Support plans for new GPs

The transition from trainee to GP can be a challenge. The extra responsibilities such as being duty doctor, supervising others and increased administrative workload that comes from having committed to a registered list of patients is a lot to take all in one go.

It is also, for many newly qualified GPs, the first time we will negotiate our own contracts, hours and responsibilities. This brings its own anxieties. A recent poll suggested that the majority of new GPs see locum working as the most attractive option providing flexibility, wellbeing and control over workload (Bostock, 2019). However, although working as a locum can provide flexibility and control, it does not provide continuity of care and this may affect the quality of care. A recent study has suggested that when GPs commit to a registered list of patients, quality of care is improved (Pereira Gray et al., 2018). Salaried GP roles can be a good way to combine continuity of care and teamwork without the responsibility and commitment of a partnership. Furthermore, the emergence of innovative roles can make salaried GP roles more attractive (Health Education England, 2018; NHS England, 2016; RCGP, 2019).

Ensuring our own wellbeing is clearly a hugely important aspect of planning our future. We are likely to be working until we are at least 68… We need to be working in sustainable ways. This is being recognised by the British Medical Association (BMA), the RCGP and the General Medical Council (GMC). Sikka et al. (2015) highlight ‘the quadruple aim’ which includes improving clinician experience alongside patient safety, patient experience and cost-effectiveness. The inclusion of clinician experience here is a huge step towards sustainability and could protect GPs from the impact of an ever-increasing workload. In a climate where recruitment and retention are a challenge and where commitment to a registered list supports quality care, perhaps we have more influence than we think over our work patterns.

In order to successfully negotiate with potential employers an idea of what is possible is essential. So what does keep you satisfied at work? Think back to previous times you have felt fed up at work and ask yourself why you felt fed up? What motivated you to come to work the next day? Hackman (1976) suggests the themes that promote job satisfaction include: financial reward; perception of fairness; control over workload; a sense of accomplishment/of completing meaningful work; praise; the opportunity to progress and improve; a supportive environment and feeling challenged. These themes significantly overlap with the key domains for building resilience to burnout: control; reward; fairness; values; community and workload (Maslach and Leiter, 2016). Any future job plan must address these issues.

Recently, it has become the norm for practices to offer the standard BMA contract to employed GPs. This ensures new GPs maintain and build on any accrued NHS benefits such as maternity pay and NHS pension, and have a set number of continuing professional development (CPD) time per week. If this type of contract is not being offered, then it would seem reasonable to negotiate for it.

Another key aspect to consider during negotiations is pay. Most practices will have a standard payment per session for salaried GPs. It is sensible to compare this to other local practices. Many practices offer other incentives such as paid GMC and indemnity fees and taking into account the level of support and other opportunities available may also be beneficial.

A GP support plan

Haxby Group Practice is a large partnership caring for 60 000 patients across the cities of York and Hull with a range of demographics, from rural, elderly, well-off populations on the outskirts of York to deprived areas in inner city Hull. They are at the forefront of new developments in leadership and system delivery for general practice. They have a GP consultation model for urgent care, have overhauled the administration system to reduce workload for GPs, and are the first practice in the UK to use the online triage system ‘Klinik’. The Haxby Group Practice has trialled a support plan for new GPs. This was born of an awareness that in order to attract newly qualified GPs to commit to a registered list of patients, and offer those levels of continuity and coordination that are well established as being the foundations of good primary care (Pereira Gray et al., 2018), the practice needed to show a commitment to the wellbeing of these GPs.

As a newly qualified GP on a support plan I have regular meetings with a mentor to discuss my potential for improvement and to give and receive feedback on the role, and I have a gradual increase in responsibility and duties (Table 1). I have found this has given me control over my workload, opportunities for improvement, and allowed me to have space to get to know my new team.

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Table 1.

Haxby Group support plan structure.

Time frame (months)	Duties
0–3	• Max two phone calls • Max two individual visits • Number of blocks in regular surgery to allow catch up time • Review of progress at 3 months with mentor
3–6	• Review of progress at 6 months with mentor
6–9	• Increasing phone calls up to eight a day as agreed with mentor- may be lower if needing extra time to bed in • Increasing visits to four a day • Review at 9 months with mentor- probation may be ended or support plan continued if blocks and reduced duties still needed
9–12	• Continuing to work towards end of probation and full list as below with steady reduction of number of blocks and increase in duties
12 onwards	• Full surgeries but with continued support from mentor as required • Private medical work where appropriate • Responsibility for enhanced service provision and Quality outcomes framework targets • Flu and other campaign clinics • Provision of full range of General Medical Services tasks