Over 2,000 hospital training posts should be axed to fund GP expansion, recommends DH review
Hospital specialist training places should be radically cut back to make way for a rapid expansion in GP recruits, recommends a major report into how to boost GP numbers commissioned by ministers.
The ‘GP taskforce’ report recommends that GP training numbers are increased alongside a ‘concomitant reduction in hospital specialty places’ and suggests 2,025 hospital training places could be decommissioned to achieve this aim.
The report commissioned by the Department of Health and written by GP education leaders looks at ways of boosting the numbers of GP postgraduate training places to 50% of all places by 2015 - since postponed to 2016 - or 3,250 GPs entering training every year.
It says there is a need to ‘redress the imbalance’ between hospital doctors and GPs and calls for a review of current targets to see if they training would be enough to meet workforce needs. It also questioned whether Health Education England would be able to meet the current target of 3,250 GPs, mandated by the DH.
Other radical recommendations include introducing a ‘federated model’ of GP training, which will enable non-training practices to play a role, an incentive scheme for trainees to go to deprived areas and a national funding scheme to help GPs return to general practice.
The authors of the report called on HEE to make a ‘commitment’ to implementing them, after GPC had accused Health Education England of ‘burying’ the report earlier this year.
But the report comes at a difficult time for HEE as the final training figures for August showed a surprise 40% increase in vacancies for GP training places in some areas. This has led to HEE introducing an unprecedented third round of GP recruitment before August in an attempt to boost numbers.
However, it is the recommendation on reducing specialty training numbers that will cause the most controversy.
The GP Taskforce, led by Wessex Deanery postgraduate dean Dr Simon Plint, recommends: ‘That the expansion in GP training numbers should be matched by a concomitant reduction in ST1 or CT1 hospital specialty entry points (decrease of 450) - particularly in those specialties known to be over-producing CCT holders.’
It adds: ‘Funding the training posts required for GP training expansion could be cost neutral to Health Education England if 2,025 specialty training posts are decommissioned.’
When Pulse first revealed that the taskforce was considering ‘capping’ hospital speciality training posts, GPC leaders said that trainees should not be ‘forced’ into entering general practice.
Dr Krishna Kasaraneni, outgoing chair of the GPC training subcommittee, told Pulse: ‘We want to get the GP trainees who are interested in general practice to apply for general practice, not by closing down all the doors and saying this is the only route available for you.
‘I’m not sure there’s any evidence that if you attract that kind of cohort into GP training, that they’ll remain in general practice, if it’s not their interest by the time they’ve reached it.’
He added: ‘I don’t think it’s sustainable and I don’t think, from an immediate shop-front point of view, whether it will cause problems for hospitals with not being able to fill their rotas, and for other specialties as well.’
But the authors of the report state: ‘The Taskforce does not underestimate the short term impact this change would have on service delivery, but believes what is effectively a transfer of educational investment into the community must accompany the transfer of care into the community, to ensure an overall medical workforce which is fit for future purpose.
‘To put this shift into perspective, the Taskforce has identified a total number of hospital training posts recorded in the Health Education England Stocktake around 45,000, and the de-commissioning of 1,350 posts to fund the 675 GP training placements would represent a 3% reduction in the overall number of hospital training posts.’
It also suggests that the Government target of 3,250 GP trainees recruited a year are reviewed. It says: ‘The Taskforce recommends the long term target for GP training ST1 entry points is reviewed following publication of the NHS England Review of Primary Care.’
The report makes recommendations about making it easier for GPs to return to work, and Pulse has already revealed steps are underway with the RCGP and HEE working on a scheme to allow overseas GPs to remain on the performers list.
The report also calls for a ‘professionally-led marketing campaign’ to promote an ‘accurate and positive’ image of general practice, to medical students and the general public, and for a ‘federated model’ of GP training.
The federated model will enable an ‘increase [in] multi-professional placement training capacity, facilitate the management of multiple trainees more efficiently, and add value for other health professionals in primary care’.
It also recommends that all foundation courses should include a GP placement, and that the Department of Health should ‘incentivise’ medical schools to increase the proportion of graduates choosing general practice.
A HEE spokesperson told Pulse: ‘The GP Taskforce Report was commissioned prior to the establishment of Health Education England.’
‘However, although it takes a very specific GP view, it contains some useful research and will be helpful information to consider as part of our Workforce Plan for England alongside other evidence and suggestions while many of the recommendations have been acted upon through commitments in our Mandate.’
A Department of Health spokesperson said of the report’s recommendations: ‘We know GPs are working under pressure which is why we have cut GPs’ targets to free up time with patients and are increasing trainees so that GP numbers continue to grow faster than the population.’