Flexibility for special clinical and non-clinical interests

We need flexible training and career development schemes in order to be flexible in our work. It's better to get people into the right job, balancing their careers with other aspects of their lives (professional and personal), than have them dissatisfied and underperforming or leaving.^1,2 A different way of working means being motivated, rather than stressed, while being able to use lifelong experiences and learn from each other. It would be good to organise domestic General Practitioners with Special Interests (GPwSI) schemes,³ with GPs enjoying developing their clinical expertise and able to help build a more integrated health service.

Clinical expertise, however, is not the only aspect of general practice; involvement in teaching and management, or simply having less involvement as doctor, per se, could greatly raise standards of care. We need protected non-contact time within the working week to stimulate clearly defined roles, responsibilities, and terms of service.

Teaching, research, and management have to be relevant career options, whose status and conditions should receive strong consideration and the same payment in workforce planning and skill utilisation. At present, it seems there is good payment for special clinical interests, but poor payment for academic roles.⁴ Changing this is important to counteract the burnout and frustration that is mainly visible in GPs more involved in these activities, and to fulfil the new definition of general practice and GPs.^5,6

It is really strange that some health ministries in some European countries (as is the case in the one for which I'm now working) are still not applying the European directives on flexibility in the workplace. This concerns a flexible career option as well as reduced normal clinical time when involved in teaching, research, and management. As discussed at EURACT Council when preparing the Educational Agenda (J Heijerman, WONCA Europe Regional Conference, Amsterdam, 2 June 2004), this lack of flexibility is clearly a real barrier to working differently, in different fields, and being able to work well.

Roger Jones⁷ wrote about seeing a much bolder attempt to endorse the ‘mixed portfolio’ approach to general practice, in which patient care is combined with other non-clinical activities. I also think that it would introduce a ‘wedge-shaped’ commitment with substantial work in early years, tapering to a considerably reduced ‘working’ commitment in more senior doctors.⁸ This would be a chance to reinvent general practice as an attractive career with a progressive career structure.

Flexibility has to suit different stages of life. To permit not having to work absurdly when your forces or your mind are ‘rebelling’ and, at the same time, allowing doctors more options, could help persuade doctors not to leave the profession for a long while yet.