Newham Health Collaborative Ltd

Case study summary

The East London borough of Newham is one of the most diverse and deprived areas of the country, and faces significant issues around recruitment and retention of GPs including a low GP/patient ratio and significant numbers of clinicians nearing retirement. Newham Health Collaborative Ltd (NHC) set up a staff bank operating across 52 practices to retain experienced GPs. GPs who join the bank are able to undertake clinical sessions or mentorship roles to support less experienced GPs. In the first seven months, four GPs who were seriously looking to leave general practice have been recruited to the bank. NHC practices now have direct access to a bank of experienced GPs at below current agency rate, which has lowered costs to practices for sessional staff.

Background

The GP Career Plus pilot was launched in March 2017 and aimed to test new models of retaining experienced doctors through pooled working arrangements with a view that additional flexibility and variety of work would persuade GPs to remain in practice. Where schemes have been successfully implemented they are helping to improve workforce resilience across the local system. The pilot contributes towards a range of measures that will help reduce the number of GPs who leave the profession early, provide an alternative option to be a locum and contribute to the Government’s target to increase the number of doctors working in general practice by 5,000.

The issue

East London faces workforce challenges in relation to recruitment and retention which are exacerbated by an aging GP population. Within the London Borough of Newham 39.2 per cent of FTE GPs are 55 and over (England average stands at 23.4%) which presents a significant challenge to workforce planning as two fifths of the workforce is expected to retire over the next 5 -10 years.

Other significant issues also exist and include:

  • a low GP/patient ratio (1:1,652 compared to the England average of 1:1,392 )
  • a high turnover of staff across the borough.

The solution

Newham Health Collaborative Ltd (NHC) set up a staff bank operating across 52 practices to retain experienced GPs. Experienced GPs are targeted directly to join. GPs who join are able to undertake clinical sessions or mentorship roles to support less experienced GPs and other professions such as community pharmacists, physician associates and ENPs/ANPs. GPs generally work in an area suited to their own expertise and interest which may be a care home, access hub, urgent centre or community care clinic.

Incentives offered to attract experienced GPs to join the staff bank include:

  • a contribution to indemnity costs (£100 per session per month)
  • a clinical supervisor
  • mentoring sessions with NHC’s Medical Director
  • access to specialised training and development

GPs are self-employed and hold a contract for employment on a sessional basis at £80 an hour (depending on sessions worked). NHC charges practices for GPs’ time, coordinated by a project manager. GPs work in an area suited to their own expertise and interest, such as standard clinical sessions, care home, access hub, urgent care centre or community clinic.

Impact

In the first seven months of implementation four GPs who were seriously looking to leave general practice have been recruited into the bank, three aged 65+ and one aged 55-59.

GPs are undertaking an average of two clinical sessions which involve both face to face and telephone consultations for practices who need to fill vacant sessions due to long term vacancies or annual leave / sick leave.

By creating this staff bank across NHC, practices have direct access to a bank of experienced GPs at below the current agency rate which has lowered the costs to the practices for sessional staff.

NHC are committed to continuing this model of delivery across the workforce once the official pilot finishes. There is recognition that workforce demands in Newham are high and NHC are well placed to support general practice in this area of need.

Lessons learned

The following are the key lessons learned from the scheme.

  • Early engagement with general practice is important to get practices on board and support the scheme.
  • Clear processes and procedures to secure GPs joining the pool are essential to ensure they know what they are signing up to.
  • A project manager, who is in a position to lead on all aspects of the pilot and whose time is dedicated solely to the project, is required.
  • A clinical lead is needed to help design and implement the scheme to ensure that the ‘offer’ is attractive.

Key contacts

  • Anne-Marie Maher-Vyas, Head of Commissioning & Transformation (Out of Hospital Team), NHS Newham CCG, a.maher-vyas@nhs.net
  • Vijayakumari Toke Ananthan, Project Manager, NHS Newham CCG, v.tananthan@nhs.net

A detailed case study can be found on the FutureNHS Collaboration Platform which describes in detail how NHC set up their scheme and the pricing model in which they used. The FutureNHS Collaboration Platform is a platform designed to share best practice and learning. To request access, please email england.primarycareworkforce@nhs.net.