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Independents' Day

In summary: GP Taskforce recommendations for tackling the workforce crisis

The GP Taskforce made a series of recommendations to tackle GP recruitment and retention. Read a summary of them here.

1) Re-commission the GP workload survey and introduce a national survey of GP vacancies.

2) Health Education England and NHS England should develop a regular extraction of ‘long-term workforce data’ – including productivity data - from GP clinical computer systems, for workforce planning.

3) NHS England should review the threshold for reinclusion on the Performers’ List and explore whether there can be more ‘flexibility’ for returning GPs.

4) NHS England and HEE should provide and fund a GP returner programme, to fund training practices and other organisations in providing GPs with training to return to work. Funding should be prioritised for returners training in under-doctored areas.

5) Conduct research to identify why doctors are leaving general practice early, and what the barriers to returning are.

6) Promote and financially support the GP Retainer scheme (or a successor scheme) and prioritise the funding to retain GPs in under-doctored areas.

7) NHS England, HEE and the RCGP should establish networks for senior GP – “Twenty Plus” groups – to provide educational and support activities, facilitate portfolio careers, and balance clinical and non-clinical commitments.

8) NHS England should review how more flexible employment models can retain GPs towards the end of their careers. They should also consider reintroducing the Flexible Careers Scheme, which provided salary contribution and professional support for GPs looking to cut down their clinical commitments, and move to part-time working, but remain in practice.

9) Launch a general practice marketing campaign, to promote an ‘accurate and positive’ image of general practices to the general public and other audiences.

10)  The Medical Schools Councils should evaluate why there is such high variation between medical schools in the proportion of medical students choosing General Practice as a career: 11% of students at Cambridge were appointed to GP training, compared to 39% at Keele.

11) Medical schools should be incentivised by the Department of Health to boost the proportion of graduates choosing GP training as a first choice.

12) All trainees should have exposure to general practice, or a placement in the community during their foundation programme.

13) Promote GP integrated clinical academic training programmes in foundation and specialty training to raise general practice’s profile as an academic discipline.

14) Set a target of 3,250 GP trainees in Specialty Training 1 by 2015.

15) Decrease the number of ST1 or Core Training 1 places in specialty or hospital-based disciplines to create the capacity for GP training, especially in oversupplied specialties.

16) Review the long-term targets for GP trainees and specialty places after NHS England publishes its Review of Primary Care report, and implement ad part of the Shape of Trainine report.

17) Boosting GP trainee places in under-doctored areas should be incentivised and made a priority in the short-term, but training places nationally should consider trainee allocation on a ‘weighted population capitation basis’. This would mean local trainee targets set in a similair way to practice and CCG funding, accounting for geographic factors, population size, and population need.

18) Local Education and Training Board funding for GP training should also be allocated on the weighted capitation basis (above), to match the allocation of GPs. But in the short-term funding will have to favour under-doctored areas to allow them to expand places or fund schemes to attract trainees to these areas.

19) HEE and the GP National Recruitment Office must assess why 25% of applicants for GP training positions are considered ‘unappointable’.

20) There should be more flexibility for doctors from other specialities to retrain as GPs, particularly around recognising priority training and career progression.

21) there should be a mandatory, fully-funded induction and refresher training course and evaluation for eligible overseas doctors without prior experience as a GP in the UK.

22) As GP training places cost more to fund, the report recommends that 2,025 speciality training places could be decommissioned to allow GP numbers to be boosted without costing HEE more money.

23)  The decommissioning and rebadging of specialty training posts should be led by LETB postgraduate deans or associate deans from a specialty background. GP schools will need specialty leadership to expand GP numbers successfully.

24) LETBs should explore the use of a ‘federated practice model’ for training - as traditional one-to-one training is seen as a limiting factor to expanding training capacity. The federated model would expose trainees to a wider range of health professionals, allow practices to manage multiple trainees, and benefit other primary care health professionals.

25) LETBs should run local programmes to recruit and develop their primary care training capacity, and should allocate £10-20k per programme to this.

Readers' comments (6)

  • Why 25% of applicants for GP training positions are considered ‘unappointable. I think most of them are IMG graduates and most of them would fail role play CSA any way. I think someone smarter in the GP Recruitment Office finally thought its unfair on both IMGs for waisting their 3years and taxpayers for waisting public money on their training. Recruitment is a problem and many GPs leave profession earlier- its a very negative balance. If similar thing happens in business or banking, most of their bosses would be taken resonsible for failure or not acting sooner.

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  • There is so much that is wrong with GP at present, not mentioned here: the low, and falling, funding for GP, down 2.3% this year. A long series of derisory pay awards, that have left practices with dramatically falling profits while having to meet rising expenses. Mounting workload that leaves many GPs having to work until midnight or later. Revalidation paperwork that takes far too long to complete. Increasing patient demand and expectation. Expected to provide clinical perfection in only 10 minutes; consultation times have to increase to 15 mins and funding must be provided for the extra doctors needed to allow this. Unrealistic expectations of GPs. Fair pensions for all at the same premiums as a few years ago, with retirement at 65 at the latest. Tackling the rapidly rising medical indemnity body subscriptions. That would be a good start.

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  • Forcing young doctors into a career in General Practice isn't going to do either them or their patients any favours. Hopefully the 1980's saw the end of the "failed hospital Dr" label that GPs had in the 1960's & 70's that hospital based staff still seem culturally to believe.

    The real issue is to improve pay and conditions - in the 1990's our workloads increased to that of hospital consultants and in 2004/05 with new GMS contract we we only few thousands off the pay of hospital consultants. That was then - this is now - GP pay has fallen way behind hospital consultants and our workloads are much higher.

    Who in their right mind would want to become a GP for less pay and more work than a hospital consultant? Its bonkers to suggest otherwise?

    Forcing a generation of young Drs into a career in General Practice does no body any favours least all patients who's new GP never wanted to be a GP and has a chip on her/his shoulder for rest of their career as a senior Dr.

    The other problem is 40% of female GPs over the age of 40 are leaving general practice all together - given >60% of new GPs are women the job needs to become more family friendly to match hospital colleagues.

    And then there are the old farts like me - pale grey and male - we've all just had enough - falling pay and increasing workload from other's dumping their work on me as a GP - I've resigned at 57 and am looking forwards to going on April Fool's day next year.

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  • Ivan Benett

    It's time for us, as a profession, to be more proactive and more positive. We need to promote general practce and develop it as a desirable career. We get so many negative messages for the press and these columns. We should be looking at more flexibility to suit the modern times and young growing families. We need to develop career progression, not static careers. We need to show variety. For example, develop GPs with an interest more, show that we don't have to work 8-6 but at weekends or late starts and early evenings. We need to show that it's OK not to take on a management role and being salaried is OK. We need to develop academic and commissioning roles. In short, rather than be gloomy or throwing our toys out, we need to take control and face up to societal changes and modernise. I'm sure these ideas wont be popular with some of the readers, but they're wanting to leave anyway. I'm talking about those who still feel they have a future in a fulfilling career and a gold plated pension.

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  • The pension is "rubbish"

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  • GP training is unnecessarily rigid. Once signed up to a training programme you are tied to that area until the end (years if p/t). Twice a year there is the option to transfer to a different deanery but only if you have valid reasons eg an existing partner moves area for work. Little chance of applying to another scheme within a deanery. It is a like joining the army. You just have to take what posts are allocated regardless of commuting nightmares or school runs.

    GP training posts in hospitals last only 4 - 6 months. Some contain fixed annual leave. Often the rotas are late. Some people have childcare nightmares as obviously plans have to be made in advance.

    'Evening surgery' at my last practice was 4-6.30 and I was lucky to be home by 8pm.

    I agree, the whole thing needs shaking up and re-thinking

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