View from the ground, by Dr Alan Begg

begg alan

Dr Alan Begg

The landscape of general practice is changing, although often not in an ideal way. Younger general practitioners are our future and it is important that we as a profession and a nation fully support and nurture them. The success of First5 Groups1 in this support process for GPs beginning what hopefully will be long and enjoyable careers is to be welcomed.

One of the big successes of the NHS in its 70 years is the move towards group practices working from modern premises. It used to be the norm for GPs to be single-handed practitioners often working from their own home, dependent on the good will of colleagues to provide holiday cover or a night off, and to have family life dominated by being on call. I should add that it has been a privilege to be a GP for half of the NHS’ 70 years. As practitioners move towards a more portfolio or salaried career, the mentoring and guidance provided within a group practice may be lost as the GP progresses on their ‘journey’ from being the ‘apprentice’ to the ‘master craftsman.’

To be successful any organisation, including primary care, requires a spectrum of ages, experience, and talents; and more needs to be done to support later career GPs. Changes to lifetime and annual superannuation allowances remove the incentive to paying into the scheme and in Scotland there are now higher tax rates for most full-time GPs. We all know colleagues who want to be free of the administrative burden of partnership, the problem of succession, and financial commitment to premises. But the reality of appraisal, revalidation, as well as professional and indemnity fees, mean that continuing to work on a locum basis or in out of hours is not so appealing either. The years of experience of these GPs are then lost to the NHS.

The figures speak for themselves. In Scotland, more than a third of GPs in practice are over the age of 50, the downward trend in those working full time continues, and practice vacancies are increasing.2 There is a rise in the number of GPs taking early voluntary retirement.3

The profession and health authorities could do more to support the transition to later career by changing work patterns, allowing job sharing arrangements as well as reducing on call commitments. In our area we have promoted the concept of a Service Achievement Award to recognise and show appreciation for a career caring for patients. For those who want to pursue other interests, the skills of being a GP are easily transferable to other roles such as a charity trustee. What is paramount however is retaining the experience and skills of a lifetime within the NHS.

The Royal College of General Practitioners (RCGP) and other bodies are acutely aware of the problems of retention in general practice. A session at the RCGP conference in Glasgow on Saturday 6 October will look at innovative ways to allow later career GPs to continue to contribute to primary care.4 If the challenges can be met and the barriers addressed, we can all benefit from using the skills and wisdom of later career GPs.


  1. Taylor C, Parsons J, Sparrow N, Gerada C. The First5 Concept. Br J Gen Pract 2011; 61 (582): 72–73. 
  2. NHS National Services Scotland. Primary care workforce survey Scotland 2017. A survey of Scottish general practices and general practice out of hours services. NHS Scotland Information Services Division, 2018. Available at:
  3. Moberly T. Rise in GPs taking early retirement. BMJ 2018; 360: k1367.
  4. RCGP annual primary care conference and exhibition programme 2018. Supporting and using the skills and wisdom of later career and retired GPs.