Over the past year, we have seen the emergence of the absurd GP unemployment crisis, with thousands of GPs struggling to find work in NHS general practice. At a time when patient demand for GP care has never been higher, GPs who are newly qualified are now faced with increased competition for the dearth of salaried and partnership opportunities in the NHS, whilst available locum posts have also drastically reduced.

The secretary of state for health, Wes Streeting, announced that, as an emergency measure to try to tackle the issue, £82m would be made available to PCNs (primary care networks) to recruit newly qualified GPs via the existing ARR (additional roles reimbursement) scheme from October 2024.

The ARR scheme has been in place since April 2019. Until the recent announcement this time-limited reimbursement scheme has been available to PCNs to recruit multiple AHPs (allied health professionals) and MAPs (medical associate professionals), but specifically excluded the employment of practice nurses and GPs, whilst real-terms core general practice funding available to employ GPs has fallen by circa 12% since 2019. This combination has directly led to the current absurdity of patients struggling to access GP appointments and the simultaneous under/unemployment of GPs.

Whilst increased investment for the recruitment and retention of GPs is both essential and to be welcomed, directing this funding via PCNs and the ARR scheme raises concerns and questions about these how these new GP roles will work in practice and what newly qualified GPs should expect from such jobs. It by no means provides the necessary longer-term solutions to the current GP under/unemployment crisis and does nothing to ensure the retention and recruitment of already establish and experienced GPs. For the profession, it represents yet another temporary sticking plaster fix, attempting to partially treat the symptom that is GP unemployment, without directly tackling the underlying causes

The transition from being a GP registrar to a fully qualified GP can be a daunting time for even the most stoic of GPs. Going from the relative protection that a GP training post provides to dealing with an increased workload and working more autonomously can come as a shock, especially in the current climate of escalating and unmanageable GP workload pressures.

Alongside the increased clinical responsibilities, it will likely be the first time registrars have had to apply for jobs and negotiate the terms and conditions of their contracts, having previously been on very prescribed, standardised national training contracts which secure their pay and benefits of employment. It can be a challenge to know your rights as a qualified GP and what to expect in terms of salary. Membership of the BMA is all the more important to protect colleagues’ workplace terms and conditions.

To ensure the effectiveness and safety of the newly qualified GP ARR Scheme, NHS England needs to ensure the necessary protections for the GPs that will potentially be working in PCNs and avoid any predictable potential pitfalls:

Contracts

GPs employed via the scheme are entitled to, as a minimum, the terms and conditions outlined in the BMA Salaried GP model contract. It is essential that these roles provide equitable terms to practice-employed salaried GPs and parity with other employed NHS doctors

Safe workloads

there must be a clear job plan outlining the day to day responsibilities of the role, ensuring safe and achievable workloads, in line with the internationally recognised safe workload limits as outlined in GPC England’s Safe Working Guidance

Mentorship

to support the challenging transition from GP registrar to fully qualified GP, the newly qualified GPs must be assigned a GP mentor with adequate time for regular one-to-one support with their mentor factored into the job plan

Work must be restricted to core general practice hours

the risks of lone working and a lack of available peer support when working during extended access hours should be avoided

Remuneration

the salary for these roles must reflect the fact that this is likely to be a fixed-term position which provides little in the way of long term security, whilst also recognising that the DDRB (Review Body on Doctors' and Dentists' Remuneration) salaried GP pay range is outdated and is not representative of actual GP salaries (as outlined by the BMA indicative pay range) and that salaried GP pay has seen a more than 32% real-terms reduction in England since 2008/09. The reimbursable full-time salary for these roles as outlined by NHS Employers currently sits at the very bottom of the DDRB salaried GP pay range at £73,114. The salary is also significantly below the bottom of the England consultant pay scale which, following the pay deal from April this year, starts at £105,504. This is derisory, uncompetitive, does not adequately value fully qualified GPs and risks failure to meet the intended aims of the scheme to temporarily alleviate the GP unemployment crisis and retain newly qualified GPs within NHS general practice. It is further problematic because, following the resident doctor pay deal agreed in September, GP registrars at the end of their training are being paid £72,516, meaning that they will barely see an increase in their pay if they take an ARRS role post qualification

A clear plan for transition

to a practice-employed job – it is essential GPs taking up these positions can be confident of ongoing employment and are not faced with a situation where the prospect of unemployment has merely been delayed by six months

Limits on working across multiple practices within a PCN

working across multiple practices, each with their own teams and unique ways of working, can be a daunting prospect for even the most established of GPs. The continuity of seeing same patients in a practice, seeing the outcomes of your management and investigations are all a vital part of GP learning and development and we know this continuity of care is better for our patients. With all this in mind, newly qualified GPs working for PCNs should not be expected to work across more than 2 practices in their role

Pension

GPs employed on the scheme must be entitled to enrolment in the NHS pension scheme.

If we are to recruit and retain the GPs we need to be able provide the timely and high-quality care patients need and if we are to prevent the further loss of GPs from the NHS it is vital that this scheme provides GPs with safe, attractive and aspirational roles.

Ultimately, the scheme does not provide the long-term solutions to the crises we face with recruitment, retention and unemployment of NHS GPs. We support the need  for a new GP contract: where general practice is adequately funded, when restrictive ring-fenced reimbursement scheme funding is re-allocated so it can be used flexibly to employ the GPs their patients need and when GP’s jobs are made sustainable and attractive by ensuring safe workloads and the reversal of pay erosion.

Mark Steggles is GP sessionals committee chair