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GPs buried under trusts' workload dump

Health Education England to consider extra year of GP training

Education bosses have backed further discussion over extending GP training to four years in a new 10-year workforce plan.

The strategy, which sets out the NHS workforce agenda across all specialisms, says that Health Education England will 'further evaluate' the case for one extra year of GP training compared to the current three.

The HEE plan, released today, says: ‘General Practice is currently the shortest specialty training programmes and HEE believes that we should further evaluate, with partners, the case for an extra training year.’

Four-year training has been an RCGP priority for several years and was backed by health secretary Jeremy Hunt until 2014 when realisation of the scale of the workforce crisis saw ministers kick plans into the long grass.

The document also commits to opening 1,000 medical school places in universities that encourage 'more students to choose shortage specialties, such as general practice and psychiatry'.

The Department of Health announced in March that medical schools, which aim to boost GP trainee uptake by exposing students to general practice, could see extra funding.

However, it was later revealed that just a third of the 1,500 new medical school places will be funded next year, while the DH consults on 'how to make available' the remaining 1,000 places 'from 2019/20'.

The HEE workforce strategy clarifies that 500 of the additional places have already been allocated with the new students to start in September 2018.

It adds: 'The remaining 1,000 places are subject to a competitive process to ensure this increase in supply of doctors meets the needs of the NHS.'

RCGP chair Professor Helen Stokes-Lampard said: 'We are encouraged to see the emphasis on general practice, particularly the proposals for enhanced GP specialty training to include a fourth year focused in the general practice setting.

'This is something that the College has long been campaigning for and will undoubtedly make our new GPs of the future more confident as well as competent in managing the complexity that is modern day general practice.'

She added that the call for an extra year of training is 'timely' as workload for GPs 'has risen by 16% over the last seven years, while the GP workforce has remained largely stagnant'.

However, Dr Krishna Kasaraneni, BMA GP committee lead on education, training and workforce, warned that the Government's target of adding 5,000 GPs to the workforce 'is nowhere near being reached'.  

He said: 'The latest figures, as indicated in the consultation report itself, showed a decline in GP numbers in England once again that has reduced the overall headcount to 2012 levels.

'We will be responding to this consultation and urging politicians to redouble their efforts to bring more GPs into the NHS, as well as looking at the proposals on GP training.' 

This comes after official figures released last month revealed a drop in the number of GPs, with 1,000 fewer GPs in the workforce this year compared to last year.

According to the workforce strategy, in a 'do nothing' scenario, which considers recent trends in productivity, the NHS will need 190,000 additional posts by 2027.

However, the plan adds: 'If additional supply were to continue at the rate that we have seen between 2012 and 2017, then an additional 72,000 staff could be expected to join the NHS.'

The strategy is open for consultation until March 2018, after which HEE will draft a final workforce plan to be released in July 2018.

Readers' comments (23)

  • There are just too many GPs around, why not make it 5 years? MRC Geeee! what was that again?

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  • Or why not make it a lifetime ? This is the only way they are going to retain these GPs.

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  • David Banner

    Unscepted is right, the huge glut of GPs at present means we need to slow down GP training to reduce numbers. Practices are drowning under CVs, doctors are desperate to join partnerships, and profits are booming. This is a sensible move to maintain Primary Care in its current healthy state*.

    (*all true on Planet RCGP of course, though I believe conditions on Planet Earth may be slightly different)

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  • Council of Despair

    forget 5 years, why not 40 years as the taxpayer spends (apparantly) millions to train GPs and it's such a priviledge to serve, and GPs have golden pensions, and we can't have professionals expressing their democratic right to leave to work abroad - can we?
    sigh - bitter yes.

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  • Sorry, I am confused. I cannot see how an extra year of training will help the workload crisis.

    Is extended training intended to benefit the trainee with more confidence, the public with safer doctors, the NHS with presumably cheaper trainees than qualified GPs, or large training practices by staffing them with externally funded GP trainees? Because as a "First 5" GP, I struggle to see how extending training will help the workload or increase recruitment.

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  • Training is currently failing, so the RCGP want even more of the same training?
    1. Reduce the period of hospital servitude and spend the time in GP instead.
    2. Stop wasting time with e-portfolio and reflective nonsense, and spend more time seeing patients. You cannot get adequate skills with only a maximum of 3 1/2 days a week seeing in patients.

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  • AlanAlmond

    Making it more difficult to train to become a GP in the UK dove tails perfectly with the wider plan to ensure most of the future GP workforce has been trained in Bulgaria - out of reach of RCGP influence. I guess at least the Australians will be chuffed. I’m baffled as to why an extra year of training will reduce work load...but then I didn’t get that extra year of training, maybe if I had i’d understand?

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  • great tactic executed at wrong moment.

    You do this before applications so people who are thinking about what they want to do go oh better get in before they add a year to the training.

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  • Having qualified in Aug, and having worked since as a locum I thought the whole training process was too long - or perhaps not efficient. The most useful aspect of training was specialty clinics and teaching from specialists (e.g. as ENT where I ran an emergency clinic). Not as a dogsbody on wards. The whole training needs to be rethought, the 'hospital' roles should be placing us in OPD not wards, spend time in MSK practice etc. 2ww clinics, gynae clinics. This would improve knowledge, improve relations with secondary care and actually provide some experience that is applicable to General Practice. I think the GPR year/s if extended should involve rotating practices in different areas, as for me I got used to chronic disease in my GPR year (elderly white working class demographic) but had very little exposure to the young or women's health, something that hinders me a little now.

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  • GP trainees fail to realise that they gain a lot by working on the wards. Its a good move by the health education england.

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  • Hmmm benefits of having double the numbers of registrars versus putting people off being a GP entirely. Who knows!! So exciting! Beats actually making the job bearable and attractive and encouraging principals with 20 years experience to stick around! And let’s open a medical school to produce just GPs and psychiatrists as well-maybe even an online course to save money- we all know they’re not real doctors anyway! Who are these total idiots!

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  • It has been considered endlessly in the past. It has been recommended endlessly in the past. It always gets rejected in the end. It was only a few months ago that HEE were trying to sack all GP Educators - I don't think they have a clue what they are doing.or where they are trying to go.

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  • Probably all on Leadership Courses.

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  • I acstually got paid more as a gp registrar in 2012 than as a salaried gp now, so it might not be a bad thing

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  • I have no idea why people think that the speciality with the most breadth,risk and isolation should have the shortest training programme. Most of us working in Education know that we do not achieve the finished product at the end of 3 years.

    An extra year spent entirely in general practice would consolidate the previous 3 years, increase management and business skills and allow learning the trade without the hoops of exams.

    This extension is even more required with the strict (much needed) enforcement of the 40 hr week within the junior doctor contract.

    I have no idea why GPs think their speciality is not worthy of more extensive training - smacks of the low self worth enveloping the profession

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  • Whenever a change is made which is expected to solve all the professions problems, it will be found wanting. This is not about the workforce crisis ( or it shouldn't be). It is about getting doctors ready to practice independently as GPS. The only way to get that experience is to do the job and see patients. I think that most registrars would benefit from the extra time, though agree with sceptical colleagues that the details of what that year entails needs to be thought through carefully

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  • An extra year has merits, but the exact details need to be clarified. GPSTs need to spend far more time in the clinics of Primary-care relevant specialities and not 'more of the same'.

    As a GP registrar, my most productive learning experiences have been in the emergency ENT/Rheum/Derm clinics or clerking in A&E and paediatrics. I came away with practical learning points that I apply when in the community. Unfortunately, the current GP training set up means opportunities for this were limited. Usually only available from my own personal time or during the 7 non-allocated days we have for study leave annually.

    The whole hospital ward based training needs looking at. I've just spent 4 months working on a specialist non-invasive ventilation (NIV) ward I'm now an expert in performing an ABG and then interpreting it to change NIV settings, but this has very little application towards my future career in GP. I've had limited opportunity to leave my ward when outpatient clinics ran due to the sheer intensity of ward work and staff shortages.

    I feel very exposed in specialities which have not been covered in my training like Dermatology, ENT, Orthopaedics or Urology.

    How about trailing different types of additional training? Maybe an optional 4 month extension to training where you are based in GP, but for 2 days of your week you are in relevant hospital outpatient clinics. We need to get the balance between service provision and training right as with the limited hours of the new contract and the strain in the NHS, we are at a significant risk of producing GPs unprepared for independent practice.

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  • Why don't we instead train NHS managers to do root cause analyses on why GP numbers are falling; and why GPs are so overloaded - particularly through work that should be done by hospitals but instead just gets dumped on GPs; or else the supportive stuff they are supposed to be doing - letters sent out on time, patients not discharged too early -- hasn't been done, yet the hospitals themselves are never sanctioned. A little bit of training for the NHS higher management wouldn't go amiss, methinks.

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  • I guess at least an extra year in training will keep them in the NHS for one more year, before they head off to Australia, Canada and New Zealand?

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  • Too many newly qualified GPs defaulting to locum world which is in many respects is high risk general practice (unknown GP sees unknown patient in least supported environment where your measure is in appointments delivered). Agree we need to make substantive roles more attractive.

    I am with you Shaba

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