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GPs buried under trusts' workload dump

Fewer trainee doctors intending to become GPs, show official figures

The proportion of foundation-year doctors intending to become GPs has dropped in the last year, according to the latest career destinations report.

The 2018 report on the intended and final career destinations of F2 doctors also found the proportion actually going into specialty training, including GP training, has plummetted from 71% in 2011, to just 38% last year.

More doctors are also taking breaks after foundation training, in part due to ‘increased stress and burn-out’, the report said.

While the BMA said the drop in GP numbers is ‘worrying’ and will only worsen the current workforce problems, Health Education England said the latest trends highlight a ‘change in attitude’ which need ‘further exploration’.

This comes despite the GP trainee recruitment target being surpassed for first time last year.

The annual UK Foundation Programme Office report surveyed all F2 trainees on their career aspirations and planned pathways, with 6,407 responses included.

It said: ‘GP self-reported intention fell from 21.4% to 18.7% and core medical training (CMT) increased from 18.3% to 20.7% compared to 2017.’

When looking at where the trainees actually ended up, the survey found the number going into specialty training (including general practice) had decreased every year since 2011, from 71.3% to 42.6% in 2017 and then 37.7% in 2018.

However, an increasing number of doctors are also taking breaks after foundation training.

‘Since 2011 there has been a downward trend in the number of F2 doctors moving directly from the Foundation Programme into specialty training in the UK, with 37.7% of F2 respondents reporting immediate entry into specialty training in 2018,’ the report said.

Although the report said it could not provide definitive reasons behind the decreasing GP numbers and increasing breaks, it is thought stress and continuous examinations could be important factors.

It said: ‘Investigation by the GMC and other organisations has demonstrated increased stress and burn-out along with dissatisfaction with certain elements of the training structure among junior doctors generally.

‘The unremitting examination and assessment cycle throughout medical school and foundation training results in many doctors expressing a desire to "step-off" training and have more control over their working schedule or to take up the opportunity to travel with or without a work component.’

It added that GP recruitment is ‘more complex’ as last year saw a record number of GP trainees recruited, an increase which seems to go against these findings.

However, this is most likely due to many of these new GP trainees not coming directly from foundation training, the report said.

BMA GP executive team member Dr Krishna Kasaraneni said: ‘Whilst it is positive that GP recruitment has improved this year, the fact that fewer and fewer foundation doctors are choosing GP as a career overall is worrying.

‘If that trend is not reversed, we do worry that GP workforce will continue to drop and the workload will become unmanageable for the ones left behind.’

Health Education England deputy medical director for education reform, Professor Sheona MacLeod, said:Opportunities for portfolio-based careers, the chance to develop additional skills and recognition of less than full-time training for doctors are just some of the factors which have led to a decrease in the number of doctors at the end of medical school who are intending to progress as soon as possible into specialty training (including GP).

‘It highlights a change in attitude which is evident prior to entry into the UK Foundation Programme and this needs further exploration.’

Earlier this month, Health secretary Matt Hancock told Pulse a new date for the Government 5,000 extra GPs target has not been set, although he admitted it would be ‘slower than was originally’ thought.

A five-year GP training scheme – recruiting trainees straight from medical degrees – is also in discussion and could start in 2021, following a pilot in East London, an NHS England advisor told Pulse.

Stated Career destinations of successful foundation level 2 (F2) doctors

Subtotal for specialty (including GP) training in UK:

2011 - 71.3%

2012 - 67.0%

2013 - 64.4%

2014 - 58.5%

2015 - 52.0%

2016 - 50.4%

2017 - 42.6%

2018 - 37.7%

Source: F2 Career Destination Report 2018

Readers' comments (14)

  • STOP THE BULLSHIT ! THIS ISN'T SOME GREAT MYSTERY OF THE COSMOS.

    IT IS REALLY SIMPLE, IF YOU KEEP TREATING PEOPLE LIKE CRAP, DON'T EXPECT THAT THEY SHOULD KEEP COMING BACK FOR MORE HELPINGS OF ABUSE.

    IT IS TIME TO THROW IN THE TOWEL, STOP ABUSING GPs, STOP THE MEDIA SPIN AND BY THE PROCESS OF MAGIC THE NUMBERS WILL START IMPROVING.

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  • OH AND PS FORGET IDEAS ABOUT THREATENING JUNIOR DOCTORS (AGAIN)...MOVE ON IT WON'T WORK.

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  • LMS spot on,they a failures at trying to manipulate the free(ish) market.This job demands/liabilities/ reponsibilities and no compensated for by work-life balance rewards and renumertion so the BS they try to improve the situation is doomed to failure.Our younger colleagues aren't as stupid as they think they are.But the executive seem as stupid as we think they are and prove it every day.

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  • So it appears that the numbers of Doctors entering ‘all’ specialty training is falling at a very rapid rate. The question is what are all these young doctors doing for income? The outcome for the whole of the NHS is going to be absolutely disastrous for those left within it and their patients. If things go on like this the NHS will fall off a cliff. There comes a time when the stress and workload of the job results in what has been a slow trickle becoming a raging torrent of Doctors and Nurses leaving with no new healthcare clinicians joining. This should be picked up by the national media, but probably will not happen.

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  • CENSORSHIP?

    it's sad but the numbers in gen prac go up when secondary care is considered worse..

    i.e. turned away from hospital rather than attracted to general practice

    The lesser of two evils ??
    where are you less likely to be scapegoated for organisational pressures

    A consultant surgeon once mentioned its not paradise and easy street on getting to consultant
    but its a long slog in a lot of specialities
    with lots of dues to be paid


    The partnership with all its benefits was the main attraction in the past
    but not now
    with unlimited liability and long hours
    and never ending bureaucracy and external costs
    Salaried - all the work and none of the benefits


    Advise to kids
    Think twice about Medicine altogether
    and if you do enter ..

    SpecialiSe in a speciality
    with better private work capacity
    better career progression / earning potential / Work life balance / Opportunites abroad

    or become a medical management consultant for the NHS.. heard they get paid tonnes

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  • CENSORSHIP?

    Numbers entering Gen Prac
    Post Brexit ...
    1. loss EU entrants ?
    2. ? External / Asia recruitment
    Plug the drain
    Stop deportation of those fully trained here and ready to work

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  • CENSORSHIP?

    If Gen practice was a true private business without so much external interference
    Truly being your own boss
    it would become attractive again

    Dentists seem to have this

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  • Are the powers that be really so stupid. Just speak to trainees and seniors and it is obvious. The benefits vs drawbacks and risks of practicing medicine have tipped away from benefit. A perfect storm of reasons;
    No light at end of tunnel in terms of pension, relative wage, status or control over work. Over and innapropriate regulation , loss of trust and undermining of the profession by politicians, media and public, increased work load and intensity of work, rota changes with loss of supportive firm due to European rest directive, impossible work life balance for women, more exams and ongoing summarise assessment throughout, revalidation ( as opposed to appraisal which I think is good), loads of alternative careers for bright and motivated people with less risk, more pay and more control. I could go on.
    Stop blaming the attitudes of doctors. They are doing what bright people do!!!

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  • This is deliberate government strategy. Doctors are costly. Destroy traditional General Practics. Hub model will emerge with lower paid clinicians/paramedical staff.
    Its already started--do any of you have paramedics,pharmacists,PAs or HCAs in your surgeries?

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  • No surprises. The UK's toxic environment to practice means medicine is no longer attractive for the best students, not to mention the excessive tax, MDO fees, CQC fees, GMC fees, subscriptions etc. People have wise up. I hope the BMA push for privatisation like the dentists. Why should we take on all these difficult cases and risks? I am quite happy seeing simple things like we used to do and not manage cytotoxics, complex chronic diseases etc.

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