This information guide is
intended for a consultant psychiatrist who may be planning a
portfolio career. The information can be used as a guide only and
is not a substitute for professional advice. If you need further
advice and support, please contact the Psychiatrists’ Support
Service or one of the organisations listed at the end of this
The term ‘portfolio’ career covers
the increasingly common situation when a psychiatrist is not in
full-time employment with a single employer, but undertakes a
variety of activities. This frequently follows retirement from the
National Health Service (NHS), but may occur at any point of your
career, either through choice or circumstance.
What may be in a portfolio?
This table is not exhaustive, but
indicates the variety of possible commitments a portfolio
psychiatrist may have.
Table: Possible commitments
of a portfolio psychiatrist
- independent private
- employed private
- mental health review tribunal
- disability assessment
- Mental Health Act work
- parole board work
- clinical, voluntary, overseas
- project work
- medical journalism
- advice or committee work for voluntary
- professional writing
- your choice, from sailing the south
seas to studying ancient Greek!
Psychiatrists will no longer be
able to remain passively on the General Medical Council (GMC)
Medical Register. Soon each psychiatrist will have to meet the
requirements for revalidation and recertification for specialist
practice. Government and GMC guidance on continuing professional
development (CPD) is still evolving and therefore remains imprecise
for doctors practising outside managed organisations or those with
It is planned that all doctors on
the GMC general register will have to be re-licensed on a 5-yearly
basis. This will be based on the Good Medical Practice guidance
(GMC, 2006) and will include:
- annual appraisal including a
standardised module agreed by the GMC
- independent 360-degree
Any issues concerning the doctor’s
conduct or practice should have been resolved before the appraisal
to the satisfaction of the responsible officer (usually the medical
director) and the regional GMC affiliate.
Only recertified psychiatrists will
be allowed to remain on the specialist registers. All the medical
Royal Colleges are working together to ensure equivalence across
every specialty. The proposals for recertification are likely to
- appraisal, formative and
- multi-source feedback
- evaluation of clinical
These will be measured against
professional standards defined by the Royal College of
To comply with the Data Protection
Act 1998, you must register with the Information Commissioner’s
Office if you hold records containing ‘person-sensitive
information’: date of birth, ethnicity, confidential case notes,
You should check that your
workplace is registered and inspected under the Care Standards Act
2000. It is also recommended that you avoid seeing patients at
their home without good clinical reason, nor in the practitioner’s
home, in isolated facilities or without a chaperone (Royal College
of Psychiatrists, 2007).
For many portfolio doctors it is
advantageous to be self-employed for tax purposes, as more
professional expenses are allowable. It is very important, as well
as a legal requirement, to keep clear financial records, including
copies of incoming and outgoing invoices.
If you are employing staff, one of
the easiest ways to organise your finances is through an accountant
with a payroll department. They can advise on all aspects of pay,
including tax and national insurance liability, contracts,
grievance procedures and employer’s liability insurance.
Before you decide to reduce or
cease full-time paid employment, it is advisable to check your
pension position. The NHS Pensions Agency will be
able to tell you what your entitlement is. Your NHS human resources
department may also be able to help. If you still have questions,
the British Medical Association (BMA) can offer advice, especially
if you have had breaks in service (there is some useful information
on the BMA website. Beyond this, professional
financial advice attuned to the needs of doctors may be
If a proportion of your income comes from a non-NHS source, you
may also want to consider contributing to a private pension scheme.
A good independent financial adviser can provide further details on
this. Paying a small monthly amount is often a relatively painless
way of contributing and you can also supplement this with a lump
sum at the end of the tax year.
Many psychiatrists support the work
of voluntary organisations, such as Age Concern, Young Minds,
Mencap, the Medical Foundation for the Care of Victims of Torture,
the Samaritans, etc. If you are working in a voluntary capacity,
you still need to maintain professional requirements, especially
when seeing patients. This may need clarification with the
organisation concerned and there may be funds available for
training and the necessary CPD. Some organisations pay expenses
The Voluntary Service Overseas (VSO)
offers well-organised opportunities for specialist work abroad.
Frequently asked questions
Q: Which group within
the College can help me?
A: The Postgraduate Educational
Services Department can advise on CPD requirements; there is also a
network of regional CPD advisers. The Private and Independent
Practice Special Interest Group (PIPSIG) helps to promote good
practice and brings together doctors in the same position.
Faculties are also developing standards and are a source of
Q: How can I get an
appraisal or supervision if I am working outside a managed
A: Some NHS trusts provide
appraisals for their recently retired or part-time consultants.
Even if your trust does not operate such a scheme, it may be worth
asking, as some employers will provide appraisal if requested. This
should follow the current NHS template, which is available online
When having an appraisal, you should ensure that you present
evidence, such as audits and patient surveys, for all the
situations you work in.
Some CPD groups for psychiatrists
undertake appraisals and/or supervision (relatively new for
consultants) for each other. More formal arrangements may be
required when the GMC and medical Royal Colleges define acceptable
appraisal standards, which are likely to include accredited
appraisers. The Royal College of Psychiatrists is currently
developing an appraisal system for Members and Fellows working
outside managed care organisations. The Independent Doctors
Forum and the London Consultants
Association also have approved appraisal schemes.
Q: What are the CPD
A: The College system currently
states 50 hours of CPD per year are necessary, of which 30 can (but
do not have to) be ‘internal’. Once a year, Form E, which outlines
objectives and activities, is signed off by the CPD group and sent
to the College. You should keep evidence of courses attended as
audits of CPD records are undertaken by the College.
Q: Do I have to keep up
with CPD requirements if I am retired or work
A: CPD is about helping to promote good practice and it is
therefore essential for all those continuing to work with patients
to maintain CPD requirements. For many portfolio doctors it can be
advantageous to register as self-employed, as tax relief is
available on many professional expenses.
Q: How can I find a CPD group? My previous colleagues
won’t have me.
A: Keep looking, perhaps for others
in the same position as yourself. College conferences and Faculty
meetings are good places for making contact and your regional CPD
coordinator should also be able to help.
Q: What is ‘multi-source
feedback’ and how do I get it?
A: Multi-source feedback
(360-degree appraisal) will soon be compulsory for relicensing and
recertification. Questionnaires are sent to a large number of
colleagues, juniors, other staff and service users to get an
overall view of clinical practice. There are various systems
available, but not all may be suited to all forms of practice. The
GMC is in the process of developing a basic tool which may be
adapted for each specialty.
Q: Do I need to have
medical indemnity cover?
A: The College strongly advises
practitioners to take out adequate insurance or professional
indemnity cover for any part of their practice which is not covered
by an employer’s indemnity scheme, in patients’ interests as well
as their own.
Sources of further help and support
HM Revenue &
Royal College of Psychiatrists
17 Belgrave Square
London SW1X 8PG
Tel: 020 7245 0412
References and further reading
- Department of Health (2007)
Trust, Assurance and Safety: The Regulation of Health
Professionals in the 21st Century. TSO (The Stationery
- Department of Health (2008)
Medical Revalidation – Principles and Next Steps. The Report of
the Chief Medical Officer for England’s Working Group.
Department of Health.
- General Medical Council (2003)
License to practise and revalidation for doctors.
- General Medical Council (2006)
Good medical practice. GMC
- GMC today (2007) Revalidation
(feature article). May, 8–9.
- GMC today (2008) Licences to
practise (feature article). August, 5–6.
- Gunn, J. (2007) CPD and the
portfolio psychiatrist. Advances in Psychiatric Treatment,
- Royal College of Psychiatrists
(2007) Vulnerable Patients, Safe Doctors: Good
Practice in our Clinical Relationships (CR146). Royal
College of Psychiatrists.
Information on the College’s CPD
approval policy and revalidaton can be found on the College
© Royal College of Psychiatrists 2008
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