How do GP trainees see their future in general practice?

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Since 2016 The King’s Fund has surveyed doctors who are in training to become GPs and at the end of 2020 we repeated this survey and 810 GP trainees across England responded. The 2020 survey findings were consistent with trends from previous years and it is striking just how consistently the findings reveal that increasing number of GPs want to have a ‘portfolio career’.

I am currently in my first year of specialist training to become a GP and I already have a portfolio way of working: I work five clinical sessions and three sessions at The King’s Fund. In this blog I am going to explore some of the reasons why GP trainees want a flexible career and what this means for the future of primary care.

Qualified GPs are paid per number of clinical sessions, with each clinical session estimated to be half a day of work. In each of my clinical sessions I will have a range of patients of different ages and backgrounds with different conditions who are all connected through their community. It is this clinical variety and opportunity to provide care that is holistic, as well as offering continuity of care, that makes a career in primary care exciting, challenging and unique compared to hospital specialists.

I entered medicine with the vision of becoming a GP who provided 'cradle to the grave' care. - GP survey participant

GPs also complete the administrative work that a clinical session generates. This might include interpreting investigation results, communicating with hospital specialists or undergoing urgent clinical assessments such as home visits. This means that a half-day session in reality lasts much longer than four hours. Our survey has consistently shown that over the past four years the most common reasons driving GP trainees wanting to work fewer half-day clinical sessions per week in their future career are intensity of work-day and volume of administrative work. Since 2016 only about 27 per cent of survey respondents have wanted to work ‘full-time’ clinical sessions one year after they have qualified.

General practice is a brilliant job, but will always be too intense to do for more than five or six clinical sessions per week. - GP survey participant

The administrative load exponentiates with increased clinical work, and the complexity and intensity of the work would lead to burn out full time. 
- GP survey participant

A portfolio career is where GPs work in a general practice for part of their week but also spend other time working in a different context or organisation. Our 2020 survey found that, consistent with previous years, approximately 45 per cent of GP trainees want to be working like this within five years of qualifying.

For me, the portfolio way of working at both a GP practice and at The King’s Fund increases my job satisfaction, and each role compliments the other: I can apply policy and systems thinking I gain at the Fund to my general practice, and bring a frontline primary care perspective to work I am involved in at The King’s Fund. The survey has shown that over the past four years the most common plans for portfolio careers are to work for other NHS services (eg sexual health or palliative care) and in medical education, both of which will bring specialist knowledge, skills and training opportunities into primary care. Portfolio working makes for both an attractive career option and brings greater expertise into local communities.

I know that when I’ve had more than one role previously I bring to each role more knowledge motivation and enthusiasm as a result of the time I spend in the other! My interests include policy, commissioning, education, coaching, leadership, workforce development... - GP survey participant

The Covid-19 pandemic has resulted in changes to the way primary care services are being delivered. While more than half of consultations with GPs are still face to face, the proportion of consultations taking place remotely by phone or video is far greater than before the pandemic began. This shift has potentially increased access for patients by providing alternative ways to seek medical care and gives added flexibility for the way GPs can work; in our survey trainees welcomed this flexibility with 74 per cent wanting to work up to two sessions per week at home one year after qualification (very few want to work more than that number of sessions per week remotely). This finding is in line with other research that we’ve undertaken on remote working in primary care. GP trainees felt this flexibility would allow them to manage their caring commitments, attend meetings and complete administrative work; but they want to remain present at the practice the majority of the time to ensure that they feel part of the primary care team.remain present at the practice the majority of the time to ensure that they feel part of the primary care team.

I enjoy the teamwork, atmosphere and seeing my patients face to face. However, I do also feel that the flexibility of home working is a great way to reduce stress, so I'd like to do one session per week of admin from home. 
- GP survey participant

Overall, we heard how GP trainees are positive about the future of general practice, with changes in changes in technology, teamworking and flexible portfolio careers making it an attractive career – it certainly makes me excited for a future career as a GP, and I believe that primary care will remain a dynamic, patient-centred, community-focused speciality.

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