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Gold, incentives and meh

GPs’ confidence crisis has created the shortfall of new trainees

Plenty of elements are conspiring against general practice, writes Dr David Bailey, but uncertainty is the most off-putting

Rising workload, a campaign of anti GP propaganda, falling incomes, and a Government intent on devaluing our hard-earned pensions: it’s hardly surprising that how demand to train for general practice is at a ten-year low.

Of course, in 2003 a workload and recruitment crisis led to GPs finally making up lost ground on comparator professions.

But is money the main issue? It’s clearly important, but the key issue for GPs across the UK is confidence: confidence that a practice that is viable now won’t be defunded into inviability; confidence that an obsession with targets won’t heap us with unfunded work; confidence that GP’s supreme skill – risk management – won’t be buried under a sea of regulations.

We must also be given confidence, at least in England, that the Government still values general practice, and won’t destroy it in the rush to cherry-pick elements of the NHS for the private sector. In future it will be vital that young GPs thinking about partnership can have more confidence over the future of their practice.

In fact, the main reason GP contract negotiators focus on financial stability is to create confidence in the profession – that’s why negotiators for Wales and Scotland insisted on a moratorium on changes to the correction factor. It’s not that we don’t want to consider more equitable funding, but we don’t think that there is a single formula that will correct payments for every size and location of practice.

Swap long days for flexible work

Even when financial stability is confirmed, GPs are still concerned by workload shift. Consultation rates are climbing 3% a year on top of population growth, meaning that GPs would be delivering more every year without extra resources – and that’s assuming neither rate increases. But the Government continues to sell the idea that GPs can be squeezed ever harder, and that more and more work can shift out of hospitals without investment. Jeremy Hunt actually admitted as much recently when he said that GPs would have to do more and more with no extra resources. (Politics is probably the only area in British life where less activity would be hugely beneficial to everyone).

Young GPs often have different aspirations to their predecessors. Flexible careers, both in terms of hours and employment or partnership, are essential to attracting new doctors to the profession. But the key to GP recruitment is confidence for practices to invest in the future.

I suggest we call for four things to improve recruitment: greater stability for practice funding and security of contract so that practices have the confidence to take on new GPs; less interference in providing a professional service so new GPs have the confidence to take on practices; recognition of GPs’ risk management skills, and independence from NHS management ‘help’; and removal of the conflicts of interest for GPs written into the NHS reforms.

The alternative to creating much-needed confidence in the profession, is that more and more young GPs put the Australian High Commission on speed dial.

Dr David Bailey is a GP in Trethomas, a contract negotiator and chair of GPC Wales.

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Stephen Dorrell, chair of the House of Commons health select committee, will be talking about where general practice will fit into the NHS of the future at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (4)

  • it's the portfolio, an obsession with reflection in everything, the unfair csa exam and a general disinterest in GP trainees welfare that is putting us off from entering and continuing this speciality. To make it worse now you are extending training to use trainees more. Try treating trainees humanely and u might notice a difference

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  • I retired last year at the age of 55, having spent the best part of my career working in General Practice. I am convinced that the profession has become devalued, abused and, quite frankly, dumbed down by the contractual changes that have afflicted it over the last years. It is no wonder that aspirants question their motives.
    In my opinion the NHS that I trained for is being completely destroyed by incentive schemes, targets, bonus payments and Governmental dithering.
    So I give thanks for the work that I gave to the NHS, but am utterly grateful to be out of it.

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  • The stupidly generous deal given to the profession by the incompetent Labour Government should never have been accepted. It simply antagonized any subsequent administration whose agenda has been to claw back an over-generous package!

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  • My wife and I, both GP partners aged 46 and with three teenaged children, uprooted ourselves mid-career, sold our house and left our outwardly very nice GP partnership last year and have moved to Australia, where conditions are so much superior and stress levels so much lower. If things had been slightly less bad, no doubt we wouldn't have gone, but the perfect storm of contract impositions, pension degradation, workload increase and media and political hostility meant it was a no-brainer.

    So long. We won't be coming back.

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