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Independents' Day

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)

  • 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.


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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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