GP workforce strategies must focus on medical school culture
Dr Ahmed Rashid writes
In the time between the publication of the Five Year Forward View last October and David Cameron’s outline of plans to launch seven-day NHS service after the Conservatives’ election win, talk has focused on the huge expansion of GP numbers that will be needed to fulfil these ambitions.
But let’s forget the future visions for a moment. Even if practice opening hours are not extended and GPs are not asked to take on more work from hospitals, there will still be a huge shortfall in GP numbers across the NHS.
In short, even if we ignore the fact that we’ll soon be asked to swim the channel, we can’t ignore the fact that we’re already drowning.
A number of solutions to the general practice workforce problem have been put forward. Many have argued that improving the working lives of GPs across the country is the only way to attract new doctors.
Some have suggested alternative primary care systems are needed such as the community health worker model where each GP leads a team of allied staff. Others, meanwhile, have proposed the slightly more controversial approach of trying to ‘control’ patient demand.
All of these suggestions are probably valid to some degree. But the elephant in the room, for me, is the fact that UK medical schools continue to demean general practice as a career choice.
The best way to transform the workforce would be to radically increase the number of qualifying GPs. Although we can’t force doctors to apply to GP training, we can endeavour to provide positive and balanced experiences to drive these choices and the responsibility to do this must rest largely with the institutions that build and shape doctors in the first place.
It is important to acknowledge that almost all medical schools have increased the proportion of curriculum time spent in general practice in recent decades. But although a recent study suggested this has been a positive move, time spent on general practice is now in decline at some schools. Although exposure to the GP environment is undoubtedly important, it’s actually only one piece of the jigsaw. The reason that GP placements were so short in the first place is theThe longstanding culture of idolising specialism, which generally lives on despite that prevails in most schools across the country is arguably the increase in GP curriculum timemost fundamental piece of all.
We know from countless national reports of the NHS in the last decade that culture and leadership are enormously important to all organisations. Medical schools are no different and have long been steeped in a culture defined by the scientists and hospital consultants that run them. From their induction week onwards, medical students are exposed to negative attitudes about general practice and are trained with a philosophy that values highly specialist and technical knowledge over human skills. Although communication training is now well established in all medical schools, most distinctions and prizes are still awarded to students who can memorise facts about rare, eponymous diseases.
Time for a review
Medical schools should start looking GP role models to show how important and interesting the specialty in their own primary care research centres.
I find it incredible, for example, that Oxford produces less GPs than most other UK medical schools despite having some truly inspirational GP professors. What is the medical school doing to showcase these world-famous, charismatic GPs who could be incredible role models to undergraduate medical students? Not enough, it might seem.
Of course, it isn’t just Oxford that this applies to. There are amazing GPs across the country in a variety of exciting roles from pre-hospital emergency care to global health. Medical students are generally exposed only to local teaching hospitals and practices and may not appreciate the enormous influence and authority that GPs have in regional and national roles.
Although medical schools may slowly be starting to get the message that they need to promote general practice, I’m not convinced that this will lead to the dramatic culture change that is needed.
One solution might be to establish a national review of UK medical schools to determine exactly how GPs are currently involved in aspects like admissions, pastoral care and designing assessments. This report should help to inform an overarching national strategy and in turn, each school should outline a ‘personal development plan’ that describes the steps they will take to help nurture the future workforce of GPs that the NHS so desperately needs.
Dr Ahmed Rashid is an academic specialty registrar in general practice in the East of England LETB.