One in eight GP training posts vacant, despite unprecedented third round of recruitmentBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6478 (Published 28 October 2014) Cite this as: BMJ 2014;349:g6478
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Much has been written about unfilled GP training posts - these latest figures further highlight the issue. And of course the impending crisis that will face many practices within the next few years, as GPs retire without Doctors to replace them.
I am currently in my second year of Foundation training, and – despite the gloomy press - intend to pursue a career in general practice. Why? Because I value the doctor-patient relationship, and believe that the future of healthcare provision lies in building on what can be delivered in primary care. Yes, I am in the minority – with most of my peers choosing hospital medicine, either in the UK or abroad. Yet I remember being told at the outset of medical school, that more than half of us would work in general practice. It is clear that the prediction then, doesn’t tally with the reality now.
The reluctance that Foundation trainees are showing in signing up to GP training is of course multi-factorial. Coverage of grumblings of discontent from within the GP ranks, do not help the cause. But neither do those remarks all too frequently heard within the hospital walls, maligning GPs and their apparent poor clinical judgements. And herein lies the rub. Is it the experiential inspiration that is missing? The opportunity to meet GPs who are passionate about their job, and delivering good care that is making a difference to patients’ lives.
With the bulk of our foundation training hospital based, how can an informed decision be made to dismiss general practice? If all foundation trainees had the opportunity to work in the community before submitting specialty applications, perhaps that would go some way to solving the GP recruitment crisis.
Competing interests: No competing interests
The author has highlighted this key problem with the take up of GP training posts earlier in July, and now again after a third round of recruitment. This certainly highlights that there is a major problem with filling of vacancies and the question that needs to be asked is "why is this happening and will it continue?".
Foundation trainees can often have a rough idea of the general field they are drawn towards i.e Medicine, surgery or community. Lifestyle within that field is naturally a large determining factor in how it is viewed.
As a medical student I was convinced I wanted to be a GP, regular patient contact, building rapport, continuity and security in knowing I would not need to be working in the evenings and weekends. Towards the end of my degree in 2013 and 2014 there was a lot of talk of how GP pressures are rising and funding is possibly reducing in proportion to the amount of work needing to be done. There was talk of reaching additional QOF targets with no monetary gain and then talk of ending the QOF targets.
These matters alongside patients having a named GP and potentially working later into the evening or even having 7 day practices has completely changed the way me and many of my peers view general practice.
Although much has not changed, it certainly does seem that in time we are heading towards longer working hours and working weekends in general practice. This then raises the question, "Will working in general practice not have similar hours to hospital practice?".
As GP surgeries increase in size, responsibilities, work load and working hours, there is more incentive to stay in hospital practice for those that were on the fence or not completely convinced they wanted to be a GP. Not because hospital medicine is easier or necessarily better, for some it is simply because there is not as many incentives as there once were in general practice. As time progresses it also becomes clear that general practice is further developing into a business where cost pressures play a significant role in the health care one provides.
I expect more juniors to take up core training programmes and continue to head towards hospital specialities if general practice continues to seem less appealing.
Competing interests: No competing interests
If a quarter of the UK applicants to GP training are rejected, is this surprising? Maybe the problem lies in the medical schools..
Data supplied by Health Education England show that, aggregating first and second application rounds of recruitment into GP training programmes across 2013 and 2014, almost exactly 25% of UK medical graduate applicants are rejected by the HEE selection system.
One quarter of these UK graduates are unsuitable for training towards a career in GP! Amounting roughly to 1,000 per annum, this is more than the number of international graduates who are recruited, and who -- in part because of their poorer performance on MRCGP assessments  -- result in additional failures, training costs and personal misery. Assuming that the selection system which has been subject to considerable research is indeed reliable and valid , this suggests that many graduates of our own medical schools are being inappropriately recruited and prepared for practice in the largest NHS specialty.
This apparent failure of UK undergraduate medical education to articulate with key UK workforce needs is startling. What are the medical schools (and their funding bodies) doing about it?
1 Wakeford R: Annual report (August 2012 - July 2013) on the results of the AKT and CSA assessments. London: Royal College of General Practitioners http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exams-overview/mrcgp-...
2 Patterson F, Lievens F, Kerrin M, Munro N, Irish W. The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies Br J Gen Pract 2013; DOI: 10.3399/bjgp13X674413
Competing interests: I am a semi‐retired university academic, psychologist not medic, who has been involved in medical training and assessment for many years, some spent some years co-directing a GP training programme. I am personally worried that we may soon, for a variety of reasons, run out of GPs.