Salaried Portfolio Innovation (SPIN) - New to Practice Fellowship Scheme

Rachel Roberts, Primary Care Dean at HEE London, tells us about the creation of the SPIN – New to Practice (NTP) Fellowship Scheme and how it’s helping to transform the future of General Practice in London.

How did the SPIN – New to Practice (NTP) Fellowship come into being?

Back in 2016-17, I was thinking carefully about the narrative I had been hearing from many GPs: that in their first five years post-qualification, they wanted more career development opportunities while working in permanent roles in a practice, becoming really embedded in their teams.

The main opportunity 93 per cent wished for was a portfolio element to their career, alongside a permanent GP role, especially if accompanied by an educator-facilitated peer support group.

This was happening alongside the concerns of employers, patients, and providers that fewer qualifying GPs were wanting permanent roles, something which was especially pronounced in areas of deprivation with already low primary care workforce numbers.

The Salaried Portfolio Innovation (SPIN) Fellowship Scheme (model) was set up to see if both qualifying GPs, and General Practice Nurses (GPN), and employers across all sectors could connect to encourage a thriving workforce in Primary Care, while also offering excellent career development opportunities and impactful cross sector working. I realised from the start that this was a model that could apply to all primary care professional groups.

This work predates the national new to practice fellowship scheme and was a case study in its development. In London, we combine the strengths of SPIN and the new to practice in a single strategy – we have dedicated programme directors for nurses and doctors, alongside project managers to help the SPIN – New to Practice Fellowship Scheme develop and expand.

Why is the SPIN NTP Fellowship Scheme so important? (What does it do that other programmes don’t?)

One of the critical differences it makes is around creating resilience in the Primary Care workforce – as these fellowships help newly qualified GPs and nurses feel supported in their transition to work in general practice. 96 per cent of GPs said they felt more supported via an external evaluation. The scheme bolsters recruitment and retention in the Primary Care workforce, by helping general practices fill vacancies for permanent salaried roles, with GPs and nurses being more likely to stay in the practice that hired them as part of their fellowship.

The scheme is supported by educational programme directors. It can offer two portfolio sessions rather than just one per week. This in turn increases GP and nurses’ capacity for local priorities and services, and adding further value to their practice and other organisations. Variety in the working week in their extended portfolio role also creates job satisfaction, as they develop new skills and knowledge, feel valued and that their work is making a positive difference.

Many of those undertaking SPIN – NTP Fellowships have a track record of going on to take up significant leadership roles in service redesign, clinical service leadership, educational and academic roles.

External evaluation, conducted by the Evidence Centre, reveals that this programme gets excellent feedback and that it encourages 85 to 90 per cent of fellows to remain in their practices.

How does the SPIN NTP Fellowship Scheme support HEE’s overarching Primary Care Strategy?

This scheme supports retention into the Primary Care workforce through truly satisfying careers. It also helps to develop and deliver excellent patient care, including patient pathways and services across sectors.

The scheme is also helping to ensure that areas of deprivation and increased workforce pressures are well supported. Our SPIN programme teams and Training Hubs signpost to vacancies and work with GP employers to create exciting portfolio opportunities to attract new GPs and nurses.

The SPIN NTP Fellowship model can be used for any primary care professional group and we now have current programmes being piloted in North East London for clinical pharmacists, as well as the ongoing London programme for GPs and practice nurses. The model can also be used for mid-career GPs and GPNs, where employers contribute the costs – HEE London’s regional team is focusing on expanding the offer for these groups this coming year.

How have partners helped to shape the SPIN NTP Fellowship Scheme?

Our partners have been critical to the success of the scheme. To name but a few they include:

• employers in general practice and all the portfolio hosts across community, intermediate and secondary care, as well as medical schools, academic health science networks, universities and the voluntary sector
• our GP and GPN programme directors who provide monthly educational group sessions and, alongside the dedicated project managers, invite employers to offer GP practice and portfolio opportunities, while also recruiting fellows
• the GP, GPN and pharmacy fellows who are keen to embark on next stages in their careers
• our HEE team, and the SPIN NTP Fellowship Scheme managers
• Canterbury Christchurch University which has provided the Postgraduate certificate for 37 GP fellows and five additional GPNs to date

What positive impact does the SPIN NTP Fellowship Scheme have (on patients / practitioners / wider workforce)? 

What advice would you give to someone thinking of taking up a SPIN NTP Fellowship?

Have a look at some of our case studies from other fellows and listen to their experiences and the opportunities it has given them, to see if you think this may be for you.

Feel free to contact the team or your regional SPIN programme directors or managers to talk about your ideas.

What have you learned by setting up the SPIN NTP Fellowship Scheme?

It’s not easy to create employment opportunities, especially co-funded by portfolio hosts, but the opportunities are fantastic when this is achieved.

Fellows really do feel empowered by being part of this programme, and greatly value the support of their programme directors.

What’s the legacy of the SPIN NTP Fellowship Scheme?

We are so pleased to have had more than 450 fellows join in London and tell us of the many ways in which they have benefited.

Many of these fellows have created new services for patients and have taken on a range of roles themselves. It is fantastic to see and hear from all SPIN NTP fellow cohorts and the positive impact they are continuing to make across London.