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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)

  • 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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