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Gold, incentives and meh

Figures show widening shortfall in GP training with 20% of places unfilled

A fifth of GP training places in the UK remain unfilled after two rounds of recruitment according to official figures obtained by Pulse, raising serious questions about Government’s promises to increase the GP workforce.

Data supplied by NHS Education Scotland show that just 80% of the 3,641 available training places across the UK have been filled ahead of the August training intake.

Education bosses in England have refused to confirm that the figures are correct, but they come shortly after the health secretary rolled back on his pre-election commitment to introduce an 5,000 additional GPs by 2020, saying this was only a ‘maximum’.

The figures are disastrous for education bosses and mark a widening shortfall in filled GP training places.

Last year, at the same stage, around 13% of places remained unfilled in England and 11% in Scotland after the unprecedented third round of recruitment - a situation that the GPC described as the ‘worst ever’.

The shortfall comes despite the health secretary boasting there had been 300 more applications to GP training this year in his ‘new deal’ speech, although Pulse later revealed this was because failed applicants had been allowed to retake entry exams.

According to the figures, around 2,918 places have been filled across the UK so far, with a third round of recruitment in England to follow.

No figures were available for England or Wales, but Scotland have filled just 240 of the 305 GP training places on offer, 79% of the total and increase of just 9% on the first round.

Health Education England has yet to publish the vacancies for GPST1 recruitment in England despite the final deadline for training place uptake having passed on 11 June, but these UK-wide figures suggest it will struggle to meet its current target of 3,250 graduates entering general practice by 2016 and there will also be shortfalls a

The Government has been under pressure to provide evidence of how it will achieve it’s pledges to drastically increase GP numbers in England, including a pre-election pledge of 5,000 new GPs by 2020, and it’s already delayed target of 3,250 medical students going into GP training by a year.

Pulse revealed last week that Jeremy Hunt has begun to distance himself from the election promise of 5,000 new GPs when, at the announcement of the ‘new deal for general practice’ two weeks ago, he said: ‘We are leaving some flexibility [in the target] because in some parts of the country it is very hard to recruit GPs.’

And last week he added that 5,000 looked like the ‘maximum’ achievable by 2020.

The DH declined to comment on today’s figures, adding the breakdown of figures for England would be available ‘shortly’.

NHS Education Scotland said that the remaining training places will still be made available for ongoing recruitment with local training boards, and a third round of recruitment will be launched in August for a February 2016 start date.

Dr Krishna Kasaraneni, chair of the GPC workforce and training subcommittee, told Pulse the figures were of ‘significant concern’ to the GPC and said the downward trend in recruitment would not reverse until young doctors could see GPs workload improving and GPs enjoying their work.

He added: ‘Is it surprising that they’re worse than last year? No, because realistically there hasn’t been a great deal of investment – in terms of making things better for general practice- in the last four months, or prior to that.’

‘If last year was the worst ever, this is even worse.’

‘Even when the concept of the new deal was announced with routine seven day working and so on, it goes to show we don’t even have the workforce at present to deal with the normal demands of general practice.’

Deputy chair of GPC Scotland Dr Andrew Buist told Pulse he hoped this would be a wake-up call for politicians.

He said: ‘I hope the Government now are waking up that they’ve got a very, very significant problem on their hands. The figures today don’t really come as a great shock, we knew this was happening.’

‘They really need to start talking up general practice, that’s one of the reasons things are so bad, they’ve been talking us down for the best part of eight years and morale is low. The young doctors, and medical students pick up on that.’

Readers' comments (55)

  • Absolutely bang on. To compound the problem further, of those doctors who undertake training, how many will complete training but leave UK general practice? Could anyone really blame them?

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  • So what if there is a 20% shortfall.These things are cyclical.In 5-10 years time we'll be talking of not having enough training places to meet demand.

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  • We, BMA, GPC warned of this a few years ago. Someone got nailed for suggesting that the workforce would also be affected by part time work, portfolio work, women naturally wanting career breaks.
    We, BMA and GPC were so lame getting the issues across that we come to the point no one wants the training places, no one wants the job (especially full time.) It was cheaper and politically less damaging not to do anything that might help GPs as we had been successfully painted as lazy over paid underworked- the exact opposite of where we are now.
    I blame HMG, Andy Burnham, Andrew Lansley, Hunt, the Daily wail and ourselves. At least in that we are all in it together.

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  • 10.28 trouble is we have to get to '5-10 years time' !

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  • There has been a shortfall for several year.... that's a ticking time-bomb, especially as many will leave the Country. It will "hit home" harder over next 3-4 years as retirements happening fast.

    There are already about 40 vacant salaried/partner posts in Leicester alone.

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  • Bob Hodges

    "So what if there is a 20% shortfall.These things are cyclical.In 5-10 years time we'll be talking of not having enough training places to meet demand."

    I think that that is possibly the most complacent piece of brain-fluff you'll be reading this week, even if you take the Daily Mail.

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  • @10:28 "So what if there is a 20% shortfall.These things are cyclical."

    Except when you're cycling off a cliff

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  • our VTS usually has 23 new trainees each year. found out at the weekend that we have 9 this year!!
    out VTS has always been popular with trainees and lots of lovely training practices including rural with great trainers.
    just shows the young doctors don't want to be GPs!

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  • 10:28am ''So what if there is a 20% shortfall.These things are cyclical.In 5-10 years time we'll be talking of not having enough training places to meet demand.''

    I have heard about this concept of ''cyclical phenomenon'' from some of the GP partners in my locality - who are under the impression that cyclically the Government will increase the funding for General Practice (as they did in 2004) when they are faced with a recruitment crisis.

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  • more bad news
    *sigh*
    *looks at picture of kangaroo on desk*

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  • It's not a cyclical phenomenon, it's a downward spiral.

    The point being that, eventually, you hit the ground.

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  • If 20% places are not filled, then there will be 20% less GPs, so the market rate for locum GPs could go up by 20%. So its time to start doing some locum sessions.

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  • I don't think Hunt knows what to do either. It is quite apparent that Osborne will not allow any further increase in finance for the NHS. Most hospital trusts are now in financial arrears. It is like a train hitting the buffers in slow motion.

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  • Vinci Ho

    To achieve something like this, you need people to cooperate ,mate . Common sense.
    The relationship between medical professionals particularly GPs and the government is historically low. Who has the biggest responsibility ? Some of you may say 'it is you guys moaning on Pulse and social media putting people off!' . Really? Have you watched some of these movies about feudal Japan when government officials failed their job and the emperor? Of course , we are now in civilisation with democracy but what should happen to these ministers , you think?

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  • Daily wail latest:
    Ministers leaving for Australia, New Zealand and Canada where the gravy train has as yet unexploited true potential!!!!!!!!!!!!!

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  • Canada is blessed with truly unhealthy levels of radioactivity.

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  • The remaining 20% of the GP Training places should immediately be filled in by our future ''Physician Assistants'' and there should be rigourous training for them for three years in a GP surgery and they should be given MRCP (Member of Royal College of Physician assitants) degrees after their training.

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  • The Profession must look at making GP training less annoying, futile and toxic. Our Educators are partly responsible for this crisis.

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  • no big deal

    there is no crisis simply because the cardigan wearers are still doing the job i.e. more patients are being seen for less money i.e. the government has done well and made the system more efficient.

    when patients have to wait months for a GP appointment or there is no local GP service then folks will take interest so really this is no news.

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  • Anonymous @12.20

    I agree with you. Until patients have to wait 4 to 6 weeks for a GP appointment AND patients are complaining AND blaming the Tories, nothing will happen. Hunt et al along with the media will still try and make out that the NHS needs to become more efficient. IF at that time the public refuses to believe the spin, then and only then more resources may be available. On the other hand co-payment may be brought in. Though this would be a huge vote loser. What is more likely is that there will be a development of further private primary healthcare services. That is why the GPC should currently be negotiating private primary health care insurance packages that we could then offer our patients

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  • This is a recruitment crisis, so what is needed is improvement in pay and conditions to make the job attractive - that means a significant hike in pay and abolishing the red tape that makes the job insufferable - QoF/CQC/revalidation.

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  • Agree with above. Doctors in the unpopular and risks areas (A+E/MAU/GP) need this to be relfected in their pay. In the private sector this would be recognised immediately - suppy and demand.

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  • Impose another contract on medical students. They must work in GP land.
    I, as a burnt out, worked to the bone GP am actually amazed that 80% posts are filled. Last night, after 45 consultations,11 phone calls, 200+ repeat and acute scripts and over a 100 blood tests, never mind the vandalised window or the plumbing crashing, I went home with my eyes googling.
    I cannot understand anybody who is not a GP already and cannot leave, wanting to become one.
    There must be other parts of the UK that are sane, because my part is slowly becoming insane.

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  • Banking has to be the most tedious ,god forsaken , leprous job in the world where psychopathy is a useful trait. However, it is not short of recruits . Of course large wads of cash make it seem attractive . What we need is a scientific trial . Group 1 is given a 50 % increase in funds and Group 2 is given some extra training and encouragement . Speculating wildly I suspect group 1 would attract more recruits . If this proves to be born out by this pilot then apply it universally. At least we will find out if money really matters .

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  • I'm a little shocked at how many have taken up placements.

    However I guess many many will be planning families and have already decided what sort of working pattern they will do.

    A useful study would be to survey their intentions going into gp training. How many potential full timers are there? they're the ones we need!

    once we take take that into account we're going to be nearer 50% in terms of potential gp time

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  • It might be worth the GMC talking to trainees ideally who have left certain training schemes that are under-filled. There may be a link between serious bullying and abuse of trainees and deaneries that have unfilled places.

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  • Dumping some of the bureaucratic nonsense, such as Appraisal and Revalidation, would help.

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  • GPs are unenviable profession,unprotected by BMA and inadequately by Medical Defence bodies.
    NHS imposes unworkable practices on GPs;a qualified bank practice nurse is replaced by a Practice nurse in training.
    Trainee receptionists are used posing as administrators.
    A functional EMIS IT system is replaced by a thrice in a consultation freezing/collapsing ALTGP system.
    When the GP complains his career is destroyed by referring him to The GMC.Is this British Justice!
    GMC MTS take NHs complaints seriously ignoring the written rebuttal presented by The GP.
    When The GP has because of NHS persecutions not earned as a GP expect him to travel to Manchester unprotected by his defence body.The Defence body had got him reinstalled as a Specialist gP and after that refused to continue protecting him

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  • Anonymous | Salaried GP | 01 July 2015 11:14am

    more bad news
    *sigh*
    *looks at picture of kangaroo on desk*



    @11:14

    Your comment is fantastic and hilarious, so I have repeated it.

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  • Better to have a picture of a kangaroo on your desk than woking in the outback with a real one on your desk! Or is it?

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  • 'In 5-10 years time we'll be talking of not having enough training places to meet demand.'

    That will be because all GPs will be private, and we will be able to offer our own combination of cost, appointment duration, continutity, facilities and convenience to mutual benefit with our patients, who will be happy to pay the market rate for our expertise.

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  • Una Coales. Retired NHS GP.

    I am still getting emails from IMGs who are facing their 4th or 5th CSA and seeking one to one tuition to complete GP training or face release with nothing to show for 3-4 years of GP training. I would suggest that if you want IMGs to come back to general practice training, you add CCTV for CSA stations and ensure 2 examiners mark each station.

    Without IMGs and BMEs, GP training vacancies will continue to widen as BMEs have historically comprised of up to 40% of GP training places.

    I have had to decline a request from a private lawyer representing an IMG GP trainee who wants one on one tuition for CSA, as I have met even British BME GP trainees who have been expelled after passing both akt and csa because they were failed in their eportfolio assessment by one subjective GP trainer. In my opinion, this suggests there are 3 ways in which a GP trainee may be blocked from completing his or her GP training. Prior to 2007, there was only summative assessment with its 99% pass rate. Enough said.

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  • I wonder hoe many of these 'hawkish trainers' who never did any of this stuff would have passed?

    Also, given how critical the situation is, it is worth talking to trainees from deaneries that are struggling to recruit / have high failure rates (indicative of poor or non existent support) to find out if there is bullying and abuse of trainees or poor training. There may be a swamp in need of draining.

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  • Why not to take trainees back who have been expelled and assess them through summarise process and let them make use of their three years training.....in my view CSA is the culprit for GP recruitment crisis, I guess IMG's do not want to take risk in their career as CSA is purely to pass white candidates and fail IMGs.
    Enough said!!!

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  • CSA is to blame 👎👎👎💯💯🔚🔜
    Any I am really laughing at situation

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  • The whole structure on GP career progression need reassessing just having the MRCGP and thats it does not addresses the work force issues.Bring back summative assement.Improve the wokforce number.After that T&Cs need to drastically improve just to get youngsters through the door.The task to refine Primary case for the 21st century is a big ask with a failing NHS,a goverment hell bent on privatisation and organisation representing/regulating us who are self interested/bloated and out of touch.In reflection we are doomed.

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  • GP Training, in my opinion , is GARBAGE. Emphasis is only on consulting skills but not clinical skills. HOW UNSAFE .

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  • GP Trainers should take part of the blame for such vacancies in GP Training Posts - because Medical Students could be afraid of getting substandard training in General Practice. GPs do not end up having medico-legal problems because of poor communication skills but because of poor clinical skills.

    When a trainee asks a trainer a straightforward question about treatment of any clinical condition, instead of giving a straightforward answer, most trainers give stupid answers like '' Where do you think you can find the information'' instead of honestly saying '' Sorry I don't know the answer''

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  • ' GPs do not end up having medico-legal problems because of poor communication skills but because of poor clinical skills. '


    the CSA has many faults but that statement is simply not true.

    The issue of medico legal problems is complex and has as much to do with workload pressures, number of clinical sessions etc

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  • @ 1 July Una Coales

    It appears that the arrogance, appalling behaviour of the RCGP could be the single most important factor for the GP recruitment crisis and may be the major cause of NHS GPs becoming extinct.

    The RCGP refused to record and have two examiners for the CSA exam. Not just in the case of appeals and ignoring the fact that this would be unconstitutional in other major western countries (eg US, Canada), this demonstrates how out of touch and inept the RCGP are. This would have provided invaluable material to help the RCGP to sort out the mess.

    Yet again, the medical profession is being destroyed by a bunch of amateurs.

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  • Trainers should be made to take the AKT examination each year to see if they are CLINICALLY competent to teach their useless consultation skills which in real life hardly any doctor would use.

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  • Some of trainer have very poor knowledge no idea of exams and nice guidelines and can easily destroy career of Doctor , there is no check on competencies of trainer

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  • Una Coales. Retired NHS GP.

    Back in 2001/3 there was a severe shortage of NHS GPs. GP land was in turmoil. GPs were burning out on call for their patients 24/7 and no one wanted to be a NHS GP. The BMA balloted its members and voted for mass undated resignation. Meanwhile deaneries did their best to entice hospital trainees with carrots to join GP training schemes. I was one such hospital doctor who was lured with bundles of carrots! Entry was one easy interview and no exams or jumping through assessment hurdles.

    There was no time to feel depressed as a British BME/IMG at never getting a NHS training number in general surgery or ENT even with double FRCS in general surgery and ENT, when GP VTS welcomed me with open arms, gave me a free weekend at forest mere health spa with free beauty treatment, free weekend at Verona, free trip on the London eye with free chinese dinner nearby, no eportfolio (my trainer had a paper logbook of competencies and just ticked off all the boxes in my last week. I mean asking me to demonstrate doing a rectal exam with FRCS in general surgery seemed a bit daf; she knew it and I knew it), 99% pass rate free MCQ+video summative assessment (although I chose the optional tougher 4-module MRCGP for £190 a module) and then £2000 study leave money and free residentials in fancy resorts with fine food and fine wines for my first 2 years as a newly qualified GP, and in S London they were handing out £5k golden handshakes to those who signed up to be salaried fodder. They lured us with so many carrots I knew there would be a stampede of hospital doctors defecting to GP land.

    Shame to see GP trainees now being beaten with sticks, referred to the GMC, burdened with expensive exams and onerous eportfolios at a time when now more than ever we need doctors' bums on seats to save the NHS but more importantly the profession of general practice.

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  • Given the crisis, why did the BMA refuse the concept of a staff grade of GP? I agree with Una that the RCGP needs sorting out, but the quick solution would be to authorise a staff grade, so all those who have fallen out of the system at this point can be welcomed back in with open arms. they would be far more useful than any Physicians associate, and probably far safer. And they'd be far more useful than any pharmacist.

    That would then buy you the time to sort the rest of the mess out.

    As for the future:
    - Expect far fewer GPs anyway you cut it. But if the choice is between PAs & AHPs or a staff grade sat below a much smaller tier of MRCGPs then that sounds more palatable to me.
    - Expect a salaried service. Look at the HMRC definition of employee vs contractor - in charge of their own work and how it is done. We already fail that test to be ICS. Bevan's aim has finally been achieved - ICS was always a fudge. He aimed for a more socialist staffing, not just a socialist output for patients.
    - Expect a capitated payment model, which will align nicely with either a fixed tax funding model from HMG, with/out a co-pay model, and/or a total switch to private insured model - probably done gradually via co-pay until it goes from 'top up and extra service' to 'only the poor get it free'.

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  • Una Coales. Retired NHS GP.

    @10:47 am what you say makes sense except IMGs/BMEs who were failed by CSA because the RCGP did not recognise negative unconscious bias or test for it, does not mean we make these GP trainees subgrade staff grades when had the exam been recorded and monitored by CCTV, 100s of IMGs/BME GP trainees may have had grounds to win appeals and be awarded MRCGP instead of face the utter humiliation of release/expulsion with nothing to show for 3-4 years of so called GP training.

    Those who have been released are now working in A&E, community hospitals or private medicine. There is no need for them to accept a subgrade staff grade post in general practice.

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  • what's the pay like in Canada? I seem to get variable answers on the google search

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  • If our country is suffering and stinking because of our useless political policies, we should attempt to clear the garbage.
    Am afraid importing non- EU doctors would not work as they are far better in their abilities than local graduates and are going to places where they are treated like professionals, not like doormats like in the UK.
    If we have a problem, we should have the guts to accept and try to solve it, though not sure would happen.
    I might sound selfish, but I wouldn't be out of work whatever happens; the poor general public would keep being manipulated by useless people in charge.

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  • Una @11.43
    Well said Una. You are a legend.
    I believe more than 90% of the IMGs released from training would have passed this Russian Roulette assessment if they had a fair chance in this closely guarded exam which continually and blatantly denied any form of evidence of the conduct of the exam to the date!! Trainees word against ONE examiners word is the only evidence you are allowed in this disgusting and immoral appeal process which they charge £800 !! HOW CAN YOU APPEAL IF YOU HAVE NO EVIDENCE TO APPEAL? AM I MISSING HERE SOMETHING?
    Engineered to fail, IMG trainees are not suitable to do substandard GP work while a lot of these guys managed to pass decent highly competitive exams such as MRCP,MRCS, MRCPch, and MRCOG. Majority of such released trainees are slowly finding their way back from the betrayals and humiliations they suffered from the very people who trusted to support and protect them. They should never turn back. These doctors are too good to be doing a second class job for GPs while they have a potential to be hospital consultants and lead happy and fulfilled lives.

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  • Dear Una,

    I was one of those IMG that luckily only failed my first attempt at the CSA. My trainer, excellent as he was, had no training on how to bridge cultural and communication gaps. I passed my second attemp only because I paid for extra courses and because I was lucky enough to have an English wife who taught me a lot about the British ways.

    Thank you for all your hard work supporting IMGs and fighting against ingustice.

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  • I will have to reflect on the learning points in this..

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