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Trainee rise must not be false dawn

After a dark period for general practice, the horizon is getting just a little bit brighter.

After a dark period for general practice, the horizon is getting just a little bit brighter. The RCGP's recent approval in principle of four-year training was a fillip, even if legitimate questions remain over how a ‘cost-neutral' programme will be delivered.

And now, as practices struggle to recruit from a job market acutely short of GPs, the Government has finally responded to demands from the profession's leaders to restock the supply. Health secretary Andrew Lansley's decision, revealed in Pulse this week, to increase the number of GP training places by about 20% is an overdue piece of good news.

Mr Lansley wants the proportion of specialty training places taken by GP registrars in England to rise from around 40% to 50% by 2015 – a significant shift in the way the country deploys its medical resources.

The absolute number of GP trainees would rise from 2,700 to 3,250 a year if the overall number of doctors trained stayed the same, although with ministers conducting a major review of medical school places, the actual number could be even higher or a little lower than that.

GPs of course are currently under unprecedented pressure, with commissioning, the CQC and revalidation all coming in quick succession like the devil's own bus service, and within the context of pay freezes and budget squeezes.

Ministers have talked repeatedly of how they not only want GPs to take responsibility for key decisions in the NHS, but for practices to expand provision by taking on a rush of hospital work.

In that context, a 20% rise in new GPs is welcome but may hardly put a dent in the bulging demands on primary care.

Not only that, but the Department of Health's decision raises two pressing questions. The first is how it got the order of its decision making so wrong. Ministers knew from the early days of the coalition Government that GPs were to be central to their plans for the NHS.

It is exasperating that for so long they remained deaf to those who demanded some proper workforce planning, and who insisted the reforms could only ever work with an expansion of general practice.

And there is a second question, which needs to be answered if Mr Lansley's announcement is to prove anything more than hot air. How does the DH propose to ensure young doctors actually take up these new GP training places? The number of doctors applying to train as GPs has crashed by more than 40% in the last three years,
and last year deaneries were unable to fill even the current number of allocated places, because they simply didn't have enough
good candidates.

GPs have suffered nearly a decade of denigration and downward pressure on their pay – yet the profession is being expected to compete for candidates with a myriad of hospital specialties, all in a much better position than general practice to sell themselves to junior doctors.

Mr Lansley needs to make general practice attractive again to young doctors. Until he does so, it will be too early to hail this shaft of light as a new dawn.

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