Solving the GP workforce’s problems

The GP Taskforce report on the scale of the workforce crisis in general practice raised two important questions.1 One was how a profession facing deep problems can be made more attractive as a career option to young people to boost numbers of general practitioners (GPs) in the future. The other was what can be done to prevent experienced GPs leaving when services are buckling under the weight of patient demand and unprecedented workloads.

The taskforce recommended enticing new recruits via a “professionally-led marketing strategy” aimed at a wide range of audiences to present an “accurate and positive image” of general practice. “We need concerted initiatives to promote general practice as a positive career choice, from school into medical school and then foundation programme training,” its chair, Simon Plint, says.

Tim Ballard, vice chairman of the Royal College of General Practitioners, believes a campaign is necessary but that it would be something of a “double-edged sword” in the context of a profession “on its knees.” He told BMJ Careers, “It has the potential to make people think, ‘If things are as bad as that then it’s not for me.’”

Ballard welcomes the idea of marketing aimed at undergraduates and foundation year levels, though he says he wasn’t aware that there was evidence showing an approach targeting school sixth formers would work. A compelling and “exciting” case for general practice could be put to people starting out in medicine and effectively turn the “current challenge that we face on its head,” he says. “The attractive side is the long-term relationship we have with patients and families, delivering holistic and whole person care.”

Ballard says “nobody is better placed than general practice” to deal with multimorbidity and the ageing population. “Nowhere do you see a greater need for really high level complex clinical thinking and delivery than you do with the balancing of the needs of individuals who have multiple long-term conditions and putting that together with their own personal fears, aspirations and family context,” he says. “There’s no recipe book for that—you can’t find it in a guideline—and that’s what the really exciting part of general practice is about.”

In his report Plint highlighted how the model of primary care would have to change to meet the needs of patients in the 21st century. This would mean practices federating to look after much larger populations and increasing multiprofessional training capacity as the distinction between primary and secondary care became more blurred with the development of integrated care.

Ballard says it is essential to ensure that what is being marketed is not a “false offer” and that the system must be fully geared up to support those entering it in providing high quality care. “The primary objective now is to get more resources into general practice, in lots of different ways to wrap around services and make the delivery of everyday general practice more sustainable,” he says. “A campaign has to be signed up to increasing the resources otherwise people will see through it.”

The taskforce recommended that further research should be undertaken with the Medical Schools Council into the factors that influence students’ career choices. It said that the profile of general practice should be raised as an academic discipline by promoting integrated clinical academic training programmes in general practice during foundation and specialty training.

The taskforce also identified major problems in retaining doctors in the primary care workforce and said that more research should be done to identify why people leave the profession early. It urged the reintroduction of the flexible careers scheme, which provided a salary contribution and professional support for doctors working less than full time.

The Royal College of General Practitioners and the British Medical Association both told the taskforce that resolving difficulties and barriers for doctors returning to practice was an urgent priority. Concerns have been raised that doctors who have been away from UK clinical practice for a time have found processes for assessing their competence and eligibility for readmission too restrictive. The college has called for a “proportionate” process to ensure a safe return to practice.

Ballard says, “People have been frozen out of the profession who could well be working back in the NHS with an appropriate level of checks and balances to make sure they’re fit for practise.”

The taskforce found that although some grants were available, many returners had agreed to retrain without any salary. There had been no hypothecated funding for refresher training since the NHS returner scheme, funded by the Department of Health, ended in 2006.

Ballard says many young doctors wishing to return to the UK from countries like New Zealand, Australia, and Canada, whose societies and systems of clinical medicine are broadly similar, were “treated the same as someone who is high risk” and thus had “massive hurdles to climb.” He says: “My understanding is they have to come back to the UK to have their interview, they can’t do it online or by Skype.”

The GP retainer scheme was specifically designed to retain doctors in the workforce, typically women with young families. However, this also lost hypothecated funding and numbers of retained doctors have fallen “dramatically,” from 1110 in 2002 to 321 in 2012, according to the taskforce.

Ballard says, “If you look at the price it costs to train a doctor from scratch and put them right the way through vocational training, it’s dramatically smaller to take someone who is a returner and give them supported re-entry into general practice. I think it’s folly to think you can save money by shutting down those routes. We should treat returners the same way as we aspire to treat our patients, which is to produce a contextualised, bespoke package for individuals.”

The taskforce said a powerful case could be made on the basis of cost effectiveness for both the returner and retainer programmes. The time has come to redesign and repackage the schemes across England, it argued.

Schemes should be centrally funded and priority should be given to GPs wishing to train and work in “underdoctored” areas, the taskforce said. It recommended NHS England should seek consensus on the threshold for assessing a doctor’s eligibility for reinclusion on a performer’s list and explore whether there could be flexibility in the managed return to practice.