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Independents' Day

RCGP meets with medical school heads to discuss 'toxic anti-GP' culture in universities

The RCGP is meeting with medical school heads to discuss the ‘toxic anti-GP culture’ in universities, which has to be addressed before the gaps in GP postgraduate training can be fixed, RCGP chair Dr Maureen Baker has said.

Responding to a question about low morale in the profession affecting whether medical graduates want to study general practice at a session during the RCGP conference in Liverpool last week, Dr Baker said that she had raised the issue of a ‘toxic anti-GP culture’ medical schools in meetings with officials.

She said that evidence suggests that students go in to medical schools with positive feelings about general practice, but this is gone by the time they leave.

It comes as GP training is in the middle of a recruitment crisis, with Health Education England falling well short of targets for recruiting GP trainees, and some parts of the country failing to fill up to 40% of places for this year’s intake.

Dr Baker’s comments follow statements by the chief executive of NHS England, Simon Stevens, who told the same conference that the rates of Oxford and Cambridge universities graduates taking up general practice was low, and called on GPs to rectify this by helping to ‘make more of the folks you teach at Cambridge more interested in taking it up’.

Similarly, last year the then chair of the GP National Recruitment Office, Professor Bill Irish, told Pulse that top universities in the country are not doing enough to produce future GPs and are adding to a recruitment crisis in the profession, while a taskforce on GP training recommended that medical schools were incentivised to produce GPs.

The RCGP chair said that she the college will be putting together evidence to discuss the issue of the culture in medical schools before meeting with the Medical Schools Council.

Dr Baker said that she had raised the issue of a ‘toxic anti-GP culture’ in meetings with education leaders.

She said: ‘There were quite a lot of colleagues who thought that was an astonishing thing to say and that it must have been years ago and that it was not like that anymore. I said that actually it was still like that and indeed we did have evidence.

‘The head of the Medical Schools Council has formally asked for a meeting to discuss this issue and we will be putting together evidence and looking at the published literature.

‘Evidence suggests that when students go into medical school, they are very positive about general practice, and when they come out of the other end, they are not. So what is going on?’

She added: ‘It will be part of how we move our campaign on, in terms of tackling attitudes to medical school.’

A taskforce review from July this year - led by GP postgraduate deans, having been commissioned by the Department of Health - called for medical schools to review their output of GPs.

It said: ‘The Medical Schools Councils should evaluate why there is such high variation between medical schools in the proportion of medical students choosing General Practice as a career:11% of students at Cambridge were appointed to GP training, compared to 39% at Keele.

‘Medical schools should be incentivised by the Department of Health to boost the proportion of graduates choosing GP training as a first choice.’

Mr Stevens last week said: ‘I was looking at the proportion of medical school graduates who choose to go into general practice and Oxford and Cambridge are amongst the lowest. A bit of a cheap jibe, perhaps, but one thing you could help us with is make more of the folks you teach at Cambridge more interested in taking it up.’

Readers' comments (40)

  • Why don't the RCGP arrange a meeting with Paul Dacre and his editorial colleagues if they truly want to address the source of the 'toxic anti GP culture'.?

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  • ‘Evidence suggests that when students go into medical school, they are very positive about general practice, and when they come out of the other end, they are not. So what is going on?’

    What tosh. What is going on indeed. Maureen puts that down to the fault of the medical school? toxic culture? The current working environment is so bad that it filters down to the students, however you try and dress it up. Still missing the point, which is, make the working environment more attractive, they want to be GPs, not try and teach, maybe even 'lie' to them about it. If they have unrealistic expectations of what it is like in real life, then how do you expect to RETAIN them?

    Can't be sheer incompetence that RCGP are missing the point, can it? or a deliberate attempt to deflect from the real issues? or maybe just doing what they think they can, with no real power or desire to challenge the real life working environment

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  • its completely natural for the young to be drawn to what is seen ( and is to some extent) the glamorous. Its as you get older and wiser you see the benefit of public health and primary care and realize real change happens at a simpler level. The resp and cardiac clinic rooms are for salvage.

    The US has until the last 20 yrs has relatively poorly developed primary care and is prob the reason why outcomes are so poor wrt money spent.

    RCGP should work on retaining those who understand primary care - let medical school do their thing.

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  • I'm really not sure which planet Dr Baker worked as a GP - certainly not planet Earth!

    Last week it was defending NHSE chief who called us "corner shops" followed by great suggestion of getting a PA for GPs. Now blaming med schools?

    Why doesn't she meet with NHSE and DoH and tell them they are the ones creating a toxic culture?

    No? It probably interferes with her political aspirations too much. We really should have a vote of no confidence in her and all of RCGP council

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  • Medical undergraduates are not stupid,they get to see how gps are treated and respected.I also suspect they have been reading the tirade against us from th gutter press and the general reporting agianst us.Last but not least they get to spend some time in practice to see what its like.They see General Practice as it is and make their own minds up.The powers that be including RCGP need to recognise what its like on the coal face and make our working lives less beurocratic and more fulfilling.The establishment cannot buck the market to make more people go into general practice there has to be somthing in it for them.At the moment there is a long list of cons and not enough pros to keep our numbers up on General Practice UK.The future seems bleak,If not in 5 year when the 50 year old leave,it will be even worse in 10 year when the fortysomething are burnt out and start leaving in their droves.Something needs to change for the better and soon.The RCGP are part of the problem .

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  • the solution is simple just follow Stevens and Howe's suggestion and lie to them - tell them life as a GP is fantastic and their future as independent doctors are secure and promise them that their term and conditions will not be torn apart. Tell them that they are valued and the GMC will treat them with respect and yes Santa Claus does exist and there are pixies at the end of the garden. Also tell them not to worry as they will have medical assistants to help them so it will be ok.

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  • Medical students are not stupid.The only thing that is toxic is general practice.Isn't it unethical for the head of the RCGP to encourage future young doctors to make a choice that they will most probably regret?

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  • Agree with all the above.
    There's something comical about them scratching their heads over this.
    Though ultimately this just reinforces for me how out of touch Maureen and the RCGP are with the bulk of us. They do not represent me

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  • Una Coales. Retired NHS GP.

    There has always been a prevailing attitude in medical schools, both in the US or UK, that those who have the brains end up as surgeons and those who fall in the bottom of the class become GPs. Why?

    Hm let's see, if you are smart, you get to become a semiprivate consultant surgeon at a NHS teaching hospital on a 6 figure salary+clinical excellence award top ups + income from a private practice. One London colorectal consultant surgeon boasted to me of his £400k total income. If you are not so smart, you may end up as a NHS salaried GP on £54k working long hours and never be able to afford a house in London for your family as you will be forever trying to repay £100k government student loans for tuitions and maintenance with no scope for private practice.

    No such thing as a 'toxic anti-GP' culture in universities, just simple economics and facts of life.

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  • Not many medical students go into medicine wanting to do General Practice! Most of us (not all) wanted to be a heart or brain surgeon.

    The changes in the contract in 2004 brought pay up and attracted more recruits. But all the negative press does not help one bit

    The way to attract candidates is to make general practice attractive.

    Otherwise I would suggest all medical students to choose hospital based medicine for much higher salaries on 4-6 clinical sessions a week and getting paid for 10!!

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  • I qualified in 2002 and I'm afraid everyone from the statistics lecture (not a doctor may I add) saying "90% of you are going to be GP's so you don't need to know anything" to the professors and consultant never had a single nice thing to say about GP's or being a GP. That has no changed at all as far as I'm aware and in fact is getting worse. The RCGP, BMA and the toothless bodies who represent us have only made it worse and are just as much to blame. It is a crap job, with all the responsibility and no positives at the moment except being your own and setting your own work pattern, this too is unlikely to last. Consultants think they can treat you like their houseman. The resilient GP and fellow like minded GP's fighting back are the only things keeping me going. Not sure how long it will last. RIP General practice. Thanks for nothing RCGP and BMA.

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  • I went to Southampton and not anti GP as I recall. Always the odd jibe from the odd snooty type but a lot of that is banter. 10 years ago when you could earn 120k and have a busy but not ridiculously stressful working day it was attractive to those of us who wanted variety, to connect with patients on more of a personal level and weren't just interested in money. Now with saleries dropping stress workload beurocracy increasing not to mention the constant micro-management, prescribing/referral restrictions etc I think we feel like undervalued overworked technicians with little clinical freedom so how does that stimulate us on an intellectual level? We don't want to be told what to do all the time we want to treat each patient as we see fit, ie, holistically and tailored to them, and I think med students see this constraint, stress and low pay and think where's the positive side?
    If universities are being negative they are right to be, otherwise they would be doing their students a disservice in the current climate.

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  • I will never advise my children to enter general practice so why should i lie to someone else's?

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  • Took Early Retirement

    I am seriously regretting that Clare Gerada couldn't have another term in office.

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  • When I went into general practice, I did so because I wanted to be part of a community and get to know the patients. I wanted to practice holistic medicine and feel that, with my patients, I could make a difference to their lives. I knew that my choice was not sexy and exciting in the way that brain surgery was but felt that the personal relationships with patients, respect and continuity would make up for it.
    Sadly every aspect of the job that I enjoyed has been eroded. Continuity barely exists, we have been reduced to a boring, mechanical, tick box medicine and are forced to think protocol before patient preference. Alongside this the sheer volume of work has created stress and even less time to actually communicate with patients.
    Without the rewarding parts of the job it has become miserable, demoralising, exhausting and sadly boring.
    Why in Gods name would a medical student choose it?

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  • Having finished my GP training a few months ago, I'm so glad that I am now free (and thankfully still young enough) to retrain!
    GP is simply being swarmed - by patients who take no responsibility whatsoever for their health and politicians who demand yet ever more from GPs fuelling unrealistic demands. Things must change...and if that means that my generation of newly qualified GPs either emigrate, change speciality or quit medicine altogether leading to a complete collapse - so be it

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  • I've never understood why these professional hierarchies exist in medicine, if anything GPs have the hardest job. Specialists have an extremely narrow outlook (relating to their one organ or interest), receive patients who have already been nicely filtered and do the same boring repetitive tasks over and over again. At least GPs have variety and have continuity of care to provide a realistic chance of seeing and learning from the outcome of their interventions, whereas secondary care specialists often just treat and discharge, never to see the patient again.

    The sad thing is that instead of finding the holistic approach to medicine attractive, GPs are insisting it's high pay they need to draw them to the job. It makes you wonder if the right candidates are being selected. If you think the job of caring for patients is worthwhile, you'd do it without obsessing about whether your salaries are bigger than consultants.

    Do the job because it's worthwhile, not because it pays for skiing trips and school fees.

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  • Anonymous | Other healthcare professional | 09 October 2014 3:01am

    Please read my post of 0.33....
    I did general practice for all thse reasons. Money is simply not an issue for me....I am lucky enough to have a husband who earns enough to provide the very simple lifestyle that we enjoy.
    The job has become miserable and it is no longer possible to provide the holistic care that you advocate. It is soul destroying to go in day after day and be forced to do mindless tasks which I do not believe help the patient in any way but make it impossible to spend time with them. To then get castigated by people like you who do not understand and label us as greedy and uncaring is the final nail in the coffin.
    (Ex partner with patient satisfaction at 98%)

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  • @0.33 'Miserable demoralising exhausting and boring'- perfectly encapsulates current general practice. At 50 still doing 9 sessions after 20 odd years I am unable to emigrate and am genuinely unsure how long I can continue in this weird, toxic and hostile job.

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  • My advice to med students - don't go into general practice unless you want to emigrate somewhere that GPs are treated well and respected. As for the RCGP - a hopeless waste of time!

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