National GP Retention Scheme: Key Features and FAQs

In England, the GP Retention Scheme (also known as the GP retainer scheme) is a national effort to keep experienced GPs in the field. It helps GPs stay in general practice by providing incentives and support. This is part of a larger strategy to tackle workforce challenges and ensure a sustainable primary care system.

Now, let's delve into the key aspects of the programme and answer common questions about the conditions, duration, and principles of the GP retainer scheme.

Key features of the GP Retention Scheme

Financial support

GPs participating in the retention scheme may receive financial incentives or a salary supplement. The exact financial arrangements can vary, and it aims to recognize the value of the experience and skills that retained GPs bring to patient care.

Flexible working arrangements

The scheme provides flexible working options to accommodate the personal circumstances and preferences of GPs. This flexibility may involve part-time work, reduced hours, or other arrangements that allow GPs to balance their professional and personal commitments.

Educational support

GPs in the retention scheme have access to educational and professional opportunities. This could include support for continuing professional development, training, and skill development.

Programmes to facilitate mentorship and peer support will be included in the scheme. This helps GPs, especially those transitioning back to work or facing challenges, to receive guidance and support from more experienced colleagues.

Well-being and work-life balance

Recognizing the importance of well-being, the scheme includes initiatives to support the mental health and work-life balance of participating GPs. This could involve access to well-being services, counselling, and resources to manage stress.

The scheme offers opportunities for career development within general practice. This could include leadership training, involvement in decision-making processes, and pathways for progression within the profession.

Financial Support for Employing Practices: GP Retention Scheme Practice Payments

The GP Retention Scheme provides direct financial support to the employing practice, not just to the retained GP. This is a critical consideration for practice managers evaluating whether to take on an RGP.

Practices receive a reimbursement of £76.92 per session, which covers up to four sessions per week. Over a full year, this equates to a maximum reimbursement of £16,000 per year for a four-session RGP. The table below summarises the annual practice reimbursement based on the number of sessions worked each week:

This reimbursement is separate from the professional expenses supplement paid to the RGP themselves (ranging from £1,000 to £4,000 annually depending on sessions). The salary and job plan are matters for negotiation between the GP and the practice.

From April 2023, the formal four-session cap was removed, meaning a practice can employ an RGP for additional sessions beyond four per week at its own expense. However, NHS England reimbursement remains capped at four sessions, so any additional sessions above that threshold will not attract the £76.92 per session payment.

Practices considering joining the scheme should factor in the cost of providing an educational supervisor and protected supervision time alongside these payments.

How to Apply for the GP Retention Scheme

If you are considering joining the GP retainer scheme, the first step is to contact your regional NHS England scheme lead. This initial conversation allows you to confirm your eligibility before committing to a formal application.

The process broadly follows these steps:

1. Read the National GP Retention Scheme Guidance published by NHS England before making contact.
2. Arrange a call with your regional NHS England GP Retention Scheme Lead to discuss your circumstances and confirm eligibility.
3. Complete the official NHS England Application and Annual Review Form, available on the NHS England publications page.
4. Submit the form to your regional NHS England team, usually via the designated GP school inbox for your area.
5. Once approved, your practice will also need to demonstrate it can meet the educational supervision requirements before the placement is confirmed.

BMA members can get contract checking and application advice by emailing bma.org.uk/support. If you are unsure which regional team to contact, the NHS England website provides details for each area.

The application covers both the GP and the practice, so both parties should be involved from the outset. Annual review forms must be submitted each year to confirm ongoing eligibility and to ensure the practice continues to meet its obligations under the scheme.

Frequently Asked Questions about the Scheme

• What does the GP Retention Scheme entail?

This programme offers comprehensive financial and educational support crafted to assist physicians who may be considering leaving the medical field. Its main goal is to encourage their continued involvement in clinical general practice.

Notably, the scheme provides support to both the retained GP (RGP) and the employing practice. Financial assistance is granted recognizing the unique nature of this role, distinguishing it from a typical part-time, salaried GP position. This distinction lies in the increased flexibility and educational support it offers. RGPs can engage in the scheme for up to five years, with an annual review ensuring their continued eligibility and the practice meeting its commitments.

• Who qualifies for this initiative?

To qualify for the programme, doctors need to consider leaving general practice while staying on the National Medical Performers List. Reasons may include personal factors like caring for family (children or adults) or health concerns. Other factors include nearing retirement or the desire for more flexible work within or outside of general practice. Eligibility also applies when a regular part-time role doesn't meet the doctor's flexibility needs, like requiring shorter clinics or annualized hours.

Moreover, eligibility is determined by the need for extra educational supervision. This applies to recently qualified doctors aiming to work 1-4 sessions weekly because of caregiving duties or those involved in 1-2 sessions, where the pro-rata study leave allowance isn't enough for consistent professional development and networks.

To participate, doctors must have full registration and a licence to practice with the General Medical Council (GMC) and be included in the National Medical Performers List.

• Why is this initiative essential?

Workforce data consistently shows a concerning trend: a significant rise in GPs leaving the profession, notably in age groups 55-59 and 60-64, with additional peaks in the 30s. The GP Retention Scheme directly addresses this by providing a supported pathway for doctors to remain in clinical practice when a standard part-time role would not meet their needs.

This initiative aims to support those contemplating leaving general practice at any career stage, especially when conventional part-time roles don't meet their flexibility needs. It also addresses cases requiring additional educational supervision.

• What is a RGP contract?

The retained GP will be treated as a salaried employee of the practice. The BMA made a retained GP model contract, like the salaried GP contract.

As mentioned earlier, RGPs can be in the programme for up to five years. They'll have an annual review with the GP Dean or their chosen deputy to assess their needs and decide if they should continue on the scheme. RGPs still need to follow revalidation and have an annual appraisal through their responsible officer.

1. BMA members can get contract checking and advice by email at bma.org.uk/support.
2. Non-members can get general information by visiting Contact-BMA.

• What are the merits of participating in this program? How does it contribute to my benefit?

The General Practitioner Retention Scheme provides crucial support for GPs facing potential departure. This is especially relevant when a standard part-time role doesn't meet a doctor's need for flexibility, requiring additional educational supervision. Participation for Retained GPs (RGPs) lasts a maximum of five years, with an annual review ensuring ongoing necessity and practice obligations.

Each RGP qualifies for an annual professional expenses supplement, ranging from £1,000 to £4,000, based on weekly sessions. Disbursed through the practice, this supplement, though subject to tax and national insurance, isn't pensionable.

The scheme allows physicians to sustain clinical practice while working up to four reimbursed sessions per week (totaling 16 hours and 40 minutes). From April 2023, the formal session cap was removed, meaning practices can now employ an RGP for additional sessions beyond four at their own expense. NHS England reimbursement, however, remains capped at four sessions per week. This allocation includes protected time for ongoing professional development and educational support.

• Can I participate in the scheme within my current practice?

Certainly, as long as the practice offers suitable work to the RGP and supports the upkeep of skills in various general practitioner tasks. The RGP needs to be part of one GP practice to have peer support at work and ensure continuity with patients.

Practices wanting to qualify must show they can meet the educational needs of the RGP and understand the educational supervision approach. The NHS England-designated RGP Scheme Lead assesses this based on the doctor's requirements. An educational supervisor, like a GP trainer or F2 supervisor, is required and should have completed a relevant training course in supervision. Specific details will be provided by the designated NHS England RGP Scheme Lead.

• Is the scheme available to doctors undergoing remediation?

No. The GP Retention Scheme is not intended to support a doctor's remediation. If the NHS England responsible officer has concerns about a doctor's fitness to practise, the doctor will generally be considered ineligible for the scheme. Doctors in this situation should seek separate advice from their responsible officer or the BMA.

• Can I enrol in the scheme if I'm not on the National Medical Performers List?

To join the scheme, doctors need to be fully registered and have a licence from the General Medical Council (GMC). They should also be on the National Medical Performers List. If you are not on the list but have practiced in the last two years, it's a good idea to check with the local Responsible Officer for advice on getting back on the list.

• What evidence can I provide to show that I'm seriously thinking about leaving or have already left general practice?

You can show your genuine consideration by providing documents like:

1. an appraisal
2. a resignation letter
3. initiation to receive a pension payment
4. or stating your intention to leave.

• How long can I stay in the programme?

You can be in the programme for up to five years. Every year, the assessment checks to see if you still need to be in it and to ensure the practice fulfils its obligations.

• How many sessions can I work?

From 1 April 2023, the formal four-session cap was removed. NHS England reimbursement remains available for up to four clinical sessions per week (totaling 16 hours and 40 minutes, or 208 sessions annually), but the session cap removed as a hard limit means practices can now directly employ an RGP for additional sessions beyond four at their own expense.

For annualized sessions, the RGP should aim for at least 30 weeks out of 52. Extended hours during the week or on weekends are possible by mutual agreement, as long as total hours stay within the contract limits. Extended-hour sessions are included in the job plan, allowing assessment of the balance between clinical work, admin, and CPD.

• What is an induction programme?

Every RGP, regardless of their experience, is required to participate in an initiation program. This programme is tailored to individual needs and is developed through discussions with them.

During the programme, RGPs are introduced to all key members of the primary care and allied teams. They gain insights into:

1. The computer system, including its use for consultations, prescribing, templates, protocols, BNF, and internal messaging systems.
2. Practice systems for managing chronic diseases, such as adding to disease registers, creating care plans, setting up patient alerts, implementing recall systems, achieving targets, and understanding team roles in disease management.
3. The location of practice policies and procedures.
4. Local and practice-specific prescribing policies.
5. Local referral pathways, collaborative working arrangements, and main service providers. In-house services are available, such as phlebotomy and ECG.
6. Essential phone contact numbers.
7. Practice appointment systems and on-call arrangements.
8. The location of emergency drugs.
9. Procedures for reporting significant events.
10. The location of the panic button and the protocol for reporting violent incidents.

• What happens when the programme ends?

You can go back to a bigger role if you want when the programme ends, but you don't have to. After 24 months with the same boss, you get all your work rights, and the boss has to keep your job even after that. If something changes in your job, talk to your boss about it and get advice. The boss should also tell the NHS England RGP Scheme Lead if there are big changes that might affect your job, like if the practice merges with another, moves, or changes its NHS England contract.

Final Thoughts on the Pros and Cons of the GP Retention Scheme

The National GP Retention Scheme in the UK presents both advantages and considerations for retained GPs. The scheme offers financial incentives, flexible working arrangements, educational support, mentorship, and initiatives for well-being. Retained GPs can benefit from annual professional expenses supplements, contributing to their sustained clinical practice.

However, tax implications and non-pensionable aspects should be considered.

While the scheme promotes work-life balance and career development, it requires compliance with revalidation and an annual appraisal. The programme's merits include addressing workforce challenges, supporting GPs at various career stages, and offering financial and educational assistance. The maximum participation period is five years, with an annual review to assess the continued need for participation.

The scheme facilitates continued practice within the current practice, emphasizing peer support and patient continuity.

However, the practice must demonstrate its ability to meet the educational needs of the RGP.

Participation requires full registration, a licence from the GMC, and inclusion in the National Medical Performers List.

To join, evidence of genuine consideration to leave general practice, such as an appraisal, resignation letter, or initiation to receive a pension payment, is necessary. The induction programme ensures a smooth transition for RGPs, introducing them to key practice elements.

Upon programme completion, RGPs can return to a larger role if desired, but it's not obligatory.

After 24 months, full employment rights are granted, and the employer must maintain the job.

Communication with the employer and the NHS England RGP Scheme Lead is crucial for addressing changes that may affect employment.

In essence, the GP Retention Scheme provides a valuable support system for GPs contemplating departure, promoting professional and personal balance while contributing to the sustainability of primary care.