Abstract
More and more colleagues finding the pressure of work more challenging are finding roles outside core clinical general practice more attractive. In this two-part article, Dr Hana Patel discusses a portfolio career in primary care.
The current trends of working in primary care
Following the COVID-19 pandemic, workload pressures in primary care have increased. A recent survey carried out by The King’s Fund found that less than a third of general practice (GP) trainees intended to work full-time (defined as eight sessions per week) upon qualifying. The survey found a majority of trainees felt that five to six clinical sessions suited them best. Reasons for this change in working pattern, included several common themes: A concern about the intensity of the working day, the increasing amount of workflow and administrative work, work-related stress and longer working hours.
Sadly, this has also been seen in a survey of working GPs, with up to a quarter of respondents reducing clinical sessions to help manage increases in workflow and administrative tasks in an attempt to reduce the adverse effects on mental health and work-related stress.
A study in the BMJ looking at the professional resilience of mid-career GPs in the UK showed that GPs felt they needed to work fewer clinical hours to improve resilience. However, working in a portfolio manner has implications for a workforce already in crisis, and may impact the overall UK population healthcare.
What is a portfolio career and what are examples of this?
Trainees coming to the end of their training programme often ask this question when deciding what their working week will look like.
Portfolio GPs are GPs with multiple jobs or different roles. Examples abound and include roles within the prison medical service or as forensic medical examiners, through to careers in medical education and roles such as training programme directors, clinical tutors and GP trainers. There are more and more professionals joining the primary care workforce, many of whom require regular supervision, including, for example, physician associates, advanced nurse practitioners and pharmacists.
Many GPs work as Appraisers for NHS England. GPs working within the NHS are required by the general medical council (GMC) to have an annual appraisal, a facilitated self-review, supported by information from the full scope of a doctor’s work. Appraisers aim to maintain the quality and consistency of appraisal for doctors.
GPs interested in leadership, quality improvement, service development or health inequalities can consider a role that contributes to primary care management. Examples include locality clinical lead roles and safeguarding lead roles. In these roles, colleagues are able to develop their leadership and management skills and use expertise in specific areas of clinical interest to develop services for their local area. It can allow colleagues to work more strategically with, for example, other practices or allow collaboration with public health colleagues or the third sector.
Some GPs broaden their scope of practice by working as civilian medical practitioners on military bases, as team doctors for sports clubs or football clubs, as GPs in the repatriation service, the air ambulance or emergency services. Aside from these clinical roles and many other examples, some GPs choose from a plethora of other roles outside medicine, whether by becoming yoga teachers, developing their own business or within the charity sector. Portfolio GPs typically have a primary care role as GP partner or sessional GP with other roles from this wide variety of roles built into their working week. Apart from their individual value, these roles offer GPs the opportunity to learn new skills, build resilience and enhance performance within core clinical work.
