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Independents' Day

GP training crisis begins in medical school, research suggests

Exclusive Medical students are spending 14% less learning time in general practice than ten years ago, new research obtained by Pulse has revealed, which experts claim is contributing to the crisis in GP training numbers.

The study, led by a GP and medical academic, reveals that the number of departments of general practice in medical schools in the UK has also reduced in that time period, while only 7% of the funding for medical schools goes into teaching general practice.

Experts have said that this contributes to the lack of interest from medical graduates in pursuing a career in general practice, after Pulse exclusively revealed that some regions are failing to fill 40% of their GP training posts.  

The new research concludes that GPs need funding to increase the building space in practices available to teach medical students, and without it the Government’s key aim of ensuring 50% of medical graduates enter general practice training by 2016 would be difficult to achieve.

It follows comments last year from the then head of the GP National Recruitment Office, Professor Bill Irish, that the top universities in the country are not doing enough to produce future GPs.

The researchers surveyed 29 UK university medical departments and found that the number of 3.5-hour teaching sessions per student delivered in general practice during years 3-5 of medical undergraduate courses declined by 14%, from 119 sessions in 2003 to 102 currently equating to 1.7 fewer weeks.

The study also revealed that only 46% of UK medical schools have departments of general practice, comparing very unfavourably to the early 2000s, when almost every medical school had one.

It also found that  the proportion of funding ‘Service Increment for Teaching (SIFT)’ funding – the mechanism used to fund undergraduate medical education - going into general practice education averages only 7.1%, across the 11 medical schools that responded.

The lead researcher, Dr Alex Harding, a GP senior lecturer at the University of Exeter Medical School, told Pulse: ‘The survey has found that at present the national average is for 14% of student placements at medical school to be in general practice. We also have found that these GP placements have been reducing over the past 10 years or so.’

He said that the main issue for the reduction in training was the lack of funding to increase practices’ space to train students

He added: ‘When students come to a GP practice they really want to see patients. This means that finding extra space for the students to talk to the patients becomes an issue. In our survey we couldn’t find much evidence of funding models to support this.’ 

GPC chair Dr Chaand Nagpaul said that the researchers’ findings were ‘extremely worrying’ and the trend ‘contradicts’ the Department of Health’s plan to have 50% of medical students going into general practice.

Dr Nagpaul said: ‘This is an extremely worrying finding, given that the Government wants to have the proportion of medical students going into general practice at 50%. If recruitment of GPs becomes more difficult it contradicts the Government’s plan to have more patients treated outside hospital.’

He added: ‘We need to provide more time and space for GPs in their premises to provide education. Students need to be in a motivating, positive environment when they are in general practice.’

Professor Irish, who is now chair of COGPED and GP director for Health Education South West, told Pulse: ‘If the figures are correct, a two week reduction in the volume of teaching delivered in primary care is deeply concerning.’

‘The target of 50% of trainees entering primary care is in the Health Education England mandate, and undergraduate exposure to high quality training in a primary care context would seem essential. Even if students don’t ultimately become GPs, there seems little doubt that a large amount of specialist care (such as in diabetes or dermatology) will be delivered outside of hospital settings.’

He added: ‘Medical practice in community settings is intrinsically different (and often more difficult) than in secondary care. Presentations are more vague and earlier, and tests which perform well in hospitals (with high disease prevalence) are often misleading in the community (where prevalence is much lower).  Familiarity with the realities of delivering care in “imperfect” areas such as the homes of elderly isolated patients is essential for all clinicians.’

Pulse reported in February that the number of applications for postgraduate GP specialty training for 2014 were 15% down on 2013.  

Readers' comments (16)

  • Surely this is a good thing for the government if they're trying to get the numbers up. The more medical students that have a good understanding of what needs to be tolerated in GP, the fewer that will do it...

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  • THE DAILY MAIL HAS A HUGE RESPONSIBILITY FOR THIS MESS-The message they give out is that GPs are predators on society and have "footballer style lives".

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  • This comment has been moderated.

  • It was like this in the 1970s: general practice was shunned then - it is shunned now.

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  • Posting this anonymously for obvious reasons: my daughter started at medical school last autumn. In the first week she was told "We aren't training you to be GPs". I thought that attitude had died since my time at med school in the late seventies/early eighties but apparently not.

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  • Dear 3.39, good luck to your daughter, it must be soul destroying for her to have your profession knocked by her school and her respect for you and her chosen career dented by those who know nothing about being a GP!- disgraceful!. Mine (GCSEyear) has her heart set on medicine, I'm not pleased but sure to be proud if she succeeds. I'm afraid in hindsight some of my tutors where that because they couldn't do the job. Real GPs should teach not those, so called, academics who do one or two days in practice to keep their eye in!

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  • Unfortunately the assumption is that more time in General Practice will make medical students more likely to choose General Practice when in fact the opposite may be true. Our students leave with a true impression of how it really is. Like our F2s they realise that General Practice is not for them.

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  • It's a sad thing; I had a wonderful GP that made me want to go into medicine. My 6 week attachment in GP land in my 5th year was wonderful too. This was still not enough to make me want to be a GP; mid training for specialism I realised we treated bed numbers and conditions and not people, so I finally realised that I really did want to be a GP. 18 years in I still want to be a GP but the current numbers of hours and patients I have to do to fulfil demand for services makes me feel that I'll never actually practice medicine how it should be, as now 'treat' number 45 of the day and not Mrs Jones.

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  • it is frightening that there are so few trainees but the propaganda by daily mail and litigation's does not bring any confidence either-hope sanity prevails

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  • "hope sanity prevails"

    This is sanity. People voting with their feet the the government and the GPC (and the public) abandon them. This is the only thing that can even potentially save General Practice.

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  • part of it is education but even with the most GP friendly medical schools, recruitment, and more importantly, retention will suffer without decent working conditions.

    junior doctors are not stupid, most of them have been trained in a way that allows them to succeed in multiple specialities.

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  • The question for the GMC is can they continue to accredit medical schools that do not provide appropriate training in general practice ? need to start with the principle that half of Medical students go into general practice, 1/2 there training should take place in primary care.

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  • General Practice is screwed. It'll take a decade to undo this which time there won't be a thing called 'General Practice' to save. Me and you my friends are the tail end of a dying dog.

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  • So what?It's no great loss.I learnt bugger all during my GP stint at med school.The real training starts after you qualify and wisdom comes several years after that if at all.

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  • At a recent crisis meeting on this subject with GP tutors, Deanery and GPC representatives in N Wales I was astonished that the sex distribution and hence slanted output was not discussed - direct questioning revealed that noone had any figures !! From my own research the 60f/40m balance has been ongoing for almost a decade and present inadequately detailed stats suggest that in a doctor's lifetime a female doctor will equate approximately to 70% of a male counterpart for blindingly good but obvious reasons. However this has never been translated into Policy where essentially numbers needed to be trained have to increase by 15-20% in order for there not to be a manpower shortfall. that is essentially why there is an overall shortfall now and it will take a huge influx and 10 years (training downtime) in order for altered policy to make the difference. Good luck with that. Present attritional policy centrally and the attacks on pensions are driving more and more Doctor's to retire which will only underline the problem. Best wishes

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  • The "real" GPs such as yourself presumably should teach but don't as it pays less and doesn't quite get you the QOF target numbers and it is easier for you to see patients than to spend hours ringing patients asking them to come in and preparing material to teach students, filling in the gaps for the university often. I wish more "real GPs" took responsibility and taught their profession and not shunned it on to the "academics" as you so put it.

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  • Azeem Majeed

    Imperial College London has several MB BS courses that GPs can teach on.


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