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At the heart of general practice since 1960

GPs’ sliding morale heralds a new jobs crisis

A perfect storm has swept the economics of general practice out of kilter, sending demand up and supply down.

A perfect storm has swept the economics of general practice out of kilter, sending demand up and supply down. Commissioning has sucked up GP time just as tax and pension changes have seen some cut their hours or take early retirement. It has become painfully difficult to recruit new GPs to practices, and – in some areas – booking a locum is like searching for a glimpse of the Tasmanian wolf.

Britain, in other words, desperately needs more GPs. That is the view of the BMA, the RCGP and the Centre for Workforce Intelligence, a Government advisory body, which recommended recently that 450 extra training places should be created over the next four years. So what is the response to this unprecedented squall of demand?

A total of 3,144 doctors were accepted onto general practice training courses this August, a drop of 7% from last year. When everyone is demanding the UK step up training to prepare for the intense pressures being placed on general practice, we are training up not more GPs, but fewer.

But the most alarming aspect of this worrying trend is its underlying cause.

This is not simply a tale of Government funding cuts. Reductions in funding are certainly a factor, and a Pulse investigation a year ago found deaneries were being hit by cuts in the GP training budget of up to 14%. But Professor Bill Irish, chair of the

GP National Recruitment Office, argues there is a more important, and disturbing, reason for the decline in training places. Doctors simply don't want to be GPs any more.

Professor Irish makes the extraordinary claim that deaneries are having to reduce the number of GP places on offer because they know they would otherwise not be able to fill them with sufficiently high-quality applicants.

Just 6,028 doctors applied for GP training in August, a reduction of 5% over the last year and 11% since August 2009. Fewer than two doctors now compete for each available place, and the implication from Professor Irish is clear – those who don't get in aren't good enough to get in.

The decline in numbers of applicants and training places wasn't part of a Government plan – the Department of Health wanted more GPs to be trained up. But ministers are unquestionably responsible, even so.

The fall in applicants reflects a slow drip of morale from the profession, as successive pay freezes and soaring workload take their toll. GPs themselves sometimes struggle to make the case for why young doctors should consider a career in general practice.

The Government has not lacked for warnings that this was coming, and we have been here before – the nGMS contract was a response to the last recruitment crisis. But there is absolutely no sign that ministers are learning the lesson, as Pulse's revelation last week that the DH is pushing brutal efficiency measures for next year's GP contract deal starkly indicates. Ministers must surely stop, just for a moment, and reflect. Is it really wise to so undermine general practice just as the profession is being handed such sweeping new responsibilities?

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