access pilot looks set to be abandoned by CCGs after NHS Canterbury and Coastal CCG found Saturday morning opening did not help local A&Es meet the four-hour target. Dr Maureen Baker, Chair of the RCGP, has described plans for 7 day access to GP surgeries as “coming from cloud cuckoo land”. The Chair of the BMA’s GP Committee, Dr Chaand Nagpaul, has also called on the Prime Minister to “jettison the political pipedreams of tomorrow”.
The Northern Irish Government is concerned about GP numbers with too few graduates entering GP training and only 33 trainees qualifying in 2014. Data released by the GMC shows that ‘elite’ university students shun general practice with only 16% of Oxford graduates applying for GP Entry. Researchers have found that the amount of time undergraduates spend in general practice has fallen by almost two weeks between 2002 and 2012.
A single-handed GP in London is suing NHS England after they terminated his contract despite loyal patients’ calls for the surgery to be re-opened. The practice’s 3,700 patients have been forced to register at other local practices at great inconvenience. In Derbyshire, a local hospital has stepped in after the closure of group of practices serving 27,000 patients. Another GP who has managed a 4,500 patient list for two years on his own, owing to problems recruiting a partner, has been hit with a breach of contract notice after going off sick from burnout. In the East of England, NHS managers are to identify practices at risk of closure owing to problems with finances, recruitment issues, sickness absences and applications for list closures. It is hoped that NHS England, working with LMCs, can offer support to practices and prevent closures. Over the past two years, 160,000 patients have been displaced by practice closures.
GPs working part-time have spoken out about how intense and draining the workload is and warned that GPs are ‘all out’. Whilst a report from Citizens Advice has found that GPs are spending nearly a fifth of their consultation time dealing with non-medical issues at a cost of nearly £400m.
One village surgery has hit the jackpot after a local businessman donated £1million to pay for new, purpose-built premises to prevent the practice closing.
A survey of GPs by the BMA has found that more than 90% of GPs think that 10-minute consultations are inadequate. With politicians focusing on access, analysis by the BMJ has shown that the benefits of GP access policies is unclear. Incentives were given for practices to open over Easter, OOH providers struggled to cover shifts whilst practices themselves saw a few as three patients during a 3 hour surgery on Easter Saturday. For more articles on GP access, visit this blog. Meanwhile, research by Exeter Medical School has found that patients rate Private GP OOH care worse than NHS or not-for-profit services.
In an attempt to fill vacancies, a new CCG recruitment initiative is trying to attract Dutch GPs. In Scotland, one practice has had to redraw its boundaries and cut its patient list by a quarter after two unsuccessful rounds of recruitment. New GMC Chair, Professor Terence Stephenson, has called for a nationwide GP counselling service to be rolled out.
Despite recent calls for more on-site pharmacies in GP surgeries, a study a shown that pharmacist-led management of chronic pain is more expensive than standard treatment by GPs. Whilst there is a growing list of conditions and treatments not funded by the NHS, 30 CCGs may face a legal threat for funding homeopathy. Whilst a new trend has seen the costs of indemnity cover shoot up with one GP quoted £30,000 for their annual premium.
Usually when you read about general practice and performance, you might be thinking about targets and referrals but one practice in Devon are putting on a ‘Loyal Variety Performance‘ in their waiting room in a concert starring doctors, patients and receptionists.
Pharmacies are still in the news with worries that the closure of small pharmacies, particularly those in isolated communities, will increase pressure on GPs and A&E. Research shows that GPs prescribed 1.1billion items for patients in 2014, including a wide variety of over-the-counter medicines such as Lemsip and Calpol. Presciptions were also issued for unmedicated products such as toothpaste and suncream.
With more than half of GPs expecting to leave General Practice before the age of 60, NHS England is urging British GPs working abroad to return to the UK. Practices are also to be given incentives to take on GP Returners with an annual grant of £8,000. Incentives are also being offered to GPs to delay their retirement in an attempt to bolster GP numbers.
Golden Hellos are being used more frequently to attract GPs to practices finding it hard to fill posts. Groby Road Practice in Leicester filled a post that had been vacant for two years thanks to the scheme. The RAF is also aiming to recruit GPs and offers a signing bonus of £50,000. Hospitals are also after GPs to help them deliver new models of primary care with some offering salaries of up to £100,000.
Applications to GP Training are down by 6% this year and a third of vacancies remain unfilled after the first round of recruitment. The RCGP has released a video aimed at medical students to promote general practice and increase applications, however, GP leaders have said that students are being told by Medical School Deans that GP is a ‘second-class’ career option.
Despite the everyday pressures of General Practice, for many doctors, it still affords the best chance of a good work life balance. An innovative campaign started by East Cumbria GP Training Programme #GreatBritishConsultations shows the beauty and benefits of rural GP life.
Opening hours and access has been one of the big stories in GP with evidence that growing numbers of patients aged 18-34 are more likely to go to A&E or Walk-In Centres than accessing services via their local surgery. Sunbury Practice in Surrey experienced patients queueing from as early as 6.45am in order to get a same-day appointment. Politicians have made various promises about improving access to GP including seven-day access, however, a study by the London School of Hygiene and Tropical Medicine found that patients would rather have extended hours on weekdays than appointments available at weekends.
There are lots of innovative ideas about improving services for patients. Homeless charity, Porchlight, has set up a new GP Link Service allowing them to liaise with patients’ GPs and other services to help prevent homelessness with the added benefit of improving their overall health and mental health.
The NHS has announced incentives for GP Practices to set up on-site pharmacies as a way to relieve the burden on GPs, provide a better service for patients and cut waste in medicines.
If you are advising a patient to lose weight, it’s worth bearing in mind a recent poll carried out by the Royal Society for Public Health which found patients were much less likely to follow advice regarding losing weight, healthy eating and exercise from health professionals they perceived as being overweight or obese.
And finally, the leaflet produced by a practice in Devon aimed at directing patients to more appropriate services which was initially condemned by NHS England is to be used as a template for other practices in the area.
Over the next few years, the demand for UK trained GPs is set to increase dramatically. Working abroad can be a fantastic experience but there are also many things to consider. This article will explore what you need to think about when planning to work abroad as a GP.
It is really important to sort out the legal side of things well in advance; this includes visas, tax, NI contributions, conditions of employment, indemnity cover. This will vary from country to country. Most countries will require you to have a medical before you go and you may also need certain immunisations too.
For many people, part of the attraction of working abroad is saving money by not having to pay any tax. However, you might wish to pay national insurance contributions voluntarily as otherwise your access to certain benefits and allowances when returning to the UK can be affected, for example, your state pension.
Your conditions of employment might be quite different to what you are used to so it is important to read these thoroughly before signing. You should also check whether your indemnity provider will cover you whilst working abroad.
If you are planning on driving abroad, depending on the country, you might need to apply for an international driving permit.
Medical System & Qualifications
In order to work abroad, you will need to check if your qualifications will be recognised by the relevant organisations and whether you will be able to practise. For example, in Australia, you are required to submit an application form to the RACGP and also apply for primary source verification to the Australian Medical Council.
Another consideration is the difference between the way the NHS works and the public health systems in other countries. Some countries, like New Zealand, charge for consultations. There may be fewer home visits and a restricted list of drugs that can be prescribed. You will need to familiarise yourself with the new system that you will be working under.
Doctors with MRCGP and CCT from the UK can practise in Australia, New Zealand, and most countries in the Middle East without any further exams or qualifications, although you will need to register with the local medical council. To work in Canada, you will need to sit the MCEE examination with further examinations if you stay beyond one year.
Social & Cultural Implications
Aside from all the legal and practical matters, there are social and cultural implications too. If you are going with a family how will the move affect them? What are the differences in culture, climate, housing and education? How will you keep in touch with family and friends back home?
Even if you are going to an English-speaking country, you should expect cultural differences, whether this is more casual dress or subtle differences in language and food. The climate might be part of the attraction but make sure you do your homework! You might assume a country is hot but then find yourself in a city that has a cool sea breeze throughout the year.
Housing can differ a lot from what you are used to both in terms of housing stock, price and how the rental market operates. A lot of research is required to identify specific areas where you might settle.
If you have children, you will need to consider their education, both the school systems on offer whilst you are abroad and how they will fit back in to the UK school system when you return. For older children you may also need to consider what exams they should take or be prepared for.
Average salaries vary from country to country, in New Zealand, you can expect approximately £90,000 p.a. however in Australia, it can be £150,000 plus. In Qatar, a 40 hour contract will command a salary of £100,000 – £120,000 plus. In Canada, you can expect to earn over £100,000 per year depending on location and any additional skills you have. Pay in Abu Dhabi and Dubai tends to be lower than other Middle Eastern countries. In addition to pay, some companies will offer benefits such as free accommodation, school fees and relocation costs.
Working abroad can provide the opportunity to have a healthier, more active lifestyle (think sun and surf in Australia or exploring New Zealand’s incredible landscape) and the chance to gain different skills and experience to ultimately improve your practice as a GP.
We will be posting more detailed articles about individual countries with profiles of doctors who are working or have worked abroad soon.
Have you worked abroad? Share your tips in the comments below.
Hannah Dryden is the site editor of GPJobs.org. Dr Mahibur Rahman is a portfolio GP and the medical director of Emedica. He is the Author of “GP Jobs – A Guide to Career Options in General Practice”. He will be teaching at the Life after CCT: GP Survival Skills course which includes a session on working abroad, which will include popular countries for UK qualified GPs, pay and terms, additional examinations and recognition of MRCGP / CCT.
Many GPs now choose to work as locum GPs, either as their main job, or as part of a portfolio career. Here is a comprehensive guide to some of the pros and cons of working freelance:
As a freelance GP, you can have more control over where and when you work. If you wish to take time off for holiday, you are free to do so without asking a boss. If you need extra money for some reason, you could increase the hours you work. If you don’t like working at a particular practice, you can choose not to book more shifts there. On some days, you might choose to take a long shift at a walk in centre (8 or even 10 hour shifts are sometimes available), to allow you to have an extra day off later in the week without affecting your income.
Being self employed
As a locum, you are your own boss. You can set your own rates, and most locums can earn more per day than most salaried GPs and some partners. As a self employed contractor rather than an employee, you are also able to claim many more expenses against your tax bill, further increasing your take home pay.
A change is as good as a rest
Sometimes working in different environments, and being able to go in, deal with the patients then leave, without getting involved in internal politics or bureaucracy can be very refreshing. It also allows you a chance to see different ways of working, to take examples of good practice from different places, and also to see what does not work well. Working several sessions as a locum can give you a really good understanding of whether a practice would be a good place to work long term before committing to a salaried position or a partnership.
As a locum, you can realistically make a £100,000+ a year working full time, and if you are willing to put in some hours covering evening or weekend shifts, or doing longer shifts in urgent care / walk in centres, it is possible to earn over £125,000 per year based on 40 hours of booked work a week including 8 weeks off every year. If you prefer not to work evenings and weekends, you could still earn over £75,000 per year working less than full time. Working 24 paid hours per week at a realistic average rate in many areas of £75 per hour with 6 weeks leave, 2 weeks bank holidays, and 2 weeks study / CPD time (total 10 weeks without any earnings) gives an income of £75,600. Short notice locum work can be very lucrative (£100+ per hour), as can sessions that require additional skills or qualifications (e..g working in drug misuse, or in secure settings).
One of the big drawbacks with working as a locum is living with uncertainty. There is no guarantee that you will be able to work as many sessions as you would like, or that practices will be willing to pay the rates that you had hoped to charge. In some areas there many trained GPs fighting for both salaried posts and locum sessions, while in others there is no shortage of work. Agency locum rates have gone down in the last year in some regions. You may not know exactly how much you will earn from month to month, or exactly where you will work from day to day. For some people this is not really a big issue, but others find it difficult to cope with a variable income when they have large fixed costs to deal with each month (e.g. paying the rent / mortgage, bills, childcare, schooling costs etc.). Some locums will, over time get most of their work from a few regular practices, so that you might have a fairly fixed amount to your income, with the variation limited to the number of additional sessions that are available each month. Over the last 12 months though, there has been a marked increase in the amount and variety of locum work available all over the UK.
Lack of continuity
One of the downsides of working in many different practices can be the lack of continuity. You can miss out on the satisfaction of seeing a patient improve after making a diagnosis and initiating treatment, or the learning that comes from following up a patient that you referred or admitted. It can also be challenging getting used to new computer systems, or different ways of handling referrals (some practices ask you to dictate, others use Choose and Book, another will ask you to type the letter yourself). Doing visits in an area that you are not familiar with can also be more time consuming. Most locums find that they will establish a few practices that use them regularly (80% of my work is from 4 practices), with the remainder being more ad-hoc bookings.
Being a locum can be very lonely. In many practices, you will arrive for your session, be shown to your room by the practice manager or a receptionist, see 18 patients in 3 hours, then leave, without seeing or talking to any other colleagues. This can be a bit of a shock to newly qualified GPs who have had the regular contact that comes with being in a training practice, as well as the pastoral benefits of being in a VTS group. If you are doing the odd sessions in many different practices, it can be difficult to build relationships with the team.
No employment rights
As a locum, you are a self employed contractor, so you do not have any of the rights a salaried employee would have. This means no paid holidays, no paid study leave, no sick pay, no automatic increase in pay and no job guarantee / entitlement to redundancy pay. Of course you can take this all into account when setting your rates and calculating how much you will have to work in order to make enough to meet all your expenses and still have a decent amount of time for holidays and study leave. You will also need to make provisions to cover your expenses if you are off sick or unable to find work for some time.
Continuing Professional Development / Revalidation
Working as a locum GP can make it more difficult to engage in CPD – for example, you may not have the opportunity to attend weekly clinical meetings or journal clubs. Although the proposals for revalidation are not yet finalised, there are suggestions that it will be more difficult for any GP not working in a managed environment (e.g. salaried / partnership) to meet the requirements for revalidation. Taking part in complete audit cycles for example, can be quite difficult if you are not working regularly in any one practice. There are ways around these though – netowrking, and joining a sessional GP group in your area can be a useful way to keep up to date, and it is not necessary to complete an audit – you can do a quality improvement project instead.
In some areas, you may find that you need to be willing to travel quite large distances to ensure that you have enough work. This can lead to increased expenses, increased tiredness and stress if you have to travel in peak times.
Like any job, there are both advantages and disadvantages to working as a locum GP. Hopefully this article is a good starting point to thinking about how this style of working might suit you. If you are thinking of starting out as a locum and have questions, please feel free to contact us with any queries – we will always do our best to offer advice and support.
If you have been working as locum for some time, or recently started, please post a comment and share your tips and advice for new locums.
Dr Mahibur Rahman is the medical director of Emedica, and the author of GP Jobs – A Guide to Career Options in General Practice. He is the course director of the popular Emedica “Life after CCT: GP Survival Skills Course” for GP Registrars in ST3 coming to the end of training and newly qualified GPs. It includes a GP Locum Masterclass, which will cover different ways of working as a locum, pros and cons of setting up a limited company, pensions and tax as a locum, how to find work and build a good reputation, setting terms and conditions and rates, and more.