Primary Care
Last year saw the publication of the NHS Long Term Workforce Plan, a long overdue and much-needed roadmap to address dwindling clinical capacity. However, while we can all get behind a vision for a brighter tomorrow, the road to hell, as they say, is paved with good intentions.
Many practices believe they may have to close their doors if things do not change soon. In a report from The Royal College of GPs, one in four GPs said their surgery may not survive, with nine in ten blaming unmanageable workloads, rising demand and staff leaving the sector.1 While cuts to retention schemes, and moves to devolve associated budgets have been met with widespread disapproval by the GP community.2,3
General practice is in crisis. So, the burning question is how can we help staff in the here and now? If the system is to improve clinician retention, it must find ways to allow clinicians to do right by their patients while maintaining their own physical and mental wellbeing, and fast.
Let’s take a look at some possible approaches.
While we’ve seen pushback in some sectors, flexible working is here to stay. The reasons are obvious - better work life balance, less travel, and a chance to fit work around other commitments such as childcare.
Remote and hybrid working have increased wellbeing and job satisfaction for many workers, but the NHS has not traditionally kept pace. And a lack of work-life balance is pushing clinicians away from primary care in particular.
Flexible working is said to often be “still too inflexible” in the NHS according to a report published by the BMA.4 A survey from UNISON in April 2024 revealed that a more than one in five women had been denied flexible working.5 In response, the organisation has called on NHS managers to do more to allow staff to work in flexible ways such as having more control over shifts or working compressed hours.
Of course, it’s important to remember that flexible working can mean many different things to different people, from working part time, to using video technology to conduct some consultations remotely. What really matters is understanding the individual needs of staff, and finding flexible working solutions that suit clinicians, practices and patients.
While it’s encouraging that the Workforce Plan stated that NHS employers should look to boost flexible working options and some positive stories are already beginning to emerge in response in that regard, the system must fully grasp this opportunity to make a meaningful difference.6,7
The faster this happens, the easier it may be to retain staff seeking a better work-life balance and a less rigid approach to delivering care.
Linked to flexible working is the increasing desire of many clinicians to pursue portfolio careers, which allow them to expand their horizons and gain new skills.
Portfolio clinicians might work in clinical leadership, research, medical teaching, medical writing, health tech or specialist medical roles. They may have several employers or spend part of the week working on a self-employed basis.
‘Mixing things up’ in this way is increasingly important for many clinicians, offering a more varied career and allowing them to pursue personal interests which may or may not be directly related to patient care.
But surely, I hear you ask, won’t this exacerbate the lack of clinical capacity in primary care? Conversely, it could actually help to retain talented clinicians who might otherwise leave the NHS entirely.
If portfolio careers become more commonly accepted, this may encourage more people to enter or re-enter primary care, knowing they can pursue other interests alongside their day-to-day clinical work. And with clinicians returning to practice with new skills and new ways of working, this could further enhance care quality and efficiency.
We’ve all seen headlines around the general practice “retirement time bomb”.
At least half of GPs are over retirement age at 10% of GP practices in England.8 And more GPs are retiring before their time, with the number of clinicians drawing their pensions at its highest level since 2019, according to reports by Pulse.9
The hyperbole may be justified for once. But that doesn’t mean there’s nothing we can do to support and retain more valuable and experienced clinicians.
Some of this comes back to the current nature of the job and its impact on clinician wellbeing. A survey by the BMA on factors that influence doctors’ retirement decisions found that health and wellbeing (85%) was the most important, followed by workload (66%) and burnout (61%).10
65% of doctors said the ability to work flexibly could persuade them to delay retirement. While job satisfaction (57%), having time to practise the most enjoyable aspects of medicine (50%) and support with workload (44%) would also influence the decision. These findings are interesting because they also suggest other options to retain staff.
We know that general practice can be draining both physically and mentally. Are there other non-clinical opportunities available for older staff, such as working in management, teaching research or in appraisal?
Pensions are key here too of course. The system can feel complex and confusing at the best of times, but changes to pension tax and contribution rates could actually make a longer working life more appealing for many GPs.
And with options for partial retirement and to retire and re-join, it may be easier for general practice doctors and nurses to work flexibly as they near retirement, claiming part of their pension alongside a salary.
To make practice life more manageable, we must of course address one of the root causes and that’s the current supply-demand mismatch. That inevitably means increasing capacity.
One way to bridge this gap is through technology. Many tools are already supporting practices to better manage workloads, save time and significantly reduce pressure on staff.
“We have more capacity to deal with other things like acute workload but also it’s just about giving people a little bit of headspace, allowing a GP to have a lunch break for example, which is really rare.”
- Dr Charlotte Hart, Clinical Director, Shrewsbury PCN
Indeed, automating administrative tasks such as patient outreach for condition reviews or chasing up blood tests, may free up practice staff to concentrate on other work. And the right tech can also help speed up time-consuming processes around QOF for example.
All of these elements can help provide that much needed ‘extra breathing room’ for staff, support job satisfaction and retention. Just take a look at the impact it’s made for Shrewsbury PCN.
Another way to create capacity is by diversifying the skills mix. For example, hiring clinical pharmacists and pharmacist technicians to work alongside GPs and practice nurses can have significant benefits.
Pharmacy staff can take care of medicines management, prescription requests and – with training – triage or treat patients with minor ailments. Clinical pharmacists can also take responsibility for long term condition management, enabling early intervention and proactive management. This can free up appointments, and give GPs and nurses more time to meet other demands.
Ultimately, improving clinical retention relies on a multitude of factors, but flexibility will be a key element in many areas. Whether it’s flexibility of approach to work-life balance, careers, tech or diversifying the practice skills mix.
There are some positive signs that the direction of travel is heading that way, granting greater freedoms to practices and PCNs. The system must continue on this path to help ensure the long-term sustainability of the clinical workforce.
However, we must also acknowledge the elephant in the room too. Things are not easy in the current climate and nothing is going to change overnight. General practice also needs more funding. The widespread reaction to this year’s contract tells us so. Without action, this poses one of the biggest immediate threats to long-term clinical retention.
Because research shows where there is higher payment per patient, more GPs and better continuity of care, there is also an association with higher life expectancy.11,12 We know when things go right, the rewards can be great.
We have a range of options for primary care partners in need of support. Suvera can provide a population health platform, virtual clinic and additional clinical expertise to help proactively manage patients with long-term conditions.
We offer proven solutions that improve health outcomes at scale and increase chronic care capacity. For example Suvera has supported system partners to successfully manage their entire hypertension registers remotely via virtual clinics, attaining 83% QOF target achievement for key hypertension indicators across all practices.
Our care team takes on end-to-end responsibility for patient condition management and medication reviews. While patients can access our web app, submit health data from home and access video and telephone consultations. This helps individuals to manage their health more easily and conveniently.
If you would like to collaborate with us, Suvera is available under the Additional Roles Reimbursement Scheme (ARRS) scheme and many other NHS funding streams.
To find out more, contact us on partnerships@suvera.co.uk.