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Outlook bleak as trainee applications hit new low

Medical graduates are continuing to shun general practice, with the number applying for GP training schemes down by 6% on last year, finds Jaimie Kaffash

‘I have seen the GP career go from one that was quite attractive to something that is very unpopular,’ says Anish Koneru, a medical student at Imperial College London.

Having once had an ‘open mind’ about a career in general practice, he has now ruled it out for good.

And he is not alone.

The number of medical graduates applying for general practice across the UK has gone down by 6% this year, hitting a six-year low.

Yet this comes at a time when the NHS, the Department of Health, the BMA and the major political parties all agree that boosting GP numbers is essential for the long-term future of the NHS.

As a further kick in the teeth to practices struggling to recruit, the figures come just a month after NHS England laid out its plans to boost the number of new GPs working for the NHS.

Health Education England is refusing to provide a regional breakdown of these figures, which include Scotland, Wales, Northern Ireland and the Defence Deanery. But Pulse understands there are substantial regional variations.

HEE claims that, in England, it is ‘well on course’ to meet its target of 3,250 new GP trainees a year.

But GP leaders believe it may be too late to avert a looming shortage of GPs, despite fevered efforts behind the scenes to do so. 

Worrying prospects

The national figures for applications, obtained by Pulse, show a fall of 6.2% on last year, with only 5,112 applicants in total.

This is an 18% drop compared with the 2009 high of 6,200 applicants – the first year for which figures are available.

The figures paint a disturbing picture of the prospects for the profession.

GP training applications - March issue

A Pulse analysis of previous years’ figures shows that, on average, 54% of applications result in filled positions. This year, that would translate into just 2,760 positions across the whole of the UK being filled by the summer – far short of the 3,125 training positions available in England alone this year.

In HEE’s East of England region, the situation is ‘dire’, according to Dr Tim Morton, chair of Norfolk and Waveney LMC, where there were just 336 applications for 332 places this year. Traditionally, there are 1.7 applications per post in the region, meaning educators were expecting more than 560 applications this year. 

Dr Morton says: ‘The profession’s warning cries have been ignored, and now they are coming true. The huge concern is that we have over-50s retiring early, partly because of the intolerable workload, and practices find themselves in a position where they cannot recruit because there are not enough younger doctors coming through the training schemes.’

And he warns that the situation in the East of England is not unusual.

‘This is national. I talk to fellow LMC chairs across the country and this is the norm, not the exception. [But] we’re in a better position than Wales, West Midlands and Yorkshire, which I find quite frightening.’

The LMC is working with HEE and NHS England to try to solve the crisis. ‘But this is about five years too late’, Dr Morton says.

It looks as though a repeat of last year’s training turmoil is on the cards. HEE was forced to introduce an unprecedented third round of recruitment last July, after some areas saw 40% of posts unfilled after the second round.

The health education body even had to introduce a ‘pre-GP training year’ in hospitals for applicants who failed to pass the assessment processes, which it claimed was to give them the experience to pass the assessment processes the following year.

GP trainer’s view: ‘We are already feeling the fall in training applications’

Dr Uzma Ahmad - online

I am a trainer and I like to train and teach. I am currently training a would-be GP, but I am worried there won’t be another one in the next allocation. 

There has definitely been a fall in applications locally; we are feeling it already as GP practices. Trainees used to apply to general practice for a variety of reasons, such as flexible working hours and job stability.

But in the past five years, negative media coverage and the Government’s constant demands to do more with less have hit morale. This has put off young doctors, which is why we’re seeing a fall in applications for GP training in Walsall and across the Black Country. 

In the long-term, if you have a look at the Five-Year Forward View, NHS England wants to move everything from secondary care to primary care. Who is going to do that work if the workforce is not there?

There is a mismatch between what they say and what the reality is.

It is already very difficult to find GPs for salaried posts, even with incentives. When I qualified in 2005, I had to go out and look for work. 

I have been a partner for years and I have never before had companies approach me with offers of locum work. These days, my inbox is full with such requests.

Dr Uzma Ahmad is a GP trainer in Walsall, and a member of the GPC education and training subcommittee.

Efforts intensify

Dr Krishna Kasaraneni, chair of the GPC education and training subcommittee, says efforts to work together to boost GP numbers are taking place on a national scale now because the training crisis has the potential to ‘impede patient care’.

He adds: ‘We are working with the NHS England and HEE to find solutions to the issues, but we do believe that politicians of all parties need to provide additional support to enable more GPs to join the NHS workforce.’

There is no doubt that efforts to improve the recruitment of trainees have been stepped up.

NHS England released a 10-point strategy in January aimed at improving recruitment and retention of GPs, with ‘golden handshakes’ for graduates entering the profession, a marketing campaign aimed at young doctors and an additional ‘flexible’ year for GPs to train in a special interest.

This came a month after HEE had released its own workforce strategy, which set out plans to increase the number of GPs available for employment by 15% by 2020, work with the RCGP to attract more medical graduates to become GPs and commission a new GP workforce report on the numbers needed to provide NHS England’s new models of care. 

The RCGP has already released a YouTube video telling medical students it is ‘the best time in a generation to become a GP’.

‘A lot more work for little reward’

However, as Dr Morton puts it, the reason behind the poor level of interest among graduates is ‘the impressions they have of primary care’.

A trainee himself, Mr Koneru would agree with this sentiment.

Having seen the effect the job had on his parents – who are both GPs – he has been put off the career for good.

He says: ‘It seems a lot more work for not much proportional reward.’

Mr Koneru says his fellow medical students keep up to date with what is going on in the profession and it is ‘absolutely the case’ that they have been put off general practice.

If NHS England and HEE are serious about increasing the numbers of GPs, they must take steps to ensure potential recruits are seeing a profession in a much healthier state.

GP training timetable

• 1 November 2014

Advert for applications for August 2015 entrance appears

• 4 December 2014

Closing date for first round of applications

• 3 January – 13 February 2015

Assessment of candidates

• 12 March 2015

Advert for second round of recruitment appears for positions not filled in the first round

• 26 March 2015

Successful first-round applicants informed

• 9 April 2015

Closing date for second round of applications

• 27 April – 15 May 2015

Assessment of candidates for second round of recruitment

• 29 May 2015

End of second round

• July 2015

Possible third round of recruitment

• August 2015

GP trainees from first two rounds of recruitment begin training

 

Pulse GP Jobs

 

pulse gp survey nov2018 180x250px v1

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Readers' comments (20)

  • @10.23

    http://www.hscic.gov.uk/catalogue/PUB14924/gp-earn-ex-1213-rep.pdf

    Page 23 - GPMS contractor GPs - distribution of average income before tax, UK,
    2011/12 and 2012/13

    Still looks like 30% of Partners take home >120k/year. You can argue about whether that's underpaid for the work we do but financially it's not quite as bleak. Yes not every partner makes that but there are still good practices out there.

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  • Still looks like 30% of Partners take home >120k/year

    MDU/MPS 7K
    Income tax 40%
    Payment on account 20%
    Pension 20%
    Practice loan 5k/y?

    Not much left to live on....

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  • Pension more like 30% for partners and more if you have added years :( - and you get to retire at nearly 70 - and you will probably be stung by extra taxes for lifetime and annual allowance.

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  • Pension is not 20% - it's 28% (employer/employee contribution)

    I "earn" just under 120K - the gross income.

    After taking the necessary costs, pension and tax, I'm left with 48k/year.

    Not exactly starving to death but that's for working 50+hours/week. If you proportion it down to average working hours of 37.5, it will be £35k/year

    Really? So if I was a partner working normal person's hours, my true earning would be £35k!? And that's for a GP in top 30% of earnings? with all the personal liability of the business?

    Does anyone wonder why no one wants to be a GP??

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  • Newly qualified GP's , young recently qualified salaried doctors , or current trainees.....STAY CLEAR OF THIS GUFF; emigrate and earn 150 k (cushy life) or 200K (hard work) or 250k ( type A personality/ suicidal sadomasochist/ Charles Bronson deathwish)!!

    or locum in the cesspit UK and set your own terms and conditions;

    GP pay is a battleground in which you will rarely win in the uk- any pay rises will be met with media headlines or tax grabs so you will be no better off; Leave for greener pastures and take your skills with you.

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  • @4.52 you've misread the table I think. That 120k is income after all costs are deducted. Page 8 provides the definitions for the report. Income is after expenses are deducted and prior to tax and superannuation.

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  • Another alarmist headline from Pulse.A 6% drop is hardly bleak.50% drop yes.

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  • i have to say that sadly the state of primary care is that disastrous that i would strongly advise young doctors to shun the uk like a plague..and go abroad at least temporarily until this country provides decent pay respect and conditions...then hopefully return.
    i am firmly of a mind now would be a good time for a major resignation threat or if ignored a strike against all non medical utter crap .i am disgusted for my younger colleagues about the present situation after 30 years as a doctor...who still firmly believes in offering rapid parity to a partner to new colleagues..unfortunately the job has become impossible and grossly dangerously overloaded..so a partnership is a poisoned chalice..for which we get no support from the cynical gmc nhse cqc and all the other self serving unrealistic delusional shower.
    the pnly thing that keeps me going like many is the genuine needs of my patients.

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  • As Dr Porter comes late to state they [ whoever that is] are targeting and denigrating General Practice deliberately. It shows in pension, pay, seniority, MPIG cuts. It shows in imposed Contracts and a reduction from 11% to 8% in England and 6% [!!!!] in NI.
    For doing at least 70% of all face to face NHS consultations - 6% !!!
    Well then folks it is time to leave and never come back.
    What surprises me is that so many people including MRCGP think that it is a fine time to join when the BMA thinks GPs are being denigrated intentionally.

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  • This comment has been moderated.

  • Anonymous | GP Partner | 09 March 2015 8:44pm

    I think the costs includes staff fees, etc but doesn't seem to include personal expenses (inc indemnity fees) though this is not clear.

    In any case, it doesn't deduct employer's pension contribution which is the largest anomaly in such figures when comparing with other medical profession as most others are employee and there for do not pay twice the pension costs as we do!

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