GP career options: an overview

Once you have finished training, there are many career options open to you. Some are obvious – become a principal in a partnership, take a salaried post, or work as a freelance (locum) sessional GP. However there are other options that you may not be aware of, or may not have considered. These include the Flexible Careers Scheme, the GP Retainer Scheme or even becoming a full time Out of Hours (OOH) doctor. What you decide to do will depend on your personal circumstances, including factors such as whether you are single or in a relationship (and what your partner is doing), your finances, the opportunities in the area you wish to work in and how you like to work.

This article will outline the different options in brief. More detailed articles on each option will be published soon.

Freelance (Locum) Sessional GP

This option gives you the most control over where and when you work, and can potentially be very lucrative. You are self employed, so are responsible for your own tax, national insurance and pension contributions. You can either arrange sessions yourself with practices locally, join a chambers, use an introduction service or work through one of the many GP locum agencies.

Salaried GP

This option will provide you with a fixed timetable and a fixed income. You are an employee, so have certain rights and protections (sick pay, holiday pay and maternity / paternity), and you will not have to worry about tax, NI or pension contributions as this will be taken care of by your employer. Pay varies according to region and from practice to practice.

Partnership / Principal

This option provides stability and is often very attractive financially, although it is a big commitment and you may have to “buy in” to become a partner. You will share responsibility for running your own business. This option often gives you the most control or say over how the practice develops, but also comes with the most responsibility. As well as clinical work, you will be responsible for the business – this can include management, staff, the building and ensuring you meet all the legal requirements in the running of the practice.

GP Retainer Scheme

This scheme often suits those who wish to work part time only. You can work a maximum of four sessions, and if you wish to do extra work, this must be approved. Practices get some of your salary costs reimbursed, and contracts are usually for a maximum of 5 years. The contract includes protected time for CPD.

Out of Hours GP

Many GPs still do some OOH work as it is now well paid, and you can often choose shifts that suit you. This may be an attractive option for new GPs to combine with another option (e.g. salaried or one of the part time schemes). However, some doctors may choose to work for some time as full time OOH doctors, working for PCT or one of the private companies that have taken over OOH provision in some areas. This is extremely well paid (up to £140k per year for 40 hours per week), but the downside is that you will always be working in the evenings and weekends, in what can be a more stressful environment than daytime practice. Working nights / weekends may suit some people (to fit in with family commitments), and there is usually scope to work part time if necessary.

Options, options, options

compassAs you can see, the end of your training is just the beginning of a new journey in General Practice. You have many choices, and your preference may change as your circumstances do. Remember that choosing one option does not usually close the others off to you, so you may locum for a few months or years to see how different practices work, before taking a salaried job. At some point you may choose to join a partnership or combine one of these options with other part time options as part of a portfolio GP career.

For the more adventurous among you, you might think about working abroad, volunteering in the developing world, or even combining luxury travel with work by becoming a ship’s doctor. These options will be looked at in another article.

There is no “one size fits all” solution – none of these options are better or worse, it is about finding what suits you and your situation – this may change over time. You should discuss some of these options with your trainer a few months before the end of your GP Registrar year.

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 with practical advice about different GP career options for new GPs.

Being a better teacher

Dr Mahibur Rahman

This article was first published in 2005 and is reproduced with the kind permission of Hospital Doctor, who retain the copyright.

Teaching is an integral part of being a doctor regardless of the stage you have reached in your career or the specialty you are following. Whether you are a house officer teaching medical students basic skills or a consultant training specialist registrars on advanced surgical techniques, there are some universal techniques that can help make you a better teacher.

Set clear learning objectives

Setting out early on the educational objectives that you would like to achieve, makes it easier to plan what and how to teach. Objectives that are clear and specific are the best, especially if set within a realistic timeframe. This helps both learner and teacher monitor progress. Setting too many objectives, or using a very difficult to achieve timeframe can lead to feelings of failure, or make the learning experience feel like a series of boxes that need ticking. Vague objectives make it difficult to gauge if you are progressing well, or if you need to make extra efforts in one part of your training.

Timetable your teaching activities

When working in a busy clinical environment, you may often find that there aren’t enough hours in the day to fit in all the demands on your time. Teaching, and preparing to teach is time that can become easy to sacrifice – juniors may find it difficult to raise objections (unlike managers!). If your teaching time is written into your timetable, and protected, this is less likely to happen, and trainee and teacher will both benefit. Don’t forget that preparation time is as important as the teaching itself.

Give useful feedback

We all need feedback so we know how we are doing. This is an essential part of the learning process – if we are doing something well, it is good to know that we are on track, and when we could improve our knowledge or skills, or are making mistakes, we may never correct them unless we realise the error. For feedback to be useful, it must be constructive – the feedback should include suggestions for improvements rather than criticism alone. Some ways to provide useful feedback are to:

  • Ask the learner to reflect on what they have done well and what they feel could be improved.
  • Always start with the positive things first.
  • Give feedback as close to the event as possible – you will both remember what happened more clearly.
  • Give clear and specific feedback about why something was not up to standard, and ways to improve it in the future.

Giving feedback that is very subjective, that is vague, ambiguous or that relates to something that cannot be changed is of little benefit, and may cause the learner to become demotivated and affect your teacher / student relationship. Feedback should never be given in a way that demeans or undermines your trainee – this is unprofessional and will only reflect poorly on your abilities as a teacher.

Keep up to date

To be a good teacher you must know your subject well. This may seem like a very obvious statement, but in the fast paced world of medical knowledge, things are constantly changing. It is important that you are not teaching concepts and methods that are no longer considered best practice. This means keeping your own skills and knowledge up to date, and updating your teaching materials (slides, handouts, tutorials) regularly. Not only will this make you a better teacher, it will make you a better clinician.

Enjoy yourself

The best teachers are those that enjoy the teaching experience and learn from it themselves. If you find that you dread every teaching slot, you might consider the need to change some aspects of your teaching style, reduce the number of trainees you are responsible for, or check if you have given yourself enough time to prepare.

Finally, if you feel that teaching is something that you really enjoy and wish to improve your skills further, you may consider pursuing a postgraduate certificate or diploma in medical education.

Salaried GP Posts – Advantages and Disadvantages

Dr Mahibur Rahman

Many doctors spend a large part of their careers working in a salaried capacity. For some doctors, it is the first step on the path to a partnership, for others, working as a salaried GP bring the benefits of working in general practice without the extra responsibility, time and uncertainty of partnership. Here is a comprehensive guide to some of the advantages and disadvantages of working as a salaried GP:

Advantages

Stability

As a salaried GP, you will have a stable work environment, being able to develop a working relationship with members of the team. You will be able to plan your finances as you will have a fixed monthly income. You should have a structured working week, making it easier to plan social engagements, childcare etc. Having a regular workplace also makes it easier to access CPD, to take part in audit and significant event analysis – all of which are important as part the appraisal and revalidation process.

Employment rights

As an employee, you have significant rights. First, you have entitlement to sick pay, a minimum amount of paid annual leave, paternity / maternity pay and leave and unpaid time off for compassionate leave. After working for 2 years in the same employment, you also gain full employment rights including the right to redundancy pay. Usually your past NHS service would be recognised towards this as long as you have not had a break in service. Employment rights are one of the biggest advantages of being an employee.

Fixed commitment

As a salaried GP you should have a job plan outlining your duties, and your work time commitment should be fixed. If the practice suddenly needs extra cover, while your employer can request that you do an extra shift, you do not have to accept, and they cannot demand that you provide the extra cover. Your main commitment will be to clinical work, and many doctors prefer this – managing other employees, dealing with the upkeep of the building, keeping an eye on the accounts will not be your responsibility.

Disadvantages

Pay

Salaried GP pay is very variable throughout the UK, and even between practices within the same region. The review body recommended range for salaried GP pay for full time doctors (working 9 sessions) is currently £55,965 and £84,453 (2016 figures). These figures apply to doctors working for GMS practices or for PCOs directly. PMS and APMS practices are free to offer any salary they wish. Average pay for salaried GPs in the UK working in either GMS or PMS practices in 2013-2014 (last available actual figures) was £54,600. This figure includes those GPs working less than full time (i.e. less than 9 sessions), which make up a large proportion of salaried GPs.

In some cases, if there is a shortage of applicants, or if you are taking a salaried role with additional responsibilities, pay can be much higher, or include a “Golden Hello” – an incentive to take a post in a specific area. In the current climate of GP shortages though, you may be able to negotiate a good overall package, especially if you have additional skills that can bring the practice extra income (such as fitting coils and implants, offering joint injections etc.). In many cases, actual take home pay for a full time salaried GP may be similar to a full time partner in a practice with below average profits once you take into account deductions for NHS pensions and indemnity.

Lack of Control

As a salaried GP, you will have less control on the direction of the practice or the services offered. You may also have less flexibility in terms of how much leave you have or when you take it, compared to working as a locum or a partner. Over time, some doctors find that the workload expected of them can creep up, with additional time and responsibilities expected that are not always reflected in additional income.

Summary

shutterstock_98508338Like any job, there are both advantages and disadvantages to working as a salaried GP. Hopefully this article is a good starting point to thinking about how whether working as a salaried GP is for you.  Please feel free to contact us with any queries you may have about your career – we will always do our best to offer advice and support.

Please post a comment and share your tips and advice for newly qualified GPs.

Developing a career as a Portfolio GP

Dr Mahibur Rahman

You may have heard the term “portfolio GP” more frequently over the last few years. This is an umbrella term used to describe any GP that has multiple jobs or that does multiple types of work within their working week. Most portfolio GPs have a primary job – this could be a partnership, a part time salaried position or being a locum GP, with one or more additional jobs in their portfolio.

Many GPs develop a portfolio over time almost by accident – what starts as a one off extra session working in a prison for example can become an interesting part of the regular working week.

The range of additional jobs that you might develop an interest in as part of your portfolio is huge – from developing a specialist interest, to taking on a management role as part of the CCG. Some of the more flexible additions to a portfolio can include:

  • Medical Education
  • Forensic Medical Examiner
  • Prison Doctor
  • GP with Specialist Interest (GPSI)

In this article I will discuss some of these options in a bit more detail.

Medical Education

There are various ways to become involved in medical education, from the occasional teaching and supervision of medical students on placement at the practice to becoming a GP trainer or Training Programme Director. Teaching can be very rewarding, as well as acting as a stimulus to refresh your own knowledge and to keep up to date.

Teaching Medical Students and Foundation Trainees

Most medical schools require doctors that will be teaching students on placement to attend a short training course (often over 1 or 2 days), and then to attend annual training days. Beyond this, you will not need to have any formal medical education qualifications. For teaching Foundation trainees, most deaneries require a similar amount of training.

Clinical Tutor

Many medical schools recruit qualified GPs to become clinical tutors to facilitate small group teaching, or teach clinical and communication skills for undergraduates at the medical school. Having experience in teaching will make you a more attractive candidate, and medical schools often offer further in house training as well as support to complete a postgraduate certificate or diploma in medical education. Time requirements are usually 1-2 sessions a week.

GP Trainer

The requirements to become a GP trainer vary by deanery, although there are some requirements that are fairly common throughout:

  • MRCGP – either by examination or via portfolio
  • Training in teaching – either a trainers’ course or a postgraduate certificate or diploma in medical education.
  • Experience – the minimum post CCT experience varies from 2 years to 5 years.

There are also requirements that need to be met in relation to the training practice. A trainer would usually need to put aside the equivalent of 2 sessions a week to allow time for supervision, tutorials and ongoing workshops for trainers.

Training Programme Director

Programme Directors (formerly known as VTS Course Organisers) have responsibility for organising the regular teaching for Speciality Training schemes, as well as supporting trainers. Programme Directors are usually appointed via deaneries, and again requirements vary across the county, although most require experience of teaching and a formal postgraduate qualification in medical education at diploma or Masters level. Many Programme Directors are experienced trainers. The time commitment required is usually equivalent to 2 sessions a week or more. In many areas with larger training schemes, there are multiple Programme Directors for the same area.

Prison GP

Working as a GP in secure environments may seem daunting, however it can have many benefits. There is currently a huge shortage of GPs in the prison service, so the rates paid are usually very good. The work includes GP style clinics and ward rounds for inmates – you will usually be well supported with an experienced nursing team, and guards are nearby (they can be in the room on request in some cases). As well as acute illness and ongoing management of chronic disease, there is a high proportion of patients with mental health issues and drug misuse problems. Undertaking the RCGP Drug Misuse certificate can be useful to give you more confidence in dealing with this aspect of the work. If you are not sure if this is for you, contact your local prison and talk to the lead clinician – in most cases they will be happy to show you around the unit and offer some induction and training. There is also usually some need for on call cover, although this varies at different units.

Portfolio GP

Forensic Medical Examiner

Forensic Medical Examiners (formerly Police Surgeons) work with police forces to provide assessment and treatment to victims of crime and persons in custody. Many FMEs are GPs that work with the police as an additional role. The work can be interesting and varied, and will include assessment and treatment of injuries, minor illness, sudden illness in custody, and assessment of victims of sexual assault. Most FMEs work as part of a group of doctors that provide cover for one or more police stations day and night. A lot of the time you may be able to be on call from home, with extra fees payable for each visit to the station. Another aspect of the work of the FME involves giving evidence in court.

GP with Specialist Interest (GPSI or GPwSI)

A GPSI is a GP that has gained additional skills allowing them to offer services that have tradionally been offerd in secondary care. They can range from ENT or minor surgery to dermatology, sexual health or musculoskeletal medicine. Usually, there is a process of accreditaion that will require relevant additional qualifications and experience and then getting signed off by a consultant to state that the practitioner is capable of independent practice. Once accredited, a practice may be able to bid for work from a CCG that will allow them to accept referrals from other practices within the area. Having a special interest can make you more attractive to a practice, and a practice offering a successful GPSI service can bring in valuable extra income. There are dozens of possible special interests, and so we will look at this in more detail in a separate article.

Variety is the spice of life

These are just a few examples of some of the options you might build into your career as a portfolio GP. I know GPs that work as civilian medical practitioners on military bases, work as team doctors for sporting clubs, are involved with the air ambulance or emergency services One of the great things about being a portfolio GP is that working in different roles can help keep you stimulated and reduce the chances of burnout. I find that for me, it really is true that “a change is as good as a rest”!

Dr Mahibur Rahman is a portfolio GP and the author of “GP Jobs – A Guide to Career Options in General Practice”. 

Working as a locum GP – advantages and disadvantages

Dr Mahibur Rahman

Working as a locum GP is a common starting point for many newly qualified GPs, with some doctors choosing to work as a freelance GP long term. In this article we will look at some of the advantages and disadvantages of working as a GP locum.
Advantages

Flexibility

As a freelance GP, you can have more control over where and when you work.  If you wish to take time off during school holidays, or go for an extended trip, you are free to do so without needing authorisation from anyone else.  If you wish to spend 6 months working just a few sessions a week you can.  If you need extra money for a specific purpose, you could increase your working week temporarily.  If you do not like the way a particular practice works, you can choose not to book more shifts there.

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.

Income

As a locum, you can realistically make a £100,000+ a year working full time if you are willing to put in some hours covering evening and weekend shifts.  If you prefer not to work evenings and weekends, you could still earn over £75,000 per year working less than full time. Working 26 hours per week at a realistic average rate of £70 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 £76,440.

Disadvantages

Uncertainty

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.

Isolation

locum gpBeing 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.  Some parts of revalidation are more challenging – e.g. taking part in complete audit cycles can be quite difficult if you are not working regularly in any one practice. The latest guidance does allow alternative quality improvement activities to account for this. As a locum, you will not get any paid CPD time or study leave, so need to account for the cost of courses or e-learning as well as the lack of income while on a course when considering your fees.

Travelling

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.

Summary

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 ask via our Facebook group or post a comment below.

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.