1. GP Workforce Retention Update GP Workforce team
February 2017

2. Introduction
The following set of slides set out the key retention initiatives that are being implemented as part of the GPFV by the GP Workforce team and where we feel the Medical Directors can engage with GPs on. If you have any questions regarding any of the initiatives please contact -

3. Retained Doctors Scheme 2016 GP Retention Scheme (2017 onwards)
A package of financial and educational support to help doctors, who might otherwise leave the profession, remain in clinical general practice.

4. Introduction
The General Practice Forward View committed NHS England to undertaking a review of the Retained Doctors Scheme to ensure that it was fit for purpose.
A review was carried out into the original retainer scheme in April Profiled the number of retainers on the scheme over the last 10 years and compared this to those leaving general practice.
While the review was being carried out an interim scheme (Retained Doctors Scheme 2016) was introduced with the aim of increasing the number of retained doctors by increasing the financial support available.
The review recommended that the scheme should focus on those GPs who are seriously considering leaving or have left general practice, when a regular part-time role does not meet the doctor’s need for flexibility and where there is a need for additional educational support. It also recommended better publicity, administration and oversight by NHS England.

5. The Retained Doctor Scheme 2016
The Retained Doctor Scheme 2016 aims to increase the number of retained doctors and provides a fixed term increase in the financial support available to practices and retained GPs. Temporary scheme while a review of the original scheme was taking place.
The Retained Doctors Scheme 2016 was launched in July (SFEs signed off in November 2016 with funding backdated to 1 July 2016).
The 2016 scheme provides 36 months of increased funding until 30 June 2019 for all existing retainees and 100 additional retained GPs.
The scheme increased the practice payment per session to £76.92 (from £59.18), and introduced an additional annual payment (salary supplement) to the GP for professional expenses of between £1000 and £4000 depending on the number of sessions worked. Top up (£17.74) and professional expenses payment paid from the transformation programme budget.
The 2016 guidance removed the expectation to return back to general practice on leaving the scheme (to include those approaching retirement, with health issues or carer responsibilities) and clarified that the scheme would support those with compelling evidence that they are intending to leave practice and would do so without this scheme.

6. GP Retention Scheme – April 2017 onwards
The review recommended:
That the future scheme should be aimed at retaining those GPs in clinical general practice:
Who are seriously considering leaving or have left general practice due:
to personal reasons
approaching retirement
or require greater flexibility
And when a regular part-time role does not meet the doctor’s need for flexibility
And where there is a need for additional educational support
The expectation to return back to general practice remains removed. :

7. GP Retention Scheme – April 2017 onwards
Better publicity – doctors working within general practice were often not aware that the retainer scheme is available.
Through the appraisal process, signposting doctors who are considering leaving
Various networks (LMC, BMA, RCGP, HEE, NHS England)
Better consistency - we know that the previous scheme varied in terms of how it was delivered across the country. The future scheme will have one national guidance handbook and a set of standard application forms.
Better oversight by NHS England to ensure that the suitable amount of the primary care allocation budget is delegated to this scheme at the local level. :

8. Original Retained Doctors Scheme Retained Doctor Scheme 2016
Original Retained Doctors Scheme
Retained Doctor Scheme 2016
GP Retention Scheme (April 2017 onwards)
Criteria to join
Personal well founded reasons for limited, paid employment.
Intended to ensure that doctors who wish eventually to return to general practice as a principal or non-principal
Doctors who might otherwise leave the profession
Different to a regular salaried GP post
Doctors who are seriously considering leaving
And when a regular part-time role does not meet the doctor’s need for flexibility
And where there is a need for additional educational support
Practice payment
£59.18
£76.92
Salary / expenses supplement
£310 (education bursary)
Between £1000 and £4000 per annum
No. sessions
1-4
Source of funding
Primary care allocation budget
Primary care allocation budget and GP Workforce 2020 transformation fund :

9. GP Retention Scheme – April 2017 onwards
Scheme enhances clarity around:
Determining whether a doctor is seriously looking to leave general practice
What additional work can be undertaken while on the scheme, inc Locum work
Further clarity around the professional expenses supplement - Further highlighting that ‘the practice should not automatically make any deductions form the RGP expenses supplement.’
Extended absence and scheme extensions - when extensions are applicable for the RGP and when payments should cease
Management / approval of the RGPs :

10. Retainer Expectations
An expected share of retainers for each region has been set out based proportionately on the primary care budget allocation.
Primary care budget allocation share (%)
South 25
London 16
Midlands 30
North 29
100.00
Proposed retainer expectations for the new scheme to inform planning guidance at a regional level
Date
Retainer numbers England
South
London
Midlands
North
15/16
191 (existing spread) 59 58 47 27
16/17
291 (100 increase)
84 (25+59)
74 (16+58)
77 (30+47)
56 (29+27)
17/18
341 (50 increase)
96 (37+59)
82 (24+58)
92 (45+47)
71 (44+27)
18/19
391 (50 increase)
109 (50+59)
90 (32+58)
107 (60+47)
85 (58+27)
19/20
441 (50 increase)
121 (62+59)
98 (40+58)
122 (75+47)
100 (73+27)
20/21
491 (50 increase)
134 (75+59)
106 (48+58)
137 (90+47)
114 (87+27)

11. Approval process
GP Deans review RGP applications and pass eligible applications with their recommendation to their NHS England local office - Director of Commissioning Operations (DCO).
NHS England DCO (or nominated deputy either within NHS England or delegated CCG) makes the final decision whether the doctor can join the scheme. The GP Dean is notified of the decision who will then notify the doctor and practice. 
NHS England local office finance team notifies Primary Care Support (PCS) England of the practice that will be hosting the retained doctor.
Payment authorisation, local finance team complete / approve retainer form and send to Primary Care Support (PCS) England. Retainer to be funded through the primary care allocation budget.
PCS England sends a claim form to the practice hosting the retained doctor and process claims when received.  Approval is sought from the relevant NHS England Contract Manager to enable PCS England to make payment to the practice directly.

12. Further information
More information including how to apply to the scheme can be found on the NHS England website -

13. GP Career Plus - pilot
The GP Career Plus pilot will help demonstrate the need and effectiveness of employing GPs through pooled arrangements, the most effective form of employer and the scope for a GP pool arrangement to become a sustainable model.

14. GP Career Plus
The purpose of the GP Career Plus pilot is to review a range of models that employ a pool of GPs that support a local health system to:
Provide clinical capacity for practices to cover: vacancies; annual leave; parental leave; and sick cover.
Carry out specific types of work e.g. long term conditions, access hub sessions, home visits.
Provide leadership through: clinical training, individual mentoring and coaching, innovation and change leadership, support for practices in crisis.
The pilot will help demonstrate the effectiveness of employing GPs through pooled arrangements, the most effective form of employer and the scope for a GP pool arrangement to become a sustainable model.
The pilot will recruit up to 80 GPs at risk of leaving the profession across 11 pilot sites. £1.1m is being committed to the pilot.
The pilot sites will go live in early Summer 2017 with a review of their effectiveness in Autumn 2017.
The GP Career Plus scheme is a small scale proof of concept scheme and is not as yet a wider workforce initiative. If the model is proved to be successful it may be advocated for use by CCGs or providers to help support GP retention.

15. More information
More information about the pilot and the pilot sites will be available via the NHS England website -

16. Clinical Pharmacists in General Practice Phase 2
The aim of this initiative is to support an extra 1,500 clinical pharmacists to work in General Practice by 2020/21. This is in addition to over 490 clinical pharmacists already working in general practice as part of a pilot, launched in July 2015.

17. Clinical Pharmacists in General Practice
The General Practice Forward View makes a commitment to have “…a pharmacist per 30,000 of the population…leading to a further 1,500 pharmacists in general practice by 2020”
There is recognition that a greater use of skill mix within general practice will be key to releasing capacity, if we are to offer patients with complex or multiple long-term conditions longer GP consultations.
£112m will be invested in this programme for the recruitment of clinical pharmacists over the next 3 years with the expectation that practices will be able to sustain the employment of the pharmacists beyond this timescale.
Other perceived benefits of the scheme are:
Supporting patients to get the best use of their medicines and identifying medicines related issues.
Improvements in the screening, prevention and diagnosis of long term conditions
Greater ability to offer more on the day appointments and provide OOH/extended hours/on-call services
Better integration with the wider healthcare systems/teams as pharmacists being key point of contact for primary and secondary care systems

18. More information
NHS England website -
Guidance for completing application form
State of readiness checklist: recruitment stage
FAQs
Link to online application portal