The NHS People Plan released this month makes for encouraging reading at first glance. Promising flexibility, will it perhaps help modernise some of the working practices in general practice?
For many years, the majority of trainees have been female. Often in their 30s, many will go on to have children during or shortly after their training. And, shortly after this, a significant number will go on to leave general practice or medicine altogether.
The years go on, and the pattern continues. When will the profession concede that the work is currently not readily compatible with raising a young family? I don’t wish to go into the rights and wrongs of the gender divide in childcare duties. Whatever you decide, inevitably those with more childcare responsibilities will need to work more flexibly. And, at present, it’s usually women, and the flexibility we need is not always available to us.
I’m sure that some of you will think that we cannot have it both ways. Did the feminists lie to us? I cannot have a satisfying career, and be a good mother.
But this simply isn’t true (at least it doesn’t need to be). I’m the child of two professional parents. My husband the same. Notably, neither of our mothers were doctors. They took ten years out of work (as was more common then), and subsequently retrained, and had very successful and rewarding careers.
Having just qualified as a GP, I find myself contemplating my future. As a female with young children - the archetypal GP trainee - flexibility is my top priority.
General practice is, according to the NHS People Plan, more flexible than other parts of the NHS. It certainly could be. This is one of the reasons many female (and male) medics choose this route. Without nights or weekends, all that is needed is a slightly shortened day with a reliable finish time, to allow parents to collect their children at a reasonable hour.
The retainer scheme, for all its flaws, was a great leveller. This scheme would have given me confidence to approach a practice to ask for a more flexible role. Knowing that they would receive some reimbursement and as a parent with heavy childcare responsibilities, I would have a blueprint of a potentially shorter day, with some extra support, to help keep me in the profession through the toughest years of parenthood.
Sadly, on approaching my CCG, due to funding shortages, the retainer scheme is no longer being offered locally, for the foreseeable future.
Without the retainer option, why would a practice offer me a flexible role when another candidate, without caring duties, could fulfil the role and need less flexibility? Realistically, I can now only expect to get a position in a more challenging practice, with greater recruitment issues.
How does this make me feel? Frankly, that general practice doesn’t want me. Even more frankly, under the present conditions, do I want general practice?
The flexible GP locum bank, mentioned in the People Plan, raises more questions. In reality, would this simply equal a cap on my pay, while giving me less control over where I work? Schemes like this have the potential to be helpful, but NHS England will need to work hard to make this option appealing, and fair to those who choose to pursue this. Without role models encouraging GPs down this route, it could easily prove another false dawn.
So, my next thought is whether I should look outside general practice, Interestingly, there is a position I am well qualified for locally. It would allow me to work flexibly in a medical role, paid a similar hourly rate to a GP (once my reduced childcare costs are factored in). It offers shorter, more reliable days, and undoubtedly, a less intense workload.
So, the cycle continues. We are trained up, qualify, and find that flexible GP roles are not easily accessible. How many female GPs have left general practice in recent years? Is anyone even counting? The issue is infrequently raised in this publication, or on other GP platforms. Despite surely being the biggest threat to the workforce over the next few decades? Alongside an excessive workload, which will be continually exacerbated by the exodus of women.
All in all, the People Plan sounds encouraging, on paper. But, in practice, with the removal of the retainer scheme locally, I cannot help but wonder if these are more empty promises.
Dr Katie Musgrave is a newly-qualified GP in Devon and quality improvement fellow for the South West