How portfolio GP careers can help GPs, patients and practices

A ‘portfolio GP’ is an umbrella term used to describe any GP who has multiple roles within their working week. Most portfolio GPs have a primary job – this could be as a GP partner, a part-time salaried GP or a locum GP – with one or more additional jobs in their portfolio.

What are the benefits of portfolio GP work?

Portfolio GP careers can have a range of benefits for GPs, patients and practices. I work full time between all my different roles, and really enjoy the variety of skills, the patient mix and the balance between clinical and non-clinical roles. Currently my clinical roles include being a partner in a small practice (two partners), working as a locum GP, covering a community drug and alcohol detox unit and occasional working as a prison GP.

My non-clinical roles include being the medical director of Emedica, where I teach revision courses for MRCGP and develop CPD on GP careers, being an examiner for the GMC PLAB part 2 and being an author for the national Prescribing Skills Assessment.

I find the change in setting refreshing and think the skills and knowledge gained from different roles help me perform better in some of the other roles.

I know several very experienced GPs who would have left GP work entirely if they did not have a portfolio career. They are now thriving and continuing to work, while they might have stopped if they had continued to work in just clinical medicine. The intensity of clinical work in most GP practices can be very stressful – I have seen a huge increase in the pressure and workload now compared to when I completed GP training in 2007. Retaining experienced GPs and not losing newly qualified GPs is a huge benefit to practices and the patients we treat.

What kind of jobs can you have as part of your portfolio?

The range of additional jobs that you might develop an interest in as part of your portfolio is huge – from developing a specialist interest, to taking on a management role as part of the CCG or health board. Here are some of the options that you might consider alongside your GP role:

• medical education
• forensic medical examiner
• prison doctor
• GP with specialist interest (GPSI)
• PCO management or clinical lead work
• appraiser.

Let’s look at some of these options in a bit more detail.

Medical education

There are various ways to become involved in medical education, from the occasional teaching and supervision of medical students on placement at the practice to becoming a GP trainer or training programme director (TPD). Teaching can be very rewarding, as well as acting as a stimulus to refresh your own knowledge and to keep up to date.

The requirements to get involved depend on the role – from doing a one or two day course to teach medical students/foundation doctors, to having a postgraduate qualification to become a TPD.

Becoming a training practice can make recruiting new GPs easier – many registrars take a job at their training practice as they are already familiar with the team and patients.

Prison GP

Working as a GP in secure environments may seem daunting; however, there are many similarities to regular GP work. A typical day might include GP-style clinics and ward rounds for inmates – you will usually be well supported by an experienced nursing team, and guards are nearby (they can be in the room on request in some cases). As well as acute illness and ongoing management of chronic disease, there is a high proportion of patients with mental health issues and drug misuse problems.

The pace is less pressured than regular GP work – I can spend 20 minutes with some patients, and a typical clinic will only have six to eight patients. Undertaking the RCGP Certificate in the Management of Drug Misuse can be useful in giving you more confidence in dealing with this aspect of the work. If you are not sure if this is for you, contact your local prison and talk to the lead clinician – in most cases they will be happy to show you around the unit and offer some induction and training. There is also usually some need for on-call cover – although this varies at different units.

Forensic medical examiner

Forensic medical examiners (formerly police surgeons) work with police forces to provide assessment and treatment for victims of crime and persons in custody. Many FMEs are GPs who work with the police as an additional role. The work can be interesting and varied, and will include assessment and treatment of injuries, minor illness, sudden illness in custody, and assessment of victims of sexual assault. Most FMEs work as part of a group of doctors that provide cover for one or more police stations day and night. A lot of the time you may be able to be on call from home, with extra fees payable for each visit to the station. Another aspect of the work of an FME involves giving evidence in court. This does require additional training – typically four to five days covering key skills and knowledge specific to FME work.

GP with specialist interest (GPSI or GPwSI)

A GPSI is a GP who has gained additional skills allowing them to offer services that have traditionally been offered in secondary care. Popular examples include ENT, minor surgery, dermatology, sexual health and musculoskeletal medicine, but there are dozens more possibilities. Usually, there is a process of accreditation that will require relevant additional qualifications and experience, which is then signed off by a consultant to state that the practitioner is capable of independent practice. Once accredited, a practice may be able to bid for work from a CCG that will allow them to accept referrals from other practices within the area. Having a special interest can make you more attractive to a practice, and a practice offering a successful GPSI service can bring in valuable extra income.

PCO management or clinical lead work

Primary care organisations (CCG, health boards, local health boards) often have opportunities for GPs to be involved in clinical lead or management roles at various levels. This may be an opportunity to develop your leadership and management skills further in a different role, or to use expertise in a specific clinical area of interest to help develop services for your local area. It can also allow you to work with doctors from different practices or to collaborate with public health colleagues.

GP appraiser

We all need to keep up to date with CPD and undergo annual appraisals as part of revalidation. You may consider becoming an appraiser to see this process from a different perspective. Most areas recruit new appraisers periodically. It can be interesting to meet GP colleagues from different practices doing different roles. The actual appraisal usually lasts a few hours, but you will need to allow time to look through the evidence of CPD and other materials before the meeting. Typically, the payment for each completed appraisal is around £500.

Variety is the spice of life

These are just a few examples of some of the options you might build into your career as a portfolio GP. I know of GPs who work as civilian medical practitioners on military bases, as team doctors for sporting clubs, or who are involved with the air ambulance or emergency services.

Some have portfolio roles outside medicine – one of my friends works as a locum GP part time and is involved in medical education, but also teaches yoga several times each week! One of the great things about being a portfolio GP is that working in different roles can help keep you stimulated and reduce stress. I find that for me, it really is true that “a change is as good as a rest”.