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Independents' Day

Medical schools 'should have funding linked to producing GPs'

Medical schools ‘have a responsibility’ for addressing the GP workforce crisis and should have their funding linked to their achievement of targets on number of GPs produced, a study led by a senior Government advisor has concluded. 

The study - ‘A systematic review of strategies to recruit and retain primary care doctors’, published in BMC Health Services Research - also found that advertising campaigns to attract junior doctors to general practice have been detrimental in some countries.

In its review of 51 studies, the paper highlights that few government interventions to increase GP recruitment – many of which are being implemented as part of the NHS’s ten-point plan for GP workforce – are supported by robust evidence.

GP leaders have said the paper shows that one-off interventions are not going to solve general practice’s ongoing workforce crisis, and that the best advert for the profession is investment so trainees see it as an attractive place to work.

The study was authored by Sir Sam Everington, chair of NHS Tower Hamlets CCG and an adviser to NHS England, and Professor Amanda Howe, vice-chair of the RCGP, among others.

It published figures revealing that fewer than 10% of graduates from Oxford and Cambridge universities went on to a career in general practice.

Health education leaders are currently conducting a review into medical school culture, and the report authors urged the Government to link funding to universities’ output.

The study concluded: ‘Medical schools have a responsibility to start taking notice of the workforce crisis in primary care and perhaps resources and funding for these universities should be based on output to meet targets.

‘Universities should be held accountable as to how much time they allocate to the primary care setting and this data should be made publically available.’

The review also found:

  • that an advertising campaign to recruit GPs in the USA had a negative effect on potential candidates, with half of those who watched the video opting for a career in general practice compared with those who didn’t watch it.
  • there could be benefits from offering additional postgraduate training in under doctored areas;
  • ‘mixed results for the use of financial incentives’, such as golden handshakes, which it said was most effective in trainees ‘who had existing links to the underserved area’;
  • that there was widespread failure to effectively evaluate the outcome of interventions with few studies employing effective comparison groups, and no randomly controlled trials on the subject.

Many of these incentives formed part of Health Education England and NHS England’s ten-point plan.

HEE are currently offering £20,000 to more than 100 junior doctors willing to train as GPs in areas like Cumbria, while it last year ran a disastrous promotional video that highlighted extra-contractual work signing sky-dive forms as a reason to be a GP.

The chair of the GPC’s education, training and workforce subcommittee, Dr Krishna Kasaraneni, told Pulse: ‘The best marketing campaign, or strategy to improve GP recruitment is investing in general practice so the job is actually enjoyable for GPs to do. It isn’t for the majority, if not all of us.’

‘When that happens, when medical students come and spend time in general practice they will see a profession they want to join. It doesn’t matter what else you tell them, unless they see it and experience it themselves it’s not going to change.’ 

A HEE spokesperson told Pulse: ’No one intervention is going to make the difference. HEE and partners in NHS England, RCGP and BMA GPC are working together on many fronts including the 10 point plan initiatives to make recruitment flexible whilst maintaining standards and other measures to enhance the GP workforce.’

Tackling toxic medical schools

Maureen Baker-RCGP 2014-Online-cropped-(c) Rachael Meyer

Maureen Baker-RCGP 2014-Online-cropped-(c) Rachael Meyer

Pulse has already shown that medical schools are beginning to recognise the problems with primary care teaching.

Earlier this year Pulse revealed that the Medical Schools Council and Health Education England (HEE) would launch a review on the ‘profile of the GP culture’ in medical schools.

This comes after RCGP chair Maureen Baker attacked the ‘toxic’ anti-GP attitudes in some UK universities at the RCGP annual conference, and top GPs reported senior staff warning students not to ‘fail and become GPs’.


Readers' comments (25)

  • Until General Practice is something that is enjoyable and felt to be worthwhile, no-one will want to do it. If as a student all you hear from General Practitioners is how awful it is, why would anyone wish to become one. I love being a GP but even I am increasingly snowed under by demand and over regulation.

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  • Dear Peter I beg to disagree:
    I think the report is targeted at entirely the wrong people
    The universities have no interest, knowledge, or concern with regard to general practice, and would not see this as anything to do with them
    The postgraduate general practice vocational training deanery advertises, selects, appoints, pays, and trains the registrars
    These autonomous bodys are answerable to no one for the public money they spend
    There is no data as to how many of their trainees are practicing general practitioners five, ten, and 20 years down the line, how many fail their exams, and how many times, and indeed how many have nervous breakdowns, in short there is no interest whatsoever in any review whatsoever of their performance.
    Until general practitioners are trained to make general practice something that is enjoyable and worthwhile, no one will want to do it

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  • They just need to let more in! My son, bright caring hard working - predicted great grades - has been applying for medicine against my and my wife (also a GP) - advice. Hasnt had a single offer. hes twice as mature as i was at his age - also he knows what medicine is - i didnt i didnt come from a medical background. apparently Keele his preferred med school had 3500 applications for 130 places. they interviewed 500 - (inc my son). Ok its not a quick win would take 7-8 years but it strikes me if they doubled the intake now we could sort the recruitment crisis and it would hardly be a lowering of standards. esp as there are figures that retention rates are really low.

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  • This is a classic example of avoiding the blindingly obvious. GP recruitment and retention is poor because of the appalling demands made upon primary care by comparison with the increasingly reduced remuneration we receive, and the constant hectoring and vilification of us. Sort out the conditions of work, and the rest will follow automatically. Not rocket science.

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  • My daughter is an Oxford medical student. She is being taught by demoralised Consultants, GPs who hate the job and hospital registrars who are increasingly looking at alternatives to medicine if the new contract is genuinely imposed. I suspect that more and more medical students will not complete their courses and more and more will not go into coalface medicine. Well done NHSE.

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  • 10:21 GP Partner
    As an ex-Partner in my 30s - tell your son again to be very thankful he was not successful, and choose a job which will pay the mortgage and not ruin his life. I would not encourage anyone to train for this job - yes the salary is ok, but it is not worth a life of slavery. 13-15 hour days, 60+ patients a day, ready to collapse all the time ... I would not wish it on anyone!

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  • Anon 10:29am. Please don't shout. It makes me (and probably others) avoid reading ANY of your mail.

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  • I like shouty people - it adds texture.

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  • The DOH reduces funding to GP land by almost 40% over the last 10 years as a form of penance. It is the fault of medical schools who have a' responsibility' to train GPs. Why should they. It s still a free country, last I looked and medical students can go where ever they wish.
    Keep on cutting the % of NHS spend on GPs, keep on increasing their workloads, so we now see 90% of contacts on 7.20 % of NHS budget and that is a clear message of how valued we are. Medical students have 4A*. They know a pig in a poke.
    Besides all this, the argument fails because GPs are leaving early.
    No point getting them to GP land if the job is so awful they all want to leave.
    Read Peverley, Copperfield, Nabi, anybody.
    They collectively say one thing, don't be a GP.

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