A Pulse analysis of the NHS workforce report reveals that we need to double the general practice training capacity in five years, and treble it by 2033. Eliza Parr explains why the NHS plan seems to fall short.
Amid chronic workforce shortages and increasing workload pressures, bringing in thousands more medical students and GP trainees each year makes for a good headline.
NHS England’s long-term workforce plan also commits to increasing trainees’ exposure to general practice at both foundation programme level and GP specialty training.
But, having read the plan end to end, you might be left wondering who will train all this fresh meat – and indeed where all this training will take place.
GP trainers are already struggling. As the number of partners are decreasing, there are fewer GPs willing to be trainers. And even if there was an unlimited supply, there would be issues with premises to house these new trainees and students.
A new Pulse analysis of the measures outlined in the NHS workforce plan show they would require a doubling of training capacity in general practice within five years, and a trebling within ten.
Yet there seems to be nothing in the plan that outlines how they hope to achieve this, with only vague references to commissioners being tasked with providing this capacity.
GP trainers and educators warn that this will derail any plans to improve the workforce, and with it any attempts to improve the profession.
Currently, GP trainers provide support and education for three medical cohorts – students, foundation doctors, and GP specialty trainees. They can be clinical or educational supervisors, which includes supervising surgeries, one-to-one tutorials and validating paperwork.
Medical students join general practice for short stints, as part of a rotation across primary, secondary, or community settings. The time they spend in general practice varies across the different medical schools, but it’s usually between two and four months spread across a five-year degree.
The plan commits to doubling the number of medical school places in England, from 7,500 now to 15,000 by 2031.
Although there is no suggestion in the plan about increasing students’ exposure to general practice, in the past few years there have been moves to make medical schools more GP-friendly, including incentivising new medical schools to encourage students to enter the profession.
For those who go on to do their foundation training, just over half of them will complete a four-month GP placement in their second year.
While no specific number of foundation places is given, the plan says growth will be ‘commensurate’ with medical school increases.
The plan also commits to all foundation year doctors doing at least one four-month placement in general practice by 2030 – up from the 55% who do so currently.
GP specialty training
NHS England pledged to increase specialty training places by 50%, from 4,000 to 6,000 by 2031, with the first 500 new places available in September 2025.
But there won’t just be more trainees – they will also begin to spend ‘the full three years of their training in primary care settings’, up from the 50% they currently spend there.
No plans for extra training capacity
So, surely along with these ambitious commitments to boost numbers and time spent in GP training, NHS England has set out a well-plotted and sensible path for a corresponding increase in training capacity?
No such forecasting or commitment can be found in the 151-page document. The issue is not ignored completely – the plan acknowledges that successfully expanding the workforce is ‘contingent’ on an ‘expanded and fully trained supervisory workforce’.
The plan recognises action is needed to expand the capacity of ‘both educators and infrastructure’. Importantly, it says expanding primary care physical estates is ‘critical’, as currently ‘insufficient physical space across an ageing estate limits GPs’ ability to increase training placements’. However, efforts to improve this are ‘outside the scope’ of the plan and will require separate investment.
Finally, the plan suggests that integrated care systems (ICSs) will take on some responsibility for planning capacity, by developing relationships ‘with education and training providers to secure domestic education capacity and efficiency’.
Yet Pulse’s analysis shows the level of capacity needed. Taking into account all the changes outlined, they will need to increase capacity immediately, and with a continued sharp rise every year until 2033.
NHSE’s medical director for primary and integrated care says expanded GP specialty training is a ‘vital element’ of the plan’s ambition to ‘meet the challenges of a growing and ageing population’.
‘The plan explains that a new approach is needed to system-wide workforce planning including the supply of educators, and we will work closely with partners including the education sector, service providers and Integrated Care Systems.
‘Various initiatives are also planned or under way to increase space and capacity for placements at GP sites across the country,’ he adds.
NHSE points to its educator workforce strategy, published in March, which set out high-level plans to develop a ‘sufficient appropriately skilled workforce’ to meet the growth in numbers projected by the long-term plan. But there’s no specific mention here of GPs or primary care.
Dr Sam Adcock, a GP and trainer in Leicester, says it seems ‘unfathomable’ that training places could increase at the rate planned, as his practice is already struggling to meet demand.
‘It’s a nice idea – it’s nice that they’re recognising there’s a workforce problem, but actually it doesn’t recognise space, it doesn’t recognise the time it will take, it doesn’t recognise that we’ve got a workforce that are no longer focussed on education and training.’
Both Dr Adcock and medical secretary of Walsall LMC Dr Uzma Ahmad say the increase in sessional GPs has contributed to a lack of trainers. Dr Ahmad says she is ‘not sure how much sessional GPs are committed to taking the trainer’s position if it is not resourced appropriately’. And Dr Adcock says the ‘large majority’ of newly qualified GPs become locums and this ‘group of doctors don’t become trainers’ because they are less likely to be in a fixed place.
Some GPs also point out that if training capacity is stretched, patient care has to remain the priority, which could mean the quality of training falls.
Dr Dean Eggitt, a GP trainer and chief executive of Doncaster LMC, says: ‘We can’t really cope with the training levels we’ve got at the moment let alone a massive expansion, because we just don’t have the resources to deal with it.
‘So when that comes on stream it’s going to have quite a significant deleterious effect for trainers to continue to either train at high quality or deliver high quality medicine at the same time – something’s got to suffer.’
Indeed, GMC surveys reinforce the feeling that trainers are already struggling with their workload, with the most recent results showing that GP trainers are among those at highest risk of burnout.
RCGP chair Professor Kamila Hawthorne says that while the ambitions to increase student and trainee numbers are welcome, this cannot happen in isolation.
‘It goes without saying that alongside an increase in GP trainees, spending longer in general practice, must come sufficient resource and protected time for GP trainers, so they can create a supportive learning environment for trainees, as they develop the skills they need to qualify for independent practice – and sufficient capacity and funding for GP practices to host more GP trainees.
‘GP trainers are currently faced with unmanageable demand – with both trainees and qualified GPs stretched beyond safe limits,’ she says.
In addition to trainer time, physical capacity is already a big issue in general practice.
GP spokesperson for the Doctors’ Association UK (DAUK) and former GP trainer Dr Steve Taylor says that while the pledges to increase training are ‘massively good news’, training capacity will be a ‘big challenge’.
Of his own practice, he says they ‘certainly haven’t got room here to take any more [trainees]’ and suggests this is likely true of most practices.
‘[The issue of room capacity] has been made even more acute with the ARRS roles that have been rolled out into primary care, because you’ve got pharmacists and physios and PAs and healthcare assistants, all of whom do need somewhere to go and work from, even if they’re not seeing patients in a clinical room,’ Dr Taylor adds.
GPs also express concerns about retention, with Dr Eggitt warning that training new people will not be possible if the NHS does not ‘keep those of us who are needed for the next 10 years to make it happen’. Similarly, Dr Taylor says that without solid retention measures for more experienced GPs, it becomes a ‘vicious cycle’.
So, to ensure their ambitious, and indeed welcome, plan to increase training places succeeds, NHS England and the Government need to pair it with a corresponding plan to increase GP trainer capacity.
And that doesn’t just mean expanding the number of trainers and the physical space in which they work – it also requires investment in retaining those experienced partners and salaried GPs who already stretch themselves to provide high quality training.
‘At the moment, most people do it because it’s an interest, or they see it as an important part of the profession, not because it necessarily financially makes any sense’, Dr Adcock says.
Without proper investment in primary care services, workforce and infrastructure, it seems likely that this goodwill and interest will quickly dry up.
Pulse’s methodology for the data modelling within this analysis can be found here.