Your questions answered

Yes. The planned changes came into effect from August 2021*. That means doctors accepted onto GP training programmes will increase the time spent in general practice by 6 months, to 2 years after completing 1 year of hospital-based training rotations, which will not alter the length of training.

*England and Wales only.

Increasingly, GPs are taking on roles that are beyond the scope of GP training and the MRCGP that require additional qualifications. But there’s no standard route to becoming a Portfolio or extended role GP. The opportunity to work flexibly and develop areas of clinical interest is one of the great benefits of shaping your own career. Some specialty areas of work will have more structured degree courses or diploma requirements, with others it may be experience.

With the support of NHS England, the Royal College of General Practitioners (RCGP) has developed a generic framework to support the accreditation of GPs with Extended Roles (GPwER). An accreditation service for GPwERs in Dermatology and Skin Surgery has been launched. The guidelines have been updated in collaboration with the British Association of Dermatologists (BAD) and Primary Care Dermatology Society (PCDS) and replace the 2011 Department of Health Guidelines for General Practitioners with Special Interest (GPwSI).

It is possible to pursue postgraduate qualifications during your training, such as a masters. You can apply for a full time out of programme experience. There are some post-qualification (i.e. ST4) fellowships that offer funded courses (the choice of subject will vary) but this depends on location. Academic Clinical Fellowships (ACFs) offer opportunities that may help support a portfolio career.

These fellowships are usually offered by Health Education England local office/deanery, training hub or primary care network (PCN).

The main thing is to just get involved in the life of the GP practice, primary care healthcare team and seeing patients. You could take the opportunity to do a project on your GP placement if you’d like to learn more about a particular aspect. Although a portfolio is not required, building a fuller understanding of general practice and medicine is worthwhile as its a stimulating and challenging academic specialty. Any preparation will always be useful.

If you look at the whole-time equivalent number of GPs working in practice, it’s clear that to meet patient need we’re a long way off running out of job opportunities! That’s why we’ve increased the number of GP specialty training places to 4,000 a year, to meet current and future demand. Qualified GPs are able to develop a portfolio career or establish special interests in or out of practice. Some decide to locum to see what kind of practice suits them best or take the opportunity to travel and work overseas before settling down. Don’t forget that partnership is an option with incentives for newly qualified GPs.

Telephone and more recently remote video consultations between clinician and patient have always had a role in general practice. Although they will never replace face-to-face appointments, there are many benefits to remote consulting for GPs and patients.

• Provides GPs with even more flexibility as you can work some sessions from home.
• Many patients (as well as GPs) love them, saving time and unnecessary journeys into the practice.
• May increase access for those with mobility or transport problems.
• Allows appropriate triage of patients and can improve effectiveness of face-to-face consultations.
• Other allied health professionals in the practice team, such as practice nurses and physician associates, can contribute to remote triaging using digital technology, which can free up time for GPs to spend longer with patients who need that level of expertise.
• GPs are finding that the freed up time is enabling them as expert generalists to spend better quality time with patients who typically these days present with complex problems and multiple co-morbidities. For many years GPs have said that they wanted this. This has the potential to make being a GP even more rewarding.

GPs have always been known for adapting and innovating - adopting digital healthcare is no exception. As remote consulting becomes the new normal across the health service, GP training programmes are already addressing these updated consultation methods with new training models and assessments. All patient safety and data security requirements remain a priority.

While a majority of trainees work on a full-time basis, the less than full time (LTFT) and out of programme (OOP) options are becoming more popular with an increasing number of trainees keen on pursuing roles as portfolio GPs.

Less than full time training (LTFT)

Deaneries, through their Postgraduate Medical Education departments, have a commitment to help all doctors recognise and achieve their full potential through career development. It is also supportive of those with health problems and caring roles and responsibilities to help make sure training can be completed. Local administrators will need to be informed of applications requiring the approval of the Training Programme Director (TPD) and the Head of School.

You can find the eligibility criteria in A Reference Guide for Postgraduate Specialty Training in the UK guidance (Page 38).

Out of Programme (OOP)

Trainees may opt to take some time out of training to develop professionally, get involved in research opportunities or get clinical expertise in areas not provided by their training programme. All requests need to be agreed by the Head of School in advance, so trainees are advised to discuss their proposals as early as possible. All applications will require support from your Training Programme Director (TPD) and are considered competitively by a panel that look at the benefits to the trainee’s career and GP practice in the NHS as well as other criteria.

You can find the eligibility criteria in A Reference Guide for Postgraduate Specialty Training in the UK guidance (Page 44).

Most GPs are independent contractors, either running the business on their own or in partnership with others. Owners and staff subscribe to an NHS pension. As with all other independent NHS contractors, GPs are responsible for running the business affairs of the practice, providing adequate premises and infrastructure to provide safe patient services and employ and train practice staff. They administer NHS budgets, work to NHS standards and are inspected by the NHS. Their work is managed by the DH through guidance and contract terms.

Over recent years there has been a steady increase in the number of large partnerships resulting in the consolidation and growth of a number of GP patient lists. In turn, the traditional staff roles have expanded and developed to meet the needs of the practice. It does mean that there’s plenty of scope for GPs who are interested in the business aspect of running a practice with the ability to make local changes.

What are working sessions?

Although a session is defined as 4 hours 10 minutes, periods of duty do not need to be exact multiples of sessions. For example, short days are permissible as long as the hours are all counted. An example would be where childcare commitments mean that an employee may prefer to work short days – perhaps two days from 9 am to 3 pm and one day from 9 am to 1.40 pm = 4 sessions (16 hours 40 minutes). 

What is a ….?

GP Partner

General practice has traditionally been run on a partnership model where practices are owned by the GPs themselves (GP partners) and are subcontracted to provide services for the NHS. Partners take a share from the profit and are responsible for providing clinical sessions as well as taking an active role in the administrative and business side of running the practice.

Unlike salaried GPs, there is no set income range for partners. A partner’s income is dependent on both the finances of the practice and how income is distributed within the partnership, so how much you can earn will vary between practices. As an example, in 2014/15 the average income for a GP partner in the UK was £101,500.

Salaried GP

Salaried GPs are employed by a practice and receive a salary for a contracted number of hours worked.

There is a minimum set of terms and conditions (‘the Model contract’) that applies to all salaried GPs employed by a GMS practice. The Model contract terms and conditions bring important improvements for salaried GPs, in line with the terms and conditions of other employed doctors in the NHS.

The suggested minimum salary range for salaried GPs is £56, 525 to £85,298. Employers have the flexibility to offer enhanced pay rates. In addition, under the Model contract, a GP's salary must be uplifted annually.

Locum GP

GP Locums work on a freelance basis and are often employed to cover back-fill, leave or sickness. Working as a locum provides a good opportunity to try working in variety of settings, seeing a range of patients and experience different ways of running a practice. It provides a good opportunity to get to know a local area. If work-life balance is important, being a locum puts you in control of how much, where and when you work.

GPs generally work freelance in three different ways:

• as independent freelance locum
• as part of a freelance GP chambers
• employed through an agency

Locum rates of pay can vary depending on which route you take.

Sessional GP

This term encompasses both salaried GPs, and GP locums.

Portfolio GP

Aside from being a partner, salaried or locum GP, there are numerous opportunities to include portfolio jobs, either full or part-time.

• GP with Special Interest (GPwSI) jobs are available in most specialties, including dermatology, diabetes and minor surgery.
• Clinical Commissioning Group (CCG) roles range from CCG Chair/Accountable officer to Clinical Director level. These jobs can be done full time or part time.
• Teaching and training roles are available if you are interested in becoming a GP educator. Depending on your interest you could either train medical students, foundation year doctors or GP specialist trainees.
• GP leadership roles include Associate Medical Director/Medical Directors of community trusts and mental health trusts.
• Working for prison health services as a GP.
• Working exclusively in Out of Hours GP services.

It varies from practice to practice. GP Partners usually share ownership of the building and work as self-employed. They deal with all aspects of running a business such as HR, finance, maintenance and safeguarding. Being an employer can sometimes be tricky. There’s extra work in terms of planning and organisation and seeing patients is a proportion of what needs to be done day to day, but it keeps the job varied, stimulating and interesting. The advantage of being a Partner is that you’re much more involved in implementing changes. You’ll find more information about the New to Partnership Payment Scheme on the NHS England website.

This is very much a concern in general practice and many GPs are active in this area. The ‘Greener Practice’ initiative explains in more detail.

More widely and driven by the Covid 19 pandemic, general practice is likely to see the continuation of flexible working patterns for GPs, removing the need for commutes to the surgery - at least part of the time. GP as a specialty has much less impact on climate change than large hospitals for example.

It is true that a number of trainees take the opportunity to travel and work abroad after and between foundation and specialty training. There are also a number of Global Health Fellowships available. Historically most doctors return to the UK. There’s an easy way to return via the Return to Practice Portfolio Route.

You will have a dedicated GP educational supervisor who will provide support throughout training with regular contact during the months in ‘non GP’ posts. There are protected education sessions with your peer group during the 3-year training programme.

Not all GP rotations have A&E posts but most acute specialty posts in hospital will involve some on-call commitment as part of their rota. There may be an opportunity at recruitment to select your preferred rotations, usually based on previous clinical experience. It’s important to look at individual schemes and get in touch with your intended local office/deanery to discuss ahead of your application. Many education providers allocate trainees their preferred choice of speciality jobs in hospital.

When successful applicants are offered their area for training, there may be a chance to select rotations.

Yes, if you have recent and relevant training or experience, including from overseas, you may be eligible for Combined Training, where up to 12 months of your experience could contribute to your GP training, details are on the RCGP website.

Each GP practice and its patient list is unique. General practice is all about teamwork. As a GP you will be working closely with other doctors in the practice, along with the wider primary care team which may include nurses, physician associates, health visitors, mental health workers, physiotherapists, social prescribers and clinical pharmacists.  Most practices hold regular multi-disciplinary meetings as well as frequent educational sessions. Days are varied and many GPs develop special interests or a portfolio career undertaking additional work in a range of different community settings.

As a GP trainee you are well supported from day one with someone to ask questions to during surgeries. During your ST3 year, you will have a minimum of 3 sessions of education each week. You will be supported on a daily basis with debrief sessions after surgeries and home visits.

The majority of patients with coughs and colds tend to treat themselves or can be seen by other practice staff. General practice is a world of infinite variety. Patients will continue to present with a range of symptoms. Some are due to simple illness but many are medically complex and require a high level of skill to not only manage pathology but to see the patient in the context of their lives, their family, home environment and personal beliefs.

To give you a better idea. In a single 3-hour surgery, it’s possible to see an array of different presentations – a child with a high fever and acute otitis media, a bereaved widow with a pathological grief reaction, a woman with newly presenting breast cancer, a manual worker with a rotator cuff injury, an elderly man with a new onset AF… any number of conditions can walk through that door and although it’s a big challenge for any clinician, it’s a stimulating and greatly rewarding experience. Later on the same day, you could find yourself performing minor surgery procedures or be the lead GP running the diabetes clinic, attending a CCG Board meeting or safeguarding case conference. Opportunities for sub-specialism are endless and you will never be bored.

There are over 270 NICE and 150 SIGN guidance documents (for England and Scotland respectively) almost all with a primary care element as well as other national and local guidelines. GPs practice evidenced based medicine. Knowing where to find and how to implement the most relevant and up to date guidance is a skill and the art of general practice is applying the knowledge and facts to individual circumstances to deliver holistic patient care. Increasingly this means dealing with a combination of preventative care, acute illness and multiple long term conditions. British general practice is known for providing a leading source of knowledge and research into patient lives, in cities towns and villages. Academic general practice involving GP trainees and post-CCT fellows contributes many articles to the BMA, British Journal of General Practice and other international journals.

Most patients value the personal relationship with ‘their GP’ which brings your working life added rewards right from the beginning of your career.

You will be well supported and receive one to one supervision to enable you to acquire the necessary knowledge and skills to diagnose and manage the diverse conditions encountered in general practice. You'll gain confidence through review and observation, as you learn the natural history patterns of disease. Supervision continues during your ‘out of hours’ training too.

Many practices have now moved to a range of appointments up to 20 minutes long. Doctors in training will start with longer appointment times and fewer patients in each clinical session. In many cases, GPs and practices have ongoing relationships and continuity of records which means it is not necessarily a 10-minute consultation but more often one in a series.

Practices continually review their access and provision of appointments and trainee GPs are encouraged to take part in this process. Some problems are easily managed within a shorter appointment time.

Research has shown that although many patients do research their symptoms and treatment options online, they usually make an appointment with a GP - who they trust, to interpret the findings.

Patients value that personal relationship which delivers an additional reward for you, right from the beginning of your career.

In general practice, particularly in training, it’s recognised that maintaining a healthy work/life balance is part of being an effective clinician. Although working full time in practice will suit many qualified GPs, others may prefer the flexibility of a varied portfolio career. This means not all your weekly sessions have to be worked in practice. You may choose to spend time in other clinical, education or leadership roles or pursuing other commitments and interests.

Education providers or your supervisor may offer further insight into some of these roles during training. You can email [email protected] outlining your particular area of interest. We can match your request and put you in contact with a portfolio or special interest GP who may give you a better idea of how they went about it.