Students May be Forced to Become GPs

[box] William Pickworth reports on Health Education England’s plan for boosting GP trainees [/box]

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Medical graduates may have no choice but to apply for GP training in a bid to tackle the current GP recruitment crisis.

This year GP recruitment opened for a third round for the first time ever in a desperate attempt to increase the number of doctors applying. This comes as growing numbers of qualified GPs are choosing to emigrate, retire early or change medical specialty. The Royal College of General Practitioners has estimated that by the year 2020, an additional 8000 GPs will be needed to provide adequate access to primary healthcare. Ed Miliband stated at the Labour conference lately that he can guarantee this number of new GPs under a Labour government. This begs the question: how?

Given the 15% reduction in applications to GP training in the last year, leaving a total of 451 places in the UK unfilled, describing the situation as a crisis would not be an overstatement. In 2012 former health secretary Andrew Lansley set out a plan to ensure 50% of all trainees become GPs. In reality this figure is well below the national target, around 40%.

David Cameron has promised to provide access to GPs 12 hours a day, 7 days a week by the year 2020. This all sounds great on paper, but how does he expect this to actually work? The number of GPs retiring before the age of 60 is at record levels – the average age currently stands at 59. With a significant number of female GPs retiring in their 30’s, it seems this crisis is one of retention as well as recruitment.

The RCGP presented their manifesto prior to the political party conferences this year. It requests a “promise to maintain and preserve ‘free at the point of need’ healthcare. This, funnily enough, was not directly addressed at said conferences. The murky topic of ‘NHS privatisation’ may be coming to the forefront in the near future.

While the idea of incentivising graduates to apply has been put forward, this seems difficult to believe when the extent of government funding cuts threatens the overall stability of the NHS. It has been suggested that doctors could undergo ‘dual training’, which could lead to the evolution of GPs with specific skill sets required to meet the demands of an ever-ageing population.

The real solution to the dwindling number of GPs in this country may not be taken so kindly by the new generation of trainee doctors. An advisory group formed by Heath Education England is considering the option of limiting the number of non-GP training posts. This effectively would leave many newly qualified doctors no option but to apply for GP training.

The Chair of the General Practitioners Committee, Dr Chaand Nagpaul has said “general practise is not seen as an attractive career option. Successive years of disinvestment has resulted in a workforce that is overstretched, lacking in morale… it does not paint an attractive picture.”

But why is the allure of general practice fading? A recent, inadvertently comical article in the Daily Mail casually placed all the blame on “moaning GPs”. It comes as no surprise that the reasons for which GPs may be so disheartened were (accidentally?) overlooked. This is just one of countless examples of the media’s negative portrayal of doctors, in particular GPs. An anti-GP campaign has been gathering strength over the last decade, with a recent analysis exposing the gross imbalance of news reports covering doctors attending fitness to practise hearings or being struck off.

A local GP was willing to offer his opinion on the matter. “GPs are under a lot of pressure, both from governing bodies and patients who have high expectations” he said. “With a significant reduction in funding and increase in workload, any GP in reach of retirement would be better off doing just that: reduce hours and increase remuneration. When medical students attend my practise for their GP placement, they see the whole practice struggling to meet demands. It comes as no surprise to me that the appeal of becoming a GP is diminishing.”

To add insult to significant injury, those who are quick to react with promise of an overgenerous pension would do well to examine the changes being implemented to NHS pension as of 2015. Not only will NHS staff pay more in to the scheme and receive less than is currently the case, the age at which full pension is awarded to doctors is to be hiked up to 67.

With this pretty picture in mind, medical students: form an orderly queue. GP training is the (only) one for you.

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