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At the heart of general practice since 1960

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

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 (10)

  • If we promote Gp as foundation on which to build on a specialisation such as gpsi then that would go a long way to attracting doctors whom prefer to sub specialise in a field of medicine but not be confined to hospital training. At the moment very little is clear on how the Gpsi system works and essentially is driven by the determination of the individual doctor.

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  • If we promote Gp as foundation on which to build on a specialisation such as gpsi then that would go a long way to attracting doctors whom prefer to sub specialise in a field of medicine but not be confined to hospital training. At the moment very little is clear on how the Gpsi system works and essentially is driven by the determination of the individual doctor.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    (1) General practice is family medicine . GPs are people's doctors . It is NOT just about high power science or the most advanced technology. Developing a relationship is the cornerstone every time you see a patient . This has to be very clear to the youngsters because many of them in medical school still see learning about the latest drugs on breast cancer or the most recent techniques in neurosurgery as the most exciting . Of course , it is personal choice but we do not know how many of them actually have that potential and enthusiasm in 'dealing' with people than withscience .Because the career is not sold to them properly. You probably cannot hence blame Oxbridge medical schools producing less GPs as Medicine is viewed as a 'clever' science.
    (2) The future of general practice in its current existing form is clearly endangered . Will we all be salaried in the near future? Being a partner with autonomy could become history very soon. If that is something desired by the youngsters , fair enough. But they may still not be able to avoid all kinds of political influences from the top. As a hospital consultant , he or she at least still has a choice of doing some private works . GPs are not even having enough time to cope with the current level of NHS work . Many of us are very pessimistic with the forthcoming imposition of changes in the contract.
    (3) Organisations representing GPs are more or less giving up in confronting the government . This is well demonstrated in events after events. How can the youngsters feel secure to join this profession ?
    (4) The current controversy on MRCGP examination is not going to help the reputation at all . What ever is going to happen (with or without JR), I am dreaded by the repercussion one way or the other.
    (5) Health and Social Care Bill could well be the last nail in the coffin of burying the existing form of our profession . So you really think the youngsters want to join this oblivion??

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    (1) General practice is family medicine . GPs are people's doctors . It is NOT just about high power science or the most advanced technology. Developing a relationship is the cornerstone every time you see a patient . This has to be very clear to the youngsters because many of them in medical school still see learning about the latest drugs on breast cancer or the most recent techniques in neurosurgery as the most exciting . Of course , it is personal choice but we do not know how many of them actually have that potential and enthusiasm in 'dealing' with people than withscience .Because the career is not sold to them properly. You probably cannot hence blame Oxbridge medical schools producing less GPs as Medicine is viewed as a 'clever' science.
    (2) The future of general practice in its current existing form is clearly endangered . Will we all be salaried in the near future? Being a partner with autonomy could become history very soon. If that is something desired by the youngsters , fair enough. But they may still not be able to avoid all kinds of political influences from the top. As a hospital consultant , he or she at least still has a choice of doing some private works . GPs are not even having enough time to cope with the current level of NHS work . Many of us are very pessimistic with the forthcoming imposition of changes in the contract.
    (3) Organisations representing GPs are more or less giving up in confronting the government . This is well demonstrated in events after events. How can the youngsters feel secure to join this profession ?
    (4) The current controversy on MRCGP examination is not going to help the reputation at all . What ever is going to happen (with or without JR), I am dreaded by the repercussion one way or the other.
    (5) Health and Social Care Bill could well be the last nail in the coffin of burying the existing form of our profession . So you really think the youngsters want to join this oblivion??

    Unsuitable or offensive? Report this comment

  • Medical students should be actively discouraged from General Practice in the future. At least as a hospital doctor you can have an NHS Contract to tick the correct boxes and get the state to pay towards your pension AND develop a Private Practice where you are in control of what you do for your patients.

    Even better don't study medicine!

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  • Why not acknowledge the real problem? students don't want to go into General Practice because it is exceedingly hard work and over the years any control that GPs had over their work has been taken away from them. The pay and conditions have deteriorated and most older GPs can't wait to retire.

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  • how can we recommend General Practice? Our students tell us that they enjoy the work , and I tell them to watch the politics - this branch of medicine may soon not exist and certainly not in the patient centred holistic socially aware way that it does now.

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  • Now let me think...Consultants have a near as damn it fixed contract, a good fixed salary, have their NHS related indemnity insurance paid and can near double their salary privately. Down side is the on-call, but I doubt GPs will escape that one for long. As for GPs; a contract that changes yearly for unproven reasons, a falling income, the hastle of hiring and more likely firing staff now etc etc DONT GO INTO GENERAL PRACTICE

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  • It looks like the medical students are more far sighted than some of my GP colleagues who will always have their heads buried in the sand.Yes..stay well clear of general practice.Specialise in something and if you don't like it in the NHS you can atleast go anywhere in the world and work for some other provider or start your own practice.Specialist skills will always be in great demand.You'll be respected as a proper doctor and will mint money.

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  • Its because of all the reflective stuff that GP trainees and registrars are forced to do/ the eportfolio and the unfair csa exam which increasingly medical students are hearing of. why would u want all of that?

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