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Don’t 'sell' general practice to us – it won’t work

Dr Jason Sarfo-Annin

The recent debate on how to 'sell' general practice to trainees has been interesting. Many have long advised that GPs shouldn’t be negative about their specialty. These people have good intentions but underestimate, I think, how highly trainees value candour.

Take the scenario of an FY2 having some taster days in general practice. Said doctor speaks with a GP principal and is given a good impression of GP, with a bit of gloss over issues such as indemnity or workload. Then the FY2 does their due diligence and does a bit of reading online. They find that NHS England have created a dedicated scheme to help GP retention.

They read case studies on the difficulties of working as a GP.

The read articles such as ‘Is GP in crisis?’ from the Kings Fund. The FY2 inevitably realises some sugar-coating has been employed. Not the end of the world – some may argue – but here’s the real problem: the next question that this FY2 then asks themselves. What other issues were they being ‘protected’ from and can they now trust what they were told by that GP principal? I would argue that the unintentional consequence of that questioning of, or loss of trust in, the GP principal is the worst possible outcome from an opportunity to recruit.

If you make any job attractive, regardless of the views of others or 'banter', people will flock to work in that job. Commentary regarding the heavy use of Microsoft Excel and PowerPoint hasn’t stopped some of my peers leaving medicine to become management consultants. The jokes about the non-surgical acumen of orthopaedic surgeons doesn’t hinder recruitment for orthopaedics at ST3. This is simply because the perceived benefits of those careers outweigh the perceived costs. It is a simplification, but that balance probably sums up the career choice of every single doctor ever.

This isn’t to say denigration of specialties in front of medical students is acceptable and doesn’t need addressing. At that stage of training I do accept the argument that perceptions matter. However, even for medical students, the perceived benefits and costs equation is just as valid.

These days most undergraduates have had people advise them that entering medicine is a bad idea. This is certainly the case amongst the sixth-form students that I have mentored for a charity over the years. Nonetheless our current crop of medical students still all took the plunge – because they think the job of being a doctor is worth it.

Perhaps the most efficient use of time and effort on improving recruitment to general practice would be to make the job attractive. It would tip that cost and benefits equation in the favour of general practice. It is something that can be influenced to a reasonable degree by the RCGP, NHS England and so on; rather than attempting to, for example, influence the nature of output from certain media outlets.

What may be helpful in the medium-term is to delve deeper into the ongoing work of Lambert and Goldacre, and to create an annual qualitative study looking at the reasons trainees choose GP at the point of entry.

A good brand knows its target market, and makes effort to keep up to speed with changes. Provided the reasons for trainees entering a VTS are compatible with the grand vision of the future of general practice then then a compelling argument can be made to tailor recruitment to the speciality specifically on these reasons.

I expect that there are some that baulk at the idea that flexibility, work-life balance or portfolio working may be strong motivations for trainees. But when push comes to shove, an army of part-time GPs is probably better than no GPs at all.

Dr Jason Sarfo-Annin is an NIHR academic clinical fellow and GPST1 in Bristol

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Readers' comments (13)

  • Sensible indeed. Yes, there are problems, but there is still much specific to GP which sets it apart from other specialities - other careers - in a positive way. We need to recognise those qualities, champion them and be prepared to defend them.

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  • As an aside, it'd be helpful if someone might be kind enough to fix the link to the cited study.

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  • Done!

  • Interesting and well written post.

    There's very much a theme from the trainees and newly qualified GP's emerging here. They see the landscape and don't want to commit to the current situation.

    However, the strategic response from the established GP business owners to the current situation will be to scale up. These larger scale providers will need less partners and key decision makers. Retiring partners will be replaced with salaried GP's/ANP's/pharmacists/PA's. Career progression for many GP's may just stop for good. The plum portfolio roles will be grabbed by the incumbents and a life of 7 day service provision lies ahead.

    To my young colleagues and future colleagues I would say to be careful the ladder isn't pulled up above you.

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  • Personally I think it's a balance that's needed- we seem to consider the options as binary- be only positive and lie or be completely negative and get the truth out there.

    Why can't there be an in between? Surely we really need to present a balanced view. I agree recruitment campaigns should focus on what trainees motivations are. But yes...these campaigns will be largely positive I expect- have you ever seen a campaign/advert for anything that isn't?! (E.g. Pretty sure holiday advert never show you all the insect bites you will get!! It's all sun sea luxury etc) Negative info on GP as you say, is not hard to find so there needs to be a balance and I think GPs in person should highlight both sides of the argument.

    All specialities are under pressure (including orthopaedics!) so trainees can rightly look to GP for flexibility and portfolio working. Whatever the negatives are you can at least control how you want to work after a short time period (part time/full time/locum etc) which other specialities don't have the luxury of (doi: family member is orthopod).

    Anyway - I'm waffling on a bit- well written article Jason- respect your views!

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  • Azeem Majeed

    Thank you for your article Jason.

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  • Is this Dr Sarfo-Annin's first article here?
    If so well done - very well written article that is both readable and informed thanks.

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  • Great job Jason. Bristol at its finest.

    I think the crucial question to ask - is not why trainees choose their speciality, but why oldies like me choose to stay. After all- we know the profession, warts and all.

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  • Very sensible article. Get the terms and conditions of the job right and the GP workforce crisis would disappear (albeit over several years).
    Instead, the language of 'GP recruitment and training' is being quietly changed to 'primary care recruitment and training' by HEE. We might start to ask why that is?

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  • Well done Jason. Light years better than the Chair of RCGP's commentary (tho' some might suggest that that would not be difficult).

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