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GPs buried under trusts' workload dump

Non-GP training posts 'could be capped' under radical plan to boost GP numbers

Exclusive Health education chiefs are set to consider capping the number of trainees entering non-GP specialties under radical plans being considered by advisers to alleviate the GP recruitment crisis.

Pulse has learnt that an advisory group set up by Health Education England to help meet its mandate to boost the proportion of medical graduates going into general practice to 50%, is looking at limiting the number of trainee posts for hospital doctors and other non-GP specialties.

The move comes as a Pulse investigation revealed the extent of the workforce crisis. Data from 8,088 GP practices in England, collected by the Health and Social Care Information Centre, shows that – excluding locum support – 149 practices had more than 4,000 patients per FTE GP and 75 were coping with more than 5,000 per GP.

Growing concerns about the shortage of GPs back in 2012 led former health secretary Andrew Lansley to set out a plan to increase the proportion of trainees going into general practice by 20% to ensure half of all trainees become GPs by 2015. But progress has been slow, with deaneries only increasing the number of GP trainees recruited last year by 95, compared with a target of 3,250 a year.

Pulse understands a GP task force, chaired by Wessex Deanery postgraduate dean Dr Simon Plint, is currently working closely with the Centre for Workforce Intelligence (CFWI) to make recommendations on how to deliver on the number of national training posts required by 2015 and is due to publish its final report soon.

A source close to the task force said it was ‘looking at ways of marketing GP as a career to medical students and foundation doctors, increasing training capacity and resources, capping recruitment into other specialities and strategies to increase retention’.  

But the idea has been criticised by GP leaders who warn the plans are ‘extremely short-sighted’ as medical graduates forced to become GPs will leave.

Dr Beth McCarron-Nash, GPC lead on education and training, said: ‘If you look at the evidence a significant number [are leaving] very early on after qualification – and that is a big concern. I think capping of other specialties and forcing doctors into general practice is extremely short-sighted because they’ll just leave.’

She added: ‘We need to make sure general practice is an attractive career option so we get the brightest young doctors who want to be GPs, and ensure GPs of the future are there for the right reasons.’

Dr Krishna Kasaraneni, chair of the GPC training subcommittee and a member of the BMA Junior Doctors Committee, agreed that medical graduates should be motivated rather than forced to join general practice.

Dr Kasaraneni said: ‘I don’t want anyone to be forced into general practice, they need to be encouraged to pursue that as an option. It’s not that hospitals are over-filled with consultants – we still need doctors in both primary and secondary care, but we need more GPs and any innovative way of making it happen we are open to.’

A spokesperson for HEE would not comment on the plan to cap specialities, but said: ‘We are anticipating a requirement in our refreshed mandate to report later this year on training requirements for the GP workforce and the information in the taskforce report will be one of the resources we look at as part of that wider work.’

Information from the CFWI report into the GP workforce last year showed there was a doubling in the number of hospital consultants trained between 1995 and 2011 and a 50% rise in other non-GP specialists, compared with only a 30% rise in the number of GPs.

Investigation: Are we running out of GPs?

A Pulse investigation has found that 21 practices across parts of London, the North and the Midlands are facing as extreme a situation as one area in North-East Essex, where NHS England has stepped in to help with recruitment, with one full-time GP serving more than 8,000 patients.

Click here to read the full investigation.

GP density map - large - online

Readers' comments (40)

  • The solution to attract new GPs and retain existing ones is to make the conditions better than they are now. Forcing people into jobs that they don't want to do won't help the crisis - they will simply leave at the other end. Ultimately, this will filter down to medical school applications and the best potential entrants will realise what a hostile environment Medicine provides - they will simply go and do something else.

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  • So they are essentially forcing many doctors to choose GP as a vocation indirectly and as a eminent Professor one said "GP is a most difficult job to do well and easiest job to do badly". People forced into General Practice woul more likely to have burn out as General Practice tends to have high levels of uncertainity compared to other specialities and hence if psychometrically not suited to some doctors who would shine in some specialities but not in others. Why not make general Practice more attractive!

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  • You can take a horse to water but you can't make it drink! Especially when it is a stinking sludge pile! Why not invest in some "flood defence" and "environmental conservation" and educate the public about being responsible with the land and it's resources. That way you'll have clear waters lapping gently at a shore lined with an array of wildlife eager to drink...... This is a bullying government threatening to bully people into jobs they do not desire. Patients will be worse off for being treated by someone who wishes they weren't there. FFS just stop attacking and build up UK general practice into what it should and could be

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  • I am counting down the days to retirement now - had one career then retrained as GP. In the space of 12 months both my jobs will be taken over by social enterprises and I spend my time wading through drivel from managers. very relieved neither child wants to do medicine - they have managed to put some of their classmates off too,

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  • The short term boost in GP numbers will be more than countered by newly trained GPs leaving as they feel forced to do something they do not want to do. A profession which has to force people against their will will be even less attractive when filled with miserable resentful people.
    In addition, denying specialist training after 7 years to those who started out with an aim to do something specific will make medicine a less attractive option for all entrants to medical school. Those that can will go abroad for further training after F2.

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  • The better option would be to make hospital medicine as equally crap as general practice to even things up....

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  • Don't worry, they are doing their best to make medicine crap for everyone!

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  • They want to bring down the whole NHS and lay it at the door of GPs who were trained but "couldn't be bothered"! Yet again it's the "lazy GPs!!!...." Whilst the f2s will emigrate also no one in their right mind will remain a UK doc. Good luck Joe public, don't forget to switch off the lights when youre the last ones to leave!

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  • The conditions of work must improve or the financial reward to compensate for the difficulty of the task must increase . For an administration that proclaims the advantages of a free market economy it is being wilfully obtuse.

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  • The numbers of trainees are revised almost every year and the trainee numbers depend on projected demand for that speciality. It has never been a open market in that respect ,that you can choose to train in whatever specilaity you want to train in. Prior to Calma the cut off point was at Senior Registrar trianing .Since Calman a trainee once recruited into a speciality subject to satisfactory asessments proceeds to end of training.This is not a exact science so no guarantee that there would be a post at end of training . However there is little point in training if there is not a reasonable prospect of empoyment in NHS at end

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  • Demand Vs Supply.
    Government has recognised that GPs are overpaid and have more power comparing to their colleagues in hospital jobs. They cannot get back what they have already given out to GPs due to legal reasons. Next best thing is to flood the market to decrease the demand. Increase the competition by bringing in well-established multinational companies to compete with business amateurs (no offence intended). By doing so, they would have a wider control of all aspect of the profession. Cleaver thought isn’t It ? Big people in big places always have ways in which they will achieve what they want, one way or the other. Some of our reputed influential colleagues will always help them to achieve their agenda.
    First they came for IMGs , now they are coming for the locals. That is how it works everywhere in the world.
    First they came for the Socialists, and I did not speak out-- Because I was not a Socialist.
    Then they came for the Trade Unionists, and I did not speak out-- Because I was not a Trade Unionist.
    Then they came for the Jews, and I did not speak out-- Because I was not a Jew.
    Then they came for me--and there was no one left to speak for me.

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  • I agree with the above in essence but....
    The problem we are discussing is the acute shortage of GPs due to doctors either being unwilling to go into general practice or leaving early.
    All other things being equal, there should be a balance between the number of people being trained and the number needed,agreed.
    However, all things are not equal, and the suggestion of restricting training other than GP is not based on the need for fewer hospital doctors (yet) but on the need to force people to do general practice.

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  • Bob Hodges

    Hold medical school interviews at the Golf Course!!

    If the applicant looks like they can swing a driver, then they'll probably make a fine GP novice 9 or 10 years down the line.

    You can no more force people to become GPs, especially full time ones, than you can to become keen golfers.

    Make the career more attractive - how about tax relief on golf club membership?

    Right - time for a quick 9 holes before evening surgery.

    Fore!!!

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  • Medicine in now an international market. The GP’s that have qualified in my surgery have the whole of the world to look for work. General practice remains a fantastic career, but why work under this constant headache from the government in a UK NHS surgery?
    They have access to better paid jobs in the hospital in the NHS, such as the new GPWSI in A&E. None of my recent trainees is remotely interested in any form or partnership; they want a career where there is good work life balance (i.e. 9-5 Monday to Thursday, EWTD compliant, no visits or on call and minimal paperwork) and none of the administration headaches – they want to be doctors and not managers.
    Several have left for Canada, Australia, Qatar and even one returned to his native Nigeria. Moving doctors from secondary care to primary care is not the answer as we will end up with a crisis in secondary care. Don’t expect the south Asian doctors to bail you out this time as they did in the 60’s and 70’s after the way they have been treated.

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  • WHEN you train a GP, you give them there wages. if you l ask them to return money spent on training, if they do not serve as gp's for three years then crisis will be over.
    when i entered g/practice, market was flooded with doctors trying to enter g/practice and we worked for very little money.
    GP'S are surely have excellent income since 2004.

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  • The next thing will be saying only those who want to do A & E medicine or General practice as news last week showed shortage there too!! - you couldn't make this up. I hope the electorate remembers the hash our co government has made of NHS not to mention the absolute waste of money

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  • Bob Hodges

    I heard that the coalition held it's Christmas Party at the Fuller's Brewery in Chiswick this year.

    No one was allowed to leave the brewery until 50% of the attendees failed a breath test.

    They're still there.

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  • >WHEN you train a GP, you give them there wages. if you l ask them to return money spent on training, if they do not serve as gp's for three years
    ---

    Excellent thinking - so no-one will want to enter training to begin with at all.....

    Well done...straight to the top of the class etc...

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  • This is a ridiculous attempt at increasing GP numbers and is never going to help address the issues. They are not listening to the problem that is being screamed at them by GPs who have had enough of the current state of General Practice, either that or there is an alternate agenda of breaking up the NHS.

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  • As a disillusioned ST3 who just cannot wait to go back into hospital medicine upon completion of GP training I think any plans to limit the number of non-GP posts should be opposed strongly!
    The government needs to understand that graduates will often move between different specialities as many junior docs simply cannot make their mind up after the relatively limited exposure to various specialities following F2 - and being forced into general practice will not solve the problem as such trainees are likely to later then go overseas, 'do the bare minimum' or quit NHS altogether.
    The powers that be should perhaps be wiling to look at other options that can complement primary care e.g expansion of Community Geriatric services, more general physicans liasing closely with primary care, quicker access to investigations, investing in more clinical psychologists (I am quite unhappy about the traditional 'primary care' & 'secondary care' divide and think that there really needs to be much better integration of the two to deal with our increasingly elderly population)
    If on the other hand hunt et al wish to ask GPs to deal with patients who have very self limiting illnesses, QOF, social problems that the government is simply not taking responsibility for, sickness certification that would invariably lead to conflict were the doctor to politely refuse..then I think many doctors would simply be foolish to choose GP as a career, who will then fill the gaps??-

    aw, just realised that a lot of english speaking IMGs have been put off by the CSA fiasco. Suddenly going back to doing nights and the politics of hospital medicine seems like paradise!

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  • Once again all anonymous except one response. If for some strange reason a health minister did read Pulse then they wouldn't pay any attention to responses because they wouldn't know who to contact about their opinion anyway.

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  • GPs need to be careful. if there is a shortage of GPs in the future and practices are unable to cope, its a good excuse for the DH to offer GP contracts to private companies. Now you might say (anonymously of course) that the private sector will struggle even more than the GPs based on the current contract, but what is offered will not be the same. No NHS Pension, No rent reimbursement, No IT costs covered, etc. Salaried GPs paid by a private company.

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  • Bob Hodges

    The flaw in your logic there Brian is the assumption that private companies would not only be able to find enough appropriately trained GPs (who current lack of existence is threatening the service) to deliver primary care, they'd also be able to employ them at a fraction of the cost.

    It don't make no sense!

    The more likely alternative is widespread collapse of the service in large areas with huge electoral consequences, unless there's industrial scale Gerrymandering, followed by a free market in GP skills and labour resulting is services rendered to the highest bidder.

    Do you think I'll be seeing patient for a fiver a pop for Serco or CareUK?

    Flesh will be denominated in KILOS not pounds!

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  • Vinci Ho

    Vinci Ho | 03 February 2014 8:42pm
    Typical right winged bullying government --
    What about blocking girls going into medical schools or women becoming GPs because politicians were moaning female doctors being a burden of NHS? Ba***rd

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  • Hey, I thought the submission to the pay review body was that there was no problem with recruitment or retention, so no increase in pay - in fact , cut wages = GPs earn too much and play too much golf. I think we are getting our Kers in a twist over nothing. There are lots of unemployed GPs playing lots of golf. FORE ! is right.

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  • And employed ones playing lots of golf as well.Fore!!

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  • Brian Austen - how would giving GP contracts to private companies increase the number of GPs available? I've heard this strange assertion before, the suggestion that if you made all GPs salaried and forced them to work 'efficiently' for less money on crappy contracts with no NHS pension suddenly you'd solve the work force crisis and they'd be GPs everywhere clamouring to work in areas of need on a sunday….how does arranging health care provision for the benefit for shareholders in private companies increase the avalibale GP workforce?…greater efficiency perhaps? …more use of nurse prescribers?... I don't know ...perhaps you could explain

    On another tack I personally post anonymously because I'm not at the end of my career and need to remain in a job..which I suspect is the case for many others...not rocket science really - congratulations on not being in this position but not every body is... had this not occurred to you??

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  • anonymous 11:00pm- be brave! why are you worried about loosing your job???? there are loads of vacancies out there... and even better ones abroad... ......best thing that could happen the profession is a mass exodus..... if one looks at the shortage in the US, Canada, Australia and New Zealand every GP in the UK could take up a post abroad....... and then we could all send the health minister a post card thanking him for inspiring us to take up a new life abroad....with a PS asking him how he is getting on in the Uk without GPs.

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  • There is no crisis just alot of hyperbole.Recruitment in any sector of the economy is cyclical and varies geographically.Vacancies in rural and inner city areas have always been the most difficult to fill.That is nothing new.Medicine remains the most popular subject for university graduates and there is only a finite capacity to absorb them all into secondary care posts.Ergo they must side step into general practice.A few may leave or emmigrate but that is proportionately a tiny figure.General practice will do just fine.

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  • "Do you feel lucky, punk ?"

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  • They tried opening the doors to more GP trainees, and that led to a disaster with large numbers of trainees in difficulty who were unable to cope with general practice.

    This led to an increased failure rate, and burn out in trainers who were unable to make a poor trainee passable. The CSA became the scape goat for many, however the simple fact was that these trainees were never suitable for GP training in the first place.

    The deaneries tightened up the selection process and the failure rates have reduced.

    The issue is that the good candidates will always go where the want, and the rest will be herded into a career they don't want, or are unsuited to.

    Make being a GP attractive, stop the media bashing and make it possible to get a partnership by reintroducing a basic partner allowance, and stop the salaried push to allow private companies in, stop stealing the pensions and driving down GP income - and all of a sudden GP numbers will grow.

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  • 8:12am This just isn't true. Its pretty simple really, there are not enough GPs getting trained in this country to meet demand..the numbers are controlled by government (not by the market) and they haven't been training enough. Supply of GPs IS cyclical in one respect - that based on working conditions and pay..when these are poor there's a recruitment crisis..this was what it was like before the new contract and this is the position we are in at the moment...working conditions are appalling and noone wants to be a GP. You cant rely on stealing GPs from other countries to fill the gap (or maybe you want to?). I work in one of the better served areas off the country as a GP locum and there is an enormous demand for my services. Almost every day I receive emails with local adverts for practices looking for salaried GPs or to cover partners retiring early or going on 'sabbatical'. Its quite a struggle to remain as a locum and not be sucked into another crappy salaried job. It wasn't like this when i moved to the area several years ago..it just wasn't. Maybe you work in a managerial/policy capacity or as a GP in atypical area of the country. Sticking your head in the sand and saying 'crisis what crisis' is a very poor approach to a dynamic situation.

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  • Bob Hodges

    I'm detecting the overpowering stench of wishful thing from anon 8:12 as well.

    Not all 6th formers are equal. Not all med students are equal. Not all F1/2 doctors are equal. Not all GP ST3s are equal. Not all GPs are equal.

    It's not about numbers alone. There is a limit on the number of GPs that are available because only a very small percentage of the population (and a minority of med school entrants) have the true natural aptitude to become good GPs, even if the do get good training and pass CSA.

    In summary not all all GPST trainees are capable of being GPs - if you flood the training schmes that proportion will fall.

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  • 12.13 PM.
    no one ask anyone to be gp's. all choose themselves. like you did.there will never be shortage till money is there to earn.
    job for life and guaranteed high income, why would you be short of gp's?

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  • Bob Hodges

    9:28 -

    There is no 'Guaranteed income' and it's been falling year on year since I became a GP in 2008 (having retrained from another specialty).

    The variables of concern here are - getting on a training scheme doesn't mean that a) You will complete the training scheme and become a GP b) If you do complete the training scheme that you'll be any good a GP and c) You'll stay in the UK. A huge number of UK GPs are in Australia now - because there's even more 'more to earn', the quality of life is better and they don't get slagged of by a coddled population desperate to abuse your time 'cos it's free!

    There IS a shortage, and what's more shortage begats shortage as the overworked rump retire ealry, emigrate or retrain. I'm considering reducing to 3/4 time because It's killing me, and I can earn more doing something else with that time.

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  • Bob Hodges

    In summary - what you're syaing is that 'market forces' will prevent a recruitment crisis whilst sticking your head in the sand and ignoring the massive body of evidence that 'market forces' ALREADY HAVE CAUSED a recruitment crisis, and serve simply to exacerbate it.

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  • this is great news !

    those drs who are forced to be GPs are going to be unhappy and leave for locum / part-time work or may go abroad to train in their chosen specialty thereby exacerbating the crisis. I know of a few hospital drs who tried training as GPs and hated it - they promptly returned to hospital medicine.

    good idea by whoever thought this up - give him/her a promotion.

    i can imagine the youngsters thinking 'i'm £100,000 in debt for my training and i want to be a cardiologist but they are forcing me to be a GP - I know i'm going to do USMLE and go to the states...'

    another winner probably by the team that brought you 111.

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  • Bob Hodges

    The same team that brought you NHS 111.........

    And Darzi Centres
    And Connecting for HEalth
    And Choose and Book
    And Most of QoF
    And ITSCs

    Team of the decade goes to Senior Civil Service at the Department of Health.

    Well done chaps - even the MoD procurement team with their famous 'more expensive to cancel ships than build them' contracts can't hold a candle to you.

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  • dear bob
    agree..so much..with you..
    the problem with the nhs is truly catastrophic waste and mismanagement by the DOH almost to the level of criminality.(how else could you describe serial unpiloted non evidence based schemes that waste desperately need resources for sick people)..and therefore failure to fund enough clinicians and beds..look at stafford..an example of wilful criminality in my opinion for which certain people should be tried and go to prison. these 'human beings' deliberately put application for trust status ahead of basic human care..but a natural result of the profound stupidity of the totally unnecessary incredibly wasteful and absolutely ludicrous 'internal market'.

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  • Bob Hodges

    You're right.

    Morally, all the blame lies inside the M25, but they've been very adept at ensuring that this does not apply legally.

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