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A faulty production line

Education bosses launch landmark review into GP attitude in medical schools

Education bosses will launch a review on attitudes and exposure to general practice in medical schools as a first step to developing a strategy for improving undergraduates’ experience of the profession.

In a presentation of its business plan for 2016/17, Health Education England has said it was launching a review after GP leaders condemned the ‘toxic’ anti-GP culture that persists in some UK medical schools, and has seen undergraduates told if they ‘fail they risk becoming GPs.’

HEE’s action plan said it aims to ‘review the profile of the GP career in medical schools, publish a report and recommendations and develop a strategy for implementation’ as a key deliverable. 

The GPC told Pulse that they were represented on the review group and had recently run a symposium with stakeholders in GP undergraduate training to identify what problems persist.

The ‘task and finish group’ has been commissioned by HEE and the Medical Schools Council, which last year said it was working with the RCGP to promote general practice, and that its members had made a ‘commitment’ to articulate the importance of general practice to students.

That committment followed comments by RCGP chair Dr Maureen Baker, who said there was a ‘toxic anti-GP culture’ in universities, which has to be addressed before the gaps in GP postgraduate training can be fixed. 

But this was undermined when Sir John Oldham, chair of the Independent Commission on Whole-Person Care and a GP in Glossop, reported that a medical school dean had told an intake of students that ‘We work you hard because we don’t want you to fail and become GPs’.

And last November NHS England director of primary care commissioning Dr David Geddes said that general practice ‘prejudice’ needed to be ‘stamped out’ at all levels of training, ‘because we need far more GPs than we need more consultants’.

A HEE spokesperson said: ’Health Education England invited Professor Val Wass to chair a working group which is co-sponsored between HEE and Medical Schools Council. This group will report in the summer. It has extensive involvement of medical students, trainees, GP bodies and medical schools.’

Dr Krishna Kasaraneni, chair of the GPC’s education, workforce and training subcommittee, told Pulse: ‘This is about trying to look at the culture in medical schools themselves, and how can we improve the quality of general practice training and education at undergraduate level. So hopefully, with positive experiences in general practice, medical students will choose general practice again.

‘This isn’t a shotgun solution because culture change is much more difficult to achieve. At least if we get the ball rolling, then 10-20 years down the road there will be many more students in general practice.’

Dr Baker said: ’We have been calling for any anti-GP rhetoric that might exist in UK medical school to be tackled for some time, so we welcome this review by Health Education England, and look forward to working with them to shape its outcome.’

Pulse revealed last week that the Department of Health was looking to reform funding for training placements in general practice at all stages of medical education.

But the negative publciity from the Government’s ongoing dispute with junior doctors has taken a toll with applications to medical schools dropping 13.5% in two years, even before Jeremy Hunt announced he would impose a new contract requiring routine weekend working. 

How to solve a problem like GP recruitment?

Professor Bill Irish - online

Professor Bill Irish - online

Research shows that undergraduates are now spending 14% less learning time in general practice than in 2004.

 Then-chair of the GP National Recruitment Office, Professor Bill Irish, pointed the finger at long-established medical schools in Oxford, Cambridge and London failing to train the best candidates for GP specialist training.

A GP Taskforce report, which HEE had been accused of burying, suggested medical schools should be incentivised for boosting recruitment.

But despite this recognition, applications for GP specialty training have fallen 5% in this year’s first recruitment round, following 11% of training places were again left vacant last year.

Readers' comments (30)

  • Yes it is all about spin and presentation. Nothing to do with the facts about the job.
    Medical students are stupid gullible fools with no independent thought who can't work out which specialties they should enter and mistake banter for real life. They actually think orthopaedic doctors are carpenters and that GPs are weak willed morons that somehow hoodwinked the entry process into medical school.

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  • Medical students can judge for themselves whether to join a profession trying to survive in a sewer. And sixth formers are choosing not to even train as a doctor!

    Until NHSE makes all NHS jobs less stressful and, believe it or not, create some enjoyment in the job recruitment will only get worse.

    Perhaps NHSE and trusts will throw open the door to doctors and nurses from Russia and Cuba......

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  • Azeem Majeed

    Medical schools could do more to promote general practice as a career for their graduates, but the current recruitment and workforce problems in NHS general practice in the UK are not caused by the actions of medical schools. These problems are relatively recent: 5-10 years ago, there was little difficulty in recruiting GPs. Newly qualified doctors are not applying for general practice training schemes and established GPs are retiring early because GPs’ working conditions have deteriorated substantially in recent years. The volume and complexity of their work has increased, and many general practices have seen large reductions in their practice budgets. The Department of Health and NHS England (and their equivalents in the devolved nations) are responsible for this, not medical schools. Medical schools do have a role in promoting careers in general practice, but the current problems in UK primary care can be rectified only when workload and funding issues in primary care have been addressed and the job of a GP is seen as more attractive to medical graduates.

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  • Medical students can figure out for themselves what they want to do. There has been a "toxic anti-GP culture "for years in many med schools but GP recruitment varies depending on the terms and conditions of the job. Often a pompous consultant who is anti-GP actually helps our recruitment. Focus on sorting out the job and trainees will come.

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  • Pay them and they will come.

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  • it's not even about the money anymore.

    this job is about as enjoyable as pulling my own toenails out with pliers.

    this job is depressing.

    it's harmful to the physical and mental health of those that do it.

    if they want to ban rugby in schools - they should definitely ban medical students coming anywhere near general practice for their own safety.

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  • I wouldnt advise anyone to do medicince as a degree at the moment.The way we are all being treated,tuition fees,juniors/ senior contract etc etc.the only reason at the moment to do medicine is to use it as a gate way to an alternative or to leave the country to emigrate.There is no bearable alternative in the UK at the moment.Its not able the medical schools its about the t&cs of the jobs you will now be lumbered with till you drop down dead because the pensions and not worth the cost.

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  • It is like ordering a review on junior doctor morale the day that juniors were shafted by the new contract being imposed!

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  • It is not a toxic anti GP culture. Not at all. Just the truth.
    A 50% reduction in pay per item in 10 years. Penance and neglect and imposed Contracts not my words, but Mr Hunt].
    The daily papers. Even the ex head of GP land, Prof Fields is ashamed of GPs, never mind Thomas or Grant etc.
    That is why almost every GP who can leave, is leaving.
    Not toxic at all. It is true, if you fail everything else you will land up in this Ss.. Hole.
    And you cannot wait to get out, seeing 45 patients a day, working 12-14 hours, going bankrupt and needing bailed out.
    Not toxic at all.
    In this age of candour, you cannot describe how bad it is in some places.
    No rest or sleep..
    Oh no, not toxic enough, because there are still plenty joining. Dear God!!!

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  • Not toxic enough. In fact, there should be a skull and crossbones over GP training, a clear warning.
    If you dont believe me, they have cut funding in GP land from almost 12 to almost 7% in 10 years.
    What does that tell you.
    In any case, just read Copperfield's article in this issue. It will tell you how toxic it actually is.
    Besides, young students, why oh why are all the GPs leaving this wonderful ship?
    Could it be holed beyond repair? Or do you want to find out?

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  • I enjoyed being a GP for a fair part of my 32 years in the job. Only a stupid or deluded medical student would go into primary care at the moment. No amount of spin (or outright fibbing) will improve the underlying situation. It is an ex-job, it has expired, it is no more.

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  • Anti-GP sentiment is nothing to anti-psychiatry sentiment throughout medical school and beyond. No reports on this though. Waste of money. The reasons for poor recruitment are clear for anyone properly looking or listening to GPs on the ground

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  • If I was a GP tutor at medical school i would suggest to the students not to become a GP.

    It's grim whatever discipline we do.

    underfunded overwhelming workload and where is occ health for ourselves. Gone to save funds.

    bye bye general practice i have had enough

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  • I have 3 children - I have discouraged them from following in my footsteps (GP partner mid 40's). Going back 15 years - the job was hard work but a joy. Now it is just hard fact worse than is hard work beyond that which I or any of my colleagues can manage. If you fancy going home at the end of every day knowing you haven't been able to do your job properly - then come on in....otherwise try another carer.

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  • This review is a joke - there is nothing attractive about General Practice. More spin and wasting more money on reviews. The review of morale of Junior Doctors is another joke.

    We need a new CEO- are you listening Mr Hunt.

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  • Are they crazy?! Med students are not fools & can see for themselves what a rubbish job GP has been made into. No amount of spin or slick salesmanship of the JH variety will be able to convince them otherwise.They can see that the emperor is indeed naked...

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  • A retrospective study of behavioural attitude and aptitude of NHS Bosses and those heading LMCs/BMA and NHSE might be a more useful study. At least we'll have an understanding where this whole sh... torrent came from !

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  • Mr Mephisto

    It is nice to known that the NHS England director of primary care commissioning said that “we need far more GPs than we need more consultants”.

    The workforce planners have obviously made an omnishambles of this one!

    Currently in Northern Ireland there are 50% more hospital consultants than there are GP’s – 1000 GP’s vs 1500 hospital consultants (approximate figures).

    These figures do not take into account staff grade or associate specialist posts.

    These are official government figures.

    The BMA published the statistics in February 2015 in a publication entitled “General practice in Northern Ireland: The case for change”

    There is a very telling graph on page 11 of the document (figure 10) which shows the massive explosion in medical registrar and medical consultant numbers from 2007 onwards.

    To read the document for yourself copy and paste file:///C:/Users/User01/Downloads/nigpc_gms_strategy_caseforchange.pdf into your browser

    If you told the average man on the street there are more hospital consultant in the country that GP’s they would tell you that you were mad.

    Unfortunately the figures are true and its the facts that are mad - proper Alice in Wonderland mad

    One pill makes you larger
    And one pill makes you small
    And the ones that mother gives you
    Don't do anything at all
    Go ask Alice
    When she's ten feet tall

    And if you go chasing rabbits
    And you know you're going to fall
    Tell 'em a hookah-smoking caterpillar
    Has given you the call
    Call Alice
    When she was just small

    When the men on the chessboard
    Get up and tell you where to go
    And you've just had some kind of mushroom
    And your mind is moving low
    Go ask Alice
    I think she'll know

    When logic and proportion
    Have fallen sloppy dead
    And the White Knight is talking backwards
    And the Red Queen's off with her head
    Remember what the dormouse said
    Feed your head
    Feed your head

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  • Don't some people tire of polishing the same old turd.Sure,if you want to enter a career of constant persecution go for it.The only people I know who are happy are those who do 1 session a week and sit on CCG boards!

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  • Im an ex GP clinical tutor at a medical school.

    I wouldnt advise any medical students to come into general practice as it is currently.

    Perhaps if things went back to how they were say 10years ago i might support the vocation but i doubt that they will. In my opinion the career is on a downward trajectory and medical students are far more savvy nowadays about career paths.

    I would however suggest that general practice is the fastest route to a CCT and therefore the quickest way out of the UK if you really must study medicine and want the chance of a decent life.

    I have read today that pension changes may force workers to keep slogging away until 75 or even 81 the way things are!!!

    It seems very clear to me that something horrific is in the pipeline for the younger generations who through no fault of their own have had the misfortune of being born at a time where greed and profligacy have meant that they have a debt burden hanging like a millstone around their necks...

    this is the first generation post war that will have a lower standard of living than their predecessors...and its only going to get worse..

    if you must study medicine be smart about it and look after yourselves.......... think seriously about leaving the UK if you wish to have a decent career, family life, working conditions, fair remuneration...


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  • There is one view prevalent in medical schools. And that is to ditch the country!

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  • So what about this, our local medical school was slated by the GMC (can yo believe it!), because 4% of the undergraduate curriculum was provided by general practice/ family medicine, the main problem was the large regional teaching hospital had gobbled up all the education budget and there was none left for primary care, says it all really!

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  • We were asked to put our hands up if we were interested in going into a general practice during a lecture at the start of the year (4th). About 1/4 said they would. The same people kept their hands up when asked if they would be interested in practicing overseas.

    Clearly it's a quicker route to bail out of this place.

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  • Anonymous | GP Partner02 Mar 2016 10:17am

    post 10.17 ---- as accurate an assessment as has ever been posted of the current state of General Practice in the UK .

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  • As a GP involved in undergraduate teaching I cannot advise medical students to enter GP training unless they are planning to emigrate. The job is toxic , its not the attitude of the medical schools its the attitude of the Media ,Governments(both Tory / Coalition and Labour), that have successfully denigrated GPs to such an extent that it is now a no go zone for graduates. Thank you Mr Blair / Mr Cameron et al..

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  • Shouldn't the headline be 'Education boses finally think about getting their house in order'.

    This is like saying 'BNP make landmark decision to consider their own bigotry'

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  • This is such a toxic area. 9.14 is quite right why haven't HEE or the Medical Schools Council done something about this before. But on the other hand having a review is so often an empty gesture and as so many have said the problems about GP recruitment stem largely from the job itself and so reviews like this can draw attention from that elephant in the room. It's a mess.

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  • When you are employed by an institution such as a medical school you should espouse their values. Teachers promoting negativity about Primary Care should be disciplined. Medical schools who find this difficult should have their funding removed.

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  • If medical students were exposed to primary care more, the percentage entering general practice would decline sharply!

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  • Anonymous | GP Partner03 Mar 2016 12:09pm

    Is that the sound of jackboots I hear?

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