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Out-of-Hours as a career option

Many GPs are finding unscheduled care can be their main job, reports Julian Tyndale-Biscoe.

Working the odd out-of-hours shift is traditionally something doctors did to bring in a bit of extra cash and they did not get much out of it in terms of career development. However, that is changing. Out-of-hours providers are often much larger organisations and can offer diverse opportunities. Witness the growing number of GPs working out-of-hours as their main career option as they discover the benefits of flexible working within a multidisciplinary team.

Dr Pamela Barcella: Out-of-hours GPs can earn £90,000

For all career stages
Many of the new out-of-hours providers were born from GP co-ops, including Take Care Now, provider of unscheduled care services in Suffolk, Essex and Worcestershire.

Dr James Kennedy, Take Care Now's medical director, says working out-of-hours as a main job can be suitable for GPs at any stage in their career.

'We have GPs who have just come out of vocational training, GPs who are working out-of-hours to support themselves while they use their in-hours time for study or research, through to GPs who are looking for the opportunity and challenge to build skills for a portfolio career.

'Working out-of-hours is also particularly attractive to GPs who want to be involved in raising young families. We employ GPs, both men and women, who spend time with their children during the day and work out-of-hours shifts during the evenings and at the weekends.'

Specific interests
According to Dr Kennedy, working within unscheduled care allows GPs to pursue specific interests that they would not always be able to focus on in the surgery.

'It's no longer just about providing a GP out-of-hours service. Providers are also involved in minor injuries units, GP-led A&E units and community hospitals. GPs with a specific interest, in palliative, elderly or emergency care, for example, can have this sort of work channelled to them.'

The opportunities to develop additional skills are diverse. GPs can be involved in designing, quality assuring and delivering care models as well as developing palliative care models.

New skills
They can also enhance their management skills by, for example, becoming part of an organisation's multidisciplinary clinical governance group. In addition, there may also be development programmes for GPs wishing to become trainers.

The organisations will provide statutory and regulatory training for their GPs and are likely to have their own staff development programme, including performance appraisals and personal development plans. Some will also contribute to the costs involved in study leave.

Ultimately, however, GPs have to offer some form of commitment in return.

'The amount of investment we put into a GP's development programme will depend on the amount of work they do for us,' says Dr Kennedy.

Good earnings
The earnings potential within the unscheduled care sector is good. For example, GPs working full time (38 hours a week) for Take Care Now can earn in excess of £90,000.

For doctors working out-of-hours as part of a portfolio career, the company expects them to carry out a minimum number of shifts so that they can keep up to speed with developments in what is now a specialist environment.

'We would expect GPs to work at least 20 shifts a year,' says Dr Kennedy.

This is no longer just an option for GPs wanting to earn a bit more cash on the side, out-of-hours is a valid career alternative that brings opportunities to practise in specialist areas, develop new skills and work within a constantly evolving environment.

Suffolk GP Dr Pamela Barcella feels that one of the most rewarding aspects of working out-of-hours today is the opportunity to work with other health professionals such as nurse practitioners.

'Working out-of-hours before the opt-out used to be isolating as GPs did their own on calls and never came into contact with other colleagues. But things have changed rapidly and today working out-of-hours means working as part of a team and being able to exchange ideas with colleagues in different disciplines.'

After university in Italy and GP training in England, Dr Barcella's first GP post was in 2000 as a locum for a practice in Felixstowe. She started working for out-of-hours provider Take Care Now in 2002 and combines this with a salaried GP post and minor surgery work for the PCT. This flexible career gives her time at home to look after her 22-month-old daughter.

Dr Barcella enjoys the demands out-of-hours makes on her professional skills.

'I'm one of three doctors carrying out telephone triage from home via a computer link into the main system so good communication skills are essential.'

She works at out-of-hours bases across Suffolk, where the ability to keep a cool head in an emergency is essential. Home visits can be particularly challenging.

'You need to be able to make a spot-on diagnosis and take decisions very quickly without having any knowledge of the patient's history.'

  • Dr Barcella uses the training and CPD programmes provided by Take Care Now to keep abreast of all the skills required for her out-of-hours work.

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