Note: Some sections of this story refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down.
“What really suits me at the moment is the flexibility of the retainer scheme” – James combines examining for the RCGP for the CSA exam and working as a General Practice.
“It’s allowed me to return to the career I love and … get back to normal life” – Kate took some time off after qualifying as a GP due to mental health issues. Flexible working helped her achieve a better work-life balance.
“The GP Retention Scheme is one important area which allows GP’S to stay in the workforce” – Mark Sanderson, Medical Director for Cambridgeshire and Peterborough CCG, talked to us about how the scheme is helping GPs and patients in this area.
In 2017 James Heathcote, 61, decided to retire from his practice in Kent, where he had been a partner for 31 years, and move to Suffolk. After a short break from clinical work he found out about the GP Retention Scheme, which has allowed him to work three sessions a week and annualise his hours. This enables him to be an examiner for the RCGP and an appraiser. He has worked at the Angel Hill Surgery in Bury St Edmunds for over a year.
“When I got to 60 I took my pension and we’d always thought that we would retire outside of London. Actually I come from Bury St Edmunds, so I’ve come home.
I wanted to still be a doctor. I felt it rather defined me. I enjoyed the work. Seeing patients is endlessly fascinating. I’m also an examiner for the RCGP CSA exams so it’s important that I’m still clinically connected.
I’ve always known about the scheme as in previous surgeries we had GPs on the scheme and one of my past careers was an LMC (local medical committee) role. I read that the scheme had been relaunched with a focus on retirement, not just young doctors with families, and it seemed like a good idea.
I have loved the retention scheme. Other GPs in my situation might do a salaried role, locum or out of hours work, but what really suits me is the flexibility of the retention scheme. It’s enabled me to do three sessions a week and still be a doctor. When I examine for the CSA I need to be available at fairly short notice and the practice is very understanding. I’ve also been accepted as an appraiser here and hope to continue doing that.
I don’t have children in school so I can work extra sessions in school holidays to create a bit of flexibility for later. I’ve got a daughter in Australia so it would be nice to go and see her.
The scheme provides continuity and educational support, which are especially important if you only work a few sessions and are new to the area. The ways of working here are quite different so there’s quite a steep learning curve. Angel Hill Surgery is a teaching practice with an educational ethos and I value the opportunity to ask questions. It’s helped me settle in the town and I really enjoy it.
This scheme has allowed me to go back and to be an ordinary GP again. I have no admin work, which frees up more time to see patients. What I’m seeing now is a different case mix; because I’m no longer a partner, I see a full variety of things and that’s exciting.
I’m 61 now. I don’t feel ready for the scrap heap. Retirement is nice; the new pace of life is very enjoyable. I’ve enjoyed having a quieter life.
In your career you have different phases of life. Rather than this all or nothing: you have to be a partner or you have to do this salaried role, this is a little bit in between. What it does is it says here is an experienced GP who still got an enthusiasm for the job; let’s create a job that will enable that doctor to work and be productive and want to stay in it. And I can see myself doing this for another five or ten years.
Staying in general practice – James’ story
Kate, 38, took some time off after qualifying as a GP due to mental health issues. When she was feeling better she discovered the GP retainer scheme, which she joined in February 2018. She currently works at Greenview Surgery in Northampton.
“I qualified in 2016 but had a gap after qualifying. Now I’ve been working as a GP retainer for nearly a year.
I love being a GP as I love the variety that you see on a day-to-day basis. No day is ever boring and I really enjoy the challenge.
I had a difficult time after I had my daughter; I suffered mental health problems and I was recovering from that. Although I was able to complete my GP training I didn’t feel that I was able to do a full-time or part-time GP role at that time.
It was very disappointing and difficult to consider leaving behind something that you’ve spent so much time doing; it becomes part of who you are and to leave that behind would have been heart-breaking.
So I decided to take some time out to fully recover from the mental health issues I’d had. When I was well and ready to start again I looked into how I could return, different schemes that were available and I found the GP Retention Scheme.
With the scheme you’re able to do a maximum of four sessions per week. Initially I did two sessions per week and as my confidence has grown I’ve increased to four sessions a week. That works really well having a young child because I’m able to pick her up from school in the afternoons.
I was very interested in the Greenview Surgery because it’s a training practice so they were very used to giving support. I have an educational supervisor and I have tutorials with her. Also I’m able to talk to any of the other GPs so I’ve found it to be a very supportive environment generally. Sanjay is one of the partners so I can talk to him. We’ve had discussions about patients, problems, dilemmas that I’ve come across so he’s helped me out with that.
When I first started I was nervous as I’d been out for a while, but my confidence has improved rapidly and I’ve been able to increase my sessions and feel much more confident on a day-to-day basis. I enjoy the fact that I can do this role and have a full family life as well.
I’d consider the scheme as an option to be supported in your role and have flexibility in terms of hours. It has worked out really well for me so I’d recommend it to anyone in a similar situation.
I’m not sure that I would have returned to medicine at all without that scheme that has allowed me support and flexibility. It’s allowed me to return to the career I love and continue my life in a positive way. Having been through negative experiences in the past, it’s allowed me to progress and get back to normal life, which is what I wanted.
Staying in general practice – Kate ‘s story
Like the rest of the country we are having problems with the number of GPs in the county. Unfortunately the numbers have slowly reduced like we’ve seen throughout the rest of England. I used to be a GP, so I know that it’s a very demanding role. The workload’s increased and unfortunately the workforce has not matched that.
For example the number of GPs over the age of 55 in our county is over 25% which means over the next few years a number of our colleagues will be retiring. There’s also been a change in the demographic of the workforce, so there are now more part-time than full-time GPs. With an increasing population – we have nearly a million patients in our county- the number of GPs we need to keep, to work with our patients unfortunately is not meeting demand.
If you think about how long it takes to train a doctor and how important GPs are in the NHS, it’s important for us at the CCG to do everything we can to retain our GPs. The GP Retention Scheme is one important scheme which allows GPs to stay in the workforce.
Before I joined the CCG I was Deputy Medical for NHS England Midlands and East and was part of the national team that redesigned what was the GP retainer scheme into the GP Retention Scheme. That involved a change in the criteria.
Now we’re able to assist a number of doctors who at various times in their career are wanting support to stay or get back into the GP workforce. For example, that could be doctors raising a young family, managing an illness, doctors with portfolio careers and a growing number of wanting to wind down their hours as they approach retirement.
It allows GPs who might not otherwise be in the workforce to remain at work. It offers flexibility and support, which is important in a demanding job like general practice.
In Cambridgeshire and Peterborough, we’re pleased to be supporting 13 doctors on the GP Retention Scheme. They’ve found it really useful because it’s allowed them to stay in the workforce and develop a job with a practice that fits with their particular needs as part of a bespoke package of support. The doctors on the scheme that I’ve spoken to have found it useful to sit down with an educational supervisor and look at their learning needs.
The average GP has anywhere around 1,600 patients per GP, that’s a lot of patients who now have a GP that they may not have had before.
I would encourage my CCG colleagues to consider the GP Retention Scheme as part of their package to support GPs. It’s nationally developed, has the support of the professional bodies and lots of GPs have found it really useful. I would hope that colleagues would see it as an important way to retain GPs in their area because I think every GP is important.