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The training crisis that is engulfing the profession

This was not meant to happen. Since 2012, the Government has been saying it wants at least half of medical training places to be for general practice.

But leaked figures obtained by Pulse reveal the worst training recruitment round for seven years, with some areas seeing almost 40% of places unfilled. The figures have been described as ‘alarming’ by GP leaders, with serious implications for the profession.

They undermine one of the main pillars of the Government’s health strategy and have all but extinguished the light at the end of the tunnel for GPs in certain areas, who saw a new generation of GPs as the answer to the unsustainable burden of workload. 

training trainer practice PPL

There can be no positive spin. The 2,630 graduates entering training in England in August is the lowest number since figures were collected in this way in 2007. In the North East, fewer than 70% of posts have been filled, while Health Education Yorkshire and Humber has only filled 78% of its posts. Health Education East Midlands is bottom of the table, filling just 63% of its places.

Indeed, the short-term crisis is so severe that Health Education East Midlands has instigated a ‘pre-training year’, which will see graduates who failed the GP training assessments fill gaps in secondary care.

The Government has already had to extend the deadline for its target of 3,250 GPs entering training annually by 2016 in England, but even this is looking optimistic now.

Dr Beth McCarron Nash, a GPC negotiator, says the figures are ‘extremely alarming’. She says: ‘Many GPs are already feeling it on the ground. We are looking at alarmingly low numbers of people applying for partnerships and salaried jobs. These recruitment figures will only make things worse.

‘We are not training enough GPs to fill current vacancies, let alone the urgent expansion of GPs we need to help us deliver the increased workload we are seeing as a result of the complexity of care and co-morbidity as patients are getting older.’

Massive gaps

‘In three years’ time, we will have no GPs coming through to fill our vacancies.’

Doncaster LMC chair Dr Dean Eggitt.

Overall in England, only 89% of the 2,994 posts available were filled – which compares with figures of around 98% for the past four years.

There is little problem with recruitment in London, where some 99% of positions have been filled, and the Kent, Surrey and Sussex and Thames Valley regions are not far behind.

But parts of northern England and the Midlands have massive gaps in their GP training programmes. Scotland and Wales – although not under Health Education England’s (HEE) jurisdiction – are also struggling with around one in 10 places lying vacant.

In Doncaster – where Pulse reported a practice was forced to offer a £20,000 ‘golden hello’ to a new partner as a result of the ongoing GP recruitment crisis in the region – only six of the 26 vacancies have been filled, says Doncaster LMC chair Dr Dean Eggitt.

Dr Eggitt says: ‘For general practice, our concerns are that the trainees are supernumerary to us now, but in three years’ time, we will have no GPs coming through to fill our vacancies.’

‘There wouldn’t be enough trained GPs to replace all those who will go even if we filled all the places’

Dr Nigel Watson, chair of Wessex LMCs

He says the LMC has just conducted a workforce survey of around 130 GPs, which shows that around 30% of the workforce intends to retire in the next five years. ‘If we are losing 30% of our workforce in five years’ time, and only six GPs are coming through, how are we going to fill that gap?’ he asks.

This is the reality shared by GPs across the country. As Dr Nigel Watson, chair of Wessex LMCs, puts it: ‘There wouldn’t be enough trained GPs to replace all those who will go even if we filled all the places. So the fact that all the places aren’t filled – and that those who are coming through might not want to go straight into general practice – means we are going to face a problem in the number of GPs coming through.’

Former RCGP chair, Professor Clare Gerada, who estimated last year that 10,000 additional trained GPs were needed to keep up with patient demand, says these figures will inevitably affect care. She says: ‘GPs now make up 30% of the medical workforce, which is disgraceful.

‘If these training numbers don’t improve, we will find that our patients will see longer waits to see a GP, more fragmentation and massively increased costs.’

The coalition Government and the Labour Party both acknowledge that their plans for more care to be provided in the community, with greater continuity of care and better access, are predicated on increasing the number of GPs.

This is reflected in the Government’s mandate to HEE, which tasks the body with ensuring that 50% of all medical graduates – translating to 3,250 graduates – should enter general practice training.

Plans undermined

‘We need urgent action from NHS England’

Professor Clare Gerada

The deadline for this target has already been pushed back from 2015 to 2016.

Dr McCarron-Nash says: ‘I don’t think they can fulfil their own target.’

Even the Department of Health admits its plans are being undermined by training recruitment being kicked into reverse. A DH spokesperson told Pulse: ‘HEE has created more training places for GPs, but this will only make a difference if the places are filled by doctors in training. HEE is putting robust plans in place to make sure the training places are filled over the next two years.’

But this action is slow in coming. Professor Gerada says: ‘We need urgent action from NHS England, addressing the short, medium and long term. We need a new recruitment, retention and refreshment strategy and we need this centrally, not just relying on local areas to find their own solutions because it is too important.’ 

There seems to be no clear strategy to solve the problem. HEE is being accused of having ‘buried’ a report on boosting the GP workforce, with no definite publication date announced.

As Pulse reported in February, the ‘GP Taskforce’ report was set to recommend a cap on the number of secondary care training posts available so that more trainees would have to go into general practice, and that practices be given grants of £20,000 for their premises so they can create more space for trainees.

But these radical ideas have yet to see the light of day, and the BMA has accused HEE of ‘burying’ the report.

Dr McCarron-Nash says: ‘We have written to HEE asking them why it have failed to publish its own report.

‘It is unacceptable that this report has been buried. This needs implementation and not burial, and these figures underline that fact.’

Pulse understands there is concern among HEE leaders over the recommendation to cap the number of secondary care posts, but HEE refuses to say why it has not yet been published.

HEE says: ‘The GP Taskforce report was commissioned before the establishment of HEE. However, although it takes a very specific GP view, it will be helpful information to consider as part of our work with partners like NHS England around the wider primary care workforce as set out in our mandate, and it will be published on our website in due course as one of the resources for this wider work.’

But, for GP leaders, the real solutions will need to come from fundamental changes that get to the core of the recruitment crisis. As Dr McCarron-Nash puts it: ‘It is the constant negative portrayal and media bashing we are seeing. We need to urgently get the DH to start talking up general practice.’

‘The profession is now facing a perfect storm’

These are the worst figures we have seen in GP recruitment since GP training was standardised in 2007.

Both the numbers of trainees entering general practice and the percentage of positions filled have dropped. This has particularly hit the north of England, the Midlands, Scotland and Wales.

What is worrying is that, despite highlighting the issue on a regular basis, not enough has been done to promote general practice as
a positive career option for young doctors.

In the short term, we would like to see the returners scheme prioritised, to allow already qualified GPs to return to work, rather having to go into this ‘pre-training year’. This ‘pilot’ is simply an exercise whereby GP training funds have been directed to non-training posts to fill empty secondary care rotas.

The ageing population and workforce crisis in general practice means that the profession is now facing a perfect storm.

The Government needs to pay attention to this and start looking at more short-term and long-term solutions that will actually work. We need a much more comprehensive long-term strategy, which would have been available if we had been given sight of the GP Taskforce recommendations, which have not been published despite being submitted at the beginning of the year.

Questions have to be asked about why this delay has occurred.

Dr Krishna Kasaraneni is chair of the GPC GP trainees subcommittee.