GP Career options

Locum vs salaried vs
partner vs portfolio GP
SYED ASKARI HASSAN
 LIFE After GP training
The Expectations:
As a newly qualified GP, people expect that you will have a significant
increase in your pay. In addition, people hope that your job becomes
easier as you may now have junior colleagues to delegate tasks.
Furthermore, people think that there is an extra prestige that comes
with becoming a fully qualified GP. If you are an international
medical graduate, there can be even more significant pressure from
home. Your family and friends may begin to assume that you are
now "rich."
The Realities

The Salary: Once you qualify as a GP, your salary may not necessarily increase and may remain
the same. Changes in your remuneration depend entirely on what you decide to do. For
example, as a salaried GP working six sessions a week (about three days a week), your salary is
about £60k/year. While this is not terrible, it is not much different from what you earn in your
final year of GP training. Most people decide to work three days a week because it helps create
a fair balance. You may choose to work full-time up to five days a week and earn more, but the
job can get very tedious. Besides, it would be best to find a way to create a healthy balance, so
you do not break down.
 The Job: 
When you qualify as a GP, your job essentially remains
the same, with very few changes. In fact, you may
even have added responsibilities but no additional pay.
You will have a set number of patients assigned to you
and no study days. In addition, you will have to work
more independently than you did in training. 
PORTFOLIO GP

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 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
OOH
Private GP
Occupational health
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.
 Salaried GP

Pros:
Stable income: As a salaried GP, you will receive a fixed salary, which can provide
financial stability and predictability.
Employee benefits: You may be entitled to employee benefits such as paid holidays, sick
leave, pension contributions, and access to training and development opportunities.
Limited financial responsibility: As an employee, you will not be responsible for the
financial management of the practice or any associated business risks.
Tax advantages: Your tax and National Insurance contributions will be deducted at
source from your salary, which can simplify the tax process.
Cons:

Limited income potential: Your salary may be lower than that of a

locum or GP partner, and your income will be fixed regardless of the
number of patients you see or the hours you work.
Limited control: You may have limited control over your work
schedule, patient load, and clinical decision-making, as you will be
working under the supervision of the practice owner.
Limited autonomy: As a salaried GP, you will have limited input into
the business decisions of the practice.
 Locum GP

Pros:
High income potential: Locum GPs can often earn higher rates of pay than
salaried GPs, and may be able to negotiate their own fees.
Flexibility: You can choose when and where you work, and can vary your
workload to suit your lifestyle and financial needs.
Autonomy: As a locum GP, you have more control over your clinical decision-
making and patient load.
Tax advantages: Locum GPs may be able to claim a range of expenses, such as
travel and equipment costs, against their income tax bill.
 Cons:
Irregular income: Your income may vary from week to week or month to
month, depending on the number of patients you see and the rates you
negotiate.
No employee benefits: You will not be entitled to paid holidays, sick leave, or
pension contributions.
Administrative burden: As a self-employed professional, you will be
responsible for managing your own finances, including invoicing, tax returns,
and National Insurance contributions.
Limited job security: Locum work is subject to availability and demand, and
there may be periods of low demand or no work available.
Useful links
(103) Life after CCT: GP Jobs - Salaried, Locum, Partner, Portfolio, GP Pay, Pitfalls for New GPs + Q
&A – YouTube
(103) What is The Pay of GPs in the UK (Locum vs Salaried vs Partner) – YouTube
(103) Day in the life of a DOCTOR (Locum GP) in the UK | How Busy Is It? - YouTube