The Bradford salaried non-principal scheme: addressing the problems of GP recruitment and retention in the inner city – it's not just the money but the support

Abstract

In the context of widespread discussion about a crisis in GP recruitment and retention we review available evidence and comment on underlying policy dynamics. There have been a number of attempts to improve recruitment and retention, and examples of salaried schemes and personal medical service pilots are discussed. The results of a postal survey to health authorities requesting information on existing salaried schemes are reported. Forty health authorities responded to the survey, of which 30 had developed a scheme. These schemes had been established to address recruitment and retention issues, provide higher professional training for GPs, provide care to specific groups of patients, to support underperforming practices, and to help practices develop their range of services and address PCG/T health priorities. We then comment, in some detail, on one particular scheme as an example – the Bradford salaried non-principal scheme. The background to the scheme is described, as is the process of selecting both scheme GPs and host practices. The impact in terms of personal and professional development of the salaried GPs is discussed. Evaluation of the scheme from the perspective of the salaried GPs (via a focus group) found that the main attractions of the scheme were the opportunity to gain experience of inner city general practice without the commitment to a partnership, opportunities for professional development, and support from the peer group of salaried GPs. A number of concerns were raised relating to the clarity of their role in the practices, in particular, the extent to which the salaried GPs were being used to absorb practice workload rather than, as proposed, to facilitate practice development.