About this toolkit

In 2022/23 NHS England invested over £60 million to support GP retention. This was used to encourage and support action to reduce loss from the GP workforce. £16 million of this funding was released via the Local GP Retention Fund, which sits alongside the national offers of Newly Qualified Fellowships, Supporting Mentors, Flexible Pools and the National GP Retention Scheme. The toolkit is based on earlier piloting of more flexible working opportunities for GPs to provide extra help for areas of the country that needed it most. Investment in GP retention continues into 2023/24 confirmed via primary care system development funding (SDF)

Delivery plan for recovering access to primary care outlines the intention to build capacity in primary care through retention and return of experienced GPs, this toolkit sets out suggested steps that may help the development of a local action plan to improve GP retention, with a strong focus on local leadership and collaboration across the system.

Who should use this toolkit?

This toolkit can be used by:

• GPs: By clinical leads, GPs and their appraisers to inform what good looks like and understand the potential contribution of different levels of the system towards making general practice a better place to be.
• Practices and Primary Care Networks: By local workforce leads to consider and respond to the support needs of their GPs, how they can engage with designing the action plan.
• System leaders: to understand the issues and key actions needed to improve GP retention and consider how to include them in integrated care board (ICB) local workforce plans.

Creating capacity to change – Retention Action Plan

Make GP retention a priority

GP retention is a key issue affecting many GPs and practices. A well-developed GP retention action plan is a key feature of local workforce plans.

Leadership and resource

Planning and implementing an action plan to improve retention takes time, effort and leadership. Engaging clinical leads for GP retention means they can play a key role in helping to champion change, generate new ideas and offer a link to ‘what’s happening on the ground’.

Project and change management resource at system and/or network level could be dedicated to co-ordinate the design and implementation of the action plan. This might include some administrative and communication support to co-ordinate and manage take-up of the support offers, and any associated procurement activity.

Primary Care Networks

Primary Care Networks (PCNs) play a key role in creating a sustainable workforce across primary care through the creation of satisfying roles for staff, development of multi-professional teams and more balanced workload for all, with a focus on preventing ill health and tackling health inequalities. There is opportunity for PCNs with a significant focus on providing capacity and support to enable the primary care workforce, including GPs, to access career progression opportunities and step into leadership roles.

Primary care training hubs

Training hubs are ideally placed to support workforce planning and the delivery of GP retention and career support initiatives locally. We recommend that the local hub is engaged at an early stage of developing the GP retention action plan to consider how they might support the delivery and resourcing of the plan going forwards.

Case studies demonstrating the role that Training Hubs can play in regard to GP retention can be accessed on the FutureNHS Collaboration Platform.

A Training Hub brings together education and training in primary and community care with the aim of developing a sustainable workforce. Specifically, training hubs can:

• Assist practices, PCNs and the wider ICB in workforce planning
• Develop capacity for training within practices and PCNs
• Support educators to make general practice ‘the best place’ to learn
• Support with retention of GP and primary care workforce at all stages of their career
• Coordinate education programmes to support service delivery ambitions
• Help introduce and embed new staff
• Support the continued professional development of all staff.

Engage and empower

Engage your stakeholders in design

Bringing system leaders and local partners together is essential to promote understanding of the issues and to create solutions that work. Encouraging open dialogue between your stakeholders – perhaps through focus group sessions and more formal project governance arrangements – also helps to foster a culture of collaboration and continuous improvement. A full range of stakeholders can be engaged in action planning activity.

Encourage take-up of the offer

Action plans provide a comprehensive support offer but if introducing several new initiatives at once it may be best to stagger the roll out and communication of these to avoid overloading your GPs and wider stakeholders with too much information at once. This may also encourage better take-up of the support offer.

Ensure GPs have room to engage and develop

Consider from the outset how you are going to create room for local GPs to participate in career development activity. This might mean structuring interventions to minimise the impact on clinical work, or considering more radical solutions such as using pooled working arrangements to provide backfill for local GPs and considering the potential impact on the workload of other practice staff.

GP Retention – Suggested contributors to the action plan

• Local medical committees
• Appraisers
• Secondary care
• GP federations
• GPs (all career stages)
• Local/regional NHS England
• ICB leads
• Royal College of General Practitioners (RCGP) representative
• Practices and networks
• Training hubs

Know the local GP workforce

The first step of developing a GP retention action plan is to take time to profile and understand the needs of local GPs to determine what support is required. A good understanding of local workforce data is key – combined with local understanding of the context. It should be noted that loss from the GP workforce occurs in different ways along the GP career pathway.

Newly qualified – Mid career – Wise years

• Emigration
• Voluntary early retirement
• Change in career direction

Loss throughout the GP career pathway due to:

• Reducing working hours due to caring commitments, managing workload (e.g. working as a locum)
• To undertake more varied work across multiple settings
• Burn out or ill health

Surveys and focus groups

Focus group sessions are a hugely valuable way to drive understanding of the issues being faced locally.

Questions you may wish to consider include:

• What is the profile of your workforce? What issues are they facing?
• How many GP trainees do you successfully retain locally post training?
• How many experienced GPs are you losing to early retirement or other factors?
• How many GPs are opting to work on a part-time or locum basis?
• How many GPs do you need to retain in the workforce in line with local workforce plans?

Snapshot surveys of local GPs are also a useful way to understand their ambitions and stressors, and to gauge the impact of current support provision.

Measuring the impact of retention

Retention can be difficult to measure and it will take time for the impact of initiatives to show in workforce figures. Workforce data, however, provides insights into local trends and can be a useful tool where available.

Quarterly primary care workforce statistics are published by NHS England and provide data on staff working in the general practice setting. Primary Care Workforce Quarterly Update – NHS Digital

Reports produced via the National Workforce Reporting Service are helpful at all levels of the system – from practices through to ICB. National Workforce Reporting Service (NWRS) – NHS Digital

Assess the support gap

Through the Local GP Retention Fund alone, over 200 retention support initiatives have been established in England. A GP retention action plan is recommended to build on existing activity and bolster it through additional support across three levels of intervention (GP; practices and networks; system). Armed with a detailed understanding of their workforce, ICBs could compare their current activity against these levels to assess gaps in support.

In undertaking this approach, it would be useful to understand:

• Progress of schemes established via the Local GP Retention Fund
• The uptake of the National GP Retention scheme across the area
• The uptake of other GP retention initiatives in place nationally
• Engagement with other schemes run through wider partner organisations (e.g. British Medical Association and Local Medical Committees, Royal College of GPs).

The three levels of intervention

1. Career support for GPs

Tailored career support provided direct to a GP according to need. GPs are individuals and their support needs will evolve as they progress through their career. The best support provision takes this into account.

2. Practices and networks

Interventions to address issues at practice and or network level that are affecting GP retention. These initiatives could be aimed at individual practices or groups of practices and may include work to address GP workload and build the multi-disciplinary team.

3. System

Interventions to address system-wide issues affecting GP retention. These may be at ICB level or across groups of networks. There is guidance within Delivery plan for recovering access to primary care that outlines how workload can be reduced by improving the interface between primary and secondary care.

What scale is best?

To support local ownership and innovation, GP retention action plans are ideally held at practice and network level but should feed into a combined plan at ICB level to maximise opportunities to collaborate across networks and groups of practices.

Refine your action plan

Gaps against the support needs of local GPs or across the three levels of intervention should now be evident and can start to be addressed through action planning.

Goals and action plan essentials have been suggested for each of the three levels of intervention. These are by no means exclusive and are there as guidance.

Through discussion with stakeholders, local areas are encouraged to agree goals to ensure they capture the key issues that need to be addressed locally. In a similar fashion, whilst action plans may maximise the opportunities available through national programmes of work, this could be combined with more targeted support at a local level.

For each level of intervention, the following sections of this toolkit present:

Goals – an example set of aspirational goals for each level of intervention.

Action plan essentials/local must do’s – elements you may wish to feature as part of your action plan to help achieve these goals.

Developing career support for GPs

Goals: Local GPs

• feel engaged with and valued by the area and system within which they work
• have opportunities to connect with other GPs
• have the opportunity to access career advice and support when they need it
• can access training and leadership opportunities to support their career progression
• have the option to work flexibly and across a range of different settings if they want to
• feel supported to return back to practice after time out of the workplace
• can access a support programme in their first two years of independent practice.

Action plan essentials

• Opportunities for GPs to engage with the local GP retention strategy
• Plan put in place to stay in touch with GPs throughout their career
• Peer support networks
• Tailored support for GPs across their career – from training through to retirement
• Support for GPs returning back to practice
• Portfolio careers and flexible working
• Coaching
• Leadership development
• Mentoring
• Two-year support programme for newly qualified GPs
• Supportive GP appraisal.

Planning at practice and network level

Goals: practices and networks

• actively look to achieve better work life balance for local GPs through continuous improvement, service redesign and development of the multi- disciplinary team
• know and understand the needs of GPs working across the network and create opportunities to support their career development
• collaborate with GPs and others across the system to make local general practice a great place to work and identify opportunities to collaborate
• engage with their local training hubs to inform development of the local infrastructure to support future GP retention.

Action plan essentials

As per career support section, plus:

• Local action plan for GP retention, which feeds into an overarching plan at system level
• Local arrangements are in place to keep in touch with GPs especially in times of transition
• Communicating support opportunities that are available to GPs locally
• Promoting and developing the practice / network as a great place to work
• Developing the multi-disciplinary team in primary care to release GP capacity and reduce workload
• Regular review and maintenance of workforce data in line with contractual requirements.

Planning at the system level

Goals: the local system

• actively works with local GPs, practices, networks and system leaders to ensure the right support is put in place to improve GP retention
• is assured that GPs know about and can access career support and advice as needed
• works with local practices, networks, system leaders and other stakeholders to actively make and promote local general practice as a great place to work
• engages with its practices, networks and training hubs to inform development of the local infrastructure to support future GP retention
• has improved collaboration and working across the interface between primary and secondary care.

Action plan essentials

As per career support, practices and networks sections, plus:

• Action plan(s) in place at system, network and practice level and processes in place to oversee delivery
• Strong engagement with a wide range of stakeholders, including training hubs
• Named clinical lead(s), change facilitation support and project management capacity in place
• GPs and their appraisers are well informed of the local and national support available, and where appropriate, are supported into schemes.
• Work across primary and secondary care with a focus on reducing GP workload.

Available national support

National support and guidance available that could be reflected in your action plan:

• Resources for GP appraisers
• GP Improvement Leads Programme
• GP Health Service
• National GP Retention Scheme
• Induction and Refresher Scheme (Return to Practice)
• Looking after you: coaching and support for the primary care workforce
• General Practice Fellowship programme
• Supporting Mentors Scheme Guidance
• Primary care flexible staff pools

Equality and health inequalities

All initiatives – and particularly where they provide support to individual GPs – should give due regard to eliminate discrimination, harassment and victimisation, to advance and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it. Consideration should also be given to the need to reduce inequalities between patients in access to, and outcomes from GP services, and to ensure services are provided in an integrated way where this might reduce health inequalities. Further guidance is available at www.england.nhs.uk/about/ equality/equality-hub/

Case studies

To aid development of the local action plan, case studies are included in Appendix 1 and are available on the FutureNHS Collaboration Platform. We will be continuing to work with local systems and areas going forwards to collect and share this good practice.

Retention action plan checklist

The checklist below suggests some key steps to creating a GP retention local action plan. This checklist can be used in conjunction with this toolkit and related national guidance. 

Engage and empower

Have you:

• undertaken a local stakeholder mapping exercise to identify who to involve?
• engaged with stakeholders to develop the action plan (engagement event, focus groups etc.)
• agreed how you will engage and involve GPs and wider stakeholders to support implementation of your action plan (e.g. pulse surveys, using of social media, posters, local press)?
• considered how you will ensure GPs have the capacity to participate in career development activity?

Creating capacity for change

Have you:

• considered how to employ the ICB funding allocations for GP retention to support implementation of your action plan, targeted at areas that need it most?
• engaged clinical leads and have a named clinical lead in place to oversee the implementation of the plan?
• recruited a project manager to oversee implementation of the retention action plan and considered change management resource, administration and communications support?
• established a project board to oversee implementation with appropriate stakeholders including GPs, PCN and ICB
• considered alignment with wider funding allocations?
• engaged with training hubs locally to consider how they will support GP retention going forward?
• considered how you align your GP retention action plan with the range of national offers that exist for GPs?

Know the local GP workforce

Have you:

• accessed GP workforce data on the National Workforce Reporting System?
• undertaken a survey to understand in more detail the issues being faced locally by GPs?
• held local focus groups to analyse and interpret published data and local surveys?
• engaged with others who are leading on retention activities locally to understand what’s already available, including schemes set up under the Local GP Retention Fund? This includes schemes that partner organisations may have separately established (LMC, HEE, ICBs, RCGP).
• assessed uptake of other Retention Scheme across the area and considered the local strategy for promoting this scheme going forwards?

Refine your action plan

Have you:

• developed an action plan and ensured plans at practice and PCN level align at system level?
• ensured that the action plan essentials are a feature of your action plan with initiatives identified to fill gaps in provision?
• ensured that the national NHS England offers are part of your action plan?
• agreed the approach to monitoring the delivery of the action plan?

Where to find out more

Future NHS Collaboration Platform

An extensive range of resources are available on the FutureNHS Collaboration Platform including templates to help ICBs and PCNs develop a theory of change and action plan, analytical tools to understand the GP demographic and a range of further case studies. To gain access, please the contact england.primarycareworkforce@nhs.net with details of your name, role and organisation.

For any further help in relation to this toolkit please contact  england.primarycareworkforce@nhs.net

Appendix 1 – case studies

Career support for GPs – case studies

Newly qualified GPs

The NHS Long Term Plan committed that ‘newly qualified doctors and nurses entering general practice will be offered a two-year fellowship’. The aim of this offer is to support GPs as they transition into independent practice and give them the best possible start in their career. Funding is allocated to ICBs to support the delivery of the fellowship scheme supported by national guidance. Support offered to newly qualified GPs will build on existing best practice which is starting to emerge across the country, and strong alignment between this and the wider local GP retention action plan is expected, with a view to creating a continuum of support across the career pathway.

Black Country Mentoring Scheme

The Black Country’s mentoring scheme has been achieved by adapting and up-scaling a popular pre-existing scheme, taking advantage of the skills and knowledge of experienced GPs within the area. This allows for younger GPs to receive guidance from mentors who have encountered similar issues and challenges specific to the area and helps re-energise the mentor’s career and allows them to “give back” to the profession. The mentoring covers a wide array of topics including: physical and mental wellbeing, professional development, advice about partnerships, practice process improvement, financial advice, regulatory affairs, and ways to avoid or deal with burnout. Recipients have reported notable benefits, stating that they feel more supported and are optimistic about their careers.

Early to Mid-Career

Somerset Peer Support Scheme

Somerset developed a scheme that provides six months of paid, facilitated peer support sessions to experienced GPs who are seriously thinking of leaving or who have recently left. Nine GPs were recruited onto the scheme in the first seven months and GPs surveyed responded that they had improved morale and a reduced sense of professional isolation as a result of being on the scheme.

Black Country Portfolio Scheme

The Black Country developed a portfolio career scheme that offers flexible career options for GPs to enhance their skills and knowledge in areas of interest (e.g. dermatology, GP education, frailty). A key benefit of portfolio roles is that patients are able to receive care without the need for specialist consultations in secondary care. It is believed that this will reduce the burden of hospital appointments, resulting in reductions in waiting lists and savings across the wider healthcare system. Up to £10,000 has been made available for each GP to support development of their portfolio roles in the Black Country. The scope of employment and the balance between each GP’s clinical and specialist sessions is agreed on a case by case basis. CPD accreditation and points are attained through learning/reflective logs, as well as successful completion of any training programmes enrolled on as part of the scheme. Within the first six months, the scheme received 66 applications and has supported 24 GPs, with GPs who sign up to the scheme expected to stay in the Black Country for two years. GPs have responded favourably to the scheme, stating that it provides a welcomed opportunity, not only to pursue an interest, but to upskill (by gaining qualifications and experience) and provide more services in general practice.

Wise Fives

Isle of Wight Legacy Five Scheme

The Isle of Wight developed a ‘Legacy 5 scheme’ that supports GPs who are within five years of retirement to make informed decisions about their futures. The scheme highlights career opportunities which may result in GPs working beyond their identified retirement dates. The scheme involves workshops focussing on financial planning and career development opportunities. GPs have access to a fund to undertake a range of training that would enable them to cultivate skills and provide care beyond their projected retirement dates.

Return to Practice

Dorset – one-day returner’s course

Dorset developed a one day course for GPs returning to the workplace after a period of absence, typically but not exclusively for GPs following parental leave or long term sickness. The course offers GPs the opportunity for simulated face to face and telephone patient consultations, with feedback from experienced GP Educators available. Participants are offered the opportunity for follow on coaching over the return to work process, through the Primary Care Workforce Centre’s coaching facility. Up to 16 GPs can attend each course and the key benefit has been that GPs who wouldn’t have returned have, due to the increased support available.

Practices and networks – case studies

Isle of Wight Career Roadmaps

The Isle of Wight recognised that there was a lot of information available for GPs but this information was spread across multiple sources, making it difficult for GPs to find and use. Furthermore, the information was not tailored to the local context of the island. With this in mind, a single point of access was created that clearly directs GPs to career development opportunities and guidance of how to navigate the local and national system. The online resource provides an overview of opportunities (roadmaps) to GPs according to their roles within general practice (i.e. registrars, salaried GPs, partners and locums).

Newham engagement activities

Newham has conducted a range of engagement activities with GPs through a range of events, use of social media (such as WhatsApp) and even visiting GPs for coffee to gain their views. A primary care event was held that attracted over 250 primary care staff including 70 GPs from across Newham. The event celebrated achievements from individuals and teams across Newham and provided the opportunity to connect with GPs and primary care staff enabling the contact details of those attending to be obtained so that they could be alerted about future learning, development and engagement activities. Emails and newsletter communications about various retention offers have been followed up with a message on WhatsApp which has been very popular at reminding GPs and wider primary care staff about the offers available.

System level – case studies

Cheshire Retention Project

Cheshire worked with GP practices to undertake a piece of research to determine the future plans of GPs who are nearing the end of their career. They developed a ‘Stay Interview’, where experienced GPs (generally over the age of 50) are interviewed by another GP to explore their future career intentions. The outputs from these interviews have been used to create an action plan to help retain these experienced GPs with new opportunities and career pathways across the local area.

North Midlands appraisals and signposting to bespoke retention packages

The ‘Soft re-boot’ of the annual appraisal was taken as an opportunity to change the culture of the appraisal from ‘I’m stressed I need to postpone my appraisal’ to ‘I’m stressed I need to book my appraisal’. This initiative focused on implementing new documentation supporting the revised appraisal process prompting soft discussions about future career choices and focuses the appraisal conversation (where indicated) on retention options enabling signposting to career options and support opportunities which could encourage GPs to stay in service. An annual conference is held where all appraisers across the area are informed of their role in supporting GPs, understanding their future plans and signposting them to the support available.

Publication reference: PR1939