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GP training crisis begins in medical school, research suggests

Exclusive Medical students are spending 14% less learning time in general practice than ten years ago, new research obtained by Pulse has revealed, which experts claim is contributing to the crisis in GP training numbers.

The study, led by a GP and medical academic, reveals that the number of departments of general practice in medical schools in the UK has also reduced in that time period, while only 7% of the funding for medical schools goes into teaching general practice.

Experts have said that this contributes to the lack of interest from medical graduates in pursuing a career in general practice, after Pulse exclusively revealed that some regions are failing to fill 40% of their GP training posts.  

The new research concludes that GPs need funding to increase the building space in practices available to teach medical students, and without it the Government’s key aim of ensuring 50% of medical graduates enter general practice training by 2016 would be difficult to achieve.

It follows comments last year from the then head of the GP National Recruitment Office, Professor Bill Irish, that the top universities in the country are not doing enough to produce future GPs.

The researchers surveyed 29 UK university medical departments and found that the number of 3.5-hour teaching sessions per student delivered in general practice during years 3-5 of medical undergraduate courses declined by 14%, from 119 sessions in 2003 to 102 currently equating to 1.7 fewer weeks.

The study also revealed that only 46% of UK medical schools have departments of general practice, comparing very unfavourably to the early 2000s, when almost every medical school had one.

It also found that  the proportion of funding ‘Service Increment for Teaching (SIFT)’ funding – the mechanism used to fund undergraduate medical education – going into general practice education averages only 7.1%, across the 11 medical schools that responded.

The lead researcher, Dr Alex Harding, a GP senior lecturer at the University of Exeter Medical School, told Pulse: ‘The survey has found that at present the national average is for 14% of student placements at medical school to be in general practice. We also have found that these GP placements have been reducing over the past 10 years or so.’

He said that the main issue for the reduction in training was the lack of funding to increase practices’ space to train students

He added: ‘When students come to a GP practice they really want to see patients. This means that finding extra space for the students to talk to the patients becomes an issue. In our survey we couldn’t find much evidence of funding models to support this.’ 

GPC chair Dr Chaand Nagpaul said that the researchers’ findings were ‘extremely worrying’ and the trend ‘contradicts’ the Department of Health’s plan to have 50% of medical students going into general practice.

Dr Nagpaul said: ‘This is an extremely worrying finding, given that the Government wants to have the proportion of medical students going into general practice at 50%. If recruitment of GPs becomes more difficult it contradicts the Government’s plan to have more patients treated outside hospital.’

He added: ‘We need to provide more time and space for GPs in their premises to provide education. Students need to be in a motivating, positive environment when they are in general practice.’

Professor Irish, who is now chair of COGPED and GP director for Health Education South West, told Pulse: ‘If the figures are correct, a two week reduction in the volume of teaching delivered in primary care is deeply concerning.’

‘The target of 50% of trainees entering primary care is in the Health Education England mandate, and undergraduate exposure to high quality training in a primary care context would seem essential. Even if students don’t ultimately become GPs, there seems little doubt that a large amount of specialist care (such as in diabetes or dermatology) will be delivered outside of hospital settings.’

He added: ‘Medical practice in community settings is intrinsically different (and often more difficult) than in secondary care. Presentations are more vague and earlier, and tests which perform well in hospitals (with high disease prevalence) are often misleading in the community (where prevalence is much lower).  Familiarity with the realities of delivering care in “imperfect” areas such as the homes of elderly isolated patients is essential for all clinicians.’

Pulse reported in February that the number of applications for postgraduate GP specialty training for 2014 were 15% down on 2013.