From practice to pedagogy: How the Salaried Portfolio Innovation Scheme is shaping GP educators

Introduction

Stepping into independent practice after GP training can feel daunting, often bringing with it a sense of isolation and risk of burnout. To help newly qualified GPs at this stage, and in the middle of a wider retention crisis, the Salaried Portfolio Innovation (SPIN) Fellowship was created (NHS England, 2020).

This fellowship provides practices with funding to allow newly qualified salaried GPs to spend up to two sessions a week in an area of special interest. This makes it easier to build portfolio careers and link up with colleagues outside of day-to-day practice.

Sadly, in 2024, NHS England announced that they would no longer be accepting new candidates to the scheme (Mahase, 2024). For us, SPIN has been a vital and invigorating part of early GP careers. Our own fellowships have centred on teaching in the Clinical and Communication Skills Unit at Queen Mary University. In this article, we will reflect on the wider benefits of the SPIN Fellowship for early career GPs, with a particular emphasis on medical education fellowships.

Improving sense of worth

The RCGP (2023) has recently defined GPs as ‘consultants in general practice’, recognising the breadth of our expertise. In reality, few of us consider ourselves on an equal footing with hospital colleagues. Medical students often undervalue GP work (Barber et al., 2018) and negative stereotypes still exist in education and the media (Barry and Greenhalgh, 2019). For new GPs, this can feed into doubts as to whether you’re ‘good enough’, further compounding career dissatisfaction (Alberti et al., 2017).

Fellowship opportunities can act as an important corrective to these doubts at a stage when self-confidence may be particularly fragile. Many of us felt proud of the teaching we delivered, and the title ‘Fellow’ reinforced our sense of expertise. Sadly, when feeling valued by patients can seem rare in the current system, feeling valued by students can offer a morale boost.

Benefits of a community

The process of becoming medical educators through the SPIN fellowship has provided us with a uniquely supportive community, which conventional salaried roles may not provide due to time and workload pressures. This has fostered continuous improvement, confidence and a sense of growth.

The environment has been conducive for building camaraderie and developing both professional and personal relationships. It has also created a safe space to discuss the challenges of clinical work and time to reflect on the working week.

This collaborative learning environment has created a space to share teaching experiences and reflect on each others’ teaching styles. The group learning process aligns with the social constructivist learning approach, described by Vygotsky (1978), emphasising the importance of learning through social interaction and shared experiences. The collaboration with other SPIN fellows has allowed us to learn how to teach, and teach well, within a nurturing learning community.

Building confidence and competence

For newly qualified GPs, breaking into medical education at prestigious universities feels out of reach as formal teaching portfolios and accredited qualifications are often prerequisites for appointment. The SPIN Fellowship dismantled such barriers by sponsoring fellows to undertake a postgraduate teaching qualification, including CILT (Certificate in Learning and Teaching) and PGCAP (Postgraduate Certificate in Academic Practice). Fellows gained the accreditation and hands-on experience demanded by universities without sacrificing income, family time or personal wellbeing.

During the year, fellows rotated through every corner of academic life: sitting on admissions panels, contributing to curriculum design, and creating clinical teaching resources including on-demand lectures and podcasts. Senior educators welcomed us into their teams, offering mentorship and constructive feedback that helped us grow in confidence as teachers. Following the fellowship, alumni have gone on to do additional educational roles and applied for GP trainer roles that once felt inaccessible.

Financial incentive

Salaried GP roles involve significant unpaid overtime, with a recent BMA report indicating that salaried GPs work on average 25% beyond their contracted hours without extra pay (GP Sessionals Committee, 2023). Additionally, many universities rely on unpaid voluntary teaching to deliver medical education.

By offering SPIN fellows payment for their educational contribution, the programme reduces dependence on goodwill, which is often unsustainable in overstretched medical workforces. Protected, paid time validates educational responsibilities and enables the GP to balance teaching with clinical work, reducing the risk of burnout. SPIN fellowships are generally paid at the same sessional rate as clinical work, which means GPs can pursue non-clinical interests with no reduction in salary.

Financial incentives also promote consistency in staffing and long-term engagement, which is beneficial to medical schools in delivering a high quality, standardised curriculum.

Benefits to clinical practice and skillset

Teaching has been shown to improve doctors’ own learning and the development of core competencies (Kondo et al., 2024). During the fellowship, teaching provided direct benefits to clinical practice and improved our clinical reasoning. Preparing to teach required us to study topics in depth, leading to a stronger understanding of underlying principles. Students often questioned variations in clinical practice, which encouraged constructive academic debate and strengthened our ability to appraise evidence.

The fellowship also increased our awareness of the diverse needs of learners. This insight shaped more inclusive teaching approaches that took into account varied backgrounds and learning styles.

In addition, we developed greater confidence in giving constructive feedback, facilitating small groups and speaking in public. These skills improved not only our effectiveness as educators, but also our daily clinical work. The integration of educational practice with clinical care continues to strengthen both the quality of teaching and the standard of patient care in practice settings.

Final thoughts and recommendations

The fellowship provided a much-needed mental break from the intensity of the clinical workload and has helped to reignite enthusiasm and a renewed sense of purpose in our GP roles. It has offered an opportunity not just to slow down, but also to reflect and share experiences, giving space to ‘breathe’.

GP burnout is a well-recognised issue worldwide, and factors such as volume and intensity of workload and low job satisfaction have been noted as issues that influence GPs intending to leave general practice (Doran et al., 2016).

With the national scheme ending, we think decision-makers need to see SPIN for what it is: an investment in the GP workforce, not a luxury.

Our recommendations