There has been a lot of debate in recent years about GP hours, workload, salaries and the need to improve the provision of out-of-hours services. Most of us will have experienced how hard it can be to get an appointment at short notice and of course serious medical problems are no great respecters of evenings or weekends.
On the other hand it is not hard to see the increasing pressure that GP surgeries are under. Many are creaking under a myriad of challenges, not least growing patient expectations and demands, expanding population numbers and chronic conditions to manage along with expanding elderly care.
The debate has been given another dimension in recent months by women GPs now outnumbering men for the first time; a trend termed, in a report from the Migration Advisory Committee (MAC), as the 'feminisation' of GP services. The claim is that this trend has led to a shortage of family doctors which could fuel demands for even bigger wages and drive the recruitment of GPs from abroad. Additionally, female GPs are considered more likely to want to work part-time, at least for part of their career, thus exacerbating the shortfall - the size of which is believed to be up to 550 GPs a year.
There is no doubt that our GP service is under severe strain. This is a highly charged debate that is admittedly away from my usual working sphere of advising City institutions, but I believe that there are some parallels. Much as City firms have benefited significantly from developing innovative flexible working schemes to attract and retain talented staff, it strikes me that a solution that could go a long way in addressing GP recruitment issues is actually to encourage more flexible working, for both sexes, not to try and restrict it.
As the MAC advised, health managers need to do more to incentivise trainee doctors to become GPs. The notion of flexibility does have to change on the part of GPs as well. I would extrapolate flexible working so that eventually there would be no such a thing as out-of-hours. This means training and recruiting GPs who are willing specifically to work evening and weekend shifts. There must be sizable groups of them out there for whom this would actually fit well with their lives and the MAC report concludes that there was no shortage of medical students, more that not enough of them are choosing to become family doctors.
The GP career cycle should be re-examined. Younger GPs, not yet with family responsibilities, could do night shifts for a period and then be given time off in lieu. Family-centric men and women could do daytime shifts while their kids are still small. Experienced older GPs could provide their wisdom in less regular time slots.
The right framework and accountability should be put in place to ensure a wraparound service that provides extended hours of care with consistent levels of coverage. General practice medicine should be established as a valued profession that allows doctors to achieve a meaningful and sustainable balance of work and home life. This would, I believe, encourage many more young men and women to join it, thus enhancing services and lessening rates of exhaustion and burn-out, and ultimately improving medical outcomes. I can't understand why the brilliant minds that are attracted to the medical profession can't sort this out.
Professor Joseph Merion Thomas 'gendered' this discussion in a controversial article last year, but was he really being mysoginistic (he stated at the time that he was coming at the issue with a pro-feminist viewpoint) or was he merely alluding to the wider issue of inflexibly rigid flexible working? In my work as an executive coach over the last twenty years, I have often noted that returning mothers are the canaries sent down the office mineshaft, placed (knowingly or otherwise) at the forefront of experimental new ways of working.
Right across the whole workforce there is pent up demand for more flexible working from youthful Generation Y, through to an increasing number of new fathers who are supporting bread-winning wives, and on to older BabyBoomers who don't want the pull-the-plug finality of retirement. I'd urge health managers to work with the grain on flexible working, rather than against it - as many top corporate organisations have also found to their benefit.
I was shocked to learn in a recent report by Bright Horizons and Working Families (Modern Families Index 2015) that 44% of men feel the need to lie to their employers about taking time off for childcare and 74% use paid annual leave to support their childcare requirements. Simply, we can't keep holding onto the old fashioned and rigid notion of 9 to 5 working. We live now in a 24/7 world. We must all continue to adapt. Some GP practices may have adopted it, but all should avoid taking an inflexible stance on flexible working.