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A faulty production line

How to ease the recruitment crisis? Turn back the clock on GP training

Professor Clare Gerada says GP training has become too cumbersome and may deter experienced doctors who might otherwise have opted for general practice

In times of stress and adversity it is always worth revisiting the past, not least to see how we can learn from it. Often we make small changes, which at the time seem sensible, but over the years have the cumulative effect of creating a stifling environment like the overcluttered homes of our grandparents.

We’re locking doctors in and removing flexibility

We now need to declutter. Begin to tidy out the overpowering, burdensome flotsam and jetsam – and in the context of general practice, this is the training processes for GPs. Despite the recent good news about increased funding in the General Practice Forward View we are still finding it hard to recruit to our GP training posts.

There are obviously well-rehearsed reasons for this, but I also wonder whether we need look beyond recruitment of medical students and retention of established GPs and examine whether our training regulations and the rigidity of the systems we have to qualify as a GP are acting as barriers to doctors already in training.

Diverting from hospital jobs

This is especially pertinent given the junior doctors’ dispute. It might be that many will rethink a career in hospital practice and will jump out of hospital into general practice. Their loss will be our gain and we should be ready to welcome hospital refugees into our fold. And before anyone shouts at me, I am not talking about ‘dumbing down’ our profession or making it the specialty of last resort – far from it. General practice will be strengthened by doctors trained in other branches of medicine, just as it was in the past.

Compulsory vocational training has been the single most important aspect of improving the quality and standards of our profession – and I was one of the first beneficiaries of this. But from a flexible process where the young (or not so young) medical graduate could meander through different specialties, gaining experience, competence and knowledge along the way, we now shoehorn doctors who are barely out of medical school into training programmes that will determine their entire professional lives.

Deep down I always knew I wanted to be a GP (influenced by my late father, himself a singlehanded GP) but I also knew I was excited by what I had seen and learned during medical school and house jobs. As with many newly qualified doctors, I wanted to show off my newly acquired skills. I wanted to prod and poke and stick tubes into patients and run for cardiac arrests and tell stories of medical heroism. After training in accident and emergency, then completing a senior house officer (SHO) medical rotation I decided to do psychiatry, for no better reason than I was interested in Freud. Finally, after realising how much I enjoyed every job, it dawned on me that my vocation was generalism.

But instead of having to start from scratch and take entry examinations just to be allowed to restart training as a GP (as medical students have to do today), I was able to fill in the gaps. I completed six months in obstetrics and gynaecology and then 12 months as a GPR (having my first baby in between).

No flexibility

The negative effect of the removal of the SHO role, which allowed experimentation and individually structured training, and its replacement with the Medical Training Application Service, means we’re locking doctors in and removing flexibility. This will be compounded by the new junior doctors’ contract, which risks removing pay related to duration of training and will require those who want to change specialty, potentially to come to general practice, to drop down the pay scale and takes no account of what they already know or have done.

In addition, GP training should be extended, something I fought hard for as RCGP chair. Three years might be enough to become competent, but it’s not long enough to become confident. Freeing up routes of entry and accreditation criteria, allowing for transferable skills, knowledge and experience into general practice and allowing longer and more personalised training should only be a good thing. It would (re)grow the pool of additional expertise in general practice.

This can only be positive for GPs, for patients and for the NHS.

Professor Clare Gerada is a GP in south London and former chair of the RCGP

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Readers' comments (32)

  • Totally agree with Prof Gerada.
    At a time UK is so short of GPs and other Drs in different specialities, specially now we are out of EU.We must do every thing possible to ease the burden on GPs and Junior Drs particularly by removing lots of unnecessary rules and regulations.

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  • how about getting rid of the rcgp eportfolio? stop making the future doctors in to good reflective entry writers rather than proper clinicians

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  • or appraisal revalidation and the gmc

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  • Lengthen the training - but extend the right bit. Mostly 4 year training up here in Scotland, but an extra year for me in hospital medicine equated to doing another 6 months of 2x specialties that I've already got ample experience of, just filling tedious rota service provision roles with no actual focus on GP relevant skills.

    Another year of actual GP experience would be incredibly valuable - I've got a fantastic GP practice and trainer, and would give my left arm for more time working in practice before CCT.

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  • Cobblers

    Whilst in part in agreement, this is tinkering. GP is dying on its feet NOW!

    I’m out as I’ve had enough. CQC, QOF, Indemnity, GMC, HMG, Appraisals, Revalidation, NHSE numpties and ever increasing demands. All with earnings reducing year on year for 10 years.

    I will do what I can, when I can and will shrug and walk away if it doesn’t suit. Now I set the pay and agenda.

    5 weeks and counting to get out. Then a rest for a month, maybe a holiday, and then locum land.

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  • If you cherish something you nourish it and value it. % of NHS spend on GPs has fallen from 11 .4 to 6.2 in NI. What does that say?
    Clearly we are not valued or cherished. I would not wish this nightmare of severely falling pay with commitments to the mortgage on the clinic, this cavalier attitude of the DOH to us GPs, with daily impositions,CQC, Litigation on new recruits.
    Please, please let GP land go because it is devalued by an elected Govt. and by inference the people.
    You can see it tin the attitude of the national newspapers.
    Get out if you can.
    Please do not come in.

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  • Under ATCF you can already shave 6 months off your hospital training of you have a background in certain specialities. This leaves 1 year of other hospital posts and 18 months of gp posts. Why would you want to make it shorter than this? Especially as so much attitudinal and ethical learning occurs in small group half day release.

    No- make the hoops less onerous- they are bordering on obsessive. And make the exams less ethnically sensitive and less expensive

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  • Shaba - I always thought the small group half day release should be a protected part of hospital jobs as well, in order to keep some enthusiasm in GPSTs. It's easy to lose sight of why we're pursuing general practice while in immersed in the slog of secondary care jobs, and a bit of small group work for peer support, and updating knowledge would be useful. No way to fit it into rotas unfortunately.

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  • I'm sad to hear you cannot get to your HDR. In Severn Deanery we expect at least 70% attendance from all trainees (only monthly in ST1 and ST2) so questions are asked if departments are not releasing their trainees.

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  • Absolutely agree with the Prof.

    I work in pharma and I know of a lost tribe of medics who would like to return to practice but are strongly detered by the hoops that we have to jump through.

    Also, bring back a GP registrar-only rotation and you will attract a number of lost medics back into the fold. Older medics (who have worked in a number of hospital jobs in the past) are deterred by returning to a hospital rotas. Make the training as long as required but make it GP only!

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