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Analysis: Why do we not have enough trainees?

'Everyone agrees we don’t have enough GPs'. Dr Krishna Kasaraneni analyses the latest GP training figures

Everyone agrees we don't have enough GPs. As the population ages and more care than ever is shifted into the community, the need for GPs is only going to increase further.

Health secretary Andrew Lansley has set a target for a 20% increase in GP trainees by 2015, the RCGP wants 10,000 more GPs by 2020, and the BMA are also supportive of cutting the number of hospital specialities places and increasing the number of GP registrars.

So why is it not happening? There are many factors which are contributing to this.

Firstly, the numbers of applicants. Although we're not struggling for applicants – the number of applications has gone up again this year, recent evidence from selection centres and exam results shows that the quality of the trainees has fallen. 

At this stage it is very difficult to say if this is a permanent change or a temporary blip and the situation needs to be monitored closely.  There are large numbers of doctors applying for GP training.  Some may not be successful first time round.  They need to reflect how they have performed on the day, do some extra training in a particular speciality, or work on their communication skills and re-apply next year.  Some may genuinely be better suited to other specialities despite wanting to pursue a career in GP.  They have to re-evaluate their options.

Another big problem we noticed recently is the capacity and funding issue for deaneries. It's all very well for Mr Lansley to say he wants to increase the number of GP trainees, but where are they going to be trained?

Deaneries can only take on extra GP trainees if they can be placed in an approved training environment with the funds to support them. But GP practices in certain parts of the country have reached capacity.

There are more foundation doctors and GP registrars working in practices than ever before.  Enhanced GP training will already test the system and increasing numbers at this stage without increasing the capacity might compromise the quality of training and therefore it is vital we don't get carried away with numbers. It's the quality of training that is the key.

Funding is also a problem. If practices are going to take on a registrar they need an extra consultation room. If a GP is going to take time out of seeing patients to teach a registrar, there needs to be adequate compensation as another GP will have to do their work.  Increasing numbers need to be backed with a significant financial injection.

And lastly, the elephants in the room are the emerging LETBs. They're in shadow stages, but already there are signs that they are heavily biased towards secondary care.

Dr Krishna Kasaraneni is chair of the BMA trainees subcommittee

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