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How you can get '5,000 new GPs' without getting 5,000 new GPs

An anonymous Health Education England employee suggests how the 5,000 GP target could be achieved without actually recruiting 5,000 more GPs

Although it was ultimately omitted from their 2015 general election manifesto, the Conservative party’s pledge to deliver ‘at least 5,000 new GPs’ by 2020 was widely reported. Those of us on the ground actively involved in recruiting and training GPs were skeptical to say the least about our chances of achieving this in the current climate. Given the length of time taken to train a GP and the pressures on the existing workforce, meeting this target seemed impossible. Had anyone asked, we would have all said so.

It does seem this realisation is beginning to dawn on others and we have seen the wording of the promise gradually and subtly change. When giving evidence to the Parliamentary Health Select Committee, Health Education England (HEE) chief executive Ian Cumming indicated that this may not be calculated in the way we might have naturally expected. It should be pretty simple: count GPs in 2015, count GPs in 2020 and find out the difference, but this gave us our first sight of some potential trickery.

Something puzzling remains: whilst those of us on the ground remain so very unconvinced, no-one from NHS England or HEE seems to have any doubt at all that the target will be met. So how might they claim to have achieved this?

So when is 5,000 not 5,000?

When it is not a NET increase

Perhaps the simplest way to ‘achieve’ the target would be to not take into account those leaving the workforce and to deal in gross, rather than net figures. This is surely too blatant a misdirection to be advisable.

When it’s not ‘GPs’, it’s ‘doctors working in primary care’

This is the key change, and where we see the language quietly shifting. It is clear now that newly recruited GP trainees will be counted (and not just the increase in their numbers over baseline). Don’t be surprised if we also start to count ‘pre-speciality trainees’. These doctors, rejected at GP selection, are placed into hospital jobs with some GP training scheme input, in the hope they apply again and are successful. But with no guarantee they will be.

Even more worrying would be if they counted any new ‘Foundation for GP’ posts. These are applicants who can’t get through selection for general practice because they are unable to demonstrate foundation competence. Again, they are placed in a hospital job to allow them to demonstrate Foundation competence prior to hopefully applying for and being successful at GP selection.

These schemes are an important part of our recruitment and should result in more GP trainees. But they are not GPs and are working in hospitals, not in primary care.

When it depends how you count GPs

Counting the number of GPs practising is actually quite difficult – for example how do you capture the number of locums working? How do you account for portfolio careers? The Health and Social Care Information Centre produces figures, but new measures are being used and they say themselves, ‘As a new collection its results must be further understood, as such these statistics are experimental and subject to change’.

Don’t be too surprised if a way is found to count GPs that results in an apparent increase in the workforce.

When it is 4,000 plus 1,000

Ian Cumming told the select committee that the 5,000 ‘new doctors in primary care’ would be made up of 4,000 new doctors and 1,000 who would otherwise have retired.

There is no sign of the pressure on GPs easing and with seven-day working on the horizon and the increasing burden of administration and regulation, the result is that means many of those in the twilights of their careers are leaving.

Reducing the exodus from the profession by delaying people’s retirement, whether through incentives or other means is not only likely to be very difficult, it is a seriously short-term solution. We need to improve the working conditions of general practice so that the job is one you can survive past 55.

When you axe broad-based training

Broad-based training was a small initiative that allowed some trainees to spend two years in various specialties before deciding on one and entering at ST2, very much in line with the Shape of Training report. It was extremely popular and well-evaluated, but has recently been scrapped in a bid to concentrate on recruiting to the 5,000 target.

When you actually need 7,500 to get 5,000

Attrition, wastage, participation. I heard recently that to produce one full time GP for the workforce you need to take at least 1.5 GP trainees into the start of training. Due to failure to progress, illness or career choice, attrition over three years of GP training can conservatively be estimated at 8%.

Then, when GPs are awarded CCTs, many of them don’t work in GP in the UK, choosing to have career breaks or work abroad. Many leave medicine or general practice altogether.

Finally, the level of participation means that many GPs choose not to work what would have traditionally been thought of as full time.

So, to produce 5,000 nine session FTE GPs (after three to three and a half years), I estimate you need to take into training at least 7,500.

When it should be 8,000

At the 2015 election, the political parties differed in their estimations of the required numbers of extra GPs, with most agreeing with the RCGP’s carefully calculated and  evidence based figure of 8,000 new GPs required. Of course 8,000 is even more unachievable, but at least it more accurately represents what we actually need.

Conclusion

We would all love to see a net increase of 5,000 GPs by 2020, but we have to acknowledge that in the sense we all understand that, it isn’t going to happen. But that doesn’t mean we should stop trying.

Let us be careful not to say we’ve achieved this when we haven’t. And let us remember the reason we aren’t going to achieve it is that UK primary care is failing.

We must all focus our efforts not just on recruiting, returning and retaining GPs, but fixing the reason why doing so is so difficult. 

The author is a GP who works for HEE

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Readers' comments (16)

  • Yet another - tongue in cheeck - way to fix the numbers..
    I retired from a GP partnership (& practice) on 31st March 2013 - the day before the HSCA came into force.
    After I retired, CQC gave my practice a hard time *because CQC had not given their permission for me to retire - or the practice to allow me to retire*.
    Could the official numbers of practicing GPs be increased by CQC refusing to allow GPs to retire?

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  • Playing with words and figures should be a criminal offence. It has somehow become acceptable to have a forked tongue and mislead a nation. What about all those who suffer, and even die ,because those "posh boys" are allowed to do what they want? What is happening to this country and why is every one oblivious...lambs to the slaughter ???!!!

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  • When I resigned from my partnership, it did not occur to me that I had to notify anyone else. NHS England were quite put out that I had not done so. I just notified them retrospectively.

    Why should it be their business to know in advance ? I certainly don't think we need their permission. They may wish it so but at the present there is no binding requirement.

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  • The thing that really worries me is that in general practice, as in hospital practice, whatever the net change will turn out to be, it's the most experienced ones who are being forced out by the work pressure, leaving much less experienced folk in place.
    I suppose it was ever thus, but there's a massive amount of experience being ditched that could have been kept & capitalized on had a more creative & constructive approach been taken!
    Another example of the McNamara fallacy - value what can be easily measured, rather than measuring what's of value...

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  • UK PRIMARY CARE IS FAILING....BECAUSE HEALTH EDUCATION ENGLAND IS FAILING.

    FAILING IN ITS REMIT, FAILING TO STAND UP TO JEREMY HUNT, FAILING TO LISTEN TO GPs.

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  • @Anonymous | GP Partner11 Dec 2015 11:51am

    WHY ARE YOU SHOUTING? WE ARE NOT DEAF. ARE YOU?

    Just kidding. Go on my son, let the tension out.

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  • Vinci Ho

    The term was popularised in the United States by Mark Twain (among others), who attributed it to the British Prime Minister Benjamin Disraeli: "There are three kinds of lies: lies, damned lies, and statistics."

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  • Bob Hodges

    Anything other than NET increase of 5000 qualified GPs working equivalent WTE to the existing workforce constitutes FRAUD in my opinion.

    It's FRAUD on several levels, but no one will be held to account. If my practice had such a lax approach to statistics it would be a criminal offence.

    The figure of 5,000 was just plucked out of the air anyway without reference to research. It's probably an underestimate of need anyway.

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  • Over regulated, over monitored, work dumping, progressive loss of income thru' declining payments, increased taxes, devaluation of pension and increased contributions, loss of seniority. Successive governments have devalued GP's. Unrealistic government expectations for the current GP work force.The stress of General Practice / Partnerships does not encourage any one in their late 50's to stay on. I'm off as I know many of my contemporaries of a similar age are. Occasional locum work post retirement seems very unattractive when you take into account escalating Professional fees and the useless requirements for appraisal. On another note what about the hundreds of GP's taken away from front line GP work and spending days in CCG committee work! Overall what a shameful loss of clinical experience

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  • I am in OZ. Gosh, how utterly terrible, horrible and devastating GP land in the UK is !! I found the 12-13 hours everyday, the work spilling into my spare time at weekends, the constant erosion of pay [ pay per item has fallen by 60% in real terms in 10 years just impossible.How come our branch of medicine in the UK has become impossible? Who should protect us from this carnage? Where are our Unions?
    It is because our GPC leaders accept gongs while GPs suffer.
    From the horror of CQC, GMC, Medical defence,papers, politicians, patients and peers thank God I am away. This system has its faults [ no where is perfect] but they value their doctors.
    If the special conference does not consider mass resignation, equate BMA= HUNT=GPC=DOH=GMC=CQC.
    Our .

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