Medicopolitical Digest

Report highlights recruitment crisis in general practice

BMJ 1996; 312 doi: (Published 24 February 1996) Cite this as: BMJ 1996;312:514
  1. Linda Beecham

    There is a serious recruitment problem in general practice now and this will deteriorate unless specific measures are taken. This is the conclusion of a report on medical workforce from a General Medical Services Committee's task force. The GMSC congratulated the task force's chairman, Dr Michael Wilson, on what many speakers said was an excellent report although it painted a gloomy picture. The committee endorsed the report and the suggestion that the GMSC should cooperate with the Royal College of General Practitioners in getting the recommendations implemented.

    The health departments and the review body have said repeatedly that there was no recruitment problem in general practice. The health departments reiterated this belief in the 1996 report of the Review Body on Doctors' and Dentists' Remuneration—“the number of trainees still exceeded the number of joiners required to sustain growth”—and disregarded the profession's evidence (p 465).

    The report points to the failure to understand the additional demands placed on general practitioners by the 1990 contractual changes, the NHS reforms, and the shift of care into the community. There had been a failure to expand the intake into medical schools, to forecast the surge in consultant expansion, or to anticipate the progressive trend to earlier retirement.


    The tables in the report highlight the changes that have taken place in general practice. The changes to the immigration rules in 1985 had made it more difficult for overseas doctors (other than those from the European Union) to work in Britain; there had been a fall in the number of doctors under 35; more doctors were seeking a less than full time commitment from the start of their careers; there had been a 26.1% increase in career grade staff in the hospital service between 1988 and 1994 compared with an increase in general practitioner principals of 4.9%; an increasing proportion of women were seeking a career in general practice and there had been a 15% fall in the number of general practice registrars between 1988 and 1994.

    Medical workforce makes 10 recommendations:

    • The transfer of additional activities to general practice must cease until identifiable resources are available

    • Medical school intake should be reviewed urgently

    • Expansion of the consultant grade must not be at the expense of recruitment to general practice

    • The review body must recognise that a primary care led NHS cannot exist without an adequate supply of properly rewarded general practitioners

    • Young doctors must be encouraged to enter general practice

    • Doctors who have completed vocational training and are not working in general practice must be encouraged to return by revising the retainer scheme and introducing retraining programmes

    • Flexible working arrangements must be established

    • Additional resources must be provided for staff, premises, and technological help to enable general practitioners to maintain their services to patients

    • Additional incentives will be required in areas with acute recruitment problems

    • Studies must be funded to identify recruitment trends, participation rates, retirement patterns, and the “missing” doctors.

    Flexible working arrangements must be established.

    View Abstract

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