In the context of our department’s GP workforce research and in light of reports today that GP numbers are showing a sustained drop, Emily Fletcher introduces the ‘GMAP’ project which aims to support the UK’s ambitions to recruit GPs from overseas.
- Across the UK, the number of GPs relative to the size of the population show a sustained drop. GPs are leaving or decreasing their hours in large numbers. Our own survey of GPs indicated that even in South West England, 37% were likely to quit patient care within five years. Some of our work highlights the many reasons for this.
- The Nuffield Trust reports today that the fall in GPs per person reflects “insufficient numbers previously being trained and going on to join the NHS; more practitioners leaving for early retirement; and failure to recruit enough from abroad”.
- On the subject of recruiting from abroad, ‘GMAP’ is a research project commissioned by NHS England and the Royal College of General Practitioners in late 2017 to compare the training and experience of overseas GPs to support the UK’s international recruitment ambitions.
International referencing and mapping of UK GP training curricula (GMAP)
Addressing a knowledge and information gap identified by NHS England, and working in collaboration with the Royal College of General Practitioners (RCGP), the GMAP project aimed to develop and pilot a method for mapping GP training and other relevant healthcare system contextual data from an overseas country to the UK, to inform future consideration of streamlined processes for overseas doctors joining the UK GP register.
Professor John Campbell leads the research team, with expert medical education input from Professor Adrian Freeman, international expertise from Dr Emma Pitchforth, project management and data collection overseen by Emily Fletcher and data collection support by Dr Leon Poltawski and Dr Jeffrey Lambert.
Background Over the last six years, the UK has experienced a worsening GP shortage in relation to recruitment and retention. Amongst a number of responses, the UK government and NHS England have sought to develop opportunities for doctors who are suitably qualified as GPs overseas to be attracted to work in the UK. In this context, for doctors outside of the European Economic Area (EEA), there is a need to ensure that their training and experience is appropriate to support them working in UK primary care.
Between the RCGP and the General Medical Council, the ‘Certificate of Eligibility for GP Registration’ (CEGPR) process examines whether doctors have equivalent experience to UK-trained GPs. However, CEGPR is cumbersome, and NHS England commissioned GMAP to develop a method for determining whether a streamlined process for assessing doctors from certain countries was possible.
Method Developing the method involved a number of stages. Our final approach to comparing training and experience of GPs who have trained outside of the UK involved mapping five specific domains: (i) the healthcare context, (ii) the GP training pathway, (iii) the GP curriculum, (iv) Assessment processes, and (v) ongoing continuing professional development and revalidation.
Pilot We published a paper in the BJGP Open in April which outlines the development of the method and its application to a pilot case study site: Australia. We concluded that implementing this systematic method for mapping GP training between countries may support the UK’s ambitions to recruit more GPs and alleviate current GP workforce pressures.
Application Since developing the method, we have gone on to apply the mapping to more countries (South Africa, Canada, and the United States of America) to further support NHS England’s overseas recruitment programme. We are also currently applying the mapping process to GP training in New Zealand.
Mapping these additional countries will inform further considerations of the CEGPR process by the RCGP and GMC as to whether streamlining can be introduced for GPs/family physicians from these countries wishing to enter UK general practice.
Whilst GMAP is very different to other research undertaken by our department, it has been hugely interesting and challenging to undertake, and with the added bonus of being of immediate use to NHS England, the RCGP and the GMC. Sadly (for me) no field trips have been required (!) but in writing up the findings for each country I have been fortunate to speak to contacts in each setting who have been generous in giving their time to help refine our interpretations.
Overseas recruitment is hardly the wholesale answer to the UK GP workforce crisis. However, it is important to draw the various strings of our GP workforce research together, and overseas recruitment is one of the many approaches to alleviating the pressure.
- Palmer B. Is the number of GPs falling across the UK? Nuffield Trust; 2019. URL: https://www.nuffieldtrust.org.uk/news-item/is-the-number-of-gps-falling-across-the-uk
- Baird B, Charles A, Honeyman M, Maguire D, Das P. Understanding pressures in general practice: King’s Fund; 2016.
- Fletcher E, Abel GA, Anderson R, Richards SH, Salisbury C, Dean SG, et al. Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners. BMJ Open 2017;7:e015853. http://dx.doi.org/10.1136/bmjopen-2017-015853
- Sansom A, Terry R, Fletcher E, Salisbury C, Long L, Richards SH, et al. Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England. BMJ Open 2018;8:e019849. http://dx.doi.org/10.1136/bmjopen-2017-019849
- Spooner S, Fletcher E, Anderson C, Campbell JL. The GP workforce pipeline: increasing the flow and plugging the leaks. British Journal of General Practice 2018;68:245. http://dx.doi.org/10.3399/bjgp18X696125
- Campbell JL, Fletcher E, Abel G, Anderson R, Chilvers R, Dean SG, et al. Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study. 2019;7:14. http://dx.doi.org/10.3310/hsdr07140
- Fletcher E, Sansom A, Pitchforth E, Curnow G, Freeman A, Hawthorne K, et al. Overseas GP recruitment: comparing international GP training with the UK and ensuring that registration standards and patient safety are maintained. BJGP Open 2019; http://dx.doi.org/10.3399/bjgpopen18X101640
- NHS England. International GP Recruitment Programme. NHS England. URL: https://www.england.nhs.uk/gp/gpfv/workforce/building-the-general-practice-workforce/international-gp-recruitment/
- Fletcher E. Moving into the GP workforce? In: University of Exeter Collaboration for Primary Care (APEx). Exeter; 2019. https://blogs.exeter.ac.uk/apex/blog/2018/10/17/moving-into-the-gp-workforce/