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At the heart of general practice since 1960

DH must act to make training vision a reality

It feels like we’ve been here before. This time last year, Pulse reported deaneries had been forced to cut the number of GP training places, and amid ever-increasing workload and an acute locum shortage, GP leaders warned of a looming job crisis.

It feels like we've been here before. This time last year, Pulse reported deaneries had been forced to cut the number of GP training places, and amid ever-increasing workload and an acute locum shortage, GP leaders warned of a looming job crisis.

Over the past 12 months, that concern has only escalated – and so Andrew Lansley's announcement in May that he planned to boost the number of GP trainees was met with a rare chorus of approval from the profession.

The health secretary not only set an ambitious new target for the number of GP training places – 3,250 in England alone by 2015 – but also indicated the increase would come as part of a radical alteration in the balance of the medical workforce. The proportion of specialty training places taken by GP registrars was to rise from 41% to 50% – a significant realignment reflecting the accelerating shift of workload from hospitals to primary care and, perhaps, a little of GPs' new commissioning importance as well.

But while no one was expecting a transformation overnight, the figures for this August's training intake show just how far that vision is from current reality. Across the UK, just eight more GP registrars have been recruited. In England, there has been a small decrease, dwarfed by hundreds of extra hospital trainees. Far from primary and secondary care beginning to reach parity, the proportion of GP trainees has actually fallen.

While ministers, GP leaders, educators and expert bodies such as the Centre for Workforce Intelligence seem in uncommon agreement on the problem, the causes – and the possible solutions – depend very much on who you ask.

The argument floated by deanery leaders last year was that a fall in the number of applicants was to blame. A shortage of quality applicants, and those for whom general practice is their first choice, undoubtedly remains a factor. But it's not the full story, not least because this year the number of first-round applications nudged upwards.

Others point to funding restrictions and a lack of capacity in GP practices. As Dr Krishna Kasaraneni, chair of the GP trainees subcommittee, writes on PulseToday, deaneries can only take on extra GP trainees if they can be placed in an approved training environment with the funds to support them. Addressing funding concerns must be a priority. But perhaps the most worrying reason offered – and the one with the most alarming implications for the future – is that in the age-old tussle between GPs and hospital colleagues, it is secondary care that is coming out on top.

The new local education and training boards may not be entirely responsible for the failure to boost GP trainee numbers. They are, after all, operating only in shadow form for now. But senior GPs believe they may already be ‘potential blockers', and the fact that they are overwhelmingly dominated by hospitals does not bode well.

Health Education England's assurance that ‘primary care-registered professionals will have proportionate membership on the board' seems incompatible with what's happening on the ground – and indeed the board's own targets. The requirement that 10% of LETB board members be from primary care may strictly speaking reflect GPs' share of the NHS workforce. But it takes no account of the organisational complexity of general practice, its importance to the health service as a whole or the relative numbers of primary and secondary care doctors.

The Department of Health may be inclined to let LETBs be, but taking a hands-off approach to the evolution of the new bodies could jeopardise the success of its workforce transformation. If we are to really see a historic shift in the balance of training, then a significant number of GPs must help oversee it.

Note: Due to some additional data coming in shortly before publication, the online version of the editorial has been changed slightly from the version printed in the magazine

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