As a medical student I assumed that at some point in the future I would stop working in the NHS, leave the UK and serve God overseas for a period of time. Inspired by the example of others, I asked the familiar question, 'when should I go?' However, a new paradigm of medical mission may be emerging. Many are now finding ways to fulfil God's call to mission at the same time as continuing to work within the NHS. These opportunities in flexible working have been made possible by Improving Working Lives [1], an initiative led by the Department of Health to develop new creative ways of employing doctors and other health professionals. Part of this initiative is known as the flexible career scheme.
Exploiting the options
As a doctor on the Flexible Career Scheme[2] I work eight sessions a week for 33 weeks. Across the year, this gives up to 19 weeks broken into three sections. I use these periods to work overseas supporting Christian medical groups in the former Soviet Union and working with NGOs implementing primary care. Balancing my commitments to my overseas work and the NHS is difficult, but the benefits to myself, the patients and the practice in having a motivated doctor who is able to apply the knowledge gained overseas in the UK (and vice versa) are enormous. As Liam Donaldson the Chief Medical Officer has remarked, 'The ultimate beneficiaries from UK professional health workers gaining international experience are NHS patients in the UK'.[3]
Other examples of those using flexible ways of working amongst CMF members include CMF's own staffworkers, who continue their medical training while working four to five sessions a week for CMF. Other doctors use their sessions to serve within their local church. Some CMF members have agreed extended annual or unpaid leave arrangements with their NHS employers to enable regular teaching or medical trips. PRIME (Partnership in International Medical Education) involves many CMF members in its medical education work across Europe and beyond.[4] GPs and those with an interest in medical education make use of study and annual leave in order to fulfil the many opportunities available through PRIME.
The Flexible Career Scheme
Doctors on the Flexible Career Scheme work less than 50% of full time and come from all branches of medicine, although posts where the work is sessional with little or no on call are more easily adapted. GPs on the scheme can work a maximum of 260 sessions a year (which can be annualised instead of committing to a particular number of sessions per week) without any out of hours work. They receive an additional eight sessions of paid educational leave annually, and also remain eligible for higher professional education monies and a golden hello if they meet the set criteria. Currently practices employing doctors on the scheme benefit financially by reclaiming 50% of the salary they pay the GP for the first year of employment, 25% for the second year and 10% for the third year. There are some potential difficulties. Since doctors on the Flexible Career Scheme work less than 50% of full time, experience gained within the scheme cannot count towards training.[5] It is also important to have understanding colleagues who are willing to accept such a flexible way of working. I have also benefited from the pastoral support of my church (who are my sending agency) and CMF.
Training flexibly
Technically, 'flexible training' means part time training which involves participation in medical activities for at least half the time of a full time trainee and can be undertaken at any stage. It was set up in order to retain doctors who might otherwise leave because they are unable or unwilling to take up full time appointments. Doctors currently training flexibly come from all specialities and include trainees with young children, those who care for a disabled relative, trainees with a disability themselves and others with religious commitments.[6] It involves doing between five and seven sessions a week, with pro rata on call, and is arranged via the flexible training dean in your local postgraduate deanery.
In addition to the schemes above, salaried posts may be negotiated with NHS employers for the number of sessions per week a doctor is willing to work. Agreed extended periods of unpaid annual leave to allow short term trips overseas are also possible. It looks like there may be exciting times ahead. In fact, all these options could herald the 'new paradigm in medical mission' that Val Inchley declared two years ago our century so sorely needs.[7] It has been said that God does not need our ability but our availability. New ways of working enable us to make the same choice as Isaiah. 'Here am I, send me'.[8]
