General practice has an image problem at medical schools
Dr Amanda Howe argues that we need to change general practice’s reputation among medical students and stop it being seen as ‘second choice’
The problems in the GP workforce are not about recruitment alone – they are to do with increasing expectations as the care of patients outside hospital becomes more complicated.
More management options, multiple morbidities, and an ageing population have increased GP workload. As the speciality has taken on new roles – commissioning, teaching, research, special interests – like other doctors, GPs need more time out of frontline service to carry out these activities while leading their practices and contributing to primary care team development.
On top of this, many GPs are finding the combination of these demands with the changes in the NHS (including revalidation) challenging as they get older so some are taking early retirement, or ‘retiring’ to work part-time.
But it’s time to face up to the fact that there are problems in recruitment. Some training schemes are not popular enough, especially in more remote or deprived areas of the country. In some schemes, there has been concern about the quality of candidates. But when a course struggles to find enough applicants reach the minimum standard for selection, so posts are then unfilled.
There are three main reasons for this.
Firstly, not all medical schools provide a positive image or experience of general practice, so students either do not know enough about it to make a positive choice, or think it is not a good job to aim for. Students are often influenced by teachers, so if a senior respected consultant is critical of GPs this may influence student attitudes. A student may be put off a speciality by a poor educational experience – for instance, if they feel they are observing ‘bad medicine’ or having their time wasted – so well-designed and -supported placements in general practice are important.
Secondly, some trainees think general practice is a difficult discipline to do well, specially if they don’t get enough confidence during their placements to feel they could have a go at it. The breadth of possible diagnoses, the variety of patients and patient expectations, and the pace of life in general practice can seem quite daunting. Students need time to adjust to the difference between community and hospital medicine.
Thirdly, there is over-provision of training in other specialities – the Centre for Workforce Intelligence reports show that more people are being trained for hospital-based specialities than are needed. This is like pouring water into a sink with two plug holes, one bigger than the other – more will go out through the larger hole than the smaller. Given that 50% of the workforce needs to go into general practice, students need a clear message about the match of training numbers with eventual career opportunity.
Better teachers, better GPs
To improve recruitment, medical schools need to invest time and resources in recruiting good GPs to teach. They also need to design work placements that are educationally effective so that students enjoy their experience of working in the community, and feel enthused by their contact with patients.
In particular, GPs who teach need to prioritise undergraduates as a practice commitment so they can influence career choice. They should treat students like future colleagues, make them feel valued and encouraged. They should also keep in touch with the ones they would like to work with, be proactive about mentoring them, and offer further career advice.
Lastly, and most importantly, we need to target ‘hard to recruit’ areas. We could overcome the bias towards big cities by incentivising people to go to more rural areas. Perhaps undertaking a post in an ‘under-doctored’ area should be a requirement for undergraduates and VTS schemes so younger doctors realise that working in these areas can be really worthwhile, and fun.
Professor Amanda Howe is a GP in Norwich, professor of primary care at the Norwich Medical School and honorary secretary of the RCGP.
Pulse Live: 30 April - 1 May, Birmingham
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.