How on Earth Do We Recruit a GP?

GP Recruitment Crisis; it’s a common problem

If you hang around with GP partners or practice managers for any time at all you’ll soon find the conversation turning to a common theme, recruitment, or lack of it. Everyone in primary care knows a surgery that are struggling to recruit or retain clinical staff.

Why is this?

Well, the answer you’ll get from most people will be the lack of GPs, but is this correct? Most of the areas where people struggle to find a permanent member of staff don’t have anywhere near as much trouble staffing their clinics with locum staff, so there are GPs in that area.

The problem isn’t likely to be solely due to the lack of available qualified GPs in the local area, but more likely to be the lack of GPs in the area who want to accept any of the current vacancies. More specifically, there is a lack of GPs who want to move from locum work into a permanent post.

Why don’t locums want to be salaried GPs or partners?

If you look at the direct comparison between the common working pattern of a locum vs a salaried GP it’s obvious what the differences are. Firstly, and most importantly, locums have total control over their workload. They set the terms of work. If they don’t like visits, they don’t have to do them, they can negotiate what times to start and finish, they can take leave whenever they want, including all the busy holiday periods and so on. On top of all that they often earn more money than salaried GPs in the same area.

So how do we attract locums to salaried posts?

If you look at the few practices that seem to have no problem attracting salaried GPs they are a few keen themes.

Firstly, they provide a fixed workload. They also remove any duty doctor or on-call commitment. They have therefore removed the most stressful part of being a GP, an unknown or unlimited workload. The unknown and not being in control is very stressful.

Secondly, they remove the most boring part of a GP’s day, they remove the need to do clinical admin such as repeat prescribing, clinical letters and reports.

The GP’s then know that when they come to work they will not be asked to do any more than their fixed working schedule and no boring paperwork. Some practices going even further and remove the need to provide home visits.

If you look at the pattern of work in these practices its hard to see the difference from that of a locum. There are very few differences, but most of them are positive: job security, sick pay, team environment, continuity, practice education etc.

It is no surprise that these practices don’t have any problems recruiting GPs to salaried roles. A practice who offer all of the above have recently recruited no less than five salaried GPs!

But we can’t provide an environment like that, what else can we do?

The first place to start is to look at your job adverts.

I can’t believe that people are still using the same old statements in their job adverts.

I’ve lost count of the ones that state lines like: “…join our hard working, high achieving practice with excellent QOF performance”, “looking for a hardworking, dedicated person…”

The language is all wrong!

An applicant will read from this “sounds like they are working way too hard to me!”.

People are no longer looking to work themselves into an early grave to demonstrate their commitment to their patients. They want a work-life balance and manageable workload. They want some energy left at the end of their working day for themselves and their family. Your advert needs to reflect that.

You need to demonstrate what you have in place to manage the workload and provide some form of work-life balance. For example, do you offer flexible working times? Why do we stick rigidly to two surgeries at fixed times? It’s not very family friendly for the school run. Do you offer term-time working?

Could you offer a portfolio career with sessions spent in other areas such as the CCG or other clinical areas? Do you offer leave for sabbaticals? Do you support further training or research?

You can’t achieve a more balanced workload without investing in your practice. Training your staff to manage clinical correspondence or to work as care navigators are only two examples of the many ways you can try and reduce the clinical workload.

Do you actually need a GP?

It’s finally been recognised in the NHS plan that we don’t always need a GP to see every patient in primary care. However, practices that have struggled to recruit GPs have already embraced this fact through necessity and have looked elsewhere for staff to manage their growing list of patients.

Could a first contact physiotherapist manage the huge percentage of musculoskeletal conditions that come through the door every day?

Could a mental health worker manage a suitable cohort of patients?

Other allied health care workers such as paramedics, pharmacists are finding a place in lots of surgeries along side non-clinical staff such as care navigators or social prescribers.

Summary

Modern GPs are looking for flexibility alongside a fixed workload. Jobs where this is offered will attract candidates over more traditional roles.

Portfolio careers are important to many GPs and jobs that allow or offer this will also stand out.
Once last thing. Even if you can only offer a job where the applicant is going to have to work pretty dam hard for the foreseeable future, please don’t shout about it!

Shout about the other things that might mitigate against the workload, such as the supportive environment you can provide, the new premises, the pizza night on a Thursday or the regular brew breaks etc.

Everywhere has something positive to offer. This is what should be front and centre in your adverts.

Bringing Primary Care Network (PCN) teams together

Everyone is talking about PCNs, that they are now in operation from the 1st July 2019 but how are they functioning? These aren’t new people forming a new organisation, these are individuals that are already working within general practice but are now starting to work more closely together.

How do you enable and facilitate bringing those teams together?


Time! It takes a lot of time, effort and passion to drive things forward. You have to believe in what the PCNs are trying to achieve and you have to push this vision forward.

It needs robust leadership, people who can see the longer term benefits, both for patients and the health and wellbeing of the workforce. They have to have the drive, however cannot ‘push’ or ‘force’ their views. They also need to listen, not just hear what is being said, but listen and take it on board, develop other peoples ideas and lead by example.

Communication is key, keeping all staff informed of what is going on, even if it does not seem that significant, means a lot to the wider workforce that are maybe not yet involved in any of the planning and strategy work. Monthly news bulletins are a great way to keep that communications flowing. It is so easy to be working so hard to make sure things are done right, yet because no-one knows what is going on, it is dismissed and not given the recognition and support it warrants.

We all know that there are no two surgeries that same in General Practice so how on earth do we get the staff to be aligned and start working together?


It needs all of the above and some facilitation, bringing any teams together can be difficult but bring 5 or 6 individual practices together is something else! By the way, PCNs are NOT about merging practices, they are about aligning resources to get the best outcomes for their populations.

It is always good to start out with the willing, have a team building event, nothing over the top like abseiling, maybe a lunch or a fun type of workshop. I would keep this to a handful of people from each surgery to get the best out of it. What you need is keen individuals that can then take it back to their practices and relay the key messages, encouraging the peers and colleagues to understand what is going on.

Following on from that, you have started to build those relationships, you now need to develop some values and a vision of how you want to work together and where you want to get to. This is often quite a challenge, are there are lots of personalities, good facilitation is key here to get the best outcomes.

Once you have all that in place, develop your strategy, agree your priorities, operationally how things will work, who will lead on the various workstreams, allow individuals the time to connect with others, this will reap the rewards downstream.

The key message here is don’t underestimate how difficult it can be to bring teams together, you have to build trust and relationships to enable the ‘good’ things to happen. Demonstrate how things can work by delivering on some small projects that actually everyone sees the benefit of.

So what about those that just don’t want to get involved?


Don’t worry about them. Forming a functioning PCN is no small task, work with those that want to, the other will come on board in their own time. For the PCN to be a successful environment, you can push people to join in. It will work because those that are in it want it to work and believe in the vision.

In the near future PCNs will need to start working with wider providers, including local Councils, community providers and the voluntary sector. For this to be successful you have to ensure that the members in your PCN are already working effectively together.

Longer-term over the next 3-5 years PCNs may take on more of a commissioning role, for this they need to fully understand their population, the needs and how they can manage these more effectively by working with the community around them to commission more appropriate local services. This will be a huge challenge, therefore the need to get a ‘functioning’ and ‘inclusive’ PCN is crucial from the beginning.