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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)

  • I love listening to the banter of medical students, they are bright, young things having the time of their lives. Leave them be, reality will hit home soon enough.

    And when the RCGP sends out colouring-in books and felt-tip pens to newly qualified GPs, what other possible reaction is there?

    Enjoy your milk and biscuits at breaktime guys (banter, obv!)

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  • I really don't think it's the banter that puts people off these careers.
    With psychiatry it's probably the fear that you might ' catch' the mental illnesses going around and with GP it's because it's generalist not specialist. Both jobs are hard.
    I think that this story is old news. It may have been relevant even 5 yrs ago but now no one wants to go into medicine at all; relatively poor pay; no respect; risk of GMC etc hanging you out to dry; negative publicity etc etc etc. I don't know any medic who would encourage their children into the job. That speaks VOLUMES

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  • My kids had good A level results and I didn't need to put them off Medicine. They said "no way are we going to do what you do " , alluding to the long hours, dwindling income and general feelings of being responsible for Jeremy *unt's random decisions in the public's perception!

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  • Ivan @7.14

    Hi Ivan, Please remember O/seas GPs thinking about coming back to the Uk are also reading these posts. 4 am in the Uk is the middle of the working day for doctors in Australasia and the Americas. Don't patronise us. It is more than enough reading these comments

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  • My son goes to Oxford medical school and despite its academic elitist undertones he has never heard ANY negative attitudes to general practice on the wards or from within the medical school. His negative attitudes towards GP come from his time spent in GP seeing GPs ground down by patient volume, snowed under by pointless bureaucracy and the constant denigration of GP by the press.

    Indeed Ivan we also dont do ourselves any favour......
    "Dr Ivan Benett told delegates at the event in Liverpool that most GPs 'do not listen' to patient concerns and the service was 'no more democratically accountable than the greengrocer".

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  • To think that banter is the main factor influencing bright medical students' postgraduate career choices is an insult to medical students and to GPs. But this is from those who would give colouring books to adults so it shouldn't be a surprise if we're treated as children.

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  • where is the evidence that banter has an effect?

    have we just given up evidence based decisions - if so can we get rid of NICE?

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  • 11.07,
    I had a very similar experience. A/E Registrar used to call VTS trainees as
    "you lot". In Obs/Gynae rotation, the midwives would call GP trainee for venflons. It reached a point when I complained to the deanery.

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  • Golden handshakes should be offered to everyone who joins GP training.That will boost GP recruitment.

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  • Negative banter is not responsible for poor recruitment to general practice. To suggest so is to vastly inflate the power of banter and amazingly patronising. Medical students aren't idiots. General practice is grossly under funded and massively dumped on. That's the reality of the current situation. This isn't an issue that can simply be fixed by spin and positive advertising. It's the result of real issues that are actually happening, not negative press. Wake up you bleedin idjits at the RCGP

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