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Investigation: Why has recruiting GPs become so hard?

Four years ago it would have seemed ludicrous to predict a shortage of GPs to fill partnerships and salaried posts.

Deaneries were warning GPs to expect unemployment after training, with reports of 50–80 applicants for every full-time role in some areas. Pulse even launched a ‘One Voice’ campaign calling for contractual changes and incentives to make it easier for practices to take on extra partners.

But fast-forward to 2013 and the profession is facing a very different jobs market. Many GPs are now complaining of a ‘dramatic’ reduction in the quality and number of candidates for vacant partnerships and of rising locum costs.

As practices struggle to cope with rising expenses, below-inflation funding awards and a huge shift in workload from hospitals into primary care, they are finding it harder to recruit GPs to share the load.

Rising vacancies

A Pulse snapshot survey of 220 practices, covering around 950 full-time positions, reveals the full extent of the problem.

The results show an average vacancy rate for all full-time-equivalent GP posts in the practice of 7.9% in January 2013 – almost double the 4.2% figure found in a similar Pulse survey in January 2012, which itself was twice the official figure of 2.1% at the start of 2011.

There’s no doubt that, for practices looking to take on GPs, the quadrupling of the vacancy rate in just two years is causing real problems. Dr Peter Swinyard, chair of the Family Doctor Association and a GP in Swindon, says: ‘It is immensely hard to recruit. This is the experience of a lot of the doctors I have talked to. We are on our second firm of headhunters now, at significant expense, to fill our vacancy.’

Dr Anne Crampton, a GP partner in Crowthorne, Berkshire, says there were 30 applicants when her practice advertised a partner post three years ago, but only five for a similar post this year. She says: ‘I don’t know why general practice seems to be so unpopular. This difficulty in recruiting came as a complete surprise.’

‘We are on our second firm of headhunters now, at significant expense, to fill our vacancy’

Dr Peter Swinyard

Dr Malcolm Kendrick, a member of the GPC’s sessional executive committee and a salaried GP in Cheshire, says there has been an ‘absolute’ turnaround from the situation five years ago.

‘It is becoming more difficult to recruit partners. There is definitely less appetite for partner roles.’

Recruitment is not such an issue in Scotland, Dr Kendrick adds, but rural practices in Wales are struggling to take on partners.

GPC deputy chair Dr Richard Vautrey says the problem has been a big concern at the BMA contract roadshows: ‘Wherever we have been, GPs have been telling us there is a recruitment and retention crisis. It is starting to happen now.’

The recruitment crisis comes at a particularly difficult time for practices, with CCGs taking over commissioning responsibilities and the new GP contract hiking up practice workload from April.

The GPC argued in response to the Government’s contract imposition that ‘practices have reached a point of workload saturation’, while LMCs have reported a ‘shocking’ rise in requests for pastoral care – partly as a result of excessive workload.

The difficulties practices are having in filling vacancies are also having a financial impact. In the Pulse survey, practices reported an average increase in locum costs of 9.5% over the past 12 months, on top of the further 9% increase seen in 2011.

Portfolio careers

So why are so few GPs applying for jobs? Official figures from the NHS Information Centre show there was a slight fall in the number of GP partners in 2011 – 27,218 – compared to 2001, when there were 27,938. By contrast, the number of consultants rose sharply from 27,782 in 2001 to 39,088 in 2011.

However, the total number of practising GPs has increased by an average of 2.3% annually since 2001, from 31,835 to 39,780. In other words, fewer GPs are taking the route into partnership, instead remaining salaried or locums. However, unlike in 2009, when competition for partnership vacancies was fierce, this now seems to be through choice.

A shift towards portfolio careers and a steadily rising number of women choosing to work part time are both having an impact, GPs say.

Dr Crampton says: ‘Nobody wants to work full time. Initially, we wanted a nine-session partner.

‘What most GPs seem to want to do now is part-time general practice and part-time GPSI work – clinical assistants, out-of-hours work, that type of thing.’

Dr Kendrick agrees partnerships are widely seen as unattractive: ‘There is a lot of uncertainty about the contract imposition, falling income and people seeing partners working ridiculous hours.

‘GPs doing other roles are now saying: “This does not look like such an attractive option”.’

At the other end of the scale, GPs are increasingly considering early retirement as the demands of the job pile up. Exactly half of the respondents to Pulse’s survey said they were thinking of retiring early. Many cited workload as a key reason for considering early retirement.

Dr Swinyard says: ‘We’re seeing more and more principals saying: “Sod this, I’m going early”. Some take roles working as locums for the last few years of their practice lives. It’s a shame to lose the wisdom of senior people – you cannot replace that.’

Looking to the future

The Department of Health has recognised that more GPs are needed for the NHS to function, with former health secretary Andrew Lansley last year setting out
a plan to boost the number of GP trainees by 20% by 2015 in England so that GP registrars would make up 50% of the specialty training places (up from 41%).

But this drive is floundering. Figures from the GP National Recruitment Office (GPNRO) last summer showed there were 2,693 GP training places accepted in England in 2012, which actually represented a net decrease of three compared with the previous year.

‘There is a significant imbalance in the workforce at junior level that has and continues to produce too many “-ologists” and too few generalists, especially GPs’

Dr Barry Lewis

This compares with a rise of almost 700 in hospital training places in England, with 4,725 places accepted, up from 4,034 in 2011. The proportion of GP trainees fell from 40% in 2011 to 36% in 2012.

A DH spokesman says: ‘The DH and Health Education England are currently working with key stakeholders to support the increase of training numbers in general practice.

‘A national GP taskforce has been established to support this work and make recommendations for increasing training posts to 3,250 each year.’

An unattractive proposition

According to the Committee of General Practice Education Directors, the struggle to recruit new GPs is down to an excess of hospital training places, rather than a dearth of GP ones. Chair Dr Barry Lewis, a GP in Rochdale, says: ‘We have expanded training steadily and have an expansion target for the next three years – there is no shortage of training places. We have empty slots in programmes, except in London and the South East.

‘There are not enough applicants because an excess of hospital specialty posts is still in the system.

‘There is a significant imbalance in the workforce at junior level that has and continues to produce too many “-ologists” and too few generalists, especially GPs.’

Research published last month showed that only 28% of medical graduates cite general practice as their first-choice career, compared with 71% who opt for secondary-care specialties.

Study leader Professor Michael Goldacre, a professor of public health at the University of Oxford, says there is ‘some cause for concern’ about this relative lack of interest in general practice from newly qualified doctors.

He says: ‘A much smaller percentage express a preference for a career in general practice than the NHS actually needs.’

Rising medical school fees and the proposed four-year training for GPs, which could begin as soon as 2014, are also likely to have an effect on the numbers entering the profession.

The reluctance of many medical graduates to opt for general practice is not new. However, the Government is doing a poor job of encouraging people into the profession, says Dr Vautrey.

‘There is a feeling there are better opportunities for them in hospital or abroad,’ he says.

Dr Swinyard – still looking to fill his practice’s outstanding vacancy – says more must be done to encourage the next generation into the profession.

‘General practice as a whole is looking less attractive as a long-term career option,’ he says. ‘I still think this is the best job in the world, but it is becoming bloody hard to do it.’