Questions and Answers: The Portfolio GP By Dr Oliver Large
We are all familiar with a day in a GP practice: A constant flow of patients coming through the consulting room door, all expecting the very highest quality advice and treatment. Letters, phone messages/ calls, visit requests and pathology results all building up for your attention. The traditional full time GP job demands that we do this 4 or 5 days a week, and we mostly accept that our working day will be 10-11 hours, with just enough time to scoff a sandwich. If we are lucky, we can nip to the lavatory while the tea is brewing. It is relentless.
Can you do this full-time? I applaud you if you can. But the good news is that you don’t have to. By choosing a ‘portfolio’ career, you can drop some of our surgery work, but maintain your income, and may even earn more, whilst adding the spice of life (variety) to your working week.
What is a portfolio career?
To put it simply, a portfolio career is one where your working week comprises of a variety of roles in different settings. Your roles could be patient-facing or non-patient facing. At least one of these roles should be patient-facing (you are a GP after all!), but non-patient-facing roles can provide your week with a few days of completely different, mentally refreshing, work. This could be completely outside of health (e.g. an author; a sportsman/woman; working for the family business) or health-related (e.g. a medico-legal advisor; career support/ development counselling; a clinical lead or clinical director; a commissioner).
If these roles seem of little interest or unattainable to you, then you can easily develop a ‘clinical’ portfolio of diverse patient-facing work by looking outside of conventional GP jobs. GPs are in huge demand outside of GP surgeries. You won’t need to look hard to discover jobs in various settings. Your local GP OOH (out-of-hours) service; GP in A&E; GPwSI in your hospital outpatients; ‘GP in the car’ taking acute call-outs from nursing homes; Private GP (often now available as ‘work from home’ using technology) – the list goes on.
Working outside of the surgery – what are the benefits?
1) Your time will be valued: Outside of a GP practice, the value of your time is often better understood. You won’t be expected to stay late to do paperwork or seeing all the extras; and if you do, you will often be financially compensated.
Example: OOH overtime – if I work for my out-of-hours provider, and find I am stuck visiting a sick patient for 1 hour after the designated end of my shift, I ask for another hour of pay.
2) You will develop new skillsets: Working in a different setting will give you new skills and confidence managing problems that are common in your new workplace but less so in your own surgery.
3) Potential to work from home: I work from home once or twice a week doing triage calls for my OOH provider, and I enjoy it. It keeps my telephone triage skills sharp.
4) Flexibility – For as long as GPs are in demand, you will be able to select work around your own commitments. You may choose to sign a contract for your extra work, but the chances are you will be able to do just as well working freelance.
Example: You want to attend your son’s nativity play: SO you don’t book work, or you give your organisation a few weeks notice that you won’t be doing that shift that day. No negotiating with your GP colleagues and practice manager!
Sounds great, should I quit my job?
Well, not necessarily. I would not personally recommend completely leaving surgery work. If you want to be a great GP, there are huge advantages of working in a surgery. No other setting can emulate the complexity of work and the understanding, appreciation and ongoing management of chronic care. You learn so much from reading letters to you from hospital specialists; attending lunchtime meetings; knocking on your colleague’s door to ask what they would do next with a patient’s uncontrolled blood pressure.
Then I’ll locum in surgery?
You are free to choose this option. There are obvious advantages: You will certainly get control back over your working day.
But you should appreciate the disadvantages too: If you are not getting any continuity with your patients and/or you are not reading letters/ attending practice meetings etc. You may have to fight harder to keep updated with the latest developments. Chances are you will de-skill if you are not careful.
Have I let patients down by cutting my time in the surgery?
GPs feel guilty whenever they tell their patients they are going part time, or leaving. Should they? I don’t believe so – in fact the opposite could be true. Working as an out-of-hours GP, or GP in A&E, clearly benefits patients. But additionally, working in a capacity that enhances the wellbeing of doctor colleagues, or develops innovative new services in your local healthcare system, could have an even larger impact for patients than you can provide in your consulting room!
Become a Portfolio GP
Dr Large works as a portfolio GP. He is a 4 session partner at Stokenchurch Medical Centre. Additionally, he works as an Out of Hours GP, as a clinical lead and clinician for Windsor Ascot Maidenhead 7 Day routine GP services, and as a prescriber for an online pharmacy.