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Gold, incentives and meh

Only one FTE GP produced for every three graduates trained, says NHS England

For every three GPs trained as full-time equivalent (FTE) only around one remains in general practice, according to NHS England. 

Speaking at Pulse Live last month, NHS England medical director for primary care Dr Nikita Kanani said more work needs to be done to attract more GPs to stay in the profession as only one for every three full-time equivalent trained GPs stays in the profession. 

In October, health and social care secretary Matt Hancock revealed that the health sector had recruited almost 3,500 GP trainees have been recruited, which exceedeed the 3,250 target for the first time and represented a 10% increase on the previous year.

Health Education England last week revealed that the number of trainees is set to increase even more this year after it recruited record numbers of graduates in the first round of intake.

But Pulse has revealed that more GPs than ever are working part time now, which may be having an effect on the number of trainees coming through the system.

Dr Kanani said that simply increasing the number of trainees may not be enough to increase GP numbers.

She said: 'We’ve now got five generations working in the NHS, so what generation one wants starting their working life is different to what generation five wants. When I go around the country speaking to trainees and  medical students, many say they weren’t encouraged to join general practice.

'It’s not been a career aspiration for a decade and we’re losing GPs dramatically. We’re training three whole-time equivalent GPs but we have one who stays as a whole-time equivalent GP. We have to change that, we have to make the day job better and we have to make it more attractive.'

She cited a report published by the King’s Fund, which found that there were 3,067 places available for GP training in 2014 but this produced only 1,250 (40%) became full-time equivalent starters. 

Talking about funding in general practice through the new five-year GP contract, Dr Kanani added that the additional staff provided through the primary care networks will help support practice teams, given the 'massively short supply of GPs and nurses'. 

As part of the contract, NHS England will fund 22,000 additional practice staff – including pharmacists, physiotherapists, paramedics, physician associates and social prescribing workers – by 2023/24.

Dr Kanani said: 'We know there is a massively short supply because the working conditions haven't been good enough for the plast 10 or 15 years. So we're bringing in staff to support mutli-disciplinary teams but we're still going to keep going with plans to recruit GPs and nurses.'

As part of the contract, NHS England will fund 22,000 additional practice staff – including pharmacists, physiotherapists, paramedics, physician associates and social prescribing workers – by 2023/24.

In 2015, then health secretary Jeremy Hunt promised to add at least 10,000 extra primary care staff, including 5,000 GPs, within five years. But Mr Hancock told Pulse earlier this year that although the target is still there it will not be met by 2020.

Data from NHS Digital released in February showed that the number of fully qualified FTE GPs has dropped by 2% pver the past year

It came after an analysis by the Health Foundation said worrying trends in the NHS workforce, including falling numbers of FTE GPs, will seriously hinder the Government's plan to move care out of hospitals and into the community.

Meanwhile, a major report looking at NHS workforce gaps found that the NHS will have 7,000 fewer FTE GPs than needed within five year, despite a major focus on increasing GP trainee numbers by 2024.  

This article was changed. It originally said GP training places led to an equivalent of 65% FTE equivalent GPs - this was incorrect

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Readers' comments (44)

  • Firstly, what is "full-time"? Most people have historically regarded it as 8-9 sessions, but we all know this is more than full time. 6-7 would be a more appropriate level for a 40 hour week

    Secondly, I agree with Clare Gerada. I work around 50 hours a week but only 4 sessions in clinical practice. My May blog will explain why

    Finally, this is not a male/female thing. It is a workload thing. Also - guess what? It's 2019 and men may actually wish to share the childcare with their female partners.

    But it's the workload that's making it unsustainable to commit to more than 6 clinical sessions. Because 6 sessions is practically a 40 hour week - even for a salaried GP. For a Partner, it's significantly more.

    We're just being paid a part time salary, that's all. What a great deal we have got.

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  • I am a 63 year old gp locum and i work partly in the uk and partly abroad. In the uk i have to cope with myriads of forms, IFR rules which vary from area to area, QOF, irritating interference in my prescribing, appraisal, and really stupid mandatory training in FGM etc etc. Outside UK there is none of this . No wonder we are putting off potential gps.

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  • The problem is - and I know that I will be shouted down - is that we are independent contractors. If we were salaried for our clinical work as hospital consultants - we could control our work load and then develop our other areas of interest. Instead we are victims of our own success. Throw work at us and we not only deliver - but over deliver. I Am not against partnership - but think we need to redefine it.

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  • Clare
    Granted, GP Partners often do most of the work. However becoming a salaried GP is not the answer. It is the salaried GPs that are being exploited more than locums. That is why most GPs are increasingly becoming locums. They have the ability to control their work load and develop other areas of interests, more than salaried GPs do. It requires very good negotiating skills for a GP to get a favourable salaried contract. Hospital Consultants have the power of the BMA Consultants committee behind them.

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  • Clare
    Many hospital consultants now prefer to be on a long-term locum basis for similar reasons to GPs. They are better able to control their work load and get higher financial remuneration for their time. Becoming a locum can also reduce tax burdens through company formation, either by becoming incorporated or forming an LLP.

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  • HMRC won’t allow long term locum with same provider. Locums & employers risk massive fines of work in same place for over 3 months. IR35. Rules

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  • Maybe medicine is becoming more akin to barristers chambers - sad as continuity is what makes general practice work and enjoyable and fun. We are at risk of throwing away best part of our profession and making the problem worse. Sadly - locums increase work load for permanent doctors & do not add to continuity.

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  • There are so many policies that work against working full time. They should not just be cancelled, but instead reversed to give more advantages to working full time (as a GP).

    I don't think it is realistic to change progressive tax rates. But how about the following:

    1 - We all know the very complicated situations with regards to pension tax - that needs to be corrected asap.
    2 - But why should a 10 session GP earning 120k pay a higher employees contribution percentage than a 7 session GP earning 84k?
    3 - Why when a 10 session GP partner who is off sick (for 2 week) get paid 180 pounds per session to cover locums, but a 5 session GP partner get 360 per session to cover locums?

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  • Even if IR35 rules apply locums normally manage to negotiate a higher hourly / sessional rate than salaried doctors. And as you say locums can get around IR35 by moving from job to job. As far as I am aware NHS employers have been told by NHSE to only offer jobs inside IR35. The concern was that many clinicians would take advantage of this loophole and give up their NHS contracts. My partner has some personal experience of this. NHSE was probably told by ‘Govt’ to do this to maintain income tax revenue.

    Sadly, as you said, this makes continuity of care worse.

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  • Clare to control burnout we need to control our workload.To do this for all the reasons above the ONLY option that is attractive is rapidly becoming portfolio working and locating.Thanks to government policies since 2004 there are no other attractive options.The RCGP/BMA have cooperated with this direction of travel.Out with partners and salaried posts go continuity and stability and up go costs.With that the NHS will disappear in a puff of smoke orbs it is at the moment a feted whimper.Conusltants are leaving,GPs are leaving, junior Drs are leaving the medical leaders and establishment have let down medics in the UK and patient are now paying the price.The only way to stop our burn out is for us to take control of our own working lives.That doesn't exist when contracted to or employed by the NHS on permanent basis.Roll on the collapse.

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