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GPs go forth

NHS chief brands GP recruitment strategy 'crazy'

The chief executive of NHS England has said that the GP recruitment strategy over the past ten years has been ‘crazy’, with four times as many graduates entering specialist training than general practice.

Responding to questioning by the Public Accounts Committee (PAC) today (Monday), Mr Stevens said ‘there clearly are substantial pressures’ on the GP workforce which mean that NHS England has to ‘make coming into GP training more attractive, including attractive relative to hospital medicine’.

Mr Stevens blamed recruitment trends over the past 10 years for the situation NHS England now finds itself after being put under pressure by PAC chair Margaret Hodge MP on whether the NHS is recruiting enough GPs within the right timescale to ensure there are sufficient GPs.

The PAC was questioning NHS England’s management team in light of a National Audit Office (NAO) report published in July that showed that 60% of out-of-hours providers are unable to fill gaps in GP rotas.

Mr Stevens said: ‘GP numbers are increasing but there clearly are substantial pressures and one of the things that we have got to do is make coming into GP training more attractive, including attractive relative to hospital medicine because one of the great unplanned consequences of the last 10 years is that whereas GP numbers are up by between a fifth and a quarter, the number of hospital consultants is up by 76% in whole-time equivalent terms.’

‘If someone had said 10 years ago that the NHS’s game plan for the next 10 years is to have between three and four times more hospital consultants added to the roster than GPs, people would have said “that’s crazy”, but that is what has happened.’

Asked by the committee why he thought that was, Mr Stevens said: ‘My personal point of view is that one of the things that has driven that is the way that the European Working Time Directive has been implemented. I think it has had the effect of sucking in doctors into hospitals to create legal rotas and to some extent training has been the tail that has wagged the dog.’

Mr Stevens also admitted that NHS England has no game plan for how what sort of increase in GP numbers that the health service will need by the end of this decade, but blamed the Government’s lack of direction on how much NHS funding will be available to staff the NHS in general.

He said: ‘We don’t have a single model for GP numbers and the simple reason is that we have no idea what resource is going to be available to the NHS come 2020. As and when Parliament sets us a budget through the end of the decade we will then be able to work out what our staffing can be based on the resources.’

It comes as health education managers in the south west of England have been forced to to arrange a ‘crisis summit’ to tackle acute problems in the GP workforce and as Health Education England (HEE) announced in July that it was running an unprecedented third recruitment round for GP trainees after Pulse revealed that as many as 40% of training places were going unfilled in some parts of the country.


Readers' comments (36)

  • Nonsense. There are not enough doctors entering GP training because being a GP has become so unattractive as a career. Sort that out then things will change. NHSE, Government, DOH and Daily Mail should reflect on how GPs have been treated over last decade as they are responsible for this mess.

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  • I agree with the above. There is absolutely no point in just increasing the number of GP trainees when you can't retain GPs because the job is too awful.

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  • whats interesting is that margaret hodge asked how many more GP's were entering GP land and he gave an answer o imply a significant increase.
    Of course such a figure is meaningless unless you take into account retirements and also FTE's.

    again they talked abt patient satisfaction surveys as though it were a positive with no mention of the administrative burden associated with it.

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  • Payment by results has incentivised hospitals to increase activity and therefore consultants, that is why the increase is so dramatic. Now they are bankrupting the NHS through overactivity. Those in charge just can't see it, or don't want to.

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  • What the commentator doesn't seem to be aware of is that we are seeing exactly the same recruitment crisis in specialist training posts - 2/3rds of emergency medicine places are unfilled and 50% of medical SpR posts

    Likewise 50% of advertised consultant post are unfilled in acute medicine, elderly care and emergency medicine

    Wherever our young doctors are going, its certainly not to hospital posts at the expense of GP training. Are they moving abroad, leaving medicine or locuming?

    Are we are spending all this time and money training medical students, only to find they change careers because all the jobs have become so unattractive?

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  • Nearly every GP I know is making alternative plans for work. Retire, locum, emigrate, portfolio career - it's all stripping the front line. It's a disaster. The last 6 months have been noticeably poorer as the chickens come home.

    You have only one solution and you know it. It's that time.

    Simon, show me the money.

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  • I think they have reached the tipping point and even if they threw money at General Practice it is too late.

    No amount of money is going to compensate for the hell that is our working conditions and the escalating personal, financial and medico legal risk we face.

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  • The analysis from ex-UnitedHealth Global executive (job description - secure new markets for health insurance), Simon Stevens, is so deliberately missing the point it is almost embarrassing to witness the blatant charade. He know full well that GP workforce crisis is manufactured and only set to get worse with the Prof Field's CQC inspection or 'GP closure regime', and further implementation of 2009 McKinsey QIPP. The end game is the US HMO model which does not need so many doctors but will replace MDs with HCA, NP, and the new (borrowed from the US) doctors assistant. The deregulation bill will allow the use of unqualified staff to deliver healthcare. This dumbed-down delivery will maximise profit for corporates that will take over primary care. The remaining rump of GP workforce will be salaried, performing conveyor-belt medicine on piece-work and providing medico-legal cover for others.
    Dumbed-down delivery will be presented as the quickest solution for a problem of political creation.
    Meanwhile our representatives (largely approaching retirement and/or doing very little clinical work) spout strong rhetoric but have no plans for any action. Indeed they fail to warn us of the true threats in the medium and long term. Is the phoney opposition the worked out joint strategy and collusion by any other name? Is it the quid pro quo negotiated along with the 'bribe' of the 2004 contract? The chickens are now coming home to roost whilst those that sold out the patients and the profession to the privatiser sit back soon to collect their fat BMA/GPC pensions and honours.
    As for the Insurance industry's man at the helm of NHS England, well I am sure his former employers will be delivered handsome share of NHS contracts for 'commissioning support'. Stevens is well qualified to advice on the transition to private insurance model.

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  • In my opinion, GP recruitment agency, deaneries and the RCGP has done such a flimsy job over last few years to make the specialty very unattractive for the potential candidates.
    They have created so much unnecessary distress and distrust regarding GP training among BME candidates while they should have supported the trainees to flourish in an environment where their potential could have put to good use. Hundreds out of training after eating up three to four years of tax payer’s money. Tax payers should sue those who mishandle their tax money. Somebody must be accountable along the way from recruitment to training to assessment. It is not all trainees fault!!!
    I am in the process of writing to Margaret Hodge the chair of Public Accounts Committee (PAC) to investigate whether the above organisations mishandled the tax payers investment on training the GP trainees over last 4 years pointing out how they may have contributed to the current recruitment crisis.

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