GP Retention Working Group: report and recommendations

3. Key Findings

3.1 Findings from the Workshops

The workshops followed a similar format using the following questions as a guide for discussion.

• What made you choose being a GP as a career - is what you are doing now what you expected?
• What is helping you to do the parts of the job that you expected (or didn’t expect) to be doing?
• From a GP career perspective, what would “good” look like for you?
• What are the parts of the job that you value the most?
• What are the biggest challenges now, and will they be the same in 5 years’ time?
• If there was one thing you could change tomorrow, what would it be?

The key themes are set out below:

3.1.1 Continuity of care

Providing continuity of care was seen as a positive factor in being a GP. It was felt that building up relationships over time was important to GPs in their role as well as being important for the patients, allowing GPs to deal with long term complex needs of each individual patient and being able to place this in the context of families, relationships, and local communities. Many identified this as the main reason they trained to become a GP, and all felt this was something they valued highly.

3.1.2 Variety and Flexible Working

Variety was also identified a factor for GPs when considering General Practice as a career choice. Having autonomy and working as part of a team was highly valued. The ability to have a ‘mobile career’ that enabled GPs to move around the country was a very appealing factor.

Many participants reported that General Practice allowed GPs to have a varied career on completion of their GP training. They described additional roles such as teaching, training, appraisal, leadership development, out of hours and additional clinical roles as allowing some flexibility and work-life balance. Some mid and later career GPs also felt these additional roles helped balance the increasing demands of delivering general medical services, and several early career GPs expressed a desire to do this to help avoid future burn-out. However, not all GPs agreed and opt to take on specialist roles, and whilst these are important functions, it is important that approaches seek to retain GPs in clinical work. Early career GPs also felt more clinical experience, leadership and management training would be helpful in supporting them towards partnership.

3.1.3 Workload

Nearly all GPs raised issues over workload. For many this was seen as the main reason for people leaving the profession, and reducing the number of sessions that they work. This was due to the significant increase in demand from patients, changing referral routes into services, and reduction of other core health and social care services. They also reported that vacancies and difficulties in GP recruitment presented real challenges in meeting patient demand/need and placed more pressure on those working in general practice.

Some participants reported that the desire to provide relational care, with continuity, was often the reason for their choosing general practice as a career, but that was being undermined by volume of the work and the need to work at pace under extreme pressure.

There was also discussion within the workshops that increased additional workload was having a negative impact on GP partnerships, with some GPs choosing to leave their partnership for this reason.

Many GPs also reported that the continued workload transfer between Secondary and Primary Care was creating additional pressures on GPs’ workload.

3.1.4 Team working

Many participants reported that working within well-functioning Primary Care teams was another positive factor in why GPs choose General Practice. Some participants reported that the rapid expansion of the wider Multi-Disciplinary Team (MDT)within General Practice had presented challenges to team working as new MDT staff worked across buildings and practices. They articulated the need to build relationships, to understand and learn each other’s roles and competencies, and to have “time to team”. There were also some concerns expressed about capacity within premises for new team members, as well as the need for clinical supervision which can add to workload pressures.

This was also compounded by an increasing number of training posts for GPs and other MDT members. While this appeared to be welcomed, it also placed additional pressure on GP capacity.

3.1.5 Career Pathway

GPs at all stages of their career told us that they felt they would benefit from a clearer career pathway. Across the workshops many GPs felt that there were different development opportunities at various stages of their career, but these were not always easy to find, and that it would be useful for this to be set out more clearly, including the provision of appropriate training and support. This could include opportunities for fellowships, learning more about specialties and leadership.

Leadership development opportunities at all stages was a common theme. Many participants identified a lack of support for GPs’ professional development throughout their career, particularly when compared to other medical professions.

Some early career GPs felt that further support is needed once they complete their GP Specialty Training which supports them in terms of preparing for partnership as well as developing the skills needed as an Expert Medical Generalist. Some highlighted the benefits of fellowships that might act as a stepping stone to the next stage of their career, and would offer opportunities to develop skills in a supported environment. Alongside this, access to peer support as well as mentoring from more experienced GPs would help to guide them through the early stage of their career. Leadership training was also identified as a need.

Some Mid-career GPs also reported that they would benefit from mentoring support, for example from enthusiastic and experienced later career GPs. Later career GPs suggested that they have an appetite for mentoring and training the GPs of the future.

Many also reported that leadership training was key to becoming a partner. While some early career GPs were already partners, others expressed concerns about the idea of becoming a partner, particularly at the early stages of their career, and were opting to choose salaried or locum posts. Alongside this, some also felt the opportunity to work in different practices and settings was attractive, before “settling down” into partnership. Across all workshops, many also expressed their concerns about the “loss” of and lack of support for the partnership model. It was felt that a clearer pathway and training should support people in preparing to be a partner.

Separate to this, there were some comparisons of existing GP terms and conditions to those of hospital consultants, who have a set number of hours, agreed job plans, time for personal development - and if this might help better match demand and capacity.

3.2 Findings from the Health Board GP Retention Survey

All Health Boards across Scotland were sent a questionnaire to provide an outline of the support currently being offered locally to retain GPs. A total of 7 Health Boards responded to the questionnaire, providing reasonable coverage of activity. Further follow-up is needed to understand the full range of support available.

Findings can be summarised as follows:

• Protected Learning Time (PLT) and Coaching was evident across all boards that responded. (Note national funding for PLT within general practice was reinstated post-pandemic in 2023)
• Ayrshire and Arran hold recruitment events targeted at GPs, and provide support for recruitment through a marketing company.
• Forth Valley, Tayside and Shetland provide their own coaching, mentoring and wellbeing support (including signposting to national wellbeing resources)
• Ayrshire and Arran and Glasgow offer access to Board Occupational Health Services.
• Some boards such as Tayside offer their own funded fellowship opportunities which differ from the ones that are offered at national level. This includes the Career Start fellowship, which provides specific support for early career GPs.
• Ayrshire and Arran, Glasgow, Lanarkshire, Lothian, and Tayside all offer support for International Medical Graduates (IMGs). This includes continued employment in the same practice post Certification of Completion of Training.

Whilst the findings from the survey have limitations, there is clear variation across Boards on the provision of GP retention initiatives. Further mapping is needed to identify whether this can be attributed to regional differences, or whether further work is needed to establish a consistent level of delivery. Alongside this, further exploration is needed on whether there are initiatives such as coaching and mentoring which may be better provided at a national level.