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GPs buried under trusts' workload dump

Almost 40% of GP training places unfilled in some areas of UK

Exclusive The proportion of GP training places filled in certain parts of the UK as fallen as low as 62% in some areas, calling into serious doubt the Government’s plans to meet targets to increase the GP workforce.

The figures for the August 2014 intake - described by the GPC as ‘the worst ever’ - reveal that 2,564 of positions have been filled in England, representing 87% of those available, which is a decrease on the 2,764 positions filled in August 2013.

This could cause major problems for the Government in achieving its target of training 3,250 new GPs a year by 2016, which itself was put back a year from the original planned implementation of 2015.

However, GP leaders said the biggest concern was the vast differences between regions, with the popular regions filling all places, but areas where workforce recruitment problems are at their most acute, such as the East Midlands, the Northern region and Merseyside, have fill rates of 62%, 71% and 72% respectively.

The East Midlands local education and training board (LETB) has even been forced into offering a ‘pre-GP training year’ within secondary care, which has been introduced because the shortfall of GP training posts has left gaps in service provision, the GPC has said.

This comes amid a workforce crisis that has seen practices being forced into offering ‘golden hellos’ to recruit partners, and a high percentage of shifts going unfilled.

Pulse revealed earlier this year that the number of graduates applying for training positions decreased by 15% from last year.

Dr Richard Vautrey, deputy chair of the GPC, said: ‘These figures are deeply concerning and represent a serious threat to the delivery of effective GP services to patients. They show that we are experiencing serious shortfalls in the number of doctors choosing to train to become GPs, which will ultimately mean fewer GPs entering the workforce across large parts of the UK, most worryingly in already under doctored areas such as the North and the Midlands.’

He added that this could lead to a gap in service between the south and north of England.

He said: ‘This worrying shortage of GPs will only exacerbate this crisis and could leave us in a situation where there are simply not enough GPs to cope with the number of patients coming through the door. The imbalance in filled posts between the north and south of England could also mean that we are seeing the opening up of a division in the standard of care patients get in different parts of the country.’

Dr Krishna Kasaraneni, chair of the GPC GP trainees subcommittee, said: ‘There are the worst figures we have ever seen in GP recruitment since everything was standardised in 2007. What is worrying is that despite us flagging the issue on a regular basis, not enough has been done to encourage young doctors to go into GP training.’

The East Midlands LETB has advertised a ‘Pre-GP Project’, a one year role which involves filling in shifts in hospital rotas for candidates who failed to achieve the required standard for GP training spots in the assessment round.

But Dr Kasaraneni criticised the plans. He said: ‘This is not like any other GP training we have seen. This is nothing but a rota filling gap, that has nothing to do with GP training.’

A Health Education England spokesperson said: ‘The number of GP training posts has been increased in 2014 to support our Mandate requirement. We are doing further work to improve the number of applications and fill rate to support that Mandate target to provide a total of 3,250 GP training places. This work includes a review of the GP recruitment process, development of a pre-GP year for prospective applicants and careers advice for foundation doctors and medical students.’

In the devolved nations, Scotland has filled 89% of posts, Wales 90% and Northern Ireland has filled 64 of its 65 training posts.

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  • training trainer practice  PPL

Readers' comments (65)

  • No surprises here than

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  • only a damn fool would be a GP in current situation, high demand & stress coupled with effective salary of £30 per hour (AFTER TAX AND EXPENSES) deduction, they would be better off as plumber or electrician or stay in hospital, if you need to know how £30 per hour I have calculated, let me know

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  • Well no coalface GP should be surprised by this. Although personally I'm quite happy for the NHS to fail (so we can build something more sustainable) the government may well have to take notice of this IF they want primary care to continue.

    IF they want it to fail, however, the plan is working.

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  • I am actually Glad, Everyday GP bashing in daily mail have done the trick
    Recruitment crisis + Retirement time bomb is perfect solution for failing NHS

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  • HUNT (whom I despise) seems to think that thuggery can solve the "GP problem". Well, this demonstrates "market forces" which are outside his control.
    He can intimidate and threaten GPs with his friends in THE DAILY MAIL but this will be the consequence.
    Hunt and the media have let down the general public and the finger should be pointed at them for this crisis.

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  • Shortfall in GP Training Recruitment (No new GP's)
    Newly Qualified GP's emigrating to land of mils and Honey (Oz, Canada etc)
    GP's in 50's retiring early
    Whatelse could go wrong

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  • The only issue is the political parties gave up of those areas some years ago. They don't care what happens is large parts of those areas affected.

    People in those areas are probably not the complaining type and hence this will have little effect on the NHS ending issue

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  • Enter general practice at your own peril.

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  • Why should anyone become a GP? it is a disastrous profession

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  • No one cares, unfortunately.

    I'll be the headline of the Mail will be about J-Lo's dance on the World cup instead.

    GP is sinking and the general public dont know and even less care. I for one will be happy when it dies - people just dont realise what they had until its gone.

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  • Without any exaggeration my work is load making me so depressed to the point that I am actually suicidal.
    I am resigning from the partnership. Sorry I can't do it any more.

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  • anon at 12.11
    I am glad you are thinking of taking some positive steps to improve how you are feeling, Nothing is worth feeling as low as that for. You, your family and your life are more important than your work. I hope you start to feel better soon and know that there is support out there for you, if you need it.

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  • Same here I also became suicidal and am also going to leave my partnership after 20 years - so sad

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  • I wish the policy makers and sections of the press can read the comments here. It is very sad to read how some of the GPs are feeling (more accurately, 'made to feel') and no wonder this is reflecting on the recruitment into the profession. We are very close to breaking point and the message needs to be conveyed to Westminster.

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  • For a while there SS Primary Care was wallowing in the swell with dead engines . Now it's taking on water and going down by the bows . It's time to man the life boats and row to dry land . Australia looks inviting .

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  • Only 40% unfilled. My county has filled only 13 out of 30 places, thats 57% unfilled and makes a more dramatic headline

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  • I'm going to NZ

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  • We now need to be paid for activity and capitation. Age group stratification as well but only complex elderly as some of these do not need to attend often but need a proper sort out. Kids need more service this would be balanced on activity. I am not sure deprivation helps as most of my repat offenders are well off upper middle class worried well, activity payments again would offset this.

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  • Not surprised to see this. Almost all my F2s in the last couple of years have decided GP is not for them when they see what it's like.

    GP bashing in the Daily (Hate) Mail, complaints against us increasing, and a govt that expects more and more out of already exhausted, highly stressed GPs working stupid hours.

    I hope it gets worse. Only then will they listen and value us. I'm also looking for ways out. This is such a dangerous job now these days, and none of these bu@@ers will support you if anything goes wrong.

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  • Only a wicked person will encourage any young doctor to go into General Practice. Not under the prevailing climate.

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  • What about all the specialist trainees who get "juiced" out of the ST bottleneck? They'll come our way most likely. We need a model where GP's can enter sub-specialist training to vary our weeks/develop skills and make some extra dough. Pure GP day in,week in,month in,year in and decade in coupled with current climate can lead to the sad stories we have read further up this column.

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  • Question:Are the posters' negative comments on Pulse a true reflection of views of GPs out there?

    I don't think so.Those who are satisfied are less likely to post.I suspect it's the same small bunch of people who always come to this site to moan and groan giving a skewed representation.I meet loads of GPs who encourage their children to go into medicine including General Practice.Now why would they do that if the situation was that dire?Perhaps that's the reason why the public turns a blind eye to the naysayers.Dr Ivan Benett from Manchester illustrates this well when he writes in his recent response to the BMJ:

    "Comments in the GP magazines are full of people moaning about how hard their lives are these days, although personally I can't remember when it was better"

    http://www.bmj.com/%5Bfield_highwire_a_cpath-raw%5D-14?tab=responses

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  • Anonymous | GP Partner | 13 June 2014 6:20pm

    Dr Ivan Bennett is on the CCG in Manchester. How your logic can relate his views to represent the coal face GP is laughable.

    I'm also worried that people like you and him simply do not see the gathering storm that is primary care. If being a GP is so great, then why are so few of our doctors entering training? The statistics do not add up.

    I dont know what kind of circles you travel in, but it doesnt represent the GP partners I see everyday, a good portion of them about to burn out.

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  • Question: to 6.20pm

    Was it the contented majority who all voted for Dr Una Coales then?

    Although I am interested to hear why you are still so contented with your lot?

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  • Dear Anon 6.20 I hope you are right and that most Gp's are happy with their lot. If you're wrong then the situation will deteriorate rapidly and we will see increasing numbers of practice failures. All will be clear in 12- 15 months . Fingers crossed .

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  • So it's clear. The vacancy rate is everyone else's fault. Nothing to do with practices/GPs and what they offer

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  • What a ridiculous notion that a pre-GP year will do anything but fill secondary care rota gaps. As a GP Registrar many of the hospital posts my colleagues and I undertook were for blatant service provision with no primary care relevance which was made worse by 6 month posts in place of the previous 4 month placements.

    Furthermore the very inflexible rotations and deanery did not allow swaps so often we repeated posts that we had already done in FY1 & FY2. In my
    own personal training scheme I did 6 months acute medicine followed by 6 months respiratory medicine instead of valuable Paeds/ENT/dermatology etc.

    It seems GP's are abused from the beginning of their training career and now facing bleak prospects on completion of training. Even consultants and staff did not bother to teach with the same enthusiasm once you were known as 'the GP trainee'. Now we wonder why we are in the position we are in.
    We need to sort this mess out starting from GP training schemes and not make our GP trainees feel like rota filler fodder!!

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  • It is not Westminister we need to complain to. Are we that bad a profession that doctors working in it are so suicidal. What is the GPC
    doing? Do we not need a stronger Union? These guys are hopeless.

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  • It's not just hospital where GPSTs are used as 'rota fodder', you'll find in a few practices that GP registrars are assigned to look after the care/nursing homes (usually the sole doctor); apparently part of a 'learning experience' (read as partner's work avoidance). It's a Shame really as the lack of interest of senior partners denies the most vulnerable patients the opportunity to be cared for by the most experienced clinicians, a scandal quite frankly.

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  • I have now passed AKT and CSA and am applying for GP jobs. I need my prospective employer to sponsor my tier 2 visa (my deanery had sponsored my tier 2 visa for the last three yearsof GP training). I find lots of jobs advertised but GP Practices seem to be unaware of people like me who need visas to remain in the UK and work as GPs. Although there is a GP shortage, my options seem to be quite limited!

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  • Anon GP Reg 9:03pm: yes I agree the whole training schemes need an upheaval with GP's taking responsibility of trainees getting appropriate experiences across the board.

    While most training practices do a good job with the primary care bit there are those that exploit the registrar too. In my experience even the quality of trainers needs addressing. There are some trainers that seem to be purely in it for the money and benefits with no interest in actually training or teaching at all. What a shame.

    If you want to make general practice attractive to trainees you need to listen to our views!!

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  • Anonymous 8:22

    GP surgeries have not folded in the past. Should many start closing in the future then the fault will not be that of the GPs.

    My surgery has existed since the 1940s with a long succession of GPs often staying 30 years before they retire.

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  • Anonymous at 9:36... I'm in complete agreement. I think us GP registrars need to take a stronger stance against this exploitation. As I'm nearing the end of my GPST3 year my biggest regret is not being rebellious enough and trying to change things!

    I think any F2 would be a fool to apply for GP training.

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  • @GP registrar | 14 June 2014 8:31am

    Why enter GP training with this attitude?Who's forcing you to carry on?Why don't you just quit and return to hospital medicine?

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  • @ GP partner - funnily enough because I like general practice but dislike the training scheme

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  • Sad but understandable that so many feel down. It is a combination of factors not least, initiative fatigue ,reducing status, pay, and pension, increasing regulation, and litigation risk. What seemed a vocation when I became a doctor now seems an increasingly arduous job. The same is true for many other professions. At least we are relatively well paid and are privileged to have a worthwhile, fascinating job and generally very appreciative patients. It is disappointing that the media and government are less appreciative - the latter as our de facto bosses should be more encouraging. In my 36 years as a doctor I can think of one Labour health minister who thanked doctors and health professionals for their hard work and Tony Blair supported our pay rise with the new contract. Not great management is it?

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  • @ 8:31 GP Registrar- am with you all the way! Ignore 11:11am.
    Am 50 and have been in General Practice a long time- i had felt in my GP training years i was used to fill service provision gaps and worked awful hours at the detriment of my family. The most continual stressful thing about my life has been my job. Despite that i have met some amazing patients that have showed me the value and dignity of life that i aspire to. Don't let people like 11.11am make you feel that your views are invalid. Go with you gut feeling and vote with your feet if you don't agree. Look after yourself first as this will enable to look after those around you who need you.

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  • May be time to get the 200 ejected trainees back into training and giving them opportunity to become a GP.

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  • @ 12:18 - don't think that's a good idea - the CSA is a reasonably fair exam (the commonest reason why trainees are ejected is CSA failure), and anything that is seen tolower the standards of general practice would be ammunination for the daily mail...reform is needed in the training schemes, more emphasise on preparing trainees to develop their communication skills to pass CSA rather than mere service provision

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  • Nothing about this in the news..it's not happening and of no interest in the eyes of those who write our papers

    I hope the likes of the writers and staff at the Daily Mail feel the FULL BRUNT of what's coming at their local GP practice. No Drs no appointments ..tough shit - congratulations ... You reap what you sow

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  • @2:00
    no the cSA is not fair. there are not two examiners for each station. the feedback is poor and there is a persistent refusal to allow the stations' recordings to be seen by candidates. Why is that? How on earth an anyone deem that to be fair for the candidate - how can you properly appeal without video evidence?

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  • The CSA is a poor excuse for an exam.

    I think focusing on the pass rates was always a mistake. The reason it fails as an exam is that it is not relevant to medical practice. Its a subjective test based on linguistic theory. It is devoid of clinical content and only tests communications skills as applied to a very narrow part of the population.

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  • Oh dear, number of registrars who thinks they are being exploited is astounding.

    Whilst there is no doubt there may be small number of practices/trainers who abuse their trainee, many mistake genuine change in general practice work load (which should be reflected in the training, after all this is what you are training for!) and exploitations. I advice the registrars to compare themselves with their secondary care counterparts. I've been qualified as GP for 5 years and enjoyed nights/weekends/bank holidays off (ok, I do often do paper work but that's my choice). My med school friend who i a senior registrar now is about to become a consultant - still doing unsociable hours. I don't hear him crying foul for being exploited.......

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  • Yes well if training practices continue to exploit gp registrars then what does one expect....Trainees should do all the home visits because 'its a great learning experience', here have loads of blood tests to do in your lunch time because 'its a great learning experience' , we will fill all your appointments before anyone else and give you the most complicated patients because your a trainee and there to be exploited

    Well am glad f2s have seen sense, trainees are trainees not free labour for practices to exploit

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  • As a GP Reg I have no intention of anything other than locum gp work at present. Should general practice continue to deteriorate I will return to hospital medicine alreay holding one cct, with a very useful generalist skill set lacked by my hospital colleagues.

    I'm in this for the long haul and I'm not going to be messed around.

    You will find many of my colleagues feel the same, or plan to take their training and leave the uk. So although the places in some areas may be filled, be very wary when assuming this will translate into future uk gps.

    We will vote with our feet. We are not stupid and will not join a sinking ship just because it's assumed we would...

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  • "We will vote with our feet. We are not stupid and will not join a sinking ship just because it's assumed we would... "

    The irony is that, if there were more like you, we wouldn't be in this mess to begin with. Good luck - and look after yourself and your family first and foremost.

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  • This is very depressing. From an OOH point of view, we already have problems with rising defence fees, changes in the make up of the workforce and driving down of costs from CCGs I am not usually so pessimistic as I have tended to scoff at previous 'the end is nigh statements' but I think we will look back on the last year as the beginning of the end of GP led primary care.
    The consequences are immense. I have just got back from a conference of European OOHs organisations and the Danes were telling me that in Copenhagen (as opposed to the rest of the country) they have bypassed GPs in OOHs and have nurse triage with hospital care. No surprise ... rising costs, more admission, overinvestigations and reduced patient satisfaction and a government desperate to back track. Will our leaders ever learn?

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  • "Will our leaders ever learn?"

    They will learn when the same thing happens here.

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  • stop complaining about a crisis - there isn't one !

    the government has done a great job of reducing GDP spend on healthcare whilst increasing the use of the service - more for less ! we should be proud to be part of that achievement.

    if there is such a crisis then explain how the many FME drs that I have met who want to be GPs are being turned away or failed on CSA? or candidates who apply for a post are 'not-suitable'. I think GP Partners are talking up a crisis and are just out for more money. If there was a crisis why are we not seeing practices going under or dissapearing. Why are GP numbers not falling? where are theses thousands of GPs who are retiring?

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  • "stop complaining about a crisis - there isn't one ! "

    Tell that to 1500 patients who were removed from a list recently reported in this newspaper. As Dr Baker says: “General practice as we know it is now under severe threat of extinction."

    If there was a crisis why are we not seeing practices going under or disappearing?

    They are about to in London - try googling MPEG...

    Why are GP numbers not falling?

    They are: "The proportion of family doctors serving every 100,000 people has also dropped, from 70 in 2009/10 to 66.5 now" Dr Chand commenting in GPonline

    Combine the above with an ageing patient demographic, falling funding to primary care and a looming GP retirement bulge and I think we might just have a problem. Now where did I leave those rose tinted spectacles...

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