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GPs buried under trusts' workload dump

Stop med school GP 'banter' to boost recruitment, says RCGP

The RCGP and Royal College of Psychiatrists have teamed up to call for an end to stigmatising ‘banter’ in medical schools, which they claim is contributing to the shortfall of GPs and psychiatrists and stifling efforts to put mental and physical health on a par.

College chiefs Professor Maureen Baker and Professor Sir Simon Wessely warned the ‘systematic denigration’ of general practice and psychiatry is putting medical students off these specialties - and said all doctors should take a stand against it.

It comes as latest figures revealed only 100 extra GPs have joined the workforce over the past six months, despite Government aims to boost recruitment and retention of GPs, and the RCGP’s own efforts to raise the profile of general practice amongst students.

In an editorial published today in the British Journal of General Practice, Professor Baker and Sir Simon noted that recent research has shown general practice and psychiatry are the most derided specialties during medical school training, and that medical students are rejecting careers in each ‘because of the stigma attached to them’.

They said a 'hierarchy' that has developed across all medical schools ‘puts physical health over mental health, hospital care over community care, specialism over generalism, and "medical" specialties over "non-medical” ones’.

This also ‘perpetuates the view that hospital-based specialties offer more excitement, clinical challenge, and prestige’ than general practice, which is seen as a ‘back-up’ option, the College leaders argued.

And they warned the stigma around psychiatry – including throwaway comments referring to psychiatrists as ’pest controllers' – is hampering the drive to achieve parity of esteem between physical and mental health.

The editorial concluded: ‘The systematic denigration we are seeing in medical schools is founded on misperceptions that maintain a negative impression of both general practice and psychiatry, and a lack of respect for the importance of these specialties.

‘It is exacerbating a shortage of GPs and psychiatrists in the NHS, and directly contravenes efforts to achieve parity of esteem between physical and mental health, causing a negative impact on patient care.’

The RCPsych is already pushing a #banthebash campaign, to ‘address Badmouthing, Attitudes, and Stigmatising in Healthcare’, and Pulse understands the RCGP is in the process of developing a GP version of the campaign, with the help of members and medical students.

But Professor Baker and Sir Simon insisted their campaigns are not about ‘prohibition of banter’ but about ‘fostering respect between specialties and an understanding that the NHS is predicated on having sufficient numbers of all medical specialties, so that we can keep patients safe and well'.

Professor Baker, who has consistently complained about medical schools’ ‘toxic anti-GP culture’ during her time as chair, said it was ‘depressing’ how little attitudes had changed.

In a separate comment, she said it was ‘very concerning’ that ‘this “banter” is yet another barrier we are up against when trying to recruit enough GPs to ensure a safe and robust service for the future of patient care’.

She added: ‘It has to stop. The College is doing what we can to challenge misplaced and archaic stereotypes, and our Think GP campaign aims to show what a fantastic career choice general practice can be – but it’s clear that more needs to be done from within medical schools, and medicine as a whole.'

Br J Gen Pr 2016; available online 29 September

How medical school ‘banter’ is putting medical students off general practice

Professor Baker has previously raised the College’s concerns about the ‘toxic anti-GP’ culture with medical school leaders, and called on them to each individually tackle what she called ‘blatant bigotry’ against general practice.

But evidence of prejudice against general practice has continued to surface, with one medical school dean telling students they 'must work hard to avoid failing and becoming GPs'.

More recently the head of the RCGP in Wales claimed junior doctors were too scared to tell trainers they intended to go into general practice in case they were barred from experience on secondary care procedures or clinics, with NHS England primary care commissioning chief Dr David Geddes acknowledging the stigma around general practice.

NHS England chief Simon Stevens has also waded into the argument, accusing Oxford and Cambridge Universities of failing to promote general practice to medical students. GMC research from last year found that 'elite' universities are shunning general practice.   

 

Readers' comments (51)

  • Not a result of medical school banter, more a result of inadequate leadership, hoist by your own petard at last, have waited almost 40 years for this. Set yourself up as better than others then the only way is down. Suck up to politicians the only way is down. RCGP needs to be dissolved as a self centred money making enterprise that should never have been given royal patronage considering it cost £20 to join initially. They have no credible teaching body, although they may think they have. I cannot comment on psychiatry but I suspect the same... look at Freud and his offspring.

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  • @Ivan

    Take it you missed the Good News issue of Pulse then???
    Think Pulse are doing their best to promote good news.

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  • Not convinced banter has much to do with it.
    When I started around 25 years ago GP was good "fun", although not quite Golden Age
    Now it isn't (but I don't think our hospital colleagues are having much fun either!)

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  • I know several GPs who've advised their medical student children not to bother with GP land.

    I wonder why?? GP land is "so great" as in "Oh, Great!!"

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  • Banter is very different to the institutionalised dismissiveness of the consultants and medical school deans that we're supposed to be teaching us as undergraduates. Too much medical school is lead by the "clots" in bow ties who were such nerds all they had was there delusions of academic superiority. GP is a great job but being ruined by people who don't appreciate it

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  • try and improve work conditions for GPs or blame 'banter' - suppose blaming banter is easier to so.

    the only mystery is why does the RCGP have so many members when there is no one that i know who admits to being a member ?

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  • I think that the "closed world" allegation applies to GPs, too. Some feel we are lucky / privileged and do not appreciate our pay and conditions. Lots of people in the UK work hard, but none harder,but if you look at other people's workload, lifestyle and levels of responsibility, ther RCGP should not be trying to say it is all roses. Perhaps the RCGP should get out of London: al;l that Nitrous Oxide has finally got to you. Get out and look about:similarly hard working professionals have much better conditions and lives than we do. It is not just the patients who have become institutionalised by the NHS!

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  • THIS IS ALL RUBBISH. WHEN I WAS A MEDICAL STUDENT AT THE START OF THE 1990s, STUDENTS REGULARLY TOOK THE **** OUT OF GP CAREER CHOICES BUT MANY BECAME GPs (LIKE ME)-THE DIFFERENCE IS NOT THE BANTER BUT THE PRESS AND THEIR HATRED AND OBESSIONAL FIXATION WITH DERIDING, HUMILIATING, RIDICULING AND TERRORISING GENERAL PRACTICE AT THE DEMAND OF GOVERNMENT SPIN DOCTORS.
    JEREMY HUNT SHOULD BE HELD PERSONALLY RESPONSIBLE AND ACCOUNTABLE FOR THE SHORTAGE OF GPs AND START MUZZLING HIS SPIN DOCTORS.

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  • 1-20 I agree. I think the current working conditions justify the negative portrayal. Our local VTS has less than 25% recruitment for this year. It is probably too late..if we want General Practice to survive, we need a thermonuclear change right now: retention is going to hit even faster than recruitment. Oh look, its 1939, where did all those tanks come from? (we watched in idleness then, too!)

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  • Is there an actual substantive and quantifiable basis for this focus on undergraduate teaching. As far as I'm aware, the derision and debasement occurs in a post-graduate setting to a much greater degree - by secondary and primary care colleagues to an equal extent. I've met students who want to be GPs during teaching sessions, but it's FY1/2 experiences that will decide their outcome. Altering the perception doesn't alter the reality.

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