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 will 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

The GP workforce in Great Yarmouth and Waveney (GYW) is rapidly shrinking due to the relatively high numbers of GPs reaching retirement age or leaving early due to increasing workload pressures. Recent pension changes are also exacerbating the issue.

The percentage of FTE GPs over the age of 55 in GYW stands at 29.8% which is 6.4% higher than the England average. In addition, GYW has a relatively low GP / patient ratio at 1:1,686 compared to the England average of 1:1,392.

Work is underway to attract more GPs into the local workforce with the number of training programmes being expanded to offset those leaving and an international recruitment drive also taking place. However the rurality of GYW impacts on the ability to attract new GPs to work in the area.

The solution

Recognising that a high priority should be to support and retain the existing workforce as well as to attract new doctors in, the CCG have a developed a scheme that involves creating a ‘bank’ of experienced GP’s that supply cover for clinical sessions to local practices to fill long-standing vacant sessions and short-term cover for sick and annual leave. The scheme involves the CCG facilitating the making of arrangements between the GPs and local practices. The contractual relationship for the provision of GP services is between the GP and practice and the CCG acts like a broker between the two parties.

Extensive, one-to-one engagement with GPs was a key success factor, as it helped to understand what would stop GPs from leaving. For GPs it was not about the money but what the CCG could do to make them feel supported and to take away the hassle and administration so that they could concentrate on meaningful clinical appointments.

GPs also were incentivised through offers of indemnity cover, longer 15-minute appointment times, access to a facilitated peer support network to reduce the potential feelings of loneliness and provide a forum to share experiences and learning, and a training budget to use for specialist interests and mandatory training, all organised through the project coordinator.

Impact

In the first seven months of implementation five GPs have been retained who would have otherwise left, three of which are over the age of 55. The scheme has been able to support local practices to fill short term vacant sessions and free up capacity for partners to focus on wider workforce planning. GPs on the scheme have been in frequent demand and practices (some of whom were running entirely on locums) have found the leadership and experience they provide to be invaluable. In summary the scheme has helped the local system to become more resilient.

Lessons learned

• Understand the workforce: It has been essential to research the GP workforce in the area to identify those likely to be leaving and approach them directly rather than sending out generic communications to promote / recruit into the scheme. This allowed us to target the GPs directly to let them know what the scheme is about and how it may benefit them.
• Understand locum working requirements / pensions: It has been important to regularly familiarise ourselves with locum working and the legal requirements around this especially when dealing with self-employed GPs.
• Understand each GP as an individual: It was essential to understand the current positon of each GP as an individual to ensure that the scheme fits around their requirements to continue offering their clinical expertise within the area. We have found it very useful to meet regularly with our GPs to plan for any future changes in their capacity and training needs.
• Understand legal requirements: It was essential to familiarise ourselves with the legal requirements for implementing the scheme – including memorandums of understanding between all parties – to allow the CCG to run the staff bank. Having this gave assurance to our practices and GPs that it was a reliable and trustworthy scheme that could offer flexible working with a number of incentives.
• Understand pre-employment checks: It was essential to fully familiarise ourselves with both minimum requirements of pre-employment checks and what is required by practices, as these may be different. The project coordinator arranges all the pre-employment checks for each GP including DBS, medical defence, qualifications, ID, proof of address, performers list etc. and communicated to practices when the first session is arranged and is available on request for CQC inspections. This gives assurance to practices and the CQC that the GPs are eligible to work.
• Understand the limitations of the scheme: There have been challenges with the perception of the scheme and the limitations around what it can offer to practices. It has often occurred that practices and CCG colleagues have seen the scheme as a locum type agency which can support all of the workforce gaps across the area when in fact this is the opposite. The scheme is designed to provide a flexible working agreement to retain the skills and expertise within the area, therefore we often communicate with our colleagues to make them aware of the capacity of the GPs and what the scheme is used for.

Key contact

Lauren Emmerson, STP Primary Care Workforce Coordinator, NHS Norfolk and Waveney CCG, lauren.emmerson1@nhs.net.

A detailed case study can be found on the FutureNHS Collaboration Platform which details how GYW set up their scheme, how it was run and GPs recruited. The FutureNHS Collaboration Platform is a platform designed to share best practice and learning. To request access, please email england.primarycareworkforce@nhs.net.