Becoming a portfolio GP

This is a guest post by Dr Ferdinand. Dr Ferdinand is the London AiT and First 5 Chair and a portfolio GP in South London. He balances a multitude of roles with a salaried job and still manages to put his kids to bed most nights of the week.

What is a portfolio GP?

Being a portfolio GP is a way of diversifying what you do as a GP, whether sessional, partnered or salaried. You can perform a range of roles rather than be stuck doing one thing. For example, this could include locum work, teaching FY2s and registrars, out of hours work, being an appraiser or working for a CCG. There's a wide range of activities you can pursue (limited only by you imagination) and you can adapt your workload and hours to suit you.

Why be a portfolio GP?

Being stuck in one place for a long time can be limiting both in terms of your personal circumstances and your opportunities for learning and development. As a portfolio GP you have the opportunity to choose your own work and fit it around your schedule. This allows you to develop a variety of interests, giving you the chance to learn new skills and apply them. Meeting and interacting with a wider range of people will also give you more networking opportunities which can open up even more options.

Specifically you may be able to develop skills such as leadership, understanding budgets, corporate governance and process, clinical skills and knowledge and quality improvement or service redesign. There are no precise outcomes, because it all depends on what you do!

What can you offer?

As a practicing GP, it is reasonably assumed that you have certain skills inherent to the profession.  You therefore have skills (to a greater or lesser extent) in time management, complex data analysis, decision making, risk assessment, team working, communication skills, diplomacy, governance and we are trustworthy......once we look at our skills in management speak, it suddenly becomes very clear why we are in demand and why someone may take a chance on us even if we don't have lost of experience. And what we lack in experience or knowledge about process can be learnt a lot quicker than the skills already listed that we already have.

With many roles, competition is sparse and so you always have a realistic possibility of getting it if you apply.  I'm yet to find a GP who couldn't find a role outside of day to day clinical practice if they wanted to.

What are the disadvantages?

Firstly, not all roles pay, or pay particularly well.  In this scenario, I suggest asking yourself what you get out of it - if you are learning and developing new skills and have a way to apply these skills, then you are building your portfolio CV and this can lead into better paid roles in the future.

If you're working and being paid for work you do as a portfolio GP then part of your income may be on a self-employed basis. This means if you're reliant on the income and the role is time limited, you need to plan for this. Rates of pay where offered usually take into account the lack of holiday and sick pay.  However if you have an extended period of illness you might find yourself without a safety net to fall back on.

It also comes with the other drawback of being self employed: doing your own taxes, and the extra burden of NHS superannuation admin obviously roles outside of the NHS are not pensionable in this way.

As well as money related issues, the lack of a specific base and continually moving around may make relations with colleagues difficult, as you might have trouble getting used to the particular working processes of where you are. This can make communication difficult but is dependent on the types of roles you take on and can be protected against to an extent.

It can also be difficult to find out what rates of pay to ask for where appropriate, as this can be a well guarded secret among GPs. For locuming a transparent service like Network Locum (now Lantum) can help with this, as all rates are clearly advertised and you can easily search for nearby jobs, though no similar portal currently exists for the wide range of other jobs out there.

If you already have a salaried job and take on an extra role, you will have to work a few extra hours, so don't take on more than you can handle. Better to do 1 extra role well than 3 extra roles averagely.

Is it right for me?

Whether you want to become a portfolio GP varies according to your particular situation. As well as the listed drawbacks, your contacts will also matter. Since you'll be managing your own work, you'll need to know where to find it and know people who will recommend you and trust you to do particular jobs. Without experience you may also find it difficult to manage the workload because of time pressures and trying to meet the expectations of multiple employers. Although you have control over your time you also need to consider whether you will be able to maintain a sensible work/life balance while earning enough.

So how do I start?

There's no need to rush into things. Take your time and consider your options, and only pursue opportunities that interest you.  This is where imagination can help - be prepared to ask people / organisations / companies "what can I, as a qualified GP, offer you?".  I know GPs who work as Directors of private companies (providing non-clinical services to the NHS), are expedition doctors, are clinical leads, provide private GP services to concerts and sporting events and many many more. I even once met a GP reg who wrote film reviews - think non clinical as well as clinical, and it's never too early to start.

I do my portfolio working around a salaried job which secures a minimum regular income and this is a safe way to get started.  be prepared to take on some roles for free, it will build your networks and give you the opportunity to learn and get some outcomes you can then build your CV with. Do some networking and especially find others who are already working as portfolio GPs and find out how they're managing or if they would be happy to mentor you - most are flattered by the request and more that happy to have a 10min chat on the phone every month or two. Ultimately, you may find it more lucrative and enjoyable to reduce your salaried/regular income in favour of a bigger portfolio.

You can find opportunities from various sources, including NHS jobs, Pulse magazine and BMJ careers. It's also a good idea to get on email lists, check organisation websites and social media, for example the RCGP London AiT First 5 Facebook Group.

In summary, look out for opportunities. Be prepared to volunteer to get experience and make contacts, learn on the job as much as possible and find a mentor who can help you through the transition.

Dr Chris Ferdinand

RCGP London AiT First 5 Chair

RCGP South London Faculty Board