Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by jchoules
17 October 2018Moving into the GP workforce?
This post is a year late. Mainly, this is due to the many, louder tasks on my Primary Care research to-do list: delivering our final report on the NIHR ReGROUP GP workforce project, writing and submitting further papers from ReGROUP (see below)Ā completing two rapid-fire projects for RCGP on mapping UK and international GP training, attending conferences of the Society for Academic Primary Care (plug: Exeter hosting next year!) and working up two major NIHR funding bidsā¦ A busy year.
Nevertheless, the UKās GP workforce ācrisisā has by no means gone away, and here’s some new research findings for you.
Last summer, we surveyed our local GP registrars at the end of their specialty training, as they were ready to move into the workforce. With the help of Health Education England, we surveyed 81 trainees in the South West Peninsula region. Forty five responded (55.5%): 40% male, 60% female, mean age 35.7 years, majority white British and obtained their primary medical qualification from the UK/Ireland:
Among the 42 intending to, or who may, move into GP work (initial career breaks aside):
It was a small survey and we conducted it a little last minute. But despite taking a year to write about it, the questions remain important to ask.
So, why did we do this? In part, it was because we saw Health Education England publish a similar small survey on the London trainees last summer, and it was also because we are genuinely interested in this. Current GP trainees are the imminent future of the GP workforce, an agenda that weāve supported with our Exeter research over the last four years.
GPs do a difficult job; they manage a high (rising) and complex workload due to the ageing population and more patients having multimorbidity. Add this to decreased NHS spend on Primary Care and resources for general practice and continually changing care models ā GPs are leaving, or decreasing their working hours, in large numbers. Our own survey of South West GPs indicated that 37% were highly likely to quit patient care within five years, a worryingly high figure that is in line with the most recent national figure of 39% from the GP Worklife Survey, and other similar survey findings reported elsewhere in the UK in recent years.
Efforts are focused on both recruitment and retention, across all stages of the workforce āpipelineā. Immediate retention of our existing GPs remains essential, and is something we have worked hard to support with our NIHR ReGROUP project. Recruitment to, and growth of, GP training places is equally critical. The governmentās target is to recruit 5,000 extra GPs and train over 15,000 GPs by 2020, as well as recruiting 2,000 overseas doctors over the next three years.
It is generally already known what sorts of specialties medical students and graduates want to pursue in their long-term careers: GP is still the most popular first choice, but this is showing a downward trend in recent years compared with other specialties and the percentage of medical graduates preferring GP remains lower than the proportion required to meet workforce needs. We also know about the choices made by Foundation doctors, through the Careers Destination report published by the Foundation Programme.Ā Again, GP specialty training is top of the list and recent growth of training places and record fill rates reported by Health Education England this year after only Round 1 all shows promising progress against government targets.
But why is it important to know what GP registrars plan to do with their careers once they qualify? Surely, they have already been successfully recruited to GP specialty training and have completed the three years of training, spending huge resources gathering the required skills and experience and delivering front-line patient care in general practice?
It matters because we must be alert to the brand new GPs who do not go on to work in a GP job, or who do so on a much reduced basis. And, alarmingly, some of those that qualify are already thinking of permanently leaving GP in the not-distant future. Training a GP all the way from medical school and through specialty training costs just under half a million pounds. If our GP registrars are not moving into the workforce once they qualify, we lose vital and expensive resource.
Something seems to be happening during training. Trainees are being exposed to the issues faced by our current working GPs and that are outlined very clearly in the Wass report. Our (very small and regional) survey adds in a small way to the picture that a percentage of trainees may be lost to the workforce in some way such that growth of training places and recruitment efforts alone will never keep up. Even in the lovely South West where the sun always shines and the surfās always up.
More work is needed to continue to improve the attractiveness of general practice and address its challenges; progress is being made in some areas but only time will really tell.
With thanks to all of the South West Peninsula GP registrars who completed our last-minute online survey last summer!
Emily Fletcher, Research Fellow
References from Primary Care Group