Roughly one third of GPs are over the age of 50. They are likely to be in clinical leadership roles, working as trainers and developing services. Many of them have worked full-time for over 20 years, handle eight or nine sessions each week and feel under pressure to continue with leadership responsibilities they do not want because the practice cannot see them in a different role.
With more and more GPs choosing flexible working and salaried positions, there is not always an obvious successor to take on responsibilities outside their clinical role.
Two years ago, Lambeth PCT in south London was presented with such a dilemma at one of its conferences.
GPs in the area raised concerns about the level of leadership and support the PCT could offer when leading GPs were retiring, leaving the NHS, demonstrating low levels of job satisfaction or seeking a broader, more portfolio-based career.
The PCT, together with the South London Organisation of Vocational Training Schemes, set up a pilot project aimed at GPs over the age of 55 to see if they could help. Of the 46 eligible GPs, 19 have already joined. The project has been funded by the Guy's and St Thomas' Charity and the South East London Workforce Development Confederation.
Project co-ordinator Virginia Morley explains its appeal: 'The project offers GPs an opportunity to explore the possible avenues of development at this later stage in their careers through three one-to-one career development sessions with a careers consultant.
'It gives them much-needed space to consider their options and where they want to go next.'
As part of the career development sessions, GPs might consider reducing the number of sessions they do; taking a sabbatical; or taking prolonged or additional study leave where they can develop clinical skills, IT skills around GP clinical software or enhance their management training.
The aim is for each GP to consider their needs as an individual.
Where GPs decide to retire or hand over their leadership roles, the project moves on to the next stage. This involves up to four half-day succession-planning sessions for the practice.
'In these sessions, practice managers and staff are supported in coping with the changes,' says Ms Morley. 'They can obtain assistance in understanding and developing the skills necessary to enable the handing over of leadership roles and ensure the smooth running of the practice.'
A facilitated peer support network is then set up. 'Young GPs have many support networks but these become fewer as GPs move into the middle part of their careers,' she explains. 'Towards the end of their careers, GPs still need that interaction but there's nothing around for them.'
Results of a formal evaluation of the project will be published in the autumn, but initial responses are positive.
'Six GPs from the project have already said they want to join the peer support network. GPs have been recommending it to their colleagues and PCT staff have noticed changes in their meetings with the GPs who have taken part in the project,' says Ms Morley.
- For more information on the project, call (020) 8265 9125 or email VSMorley1@aol.com
DR RICHARD WILLIAMS: A USEFUL REALISATION
Dr Richard Williams, 57, is a partner at the Brixton Hill Group Practice in south London. It is a PMS training practice with a list of 10,500 patients.
There are six full-time-equivalent partners, with many GPs working part-time.
Dr Williams was approached by project organisers because he was eligible to take part.
'I wasn't thinking about retiring,' he says,' but I had been thinking about making changes. I worked full-time in this practice from 1984 to about 2000, when I became involved with the primary care group and then the PCT. I am a member of the professional executive committee and am also doing some overlapping primary care research.
'The one-to-one sessions really helped me to think through some concrete issues about what affects both me and my colleagues,' he added.
Through this, Dr Williams realised that all his roles were linked to being a GP and that, if he stopped being one, he could not fulfil his other roles either.
Having been full-time at the practice for such a long time, Dr Williams' patients had grown very accustomed to him always being available.
'I came to realise that I cannot really reduce the amount of time I spend in the practice any further,' he says. 'It puts too much stress and strain on the practice. It was a useful realisation. Now I know that going down to one or two days is not an option.'
Dr Williams feels that, as a result of taking part in the project, he will make better decisions when he feels ready to make them. He would recommend other GPs to go through this process.
'It's good to think through your role ahead of making any changes and think how the changes might affect other people,' he comments. 'When I do retire, I would prefer to leave on a good note rather than a sour one through having made the situation for the others difficult in my last years.'
DR RICHARD SAVAGE: I HAVE TIME AND SPACE NOW
Dr Richard Savage is a senior partner at the Stockwell Group Practice in south London. The practice has eight partners and a list of 15,000 patients. Two years ago he began to feel that he was losing confidence clinically and asked his PCT for a one-day-per-week sabbatical.
'I was approaching retirement age and was beginning to feel overwhelmed,' he says. 'I was struggling to keep up with NICE guidelines and began to think that I should just go. I didn't know whether I was simply losing confidence or if my performance was actually becoming inferior.'
Dr Savage saw how his friends outside medicine changed jobs every few years.
'I had to ask myself whether I was a bit mad to be doing the same thing for over 30 years,' he says. 'It is easy to be completely subsumed by general practice. I wanted to review my job and find out whether reducing my workload might actually lead to improved performance.'
Lambeth PCT invited Dr Savage to sit on the steering committee of its project for other GPs. He attended brainstorming meetings with the PCT and project coordinator Virginia Morley.
Having helped develop the project, Dr Savage used its services to help evaluate what he wants.
'Locum cover is tricky and there have been a couple of hiatuses when I couldn't cover my sabbatical day each week,' he says. 'However, over the past 18 months I have not been feeling so overwhelmed.
'I have had three one-to-one coaching sessions through the project and these have demonstrated real change. The sabbatical has given me the chance to explore who I want to be today and what to do in the future.
'Five or six years ago, if it had been possible for me to retire, I would have done. These days I think that, as long as I am able to do a good job, I will stay. I have the time and space to review this frequently.
I have also had time to review my finances so I know how I would cope financially if I decided to cut the number of my sessions.'
The changes in Dr Savage's life have been good for his practice. 'Back in the 1980s our practice was at the forefront of general practice IT but we had turned into Luddites,' explains Dr Savage. 'So I spend some of my sabbatical working on the practice computer system and bringing my IT skills up to speed. I am improving the patient database to give us more accurate information, which should help us to make better clinical decisions.' Dr Savage acknowledges that many GPs who are at a similar stage are very clear about what they want to do and when they want to retire. For those who are vacillating, however, his advice would be: 'Just take your foot off the pedal and talk to someone.'
GP DISSATISFACTION - THE EVIDENCE
- In 2002, a Kings Fund report showed that older staff leave the NHS early because of increased workload, long hours, lack of staff, support and recognition, compromises to patient experience, a rigid career structure and continuous change.
- In 2003, a survey of job satisfaction and retirement intentions among GP principals for the National Primary Care Research and Development Centre concluded that job satisfaction was an important factor underlying their intention to quit.
- Research on GPs in the Northern Deanery in 2004 found that the major factor influencing GPs' plans to retire was dissatisfaction with their role, and that change was a major factor producing this dissatisfaction.
Researchers concluded that the government would need to consider how to tackle this for the sake of stability and continuity.